Download Criterion (DDE-a) is met if

Table of Contents
Dimension 1: Withdrawal ..................................................................................................................................................... 12
Level of Care: Detoxification - Outpatient Treatment (I-D) .............................................................................................. 12
Summary ....................................................................................................................................................................... 17
Criterion ........................................................................................................................... Error! Bookmark not defined.
Criteria – All Substances................................................................................................... Error! Bookmark not defined.
Length of Service – All Substances ................................................................................................................................ 21
Level of Care: Detoxification – Intensive Outpatient (II-D) ............................................................................................... 27
Summary ....................................................................................................................................................................... 27
Criterion ........................................................................................................................... Error! Bookmark not defined.
Criteria – All Substances................................................................................................... Error! Bookmark not defined.
Length of Service – All Substances ................................................................................................................................ 30
Level of Care: Detoxification – Medically Monitored Intensive Inpatient Treatment (III.7-D) ......................................... 38
Summary ....................................................................................................................................................................... 38
Criterion ........................................................................................................................... Error! Bookmark not defined.
Criteria – All Substances................................................................................................................................................ 40
Length of Service – All Substances ............................................................................................................................... 12
Level of Care: Detoxification – Medically Managed Inpatient Treatment (IV) ................................................................. 41
Summary ....................................................................................................................................................................... 41
Criterion ........................................................................................................................... Error! Bookmark not defined.
Criteria – All Substances................................................................................................... Error! Bookmark not defined.
Length of Service – All Substances ................................................................................................................................ 45
Level of Care: Early Intervention (0.5) .............................................................................................................................. 51
Summary ....................................................................................................................................................................... 51
Criterion ........................................................................................................................... Error! Bookmark not defined.
Criteria – All Substances................................................................................................... Error! Bookmark not defined.
Level of Care: Outpatient Treatement (I).......................................................................................................................... 53
Summary ....................................................................................................................................................................... 53
Criterion ........................................................................................................................... Error! Bookmark not defined.
Criteria – All Substances................................................................................................... Error! Bookmark not defined.
Level of Care: Opiate Maintenance Therapy .................................................................................................................... 56
Summary ....................................................................................................................................................................... 56
Criterion ........................................................................................................................... Error! Bookmark not defined.
Criteria – All Substances................................................................................................... Error! Bookmark not defined.
Level of Care: Intensive Outpatient (II.1) .......................................................................................................................... 60
Summary ....................................................................................................................................................................... 60
Criterion ........................................................................................................................................................................ 60
Criteria -- All Substances .............................................................................................................................................. 60
Level of Care: Partial Hospitalization (II.5) ........................................................................................................................ 61
Summary ....................................................................................................................................................................... 61
Criterion – All Substances ............................................................................................................................................. 61
Criteria - - All Substances .............................................................................................................................................. 61
Level of Care: Clinically Managed Low-Intensity Residential Services (III.1) .................................................................... 62
Summary – All Substances ............................................................................................................................................ 62
Criterion ........................................................................................................................................................................ 62
Criteria........................................................................................................................................................................... 62
Level of Care: Clinically Managed Medium-Intensity Residential Services (III.3) ............................................................. 63
Summary – All Substances ............................................................................................................................................ 63
Criterion – All Substances ............................................................................................................................................. 63
Criteria........................................................................................................................................................................... 63
Level of Care: Clinically Managed High Intensity Residential Treatment (III.5) ................................................................ 64
Summary –All Substances ............................................................................................................................................. 64
Criterion – All Substances ............................................................................................................................................. 64
Criteria........................................................................................................................................................................... 64
Level of Care: Medically Monitored Intensive Inpatient Treatement (III.7) ..................................................................... 65
Summary – All Substances ............................................................................................................................................ 65
Criterion – All substances.............................................................................................................................................. 65
Criteria........................................................................................................................................................................... 65
Level of Care: Medically Managed Inpatient Treatement (IV).......................................................................................... 66
Summary – All Substances ............................................................................................................................................ 66
Criterion ........................................................................................................................................................................ 66
Criteria........................................................................................................................................................................... 66
Dimension 2: Biomedical Conditions and Complications ..................................................................................................... 69
Level of Care: Early Intervention (0.5) .............................................................................................................................. 70
Summary ....................................................................................................................................................................... 70
Level 0.5 (Early Intervention) Sole Criterion ................................................................................................................. 70
Level 0.5 (Early Intervention) Placement Criterion ....................................................................................................... 70
Level of Care: Outpatient Treatment (I)............................................................................................................................ 72
Summary ....................................................................................................................................................................... 72
Level I (Outpatient Treatment) Sole Criterion .............................................................................................................. 72
Level I (Outpatient Treatment) Placement Criterion .................................................................................................... 72
Level of Care: Opiate Maintenance Therapy .................................................................................................................... 74
Level OMT (Opioid Maintenance Therapy) Summary .................................................................................................. 74
Level IV (Medically Managed Inpatient Treatment) Placement Criteria ...................................................................... 75
Level of Care: Intensive Outpatient (II.1) .......................................................................................................................... 78
Level II.1 (Intensive Outpatient) Summary ................................................................................................................... 78
Level II.1 (Intensive Inpatient) Placement Criteria........................................................................................................ 78
Level of Care: Partial Hospitalization (II.5) ........................................................................................................................ 80
Level II.5 (Partial Hospitalization) Summary ................................................................................................................. 80
Level II.5 (Partial Hospitalization) Criteria..................................................................................................................... 80
Level II.5 (Partial Hospitalization) Placement Criteria) ................................................................................................. 81
Level of Care: Clinically Managed Low-Intensity Residential Services (III.1) .................................................................... 82
Level III.1 (Clinically Managed Low-Intensity Residential Services) Summary.............................................................. 82
Level III.1 (Clinically Managed Low-Intensity Residential Services) Criteria ................................................................. 82
Level III.1 (Clinically Managed Low-Intensity Residential Services) Placement Criteria ............................................... 84
Level of Care: Clinically Managed Medium-Intensity Residential Services (III.3) ............................................................. 86
Level III.3 (Clinically Managed Medium-Intensity Residential Services) Summary....................................................... 86
Level III.3 (Clinically Managed Medium-Intensity Residential Services) Criteria .......................................................... 86
Level III.3 (Clinically Managed Medium-Intensity Residential Services) Placement Criteria ........................................ 88
Level of Care: Clinically Managed High-Intensity Residential Treatment (III.5) ............................................................... 90
Level III.5 (Clinically Managed High-Intensity Residential Services) Summary ............................................................. 90
Level III.5 (Clinically Managed High-Intensity Residential Services) Placement Criteria .............................................. 92
BIO Criteria .................................................................................................................................................................... 92
Level of Care: Medically Monitored Intensive Inpatient Treatment (III.7) ....................................................................... 94
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Summary ................................................................ 94
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Placement Criteria .................................................. 95
BIO Criteria .................................................................................................................................................................... 95
Level of Care: Medically Managed Inpatient Treatment (IV)............................................................................................ 97
Level IV (Medically Managed Inpatient Treatment) Summary ..................................................................................... 97
Level IV (Medically Managed Inpatient Treatment) Placement Criteria ...................................................................... 98
Dimension 3: Emotional, Behavioral or Cognitive Conditions and Complications ............................................................ 101
General Prerequisites........................................................................................................... Error! Bookmark not defined.
Level of Care: Dual Diagnosis Enhanced Outpatient Treatment (I) ................................................................................ 102
Level I (Dual Diagnosis Enhanced Outpatient Treatment) Summary ......................................................................... 102
Level I (Dual Diagnosis Enhanced Outpatient Treatment) Criteria ............................................................................. 102
Level I (Dual Diagnosis Enhanced Outpatient Treatment) Placement Criteria ........................................................... 104
Level of Care: Dual Diagnosis Enhanced Intensive Outpatient Treatment (II.1) ............................................................ 105
Level II.1 (Dual Diagnosis Enhanced Intensive Outpatient Treatment) Summary ...................................................... 105
Level II.1 (Dual Diagnosis Enhanced Intensive Outpatient Treatment) Criteria ......................................................... 105
Level II.1 (Dual Diagnosis Enhanced Intensive Outpatient Treatment) Placement Criteria ....................................... 107
Level of Care: Dual Diagnosis Enhanced Partial Hospitalization (II.5) ............................................................................ 109
Level II.5 (Partial Hospitalization) Summary ............................................................................................................... 109
Level II.5 (Partial Hospitalization) Criteria................................................................................................................... 109
Level II.5 (Partial Hospitalization) Placement Criteria................................................................................................. 114
careLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisEnhanced = falseLevel of Care: Dual Diagnosis Enhanced
Clinically Managed Low Intensity Residential Treatment (III.1) ..................................................................................... 118
Level III.1 (Dual Diagnosis Enhanced Clinically Managed Low Intensity Residential Treatment) Summary............... 118
Level III.1 (Dual Diagnosis Enhanced Clinically Managed Low Intensity Residential Treatment) Criteria .................. 118
Level III.1 (Dual Diagnosis Enhanced Clinically Managed Low Intensity Residential Treatment) Placement Criteria119
Level of Care: Dual Diagnosis Enhanced Clinically Managed Medium-Intensity Residential Treatment (III.3) .............. 124
Level III.3 (Dual Diagnosis Enhanced Clinically Managed Medium Intensity Residential Treatment) Summary ....... 124
Level III.3 (Dual Diagnosis Enhanced Clinically Managed Medium Intensity Residential Treatment) Criteria ........... 124
Level III.3 (Dual Diagnosis Enhanced Clinically Managed Medium Intensity Residential Treatment) Placement
Criteria......................................................................................................................................................................... 125
Level of Care: Dual Diagnosis Enhanced Clinically Managed High Intensity Residential Treatment (III.5) .................... 129
Level III.5 (Dual Diagnosis Enhanced Clinically Managed High Intensity Residential Treatment) Summary .............. 129
Level III.3 (Dual Diagnosis Enhanced Clinically Managed High Intensity Residential Treatment) Criteria ................. 129
Level III.5 (Dual Diagnosis Enhanced Clinically Managed High Intensity Residential Treatment) Placement Criteria
..................................................................................................................................................................................... 129
Level of Care: Dual Diagnosis Enhanced Medically Monitored Intensive Inpatient Treatment (III.7)............................ 134
Level III.7 (Dual Diagnosis Enhanced Medically Monitored Intensive Inpatient) Summary ....................................... 134
Level III.7 (Dual Diagnosis Enhanced Medically Monitored Intensive Inpatient) Criteria .......................................... 134
Level III.7 (Dual Diagnosis Enhanced Medically Monitored Intensive Inpatient) Placement Criteria ........................ 136
Level of Care: Dual Diagnosis Capable/ATO Intensive Outpatient (II.1) ......................................................................... 142
Level II.1 (Dual Diagnosis Capable/ATO Intensive Outpatient) Summary .................................................................. 142
Level II.1 (Dual Diagnosis Capable/ATO Intensive Outpatient) Criteria ...................................................................... 142
Level II.1 (Dual Diagnosis Capable/ATO Intensive Outpatient) Placement Criteria ................................................... 143
Level of Care: Dual Diagnosis Capable/ATO Clinically Managed Low-Intensity Residential Treatment (III.1) ............... 145
Level III.1 (Dual Diagnosis Capable/ATO Clinically Managed Low-Intensity Residential Treatment) Summary......... 145
Level III.1 (Dual Diagnosis Capable/ATO Clinically Managed Low-Intensity Residential Treatment) Criteria ............ 145
Level III.1 (Dual Diagnosis Capable/ATO Clinically Managed Low-Intensity Residential Treatment) Placement Criteria
..................................................................................................................................................................................... 147
Level of Care: Dual Diagnosis Capable Clinically Managed Medium-Intensity Care (III.3) ............................................. 150
Level III.3 (Dual Diagnosis Capable Clinically Managed Medium-Intensity Care) Summary....................................... 150
Level III.3 (Dual Diagnosis Capable Clinically Managed Medium-Intensity Care) Criteria .......................................... 150
Level III.3 (Dual Diagnosis Capable/ATO Clinically Managed Low-Intensity Residential Treatment) Placement Criteria
..................................................................................................................................................................................... 152
Level of Care: Dual Diagnosis Capable Clinically Managed High-Intensity Residential Treatment (III.5) ....................... 156
Level III.5 (Dual Diagnosis Capable Clinically Managed High-Intensity Residential Treatment) Summary ................ 156
Level III.5 (Dual Diagnosis Capable Clinically Managed High-Intensity Residential Treatment) Criteria .................... 156
Segment II: Danger and Impulsivity ............................................................................................................................ 157
Level III.5 (Dual Diagnosis Capable Clinically Managed High-Intensity Residential Treatment) Placement Criteria .. 158
Level of Care: Dual Diagnosis Capable Medically Monitored High-Intensity Residential Treatment (III.7) ................... 163
Level III.7 (Dual Diagnosis Capable Medically Monitored High-Intensity Residential Treatment) Summary ............. 163
Level III.7 (Dual Diagnosis Capable Medically Monitored High-Intensity Residential Treatment) Criteria ................ 163
Level III.7 (Dual Diagnosis Capable Medically Monitored High-Intensity Residential Treatment) Placement Criteria
..................................................................................................................................................................................... 165
Level of Care: Early Intervention (0.5) ............................................................................................................................ 171
Level 0.5 (Early Intervention) Summary...................................................................................................................... 171
Level 0.5 (Early Intervention) Sole Criterion ............................................................................................................... 171
Level 0.5 (Early Intervention) Placement Criterion ..................................................................................................... 171
Level of Care: Outpatient Treatment (I).......................................................................................................................... 173
Level I (Outpatient Treatment) Summary ................................................................................................................... 173
Level I (Outpatient Treatment) Criteria ...................................................................................................................... 173
Level I (Outpatient Treatment) Placement Criteria .................................................................................................... 176
Dual Diagnosis Enhanced Criteria ............................................................................................................................... 177
Dual Diagnosis Capable Criteria .................................................................................................................................. 177
Level of Care: Opiate Maintenance Therapy .................................................................................................................. 181
Level OMT (Opiate Maintenance Therapy) Summary ................................................................................................ 181
Level I (Outpatient Treatment) Criteria ...................................................................................................................... 181
Level OMT (Opiate Maintenance Therapy) Placement Criteria .................................................................................. 183
Level of Care: Partial Hospitalization (II.5) ........................................................................... Error! Bookmark not defined.
Summary – All Segments ................................................................................................. Error! Bookmark not defined.
Criterion ........................................................................................................................... Error! Bookmark not defined.
Criteria – All Segments ..................................................................................................... Error! Bookmark not defined.
Level of Care: Medically Managed Intensive Inpatient Treatement (IV) ....................................................................... 185
Level IV (Medically Managed Medium Intensive Inpatient Treatment) Summary ..................................................... 185
Level IV (Medically Managed Medium Intensive Inpatient Treatment) Criteria ........................................................ 185
Level IV (Medically ManagedIntensive Inpatient Treatment) Placement Criteria ..................................................... 187
Dimension 4: Readiness to Change ..................................................................................................................................... 190
Level of Care: Early Intervention (0.5) ............................................................................................................................ 191
Level 0.5 (Early Intervention) Summary...................................................................................................................... 191
Level 0.5 (Early Intervention) Sole Criterion ............................................................................................................... 191
Level 0.5 (Early Intervention) Placement Criterion ..................................................................................................... 191
Level of Care: Outpatient Treatment (I).......................................................................................................................... 193
Level I (Outpatient Treatment) Summary ................................................................................................................... 193
Level I (Outpatient Treatment) Criteria ...................................................................................................................... 193
Level I (Outpatient Treatment) Placement Criteria .................................................................................................... 195
Level of Care: Intensive Outpatient (II.1) ........................................................................................................................ 196
Level II.1 (Intensive Outpatient) Summary ................................................................................................................. 196
Level II.1 (Intensive Outpatient) Criteria..................................................................................................................... 196
Level II.1 (Intensive Outpatient) Placement Criteria................................................................................................... 198
Dual Diagnosis Criteria ................................................................................................................................................ 198
Level of Care: Partial Hospitalization (II.5) ...................................................................................................................... 200
Level II.5 (Partial Hospitalization) Summary ............................................................................................................... 200
Level II.1 (Intensive Outpatient) Criteria..................................................................................................................... 200
Level II.5 (Partial Hospitalization) Placement Criteria) ............................................................................................... 201
Level of Care: Clinically Managed Low-Intensity Residential Services (III.1) .................................................................. 203
Level III.1 (Clinically Managed Low-Intensity Residential Services) Summary............................................................ 203
Level II.1 (Intensive Outpatient) Criteria..................................................................................................................... 203
Level III.1 (Clinically Managed Low-Intensity Residential Services) Placement Criteria ............................................. 205
Level of Care: Clinically Managed Medium-Intensity Residential Treatment (III.3) ....................................................... 208
Level III.3 (Clinically Managed Medium-Intensity Residential Treatment) Summary................................................. 208
Level III.3 (Clinically Managed Medium-Intensity Residential Treatment) Criteria .................................................... 208
Level III.3 (Clinically Managed Medium-Intensity Residential Treatment) Placement Criteria .................................. 210
Level of Care: Clinically Managed High-Intensity Residential Treatment (III.5) ............................................................. 212
Level III.5 (Clinically Managed High-Intensity Residential Treatment) Summary ....................................................... 212
Level II.5 (Clinically Managed High-Intensity Residential Treatment) Criteria ........................................................... 212
Level of Care: Medically Monitored Intensive Inpatient Treatment (III.7) ..................................................................... 216
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Summary .............................................................. 216
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Criteria .................................................................. 216
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Placement Criteria ................................................ 218
Dual Diagnosis Criterion (Final Rules) ......................................................................................................................... 218
Level of Care: Medically Managed Intensive Inpatient Treatment (IV) .......................................................................... 219
Summary ..................................................................................................................................................................... 219
Dimension 5: Relapse, Continued Use, or Continued Problem Potential........................................................................... 220
Level of Care: Early Intervention (0.5) ............................................................................................................................ 221
Level 0.5 (Early Intervention) Summary...................................................................................................................... 221
Level 0.5 (Early Intervention) ...................................................................................................................................... 221
Level of Care: Outpatient Treatment (I).......................................................................................................................... 223
Level I (Outpatient Treatment) Summary ................................................................................................................... 223
Level I (Outpatient Treatment) ................................................................................................................................... 223
Level of Care: Opiate Maintenance Therapy .................................................................................................................. 226
Level OMT (Opioid Maintenance Therapy) ................................................................................................................. 226
Level of Care: Intensive Outpatient (II.1) ........................................................................................................................ 230
Level II.1 (Intensive Outpatient) Summary ................................................................................................................. 230
Level of Care: Partial Hospitalization (II.5) ...................................................................................................................... 233
Level II.5 (Partial Hospitalization) Summary ............................................................................................................... 233
Level of Care: Clinically Managed Low-Intensity Residential Treatment (III.1) .............................................................. 238
Level III.1 (Clinically Managed Low-Intensity Residential Treatment) Summary........................................................ 238
Level of Care: Clinically Managed Medium-Intensity Residential Treatment (III.3) ....................................................... 242
Level III.3 (Clinically Managed Medium-Intensity Residential Treatment) Summary................................................. 242
Level of Care: Clinically Managed High-Intensity Residential Treatement (III.5) ........................................................... 247
Level III.5 (Clinically Managed High-Intensity Residential Treatment) Summary ....................................................... 247
Level of Care: Medically Monitored Intensive Inpatient Treatment (III.7) ..................................................................... 252
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Summary .............................................................. 252
Level of Care: Medically Managed Intensive Inpatient Treatment (IV) .......................................................................... 255
Summary ..................................................................................................................................................................... 255
Criterion ...................................................................................................................................................................... 255
Criteria......................................................................................................................................................................... 255
Dimension 6: Recovery/Living Environment ....................................................................................................................... 256
Level of Care: Early Intervention (0.5) ............................................................................................................................ 257
Level 0.5 (Early Intervention) Summary...................................................................................................................... 257
Level 0.5 (Early Intervention) ...................................................................................................................................... 257
Level 0.5 (Early Intervention) Placement Criterion ..................................................................................................... 258
Level of Care: Outpatient Treatment (I) Level I (Outpatient Treatment) Summary ...................................................... 260
Level I (Outpatient Treatment) ................................................................................................................................... 260
Level I (Outpatient Treatment) Placement Criteria Original Equation: ..................................................................... 264
Level of Care: Opiate Maintenance Therapy .................................................................................................................. 266
Level Opiate Maintenance Therapy Summary ............................................................................................................ 266
Level Opiate Maintenance Therapy Criterion ............................................................................................................. 266
Level Opiate Maintenance Therapy Placement Criteria ............................................................................................. 267
Level of Care: Intensive Outpatient (II.1) ........................................................................................................................ 270
Level II.1 (Intensive Outpatient) Summary ................................................................................................................. 270
Level II.1 (Intensive Outpatient) Criteria..................................................................................................................... 270
Level II.1 (Intensive Outpatient) Placement Criteria................................................................................................... 271
Dual Diagnosis Criteria ................................................................................................................................................ 271
Level of Care: Partial Hospitalization (II.5) ...................................................................................................................... 273
Level II.5 (Partial Hospitalization) Summary ............................................................................................................... 273
Level II.5 (Partial Hospitalization) Criteria................................................................................................................... 273
Level II.5 (Partial Hospitalization) Placement Criteria) ............................................................................................... 274
Level of Care: Clinically Managed Low-Intensity Residential Services (III.1) .................................................................. 276
Level III.1 (Clinically Managed Low-Intensity Residential Services) Summary............................................................ 276
Level III.1 (Intensive Outpatient) Criteria.................................................................................................................... 276
Level III.1 (Clinically Managed Low-Intensity Residential Services) Placement Criteria ............................................. 279
Level of Care: Clinically Managed Medium-Intensity Residential Services (III.3) ........................................................... 282
Level III.3 (Clinically Managed Medium-Intensity Residential Services) Summary..................................................... 282
Level III.3 (Clinically Managed Medium-Intensity Residential Services) Criteria ........................................................ 282
Level of Care: Clinically Managed High-Intensity Residential Services (III.5) ................................................................. 288
Level III.5 (Clinically Managed High-Intensity Residential Treatment) Summary ....................................................... 288
Level III.5 (Clinically Managed High-Intensity Residential Treatment) Criteria .......................................................... 288
Level III.5 (Clinically Managed High-Intensity Residential Treatment) Placement Criteria ........................................ 291
Dual Diagnosis Criteria ................................................................................................................................................ 291
Level of Care: Medically Monitored Intensive Inpatient Treatment (III.7) ..................................................................... 294
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Summary .............................................................. 294
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Criteria .................................................................. 294
Diagnosis ............................................................................................................................................................................. 299
LEVEL of Care: Detoxification – Outpatient ( I-D) ........................................................................................................... 300
Decision Rules .................................................................................................................. Error! Bookmark not defined.

DxLIDa = TRUE If [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a =2)] OR [(any of ASId01R thru -d13bR
<=1wk) & (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)] OR [DSM-IV-SA or SD=1] ...................................... 300
LEVEL of care: Detoxification –Intensive Outpatient (II-D) ............................................................................................. 302
Decision Rules .................................................................................................................. Error! Bookmark not defined.

DxLIIDa = TRUE If [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a =2)] OR [(any of ASId01R thru -d13bR
<=1wk) & (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)] OR [DSM-IV-SA or SD =1] ..................................... 302
LEVEL of Care: Detoxification – Clinically Managed Low-Intensity Residential Services (III.2-D) .................................. 305
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL of Care: Detoxification – Medically Monitored Inpatient Treatment (III.7-D) ..................................................... 306
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL of Care: Detoxification – Medically Managed Inpatient Treatment (IV-D) .......................................................... 307
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL of Care: Early Intervention (0.5) ........................................................................................................................... 308
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL of Care: Outpatient Treatement (I – OP) .............................................................................................................. 310
Decision Rules ............................................................................................................................................................. 310
LEVEL of Care – Dual Diagnosis Capable: Outpatient Treatment (I - OP/DDC) .................... Error! Bookmark not defined.
Decision Rules ............................................................................................................................................................. 310
LEVEL of Care: Dual Diagnosis Enhanced Outpatient (I - OP/DDE) ...................................... Error! Bookmark not defined.
Decision Rules ............................................................................................................................................................. 311
Level of Care: Opiate Management Therapy (OMT) ....................................................................................................... 315
Decision Rules ............................................................................................................................................................. 315

DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)] AND [(any of ASId01R thru -d13bR <=24 hrs)
& (ASIm6a =2)] OR [(any of ASId01R thru -d13bR <=1wk) & . (CIWA OR CINA Total>4 OR CUAD##/02 OR
##/03=1)] OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1] ...... 315

DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 &
(ASIp19i>0)] ................................................................................................................................................................. 315
LEVEL of care II.1- Intensive Outpatient Treatment ....................................................................................................... 319
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL II.1- Intensive Outpatient Treatment/Dual Diagnosis Capable ................................. Error! Bookmark not defined.
Decision Rules ............................................................................................................................................................. 320
LEVEL II.1- Intensive Outpatient Treatment/Dual Diagnosis Enhanced .............................. Error! Bookmark not defined.
Decision Rules ............................................................................................................................................................. 320
LEVEL II.5- Partial Hospitalization ................................................................................................................................... 322
Decision Rules .................................................................................................................. Error! Bookmark not defined.

DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)]
AND [(any of
ASId01R thru -d13bR <=24 hrs) & (ASIm6a =2)]
OR [(any of ASId01R thru -d13bR
<=1wk) &
. (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1] ......................... 322

DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 &
(ASIp19i>0)] ................................................................................................................................................................. 322
LEVEL II.5- Partial Hospitalization/Dual Diagnosis Capable ................................................. Error! Bookmark not defined.
Decision Rule .................................................................................................................... Error! Bookmark not defined.
LEVEL II.5- Partial Hospitalization/Dual Diagnosis Enhanced .............................................. Error! Bookmark not defined.
Decision Rule .................................................................................................................... Error! Bookmark not defined.
LEVEL III.1 – Clinically Managed Low Intensity Residential Services............................................................................... 324
Decision Rule .................................................................................................................... Error! Bookmark not defined.

DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)] AND [(any of ASId01R thru -d13bR <=24 hrs)
& (ASIm6a =2)] OR [(any of ASId01R thru -d13bR <=1wk) & . (CIWA OR CINA Total>4 OR CUAD##/02 OR
##/03=1)] OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1] ........ 324

DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 &
(ASIp19i>0)] ................................................................................................................................................................. 324
LEVEL III.1 – Clinically Managed Low Intensity Residential Treatment Services/Dual Diagnosis Capable Error! Bookmark
not defined.
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL III.1 - Clinically Managed Low Intensity Residential Treatment Services /Dual Diagnosis Enhanced .............. Error!
Bookmark not defined.
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL III.3 – Clinically Managed Medium Intensity Residential Treatment ................................................................... 326
Decision Rules .................................................................................................................. Error! Bookmark not defined.

DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)]
AND [(any of
ASId01R thru -d13bR <=24 hrs) & (ASIm6a =2)]
OR [(any of ASId01R thru -d13bR
<=1wk) &
. (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1] ......................... 326

DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 &
(ASIp19i>0)] ................................................................................................................................................................. 326
LEVEL III.3 - Clinically Managed Medium Intensity Residential Treatment /Dual Diagnosis Capable Error! Bookmark not
defined.
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL III.3 - Clinically Managed Medium Intensity Residential Treatment /DUAL DIAGNOSIS ENHANCED .............. Error!
Bookmark not defined.
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL III.5 – Clinically Managed High Intensity Residential Treatment .......................................................................... 328
Decision Rules .................................................................................................................. Error! Bookmark not defined.

DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)]
AND [(any of
ASId01R thru -d13bR <=24 hrs) & (ASIm6a =2)]
OR [(any of ASId01R thru -d13bR
<=1wk) &
. (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1] ......................... 328

DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 &
(ASIp19i>0)] ................................................................................................................................................................. 328
LEVEL III.5 - Clinically Managed High Intensity Residential Treatment/Dual Diagnosis Capable ....... Error! Bookmark not
defined.
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL III.5 - Clinically Managed High Intensity Residential Treatment/DUAL DIAGNOSIS ENHANCED .....Error! Bookmark
not defined.
Decision Rule .................................................................................................................... Error! Bookmark not defined.
LEVEL III.7 – Medically Monitored Intensive Inpatient Treatment ................................................................................. 330
Decision Rule .................................................................................................................... Error! Bookmark not defined.

DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)]
AND [(any of
ASId01R thru -d13bR <=24 hrs) & (ASIm6a =2)]
OR [(any of ASId01R thru -d13bR
<=1wk) &
. (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1] ......................... 330

DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 &
(ASIp19i>0)] ................................................................................................................................................................. 330
LEVEL III.7 - Medically Monitored Intensive Inpatient Treatment /Dual Diagnosis CapableError! Bookmark not defined.
Decision Rule .................................................................................................................... Error! Bookmark not defined.
LEVEL III.7 - Medically Monitored Intensive Inpatient Treatment /DUAL DIAGNOSIS ENHANCED .... Error! Bookmark not
defined.
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL IV – Medically Managed Intensive Inpatient Treatment ...................................................................................... 332
Decision Rule .................................................................................................................... Error! Bookmark not defined.

DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)]
AND [(any of
ASId01R thru -d13bR <=24 hrs) & (ASIm6a =2)]
OR [(any of ASId01R thru -d13bR
<=1wk) &
. (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1] ......................... 332

DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 &
(ASIp19i>0)] ................................................................................................................................................................. 332
LEVEL IV - Medically Managed Intensive Inpatient Treatment /Dual Diagnosis Capable.... Error! Bookmark not defined.
Decision Rules .................................................................................................................. Error! Bookmark not defined.
LEVEL IV - Medically Managed Intensive Inpatient Treatment /DUAL DIAGNOSIS ENHANCED ......... Error! Bookmark not
defined.
Decision Rule .................................................................................................................... Error! Bookmark not defined.
Dimension 1: Withdrawal
Length of Service – All Substances
The patient continues in a Level III.7-D detoxification program until withdrawal signs and symptoms are sufficiently
resolved that he or she can be safely managed at a less intensive level of care; orAlternatively, the patient’s signs and
symptoms of withdrawal have failed to respond to treatment and have intensified (as confirmed by higher scores on the
CIWA-Ar or other comparable standardized scoring system), such that transfer to a Level IV-D detoxification service is
indicated.
Dimension 1: Level III-7 Medically Monitored Intensive Inpatient
Pseudo Code
D1LIII-7 VARIABLES:
Let experiencedNauseaOrVomitedRecentlyCiwa =
assessment.DrugAndAlcoholSection.CiwaScale.ExperiencedNauseaOrVomitedRecently;
Let observedTremorCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTremor;
Let observedSweatingCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedSweating;
Let observedNervousness = assessment.DrugAndAlcoholSection.CiwaScale.ObservedNervousness;
Let interviewerObservationOfPatientAgitationLevel =
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel;
Let observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances;
Let auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
Let visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
Let headAcheOrFullnessSeverity = assessment.DrugAndAlcoholSection.CiwaScale.HeadAcheOrFullnessSeverity;
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
Let timingOfPositiveResponseToDetoxificationCare =
assessment.CompletionSection.TimingOfPositiveResponseToDetoxificationCare;
Let numberOfDaysUsedInPast30DaysBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.NumberOfDaysUsedInPast30Days;
Let wasSubstanceTakenAsPrescribedBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.WasSubstanceTakenAsPrescribed;
Let numberOfDaysUsedInPast30DaysOtherSeditive =
assessment.DrugAndAlcoholSection.OtherSedativeUse.NumberOfDaysUsedInPast30Days;
Let wasSubstanceTakenAsPrescribedOtherSeditive =
assessment.DrugAndAlcoholSection.OtherSedativeUse.WasSubstanceTakenAsPrescribed;
Let hasMaintainedBarbituatesDoseAtTherapeuticLevels =
assessment.DrugAndAlcoholSection.InterviewerEvaluation.HasMaintainedBarbituatesDoseAtTherapeuticLevels;
Let hasMaintainedSedativeDoseAtTherapeuticLevels =
assessment.DrugAndAlcoholSection.InterviewerEvaluation.HasMaintainedSedativeDoseAtTherapeuticLevels;
Let numberOfDaysUsedInPast30DaysAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysIntoxicatedInPast30DaysAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfDaysIntoxicatedInPast30Days;
Let numberOfDaysUsedInPast30DaysHeroin = assessment.DrugAndAlcoholSection.HeroinUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysCocaine = assessment.DrugAndAlcoholSection.CocaineUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysStimulant = assessment.DrugAndAlcoholSection.StimulantUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.NumberOfDaysUsedInPast30Days;
Let signsOfIntoxicationExist = assessment.MedicalSection.SignsOfIntoxicationExist;
Let observedRetardationOfThoughtOrSpeech =
assessment.PsychologicalSection.DepressionEvaluation.ObservedRetardationOfThoughtOrSpeech;
Let numberOfTimesWithdrawalCausedDeliriumTremensAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfTimesWithdrawalCausedDeliriumTremens;
Let substanceOverdoseInPast24Hours =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.SubstanceOverdoseInPast24Hours;
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering;
Let hasEverUsedHeroin = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedHeroin;
Let lastUsedHeroin = assessment.DrugAndAlcoholSection.HeroinUse.LastUsed;
Let hasEverUsedMethadone = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedMethadone;
Let lastUsedMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.LastUsed;
Let hasEverUsedOtherOpiate =
assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedOtherOpiate;
Let lastUsedOtherOpiate = assessment.DrugAndAlcoholSection.OtherOpiateUse.LastUsed;
Let toBePrescribedOpioidDetoxificationProtocol =
assessment.DrugAndAlcoholSection.OpioidMaintenanceTherapy.ToBePrescribedOpioidDetoxificationProtocol;
Let routeOfIntakeHeroin = assessment.DrugAndAlcoholSection.HeroinUse.RouteOfIntake;
Let routeOfIntakeMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.RouteOfIntake;
Let routeOfIntakeOtherOpiate = assessment.DrugAndAlcoholSection.OtherOpiateUse.RouteOfIntake;
Let highestCareLevelFailedFromInPast90Days =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.HighestCareLevelFailedFromInPast90Days;
Let hasEverUsedCocaine = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedCocaine;
Let lastUsedCocaine = assessment.DrugAndAlcoholSection.CocaineUse.LastUsed;
Let hasEverUsedStimulant = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedStimulate;
Let lastUsedStimulant = assessment.DrugAndAlcoholSection.StimulantUse.LastUsed;
Let rangeOfMoodInPastWeek = assessment.PsychologicalSection.DepressionEvaluation.RangeOfMoodInPastWeek;
Let rangeOfGuiltInPastWeek = assessment.PsychologicalSection.DepressionEvaluation.RangeOfGuiltInPastWeek;
Let appearanceOfDepressionWithdrawal =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfDepressionWithdrawal;
Let appearanceOfHostility = assessment.PsychologicalSection.InterviewerRating.AppearanceOfHostility;
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking;
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts;
Let numberOfDaysExperiencedSubstanceProblemsInPast30Days =
assessment.DrugAndAlcoholSection.DrugConsequences.NumberOfDaysExperiencedSubstanceProblemsInPast30Days;
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers;
Let strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse;
Let isPatientExperiencingWithdrawalSignsSymptoms =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.IsPatientExperiencingWithdrawalSignsSymptoms;
Let experiencedNauseaOrVomitedRecently = assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
Let observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
Let observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
Let observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
Let observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
Let observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
Let observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
Let observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
Let hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
Let feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
Let hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
Let heartRate = assessment.MedicalSection.HeartRate;
Let usuallyLeftDetoxificationBeforeAdvised =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.UsuallyLeftDetoxificationBeforeAdvised;
Let previousSubstanceUseTreatment =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.PreviousSubstanceUseTreatment;
Let usuallyEnteredContinuedTreatmentAfterDetoxification =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.UsuallyEnteredContinuedTreatmentAfterDetoxification;
Let interviewerScoreOfAttitude =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude;
Let interviewerScoreOfReadiness =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness;
Let helpfulnessOfTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment;
Let possibleFutureRelapseCause =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause;
Let hasAlcoholImminentWithdrawalPotential =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.AlcoholAnyUseScore.
HasImminentWithdrawalPotential;//oB_ImminentWD01
Let hasHeroinImminentWithdrawalPotential =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.
HeroinScore.HasImminentWithdrawalPotential; //oB_ImminentWD03
Let hasMethadoneImminentWithdrawalPotential =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.
MethadoneScore.HasImminentWithdrawalPotential;//ImminentWD04
Let hasOtherOpiateImminentWithdrawalPotential =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.
OtherOpiatesAnalgesicsScore.HasImminentWithdrawalPotential;//ImminentWD05
Let hasBarbiturateImminentWithdrawalPotential =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.BarbituratesScore.
HasImminentWithdrawalPotential;//ImminentWD06
Let hasOtherSedativeHypnoticImminentWithdrawalPotential =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.OtherSedativesHypnoticsSco
re.HasImminentWithdrawalPotential;//ImminentWD07
Let careLevel_III_7_DetoxScore = new CareLevel_III_7_DetoxificationScore();
Let ciwa = Utilities.CalculateCiwa(experiencedNauseaOrVomitedRecentlyCiwa, observedTremorCiwa,
observedSweatingCiwa, observedNervousness, interviewerObservationOfPatientAgitationLevel,
observedTactileDisturbances, auditoryDisturbanceLevel, visualDisturbanceLevel,
headAcheOrFullnessSeverity, interviewerObservationOfPatientSenseOfAwareness);
Let cina = Utilities.CalculateCina(experiencedNauseaOrVomitedRecently,
observedGooseFlesh, observedSweating, observedRestlessness, observedTremor, observedLacrimination,
observedNasalCongestion, observedYawning, hasAbdominalPain, feelsHotOrCold, hasMuscleAches, heartRate);
Let
Let
Let
Let
Let
heroinUseFrequency = Utilities.CalculateFrequency(hasEverUsedHeroin, lastUsedHeroin); // ASId03R
methadoneUseFrequency = Utilities.CalculateFrequency(hasEverUsedMethadone, lastUsedMethadone); // ASId04R
otherOpiateUseFrequency = Utilities.CalculateFrequency(hasEverUsedOtherOpiate, lastUsedOtherOpiate); // ASId05R
cocaineUseFrequency = Utilities.CalculateFrequency(hasEverUsedCocaine, lastUsedCocaine); // ASId08R
stimulantUseFrequency = Utilities.CalculateFrequency(hasEverUsedStimulant, lastUsedStimulant); // ASId09R
D1LIII.7-a1:
Let careLevel_III_7_DetoxScore.IsWithdrawingFromAlcoholCIWA10OrGreaterAtThisLevel =
hasAlcoholImminentWithdrawalPotential.Value And (ciwa >= 10) And (timingOfPositiveResponseToDetoxificationCare
>=
3);
D1LIII.7-a2:
Let usedBarbiturateSeditiveFrequently = ( (numberOfDaysUsedInPast30DaysBarbiturate > 26) And
(wasSubstanceTakenAsPrescribedBarbiturate == 2) ) Or
( (numberOfDaysUsedInPast30DaysOtherSeditive > 26) And (wasSubstanceTakenAsPrescribedOtherSeditive = 2) );
careLevel_III_7_DetoxScore.HasIngestedSeditivesMoreThanTherapeuticLevelsDailyMoreThan4Weeks =
usedBarbiturateSeditiveFrequently And ( (hasMaintainedBarbituatesDoseAtTherapeuticLevels != true) Or
(hasMaintainedSedativeDoseAtTherapeuticLevels != true) );
D1LIII.7-a3:
careLevel_III_7_DetoxScore.HasIngestedSeditivesMoreThanTherapeuticLevelsMoreThan4WeeksWithAlcoholCombination =
usedBarbiturateSeditiveFrequently And
( (numberOfDaysUsedInPast30DaysAlcohol >= 15) Or
(numberOfDaysIntoxicatedInPast30DaysAlcohol >= 15) Or (numberOfDaysUsedInPast30DaysHeroin >= 15) Or
(numberOfDaysUsedInPast30DaysMethadone >= 15) Or (numberOfDaysUsedInPast30DaysOtherOpiate
>= 15) Or (numberOfDaysUsedInPast30DaysCocaine >= 15) Or
(numberOfDaysUsedInPast30DaysStimulant >= 15) Or
(numberOfDaysUsedInPast30DaysHallucinogen >= 15) Or (numberOfDaysUsedInPast30DaysSolventAndInhalant >= 15) ) And
( IsBtw(ciwa, 8, 15) And (timingOfPositiveResponseToDetoxificationCare > 2) );
D1LIII.7-a4:
careLevel_III_7_DetoxScore.HasLethargyWithAlcoholDrugsHistorySevereWithdrawalOrNotStabilizedAtLevel =
((signsOfIntoxicationExist >= 1) And (observedRetardationOfThoughtOrSpeech > 2) And
((numberOfTimesWithdrawalCausedDeliriumTremensAlcohol + substanceOverdoseInPast24Hours) >= 1)) Or
( ( (interviewerObservationOfPatientSenseOfAwareness >=3) Or
(appearanceOfTroubleConcentratingOrRemembering > 3) ) And (timingOfPositiveResponseToDetoxificationCare > 2) );
D1LIII.7-a5:
Let usedHeroinMethadoneOpiateFrequently = ( ( (hasEverUsedHeroin = true) And (heroinUseFrequency < 5) ) Or
((hasEverUsedMethadone = true) And (methadoneUseFrequency < 5) ) Or
( (hasEverUsedOtherOpiate = true) And (otherOpiateUseFrequency < 5) ) ) And
( (numberOfDaysUsedInPast30DaysHeroin > 14) Or (numberOfDaysUsedInPast30DaysMethadone > 14) Or
(numberOfDaysUsedInPast30DaysOtherOpiate > 14) );
careLevel_III_7_DetoxScore.HasUsedInjectableOpiatesDailyMoreThan2WeeksNeedsMedicationToComplete =
(toBePrescribedOpioidDetoxificationProtocol = 1) And (usedHeroinMethadoneOpiateFrequently And
((routeOfIntakeHeroin = 5) Or (routeOfIntakeMethadone = 5) Or (routeOfIntakeOtherOpiate = 5)))
And (highestCareLevelFailedFromInPast90Days <= 9);
D1LIII.7-a6:
Let careLevel_III_7_DetoxScore.AntagonistMedicationUsedInWithdrawalBriefButIntensiveDetox =
usedHeroinMethadoneOpiateFrequently And (toBePrescribedOpioidDetoxificationProtocol = 3);
D1LIII.7-a7:
Let usedCocaineStimulantFrequently = ( ( (hasEverUsedCocaine = true) And (cocaineUseFrequency <= 3) ) Or (
(hasEverUsedStimulant = true) And (stimulantUseFrequency <= 3) ) ) And
( (numberOfDaysUsedInPast30DaysCocaine >= 15) Or (numberOfDaysUsedInPast30DaysStimulant >= 15) );
careLevel_III_7_DetoxScore.IsExperiencingStimulantsWithdrawalPoorImpulseControlOrCopingSkills =
usedCocaineStimulantFrequently And
(((rangeOfMoodInPastWeek > 2) Or (rangeOfGuiltInPastWeek > 2) Or (observedRetardationOfThoughtOrSpeech > 2) Or
(interviewerObservationOfPatientAgitationLevel > 3) Or (auditoryDisturbanceLevel > 3) Or (visualDisturbanceLevel
> 3) Or (appearanceOfDepressionWithdrawal > 2) Or (appearanceOfHostility > 2) Or
(appearanceOfParanoiaOrImpairedThinking > 2) Or (hasSuicidalThoughts > 2)) And
((numberOfDaysExperiencedSubstanceProblemsInPast30Days = 4) Or
(strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers = 4) Or (strategyToPreventRelapse = 4)));
D1LIII.7D-a:
Let careLevel_III_7_DetoxScore.IsExperiencingSevereWithdrawalManageableAtLevelOfService =
(isPatientExperiencingWithdrawalSignsSymptoms = 4);
D1LIII.7D-b:
Let needsDetoxMeds = ((hasAlcoholImminentWithdrawalPotential.Value Or hasBarbiturateImminentWithdrawalPotential.Value
Or hasOtherSedativeHypnoticImminentWithdrawalPotential.Value)
And (ciwa > 10)) Or ((hasHeroinImminentWithdrawalPotential.Value Or hasMethadoneImminentWithdrawalPotential.Value
Or hasOtherOpiateImminentWithdrawalPotential.Value) And
((cina > 10) Or (toBePrescribedOpioidDetoxificationProtocol > 0)));
careLevel_III_7_DetoxScore.IsLikelyPatientNeedingMedicationWillNotCompleteDetoxDifferentLevel =
( (usuallyLeftDetoxificationBeforeAdvised = true) Or ((previousSubstanceUseTreatment > 0) And
(usuallyEnteredContinuedTreatmentAfterDetoxification = false)) Or (highestCareLevelFailedFromInPast90Days < 9) )
And ( (strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers > 3) Or (interviewerScoreOfAttitude > 3) Or
(interviewerScoreOfReadiness > 3) Or (helpfulnessOfTreatment > 3) Or (possibleFutureRelapseCause > 3) Or
(strategyToPreventRelapse > 3) ) And needsDetoxMeds;
D1LIII.7 Is Met:
careLevel_III_7_DetoxScore.IsMet =
( careLevel_III_7_DetoxScore.IsExperiencingSevereWithdrawalManageableAtLevelOfService.Value Or
careLevel_III_7_DetoxScore.IsWithdrawingFromAlcoholCIWA10OrGreaterAtThisLevel.Value Or
careLevel_III_7_DetoxScore.HasIngestedSeditivesMoreThanTherapeuticLevelsDailyMoreThan4Weeks.Value Or
careLevel_III_7_DetoxScore.HasIngestedSeditivesMoreThanTherapeuticLevelsMoreThan4WeeksWithAlcoholCombination.
Value Or
careLevel_III_7_DetoxScore.HasLethargyWithAlcoholDrugsHistorySevereWithdrawalOrNotStabilizedAtLevel.Value Or
careLevel_III_7_DetoxScore.HasUsedInjectableOpiatesDailyMoreThan2WeeksNeedsMedicationToComplete.Value Or
careLevel_III_7_DetoxScore.AntagonistMedicationUsedInWithdrawalBriefButIntensiveDetox.Value Or
careLevel_III_7_DetoxScore.IsExperiencingStimulantsWithdrawalPoorImpulseControlOrCopingSkills.Value Or
careLevel_III_7_DetoxScore.IsLikelyPatientNeedingMedicationWillNotCompleteDetoxDifferentLevel.Value);
return careLevel_III_7_DetoxScore;
Level of Care: Detoxification - Outpatient Treatment (I-D)
Level I-D (Detoxification - Outpatient Treatment) Summary
The patient requires 24-hour medical monitoring but not intensive treatment.
Level -D (Detoxification - Outpatient Treatment) Criteria
Criterion- Alcohol (a)
MinimumRiskSevereWithdrawalSyndromeCanSafelyManage
BOTH (a) The patient is experiencing at least mild signs and symptoms of withdrawal, or there is evidence (based on
history of substance intake, age, gender, previous withdrawal history, present symptoms, physical condition, and/or
emotional, behavioral or cognitive condition) that withdrawal is imminent. The patient is assessed as being at minimal
risk of severe withdrawal syndrome and can be safely managed at this level.
Original Equation
If [ASId##R<=3d & ASId##F>=15d & (Any of: CUAD-##01, -##02 or -##03 >0)] where Any ##=Any of Substances 1-12
D1LIDa = TRUE If ASId99 <=1
Criterion- Alcohol (a-1)
MildToModerateAlcoholWithdrawalCIWALessThan8
INCL. (a) [1] Alcohol: The presence of mild to moderate symptoms of withdrawal, with a CIWA-Ar (Clinical Institute
Withdrawal Assessment-Alcohol, Revised) score of less than 8, or the equivalent for a comparable standardized scoring
system.
Original Equation
D1LID-a1 (Alc.) = TRUE If [(ASId01R or d02R<=3d) & (ASId01F or -d02F >14d)] & ASId17a&c=0 & (CUAD-Alc02 or -03 or Itx02 or -03 =1)& CIWA-Ttl<8
Narrative
Criterion is met if:
[(1 or 2) And (3 or 4)] And 5 And (6) And 7
1) Last alcohol use by patient was <= 3 days ago
2) Last alcohol use to intoxication by patient was <= 3 days ago
3) Patient used alcohol at least 14 days out of the last month
4) Patient used alcohol to intoxication at least 14 days out of the last month
5) Patient has had alcohol DTs
6) Patient needs more alcohol to gain same feelings (increased tolerance) and uses to stave off sickness
7) CIWA score for patient is < 8
Criterion- Sedatives (a-2)
RecentSedativeUseNotComplicatedByAlcoholUseToProduceWithdrawal
OR (a) [2] Sedative-hypnotics: Any recent use is confined to therapeutic levels and is not complicated by daily use of
alcohol or other mind-altering drugs known to produce a significant withdrawal syndrome.
Original Equation
D1LID-a2 (Sed.) = TRUE If [(ASId06X =1 & ASId06Q <2) OR (ASId07X =1 & ASId07Q <2)
D1LIVD =0, i.e., 'untrue')]
AND (All of: D1LIID, D1LIII.7D,
Criterion- Sedatives (a-3)
ReliableHistoryWithdrawingFromTherapeuticSedativeDoses
OR (a) [2] Sedative-hypnotics: There is a reliable history that the patient is withdrawing from therapeutic doses of
sedative-hypnotics, but there is no evidence of other alcohol or drug dependence. Withdrawal symptoms have
responded to, or are likely to respond to, substitute doses of sedative-hypnotics in the therapeutic range within 2 hours
Original Equation
D1LID-a2 (Sed.) = TRUE If [(ASId06X =1 & ASId06Q <2) OR (ASId07X =1 & ASId07Q <2)
D1LIVD =0, i.e., 'untrue')]
AND (All of: D1LIID, D1LIII.7D,
Criterion- Opiates (a-4)
UseOfHighPotencyOpiatesNotBeenDailyForMoreThan2Weeks
OR (a) [4] Opiates (for withdrawal management not using opiate substitution methods of detoxification): Either the
patient’s use of high-potency opiates (such as injectable or smoked forms) has not been daily for more than 2 weeks
preceding admission or the use of opiates is near the therapeutically recommended level.
Original Equation
D1LID-a4 (Op.) = TRUE If ASId25f=1 & [(Any of: ASId03,4,5R<5d & All of: ASId03,4,5F <14) OR (ASId04Q or d05Q<2)]
Criterion- Opiates (a-5)
IsBeingOpiateDetoxedGraduallyOrTreatedForMildWithdrawal
OR (a) [5] Opiates (for withdrawal management using opiate substitution methods of detoxification, such as methadone
or other appropriate opiate): Either the patient is being detoxified gradually from opiate maintenance or the patient is
being treated for mild opiate withdrawal symptoms.
Original Equation
"D1LID-a5 (Op.) = TRUE If ASId25f=2 & [(Any of: ASId03,4,5R <5d & Any of: ASId03,4,5F >14 & CINA-Ttl >5 & <10) OR
(ASId25g=1)]"
Criterion- Stimulates (a-6)
IsExperiencingStimulantsWithdrawalButGoodImpulseControl
OR (a) [6] Stimulants: The patient is withdrawing from stimulants and is experiencing some lethargy, agitation,
paranoia, mild psychotic symptoms or depression, but he or she has good impulse control.
Original Equation
D1LID-a6 (Sti.) = TRUE If [(ASId08R or d09R =<3d) & (ASId08F or d09F >=15d)] & (Any of:
CIWA5,7or8 =1to3 OR ASIp15thru18bor19 =1) & (All of: ASId22d & d22f & d24z <2)
ASIp14=1to2; ASIp18c=1to4;
Criterion- Nicotine (a-7)
IsExperiencingNicotineWithdrawalRequiresSymptomaticTreatment
OR (a) [7] Nicotine: The patient is withdrawing from nicotine and is experiencing withdrawal symptoms that require
either nicotine replacement therapies or non-nicotine agents for symptomatic treatment.
Original Equation
D1LID-a7 (Nic.) = TRUE If ASId13aR =<3d
& ASId13aF >=15d & Any of:CUAD-13a/02thru05 =1 & CUAD-13a19 >0
Criteria- Psychosocial Issues (b1, b2, b3)
HasWithdrawalSymptomsMinimalRiskCanCompleteNeededDetox
AND (b) The patient has withdrawal symptoms but is at minimal risk of severe withdrawal syndrome and is assessed as
likely to complete needed detoxification and to enter into continued treatment or self-help recovery, as evidenced by
meeting [1] or [2] or [3]:
OR (b) [1] The patient has an adequate understanding of ambulatory detoxification and has expressed commitment to
enter such a program;
OR (b) [2] The patient has adequate support services to ensure commitment to completion of detoxification and entry
into ongoing treatment or recovery;
OR (b) [3] The patient is willing to accept a recommendation for treatment (for example, to begin disulfiram, naltrexone
or other medication once withdrawal has been managed, or to attend outpatient sessions or self-help groups).
Original Equation
D1LID-b = TRUE If (ASId24v<4 & d24w<2 & l1x<2) OR (ASIf6a, f19h,&d22f <2) OR (ASIf24b&c =2) OR (ASId24v<5 & d24w&24x
<2)
Criterion- Psychosocial Issues (c)
HasAndRespondsToEmotionalSupportAndComfort
AND (c) For patients whose withdrawal symptoms are no more severe than those noted in section (a), the patient has,
and responds positively to, emotional support and comfort, as evidenced by BOTH (c) [1] and [2]:
BOTH (c) [1] Decreased emotional symptoms at the close of the initial treatment session;
AND (c) [2] The patient’s or support person’s ability to clearly understand instructions for care, and the presence of both
the ability and resources to follow instructions.
Original Equation
D1LID-c = TRUE If (Post1 =1) & [(ASIp6D=0 & ASIp18=0 & CIWA10=0) OR (All of:ASIf6a,f19h,& d22f
<3)]
Criteria- All Substances
Original Equation
D1LID = TRUE If D1LID(any of: a,a1-a7) & D1LIDb & D1LIDc
Length of Service – All Substances
The patient continues in a Level I-D detoxification program until withdrawal signs and symptoms are sufficiently resolved
that he or she can participate in self-directed recovery or ongoing treatment without the need for further medical or
nursing detoxification monitoring; or
Alternatively, the patient’s signs and symptoms of withdrawal have failed to respond to treatment and have intensified
(as confirmed by higher scores on the CIWA-Ar or other comparable standardized scoring system), such that transfer to
a more intensive level of detoxification service is indicated; or

The patient is unable to complete detoxification at Level I-D, despite an adequate trial. For example, he or she is
experiencing intense craving and evidences insufficient coping skills to prevent continued alcohol or other drug
use concurrent with the detoxification medication, indicating a need for more intensive services (such as
addition of a supportive living environment).
Dimension 1: Level I-D Detoxification Outpatient Treatment
Pseudo Code
Let
Let
Let
Let
Let
Let
hasEverUsedAlcohol = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedAlcohol;
lastUsedAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.LastUsed;
alcoholUsedToIntoxication = assessment.DrugAndAlcoholSection.AlcoholUse.AlcoholUsedToIntoxication;
lastUsedToIntoxification = assessment.DrugAndAlcoholSection.AlcoholUse.LastUsedToIntoxification;
numberOfDaysUsedInPast30DaysAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfDaysUsedInPast30Days;
numberOfDaysIntoxicatedInPast30Days =
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfDaysIntoxicatedInPast30Days;
Let numberOfTimesWithdrawalCausedDeliriumTremens =
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfTimesWithdrawalCausedDeliriumTremens;
Let numberOfTimesWithdrawalCausedSeizures =
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfTimesWithdrawalCausedSeizures;
Let substanceOverdoseInPast24Hours =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.SubstanceOverdoseInPast24Hours;
Let experiencesWithdrawalSicknessAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.ExperiencesWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.UseSubstanceToPreventWithdrawalSickness;
Let experiencedNauseaOrVomitedRecentlyCiwa =
assessment.DrugAndAlcoholSection.CiwaScale.ExperiencedNauseaOrVomitedRecently;
Let observedTremorCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTremor;
Let observedSweatingCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedSweating;
Let observedNervousness = assessment.DrugAndAlcoholSection.CiwaScale.ObservedNervousness;
Let interviewerObservationOfPatientAgitationLevel =
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel;
Let observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances;
Let auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
Let visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
Let headAcheOrFullnessSeverity = assessment.DrugAndAlcoholSection.CiwaScale.HeadAcheOrFullnessSeverity;
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
Let hasHealthCareProviderPrescribedUseBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.HasHealthCareProviderPrescribedUse;
Let wasSubstanceTakenAsPrescribedBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.WasSubstanceTakenAsPrescribed;
Let hasHealthCareProviderPrescribedUseOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.HasHealthCareProviderPrescribedUse;
Let wasSubstanceTakenAsPrescribedOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.WasSubstanceTakenAsPrescribed;
Let hasEverUsedBarbiturate =
assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedBarbiturates;
Let lastUsedBarbiturate = assessment.DrugAndAlcoholSection.BarbiturateUse.LastUsed;
Let numberOfDaysUsedInPast30DaysBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.NumberOfDaysUsedInPast30Days;
Let hasEverUsedOtherSedative =
assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedOtherSedatives;
Let lastUsedOtherSedative = assessment.DrugAndAlcoholSection.OtherSedativeUse.LastUsed;
Let numberOfDaysUsedInPast30DaysOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.NumberOfDaysUsedInPast30Days;
Let noNonSedativeDiagnosis = assessmentScore.DiagnosisResults.NoNonSedativeDiagnosis;
Let timingOfPositiveResponseToDetoxificationCare =
assessment.CompletionSection.TimingOfPositiveResponseToDetoxificationCare;
Let hasEverUsedHeroin = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedHeroin;
Let lastUsedHeroin = assessment.DrugAndAlcoholSection.HeroinUse.LastUsed;
Let hasEverUsedMethadone = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedMethadone;
Let lastUsedMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.LastUsed;
Let hasEverUsedOtherOpiate =
assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedOtherOpiate;
Let lastUsedOtherOpiate = assessment.DrugAndAlcoholSection.OtherOpiateUse.LastUsed;
Let numberOfDaysUsedInPast30DaysHeroin = assessment.DrugAndAlcoholSection.HeroinUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.NumberOfDaysUsedInPast30Days;
Let toBePrescribedOpioidDetoxificationProtocol =
assessment.DrugAndAlcoholSection.OpioidMaintenanceTherapy.ToBePrescribedOpioidDetoxificationProtocol;
Let wasSubstanceTakenAsPrescribedMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.WasSubstanceTakenAsPrescribed;
Let wasSubstanceTakenAsPrescribedOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.WasSubstanceTakenAsPrescribed;
Let experiencedNauseaOrVomitedRecently = assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
Let observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
Let observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
Let observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
Let observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
Let observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
Let observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
Let observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
Let hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
Let feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
Let hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
Let heartRate = assessment.MedicalSection.HeartRate;
Let graduallyDetoxedFromOpioidMaintenanceTherapy =
assessment.DrugAndAlcoholSection.OpioidMaintenanceTherapy.GraduallyDetoxedFromOpioidMaintenanceTherapy;
Let hasEverUsedCocaine = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedCocaine;
Let lastUsedCocaine = assessment.DrugAndAlcoholSection.CocaineUse.LastUsed;
Let hasEverUsedStimulant = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedStimulate;
Let lastUsedStimulant = assessment.DrugAndAlcoholSection.StimulantUse.LastUsed;
Let numberOfDaysUsedInPast30DaysCocaine = assessment.DrugAndAlcoholSection.CocaineUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysStimulant = assessment.DrugAndAlcoholSection.StimulantUse.NumberOfDaysUsedInPast30Days;
Let rangeOfMoodInPastWeek = assessment.PsychologicalSection.DepressionEvaluation.RangeOfMoodInPastWeek;
Let observedRetardationOfThoughtOrSpeech =
assessment.PsychologicalSection.DepressionEvaluation.ObservedRetardationOfThoughtOrSpeech;
Let appearanceOfDepressionWithdrawal =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfDepressionWithdrawal;
Let appearanceOfHostility = assessment.PsychologicalSection.InterviewerRating.AppearanceOfHostility;
Let appearanceOfAnxietyNervousness = assessment.PsychologicalSection.InterviewerRating.AppearanceOfAnxietyNervousness;
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking;
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering;
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts;
Let numberOfDaysExperiencedSubstanceProblemsInPast30Days =
assessment.DrugAndAlcoholSection.DrugConsequences.NumberOfDaysExperiencedSubstanceProblemsInPast30Days;
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers;
Let strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse;
Let hasEverUsedNicotine = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedNicotine;
Let lastUsedNicotine = assessment.DrugAndAlcoholSection.NicotineUse.LastUsed;
Let numberOfDaysUsedInPast30DaysNicotine = assessment.DrugAndAlcoholSection.NicotineUse.NumberOfDaysUsedInPast30Days;
Let experiencesWithdrawalSicknessNicotine = assessment.DrugAndAlcoholSection.NicotineUse.ExperiencesWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessNicotine =
assessment.DrugAndAlcoholSection.NicotineUse.UseSubstanceToPreventWithdrawalSickness;
Let unableToStopUsingSubstanceNicotine = assessment.DrugAndAlcoholSection.NicotineUse.UnableToStopUsingSubstance;
Let substanceUseReductionAttempted = assessment.DrugAndAlcoholSection.NicotineUse.SubstanceUseReductionAttempted;
Let hasUsedSubstanceKnowingProblemsWorsened =
assessment.DrugAndAlcoholSection.NicotineUse.HasUsedSubstanceKnowingProblemsWorsened;
Let isPatientExperiencingWithdrawalSignsSymptoms =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.IsPatientExperiencingWithdrawalSignsSymptoms;
Let interviewerScoreOfReadiness =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness;
Let concernsAboutPursuingTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment;
Let desireAndExternalFactorsDrivingTreatment = assessment.LegalSection.DesireAndExternalFactorsDrivingTreatment;
Let livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery;
Let closestContactsNeedsAndWillingnessToHelpTreatment =
assessment.FamilyAndSocialHistorySection.ClosestContactsNeedsAndWillingnessToHelpTreatment;
Let isSupportPersonAvailableFor7Days = assessment.FamilyAndSocialHistorySection.IsSupportPersonAvailableFor7Days;
Let isOutpatientMonitoringAvailable8To24Hours =
assessment.FamilyAndSocialHistorySection.IsOutpatientMonitoringAvailable8To24Hours;
Let helpfulnessOfTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment;
Let respondedPositivelyToEmotionalSupportDuringInterview =
assessment.CompletionSection.RespondedPositivelyToEmotionalSupportDuringInterview;
Let significantPeriodImpairedThoughtInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodImpairedThoughtInLast24Hours;
Let alcoholUseFrequency = Utilities.CalculateFrequency(hasEverUsedAlcohol, lastUsedAlcohol); //ASId01R
Let alcoholUsedToIntoxicationFrequency = Utilities.CalculateFrequency(alcoholUsedToIntoxication,
lastUsedToIntoxification); // ASId02R
if (alcoholUseFrequency > alcoholUsedToIntoxicationFrequency And alcoholUsedToIntoxicationFrequency > 0)
{
alcoholUseFrequency = alcoholUsedToIntoxicationFrequency;
}
Let heroinUseFrequency = Utilities.CalculateFrequency(hasEverUsedHeroin, lastUsedHeroin); // ASId03R
Let methadoneUseFrequency = Utilities.CalculateFrequency(hasEverUsedMethadone, lastUsedMethadone); // ASId04R
Let otherOpiateUseFrequency = Utilities.CalculateFrequency(hasEverUsedOtherOpiate, lastUsedOtherOpiate); // ASId05R
Let barbiturateUseFrequency = Utilities.CalculateFrequency(hasEverUsedBarbiturate, lastUsedBarbiturate); // ASId06R
Let otherSedativeUseFrequency = Utilities.CalculateFrequency(hasEverUsedOtherSedative, lastUsedOtherSedative); //
Let cocaineUseFrequency = Utilities.CalculateFrequency(hasEverUsedCocaine, lastUsedCocaine); // ASId08R
Let stimulantUseFrequency = Utilities.CalculateFrequency(hasEverUsedStimulant, lastUsedStimulant); // ASId09R
Let nicotineUseFrequency = Utilities.CalculateFrequency ( hasEverUsedNicotine, lastUsedNicotine ); //
Let alcolholUse = ( ( ( hasEverUsedAlcohol ?? false ) And alcoholUseFrequency <= 3 ) Or
( ( alcoholUsedToIntoxication ?? false ) And alcoholUsedToIntoxicationFrequency <= 3 ) )
( numberOfDaysUsedInPast30DaysAlcohol > 14 Or
numberOfDaysIntoxicatedInPast30Days > 14 ) And
numberOfTimesWithdrawalCausedDeliriumTremens = 0 And
numberOfTimesWithdrawalCausedSeizures = 0 And
substanceOverdoseInPast24Hours = YesNoNotSure.No And
( ( not experiencesWithdrawalSicknessAlcohol ) Or
( not useSubstanceToPreventWithdrawalSicknessAlcohol ) );
ASId13aR
And
Let ciwa = Utilities.CalculateCiwa ( experiencedNauseaOrVomitedRecentlyCiwa,
observedTremorCiwa, observedSweatingCiwa, observedNervousness,
interviewerObservationOfPatientAgitationLevel, observedTactileDisturbances,
auditoryDisturbanceLevel, visualDisturbanceLevel, headAcheOrFullnessSeverity,
interviewerObservationOfPatientSenseOfAwareness );
Let level_I_DetoxScore.MildToModerateAlcoholWithdrawalCIWALessThan8 = alcolholUse And ( ciwa < 8 );
Let level_I_DetoxScore.RecentSedativeUseNotComplicatedByAlcoholUseToProduceWithdrawal =
( ( not hasHealthCareProviderPrescribedUseBarbiturate ) And wasSubstanceTakenAsPrescribedBarbiturate <
SubstanceTakenAsPrescribed.More ) Or
( ( not hasHealthCareProviderPrescribedUseOtherSedative ) And wasSubstanceTakenAsPrescribedOtherSedative <
SubstanceTakenAsPrescribed.More );
Let level_I_DetoxScore.ReliableHistoryWithdrawingFromTherapeuticSedativeDoses =
( ( ( not hasEverUsedBarbiturate ) And
barbiturateUseFrequency < 8 And numberOfDaysUsedInPast30DaysBarbiturate >= 15 ) Or
( ( not hasEverUsedOtherSedative ) And
otherSedativeUseFrequency < 8 And noNonSedativeDiagnosis And
timingOfPositiveResponseToDetoxificationCare < DetoxificationCareResponseTiming.Within4To8Hours;
Let opiateUse = ( ( ( hasEverUsedHeroin ?? false ) And heroinUseFrequency < 5 ) Or
( ( hasEverUsedMethadone ?? false ) And methadoneUseFrequency < 5 ) Or
( ( hasEverUsedOtherOpiate ?? false ) And otherOpiateUseFrequency < 5 ) ) And
( numberOfDaysUsedInPast30DaysHeroin > 14 Or numberOfDaysUsedInPast30DaysMethadone > 14 Or
numberOfDaysUsedInPast30DaysOtherOpiate > 14 );
Let level_I_DetoxScore.UseOfHighPotencyOpiatesNotBeenDailyForMoreThan2Weeks =
toBePrescribedOpioidDetoxificationProtocol = OpioidDetoxificationProtocol.NonopioidSubstitution And
( opiateUse Or wasSubstanceTakenAsPrescribedMethadone < SubstanceTakenAsPrescribed.More Or
wasSubstanceTakenAsPrescribedOtherOpiate < SubstanceTakenAsPrescribed.More );
Let cina = Utilities.CalculateCina(experiencedNauseaOrVomitedRecently, observedGooseFlesh,
observedSweating, observedRestlessness, observedTremor, observedLacrimination,
observedNasalCongestion, observedYawning, hasAbdominalPain, feelsHotOrCold,
hasMuscleAches, heartRate );
Let level_I_DetoxScore.IsBeingOpiateDetoxedGraduallyOrTreatedForMildWithdrawal =
toBePrescribedOpioidDetoxificationProtocol == OpioidDetoxificationProtocol.OpioidSubstitution
( ( opiateUse And cina > 5 And cina < 10 ) Or
( not graduallyDetoxedFromOpioidMaintenanceTherapy ) );
And
Let stimulantsUse = ( ( ( not hasEverUsedCocaine ) And cocaineUseFrequency <= 3 ) Or
( ( not hasEverUsedStimulant ) And stimulantUseFrequency <= 3 ) ) And
( numberOfDaysUsedInPast30DaysCocaine >= 15 Or
numberOfDaysUsedInPast30DaysStimulant >= 15 );
Let level_I_DetoxScore.IsExperiencingStimulantsWithdrawalButGoodImpulseControl =
stimulantsUse And
( IsBtw ( rangeOfMoodInPastWeek, RangeOfMood.IndicatedOnlyOnQuestioning,
RangeOfMood.SpontaneouslyReportedVerbally ) Or
IsBtw ( observedRetardationOfThoughtOrSpeech,
RetardationOfThoughtOrSpeech.SlightRetardationAtInterview,
RetardationOfThoughtOrSpeech.ObviousRetardationAtInterview ) Or
IsBtw ( interviewerObservationOfPatientAgitationLevel, 1, 3 ) Or
IsBtw ( auditoryDisturbanceLevel, AuditoryDisturbanceLevel.VeryMildHarshnessOrAbilityToFrighten,
AuditoryDisturbanceLevel.ModerateHarshnessOrAbilityToFrighten ) Or
IsBtw ( visualDisturbanceLevel, VisualDisturbanceLevel.VeryMildSensitivity,
VisualDisturbanceLevel.ModerateSensitivity ) Or
( appearanceOfDepressionWithdrawal = 1 ) Or
( appearanceOfHostility = 1 ) Or
( appearanceOfAnxietyNervousness = 1 ) Or
( appearanceOfParanoiaOrImpairedThinking = 1 ) Or
( appearanceOfTroubleConcentratingOrRemembering = 1 ) Or
( hasSuicidalThoughts = 1 ) )
And
numberOfDaysExperiencedSubstanceProblemsInPast30Days < 2 And
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers < LikertScale.Moderately And
strategyToPreventRelapse < RelapsePreventionStrategies.SomeIdeasAndOccasionalEffort;
Let level_I_DetoxScore.IsExperiencingNicotineWithdrawalRequiresSymptomaticTreatment =
( hasEverUsedNicotine ?? false ) And
nicotineUseFrequency <= 3 And
numberOfDaysUsedInPast30DaysNicotine >= 15 And
( ( not experiencesWithdrawalSicknessNicotine ) Or
( not useSubstanceToPreventWithdrawalSicknessNicotine ) Or
( not unableToStopUsingSubstanceNicotine ) Or
( not substanceUseReductionAttempted ) ) And
( not hasUsedSubstanceKnowingProblemsWorsened );
Let level_I_DetoxScore.MinimumRiskSevereWithdrawalSyndromeCanSafelyManage =
isPatientExperiencingWithdrawalSignsSymptoms <= SignsOfWithdrawal.MildRiskOfWithdrawalCanBeManagedAtCareLevel_I;
Let level_I_DetoxScore.HasWithdrawalSymptomsMinimalRiskCanCompleteNeededDetox =
( interviewerScoreOfReadiness < 4 And
concernsAboutPursuingTreatment < ConcernsAboutPursuingTreatment.PassiveOrSomeHesitations And
desireAndExternalFactorsDrivingTreatment <
DesireAndExternalFactorsDrivingTreatment.AmbivalentAndExternallyPersuaded )
Or
( livingArrangementAffectOnRecovery <
LivingArrangementAffectOnRecovery.WillPermitRecoveryIfSufficientlyMotivated And
closestContactsNeedsAndWillingnessToHelpTreatment <
NeedsAndWillingnessToHelpTreatment.NeedsCouplesOrFamilyCounselingOrTherapyAndWillParticipate And
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers < LikertScale.Moderately )
Or
( isSupportPersonAvailableFor7Days = YesNoNotSure.Yes And
isOutpatientMonitoringAvailable8To24Hours = YesNoNotSure.Yes )
Or
( interviewerScoreOfReadiness < 5 And
concernsAboutPursuingTreatment < ConcernsAboutPursuingTreatment.PassiveOrSomeHesitations And
helpfulnessOfTreatment < HelpfulnessOfTreatment.LimitedSenseOfPersonalResponsibilityForRecovery );
Let level_I_DetoxScore.HasAndRespondsToEmotionalSupportAndComfort =
( not respondedPositivelyToEmotionalSupportDuringInterview ) And
( ( significantPeriodImpairedThoughtInLast24Hours = LikertScale.NotAtAll And
observedRetardationOfThoughtOrSpeech = RetardationOfThoughtOrSpeech.NormalSpeechAndThought And
interviewerObservationOfPatientSenseOfAwareness = SenseOfAwareness.OrientedAndCanDoSerialAdditions ) Or
( livingArrangementAffectOnRecovery <
LivingArrangementAffectOnRecovery.WillDiscourageOrHinderTreatment And
closestContactsNeedsAndWillingnessToHelpTreatment <
NeedsAndWillingnessToHelpTreatment.NotClearIfWillHelpOrNoOneAvailable And
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers < LikertScale.Considerably ) );
Let level_I_DetoxScore.IsMet =
( level_I_DetoxScore.MinimumRiskSevereWithdrawalSyndromeCanSafelyManage.Value Or
level_I_DetoxScore.MildToModerateAlcoholWithdrawalCIWALessThan8.Value Or
level_I_DetoxScore.ReliableHistoryWithdrawingFromTherapeuticSedativeDoses.Value Or
level_I_DetoxScore.UseOfHighPotencyOpiatesNotBeenDailyForMoreThan2Weeks.Value Or
level_I_DetoxScore.IsBeingOpiateDetoxedGraduallyOrTreatedForMildWithdrawal.Value Or
level_I_DetoxScore.IsExperiencingStimulantsWithdrawalButGoodImpulseControl.Value Or
level_I_DetoxScore.IsExperiencingNicotineWithdrawalRequiresSymptomaticTreatment.Value
)
And level_I_DetoxScore.HasWithdrawalSymptomsMinimalRiskCanCompleteNeededDetox.Value
And level_I_DetoxScore.HasAndRespondsToEmotionalSupportAndComfort.Value;
return level_I_DetoxScore;
Level of Care: Detoxification – Intensive Outpatient (II-D)
Level II-D (Detoxification – Intensive Outpatient) Summary
Insert here
Level II-D (Detoxification – Intensive Outpatient) Criteria
Criterion- Alcohol (a)
ModerateRiskOfSevereWithdrawalOutsideProgramSetting
BOTH (a) The patient is experiencing signs and symptoms of withdrawal, or there is evidence (based on history of
substance intake, age, gender, previous withdrawal history, present symptoms, physical condition, and/or emotional,
behavioral or cognitive condition) that withdrawal is imminent. The patient is assessed as being at moderate risk of
severe withdrawal syndrome outside the program setting, is free of severe physical and psychiatric complications, and
would safely respond to several hours of monitoring, medication and treatment. Examples include, but are not limited
to:
Original Equation
If [ASId##R<=3d & ASId##F>=15d & (Any of: CUAD-##01, -##02 or -##03 >0)] where Any ##=Any of Substances 1-12
Narrative
Criterion is met if:
Criterion- Alcohol (a1)
AlcoholCIWAScore8To15
(a) [1] Alcohol: A CIWA-Ar (Clinical Institute Withdrawal Assessment-Alcohol, Revised) score of 8 to 15, or the
equivalent for a comparable standardized scoring system.
Original Equation
D1LID-a1 (Alc.) = TRUE If [(ASId01R or d02R<=3d) & (ASId01F or -d02F >14d)] & ASId17a&c=0 & (CUAD-Alc02 or -03 or Itx02 or -03 =1)& CIWA-Ttl<8
D1LIID-a1 (Alc.) = TRUE If [(ASId01R or d02R <=3d) & (ASId01F or d02F >14d)] & ASId17a&c =0 & (CUAD-Alc02 or -03 or Itx02 or -03 =1)& CIWA-Ttl=8to15 & meets D2LII & D3LII criteria
Criterion- Sedative-Hypnotics (a4)
HasIngestedSedativesTherapeuticLevelAtLeast6MonthsSymptomMinimalRisk
OR (a) [4] Sedative-hypnotics: The patient has ingested sedative-hypnotics at not more than therapeutic levels daily for
at least 6 months, in combination with daily alcohol use or regular use of another mind-altering drug known to have its
own dangerous withdrawal syndrome. Nonetheless, the risk of seizures, hallucinations, dissociation or severe affective
symptoms outside the program is minimal.
Original Equation
D1LIID-a4 (Sed.) = TRUE If [(ASId06Q <2 & d06F>26 & d06D>=6m) OR (ASId07Q <2 & d07F>26 & d07D>=6m)] & (Any of: ASId01F
through d05F >=15) & (ASIm6r=0 & CIWA-2,4thru8 all<3 & & (ASIp 3D,3aD,3cD,3dD,4D,4uD,6D all<3) & (ASIp 14 & 18c <5)
Criterion- Sedative-Hypnotics (a2)
HistoryOfWithdrawalFromSedativesOtherDrugDependenceRespondedTo
OR (a) [2] Sedative-hypnotics: There is a reliable history that the patient is withdrawing from sedative-hypnotics, but
there is no evidence of other drug dependence, and withdrawal symptoms have responded to, or are likely to respond
to, substitute doses of sedative-hypnotics in the therapeutic range within the observable hours of the program.
Original Equation
D1LIID-a2 (Sed.) = TRUE If [{(ASId06R<=8d & ASId06F >=15d & (Any CUAD-01, 02 OR 03 for Subst-06>0)} OR {ASId07R<=8d &
ASId07F >=15d & (Any CUAD-01, 02 OR 03 for Subst-07>0)}] & [DSM-IV-SD(wP or woP) for All of: ASId1-5,8-12 =0] &
(Post3=2)
Criterion- Sedative-Hypnotics (a3)
HasIngestedSedativesExcessTherapeuticLevelAtLeast4WeeksMinimalRisk
OR (a) [3] Sedative-hypnotics: The patient has ingested sedative-hypnotics in excess of therapeutic levels daily for at
least 4 weeks, but the risk of seizures, hallucinations, dissociation or severe affective disorder during unobserved periods
outside the program is assessed as minimal. Close hourly monitoring is available, if needed. There is no accompanying
chronic mental or physical disorder that poses a danger to the patient during withdrawal.
Original Equation
D1LIID-a3 (Sed.) = TRUE If [(ASId06F>26d & d06Q =2) OR (d07F>26d & d07Q =2)] & (ASIm6r=0 & CIWA-2,4thru8 all<3 & (ASIp
3D,3aD,3cD,3dD,4D,4uD,6D all<3) & (ASIp 14 & 18c <5) & (Dim2<LIII & Dim3<LIV & ASId25=1 & Post3<3)
Criterion- Opiates (a5)
AbstinenceSyndromeCanBeStabilizedAtHomeWithAppropriateSupervision
OR (a) [5] Opiates (for withdrawal management not using opiate substitution methods of detoxification): The
abstinence syndrome—as indicated by vital signs and evidence of physical discomfort or craving—can be stabilized by
the end of each day’s monitoring, so that the patient can manage such symptoms at home with appropriate supervision.
Original Equation
D1LIID-a5 (Op.) = TRUE If ASId25f=1 & (Any of: ASId03,4,5R <5d & Any of: ASId03,4,5F >14) & CINA-Ttl=10to14 & Post3<3
Criterion- Opiates (a6)
WithdrawalFromOpiatesSymptomsSeverityWarrantsExtendedMonitoring
OR (a) [6] Opiates (for withdrawal management using opiate substitution methods of detoxification, such as methadone
or other appropriate opiate): The withdrawal signs and symptoms are of such severity or instability that extended
monitoring is required to determine the appropriate dosage.
Original Equation
D1LIID-a6 = TRUE If ASId25f=2 & (Any of: ASId03,4,5R <5d & Any of: ASId03,4,5F >14) & CINA-Ttl>10 & Post3<3
Criterion- Stimulants (a7)
StimulantsWithdrawalReadinessForAmbulatoryOrClinicallyManagedLevels
OR (a) [7] Stimulants: The patient is withdrawing from stimulants and is experiencing significant lethargy, agitation,
paranoia, psychotic symptoms or depression, and requires extended outpatient monitoring to determine impulse
control and readiness for Level I-D ambulatory detoxification services or the need for Level III.2-D detoxification services.
Original Equation
D1LIID-a7 (Sti.) = TRUE If [(ASId08R or d09R =<3d) & (ASId08F or d09F >=15d)] & [(Any of: ASIp14=3to6; ASIp18c=5to6;
CIWA5,7,or 8 >3, OR ASIp15thru18bor19 =2) & (Any of: ASId22d or d22f OR d24z =2to3)
Criterion- Psychosocial Issues (b)
LikelyToCompleteDetoxEnterContinuedTreatmentOrSelfHelpRecovery
AND (b) The patient is assessed as likely to complete detoxification and to enter into continued treatment or self-help
recovery, as evidenced by meeting [1] and either [2] or [3] or [4]:
AND (b) [1] The patient or support persons clearly understand instructions for care and are able to follow instructions;
OR (b) [2] The patient has an adequate understanding of ambulatory detoxification and has expressed commitment to
enter such a program;
OR (b) [3] The patient has adequate support services to ensure commitment to completion of detoxification and entry
into ongoing treatment or recovery;
OR (b) [4] The patient evidences willingness to accept a recommendation for treatment once withdrawal has been
managed (for example, to attend outpatient sessions or self-help groups).
Original Equations
D1LIIDa = TRUE If ASId99 = 2
D1LIID-b = TRUE If [(ASIp6=0 & ASIp18=0 & CIWA10=0) OR (ASIf6a & f19h <2) OR (ASIf24b&c=1] & [(ASId24v,24w, &l1x <2) OR
(ASIf6a,f19h,&d22f <2) OR (ASId24x,24y,&24z <2)]
Criteria- All Substances
Original Equation
D1LIID = TRUE If D1LIID(any of: a,a1-a7) & D1LIIDb
Length of Service – All Substances
The patient continues in a Level II-D detoxification program until withdrawal signs and symptoms are sufficiently
resolved that he or she can be safely managed at a less intensive level of care; or
Alternatively, the patient’s signs and symptoms of withdrawal have failed to respond to treatment and have intensified
(as confirmed by higher scores on the CIWA-Ar or other comparable standardized scoring system), such that transfer to
a more intensive level of detoxification service is indicated; or
The patient is unable to complete detoxification at Level II-D, despite an adequate trial. For example, he or she is
experiencing intense craving and has insufficient coping skills to prevent continued alcohol or other drug use, indicating
a need for more intensive services.
Dimension 1: Level II-D Detoxification Intensive Outpatient
Pseudo Code
Let
Let
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Let
hasEverUsedAlcohol = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedAlcohol;
lastUsedAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.LastUsed;
alcoholUsedToIntoxication = assessment.DrugAndAlcoholSection.AlcoholUse.AlcoholUsedToIntoxication;
lastUsedToIntoxification = assessment.DrugAndAlcoholSection.AlcoholUse.LastUsedToIntoxification;
numberOfDaysUsedInPast30DaysAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfDaysUsedInPast30Days;
numberOfDaysIntoxicatedInPast30Days =
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfDaysIntoxicatedInPast30Days;
numberOfTimesWithdrawalCausedDeliriumTremensAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfTimesWithdrawalCausedDeliriumTremens;
numberOfTimesWithdrawalCausedSeizuresAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfTimesWithdrawalCausedSeizures;
substanceOverdoseInPast24HoursAlcohol =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.SubstanceOverdoseInPast24Hours;
experiencesWithdrawalSicknessAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.ExperiencesWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.UseSubstanceToPreventWithdrawalSickness;
experiencedNauseaOrVomitedRecentlyCiwa =
assessment.DrugAndAlcoholSection.CiwaScale.ExperiencedNauseaOrVomitedRecently;
observedTremorCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTremor;
observedSweatingCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedSweating;
observedNervousness = assessment.DrugAndAlcoholSection.CiwaScale.ObservedNervousness;
interviewerObservationOfPatientAgitationLevel =
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel;
observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances;
auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
headAcheOrFullnessSeverity = assessment.DrugAndAlcoholSection.CiwaScale.HeadAcheOrFullnessSeverity;
d2CareLevel_II_1_ScoreIsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevel_II_1_IntensiveOutpatientScore.IsMet;
d3CareLevel_II_1_ScoreIsMet =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_II_1_IntensiveOutpatientScore.IsMet;
d2CareLevel_II_5_ScoreIsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevel_II_5_PartialHospitalizationScore.IsMet;
d3CareLevel_II_5_ScoreIsMet =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_II_5_PartialHospitalizationScore.IsMet;
hasEverUsedBarbiturate =
assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedBarbiturates;
lastUsedBarbiturate = assessment.DrugAndAlcoholSection.BarbiturateUse.LastUsed;
numberOfDaysUsedInPast30DaysBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.NumberOfDaysUsedInPast30Days;
increasedDoseRequiredToGetSameEffectBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.IncreasedDoseRequiredToGetSameEffect;
experiencesWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.ExperiencesWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.UseSubstanceToPreventWithdrawalSickness;
hasEverUsedOtherSedative =
assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedOtherSedatives;
lastUsedOtherSedative = assessment.DrugAndAlcoholSection.OtherSedativeUse.LastUsed;
numberOfDaysUsedInPast30DaysOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.NumberOfDaysUsedInPast30Days;
experiencesWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.ExperiencesWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.UseSubstanceToPreventWithdrawalSickness;
unableToStopUsingSubstanceOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.UnableToStopUsingSubstance;
noNonSedativeDiagnosis = assessmentScore.DiagnosisResults.NoNonSedativeDiagnosis;
timingOfPositiveResponseToDetoxificationCare =
assessment.CompletionSection.TimingOfPositiveResponseToDetoxificationCare;
wasSubstanceTakenAsPrescribedBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.WasSubstanceTakenAsPrescribed;
wasSubstanceTakenAsPrescribedOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.WasSubstanceTakenAsPrescribed;
Let d2CareLevel_0_5_ScoreIsMet = assessmentScore.Dimension2BiomedicalScores.CareLevel_0_5_EarlyInterventionScore.IsMet;
Let d2CareLevel_III_1_ScoreIsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
IsMet;
Let d2CareLevel_I_ScoreIsMet = assessmentScore.Dimension2BiomedicalScores.CareLevel_I_OutpatientScore.IsMet;
Let d2CareLevel_III_1_ScoreIsMetDim2Level3LowIntensity =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
IsMetDim2Level3LowIntensity;
Let d2CareLevel_III_3_ScoreIsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentSco
re.IsMet;
Let d2CareLevel_III_3_ScoreIsMetDim2Level3ModerateIntensity =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentSco
re.IsMetDim2Level3ModerateIntensity;
Let d2CareLevel_III_5_ScoreIsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore
.IsMet;
Let d2CareLevel_III_5_ScoreIsMetDim2Level3HighIntensity =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore
.IsMetDim2Level3HighIntensity;
Let d2CareLevel_III_7_ScoreIsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore.
IsMet;
Let d2CareLevel_III_7_ScoreIsMetDim2Level3MedicalMonitoring =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore.
IsMetDim2Level3MedicalMonitoring;
Let d2CareLevel_IV_ScoreIsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore.IsMet;
Let d3CareLevel_IV_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore.
IsDualDiagnosisEnhanced;
Let numberOfMonthsUsedInLifetimeBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.NumberOfMonthsUsedInLifetime;
Let numberOfMonthsUsedInLifetimeOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.NumberOfMonthsUsedInLifetime;
Let symptomsLifeThreateningBecauseOfSubstanceUse =
assessment.CompletionSection.SymptomsLifeThreateningBecauseOfSubstanceUse;
Let rangeOfMoodInPastWeek = assessment.PsychologicalSection.DepressionEvaluation.RangeOfMoodInPastWeek;
Let rangeOfGuiltInPastWeek = assessment.PsychologicalSection.DepressionEvaluation.RangeOfGuiltInPastWeek;
Let rangeOfInterestInDoingThingsInPastWeek =
assessment.PsychologicalSection.DepressionEvaluation.RangeOfInterestInDoingThingsInPastWeek;
Let rangeOfEnergyInPastWeek = assessment.PsychologicalSection.DepressionEvaluation.RangeOfEnergyInPastWeek;
Let rangeOfIrritabilityInPastWeek = assessment.PsychologicalSection.DepressionEvaluation.RangeOfIrritabilityInPastWeek;
Let observedRetardationOfThoughtOrSpeech =
assessment.PsychologicalSection.DepressionEvaluation.ObservedRetardationOfThoughtOrSpeech;
Let prnHourlyMonitoringSufficientToDetermineDetoxServiceLevel =
assessment.CompletionSection.PrnHourlyMonitoringSufficientToDetermineDetoxServiceLevel;
Let numberOfDaysUsedInPast30DaysHeroin = assessment.DrugAndAlcoholSection.HeroinUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.NumberOfDaysUsedInPast30Days;
Let hasEverUsedHeroin = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedHeroin;
Let lastUsedHeroin = assessment.DrugAndAlcoholSection.HeroinUse.LastUsed;
Let hasEverUsedMethadone = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedMethadone;
Let lastUsedMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.LastUsed;
Let hasEverUsedOtherOpiate =
assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedOtherOpiate;
Let lastUsedOtherOpiate = assessment.DrugAndAlcoholSection.OtherOpiateUse.LastUsed;
Let toBePrescribedOpioidDetoxificationProtocol =
assessment.DrugAndAlcoholSection.OpioidMaintenanceTherapy.ToBePrescribedOpioidDetoxificationProtocol;
Let experiencedNauseaOrVomitedRecently = assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
Let observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
Let observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
Let observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
Let observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
Let
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observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
heartRate = assessment.MedicalSection.HeartRate;
hasEverUsedCocaine = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedCocaine;
lastUsedCocaine = assessment.DrugAndAlcoholSection.CocaineUse.LastUsed;
hasEverUsedStimulant = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedStimulate;
lastUsedStimulant = assessment.DrugAndAlcoholSection.StimulantUse.LastUsed;
numberOfDaysUsedInPast30DaysCocaine = assessment.DrugAndAlcoholSection.CocaineUse.NumberOfDaysUsedInPast30Days;
numberOfDaysUsedInPast30DaysStimulant = assessment.DrugAndAlcoholSection.StimulantUse.NumberOfDaysUsedInPast30Days;
appearanceOfDepressionWithdrawal =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfDepressionWithdrawal;
appearanceOfHostility = assessment.PsychologicalSection.InterviewerRating.AppearanceOfHostility;
appearanceOfAnxietyNervousness = assessment.PsychologicalSection.InterviewerRating.AppearanceOfAnxietyNervousness;
appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking;
appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering;
hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts;
numberOfDaysExperiencedSubstanceProblemsInPast30Days =
assessment.DrugAndAlcoholSection.DrugConsequences.NumberOfDaysExperiencedSubstanceProblemsInPast30Days;
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrengthOfSubstanceUseUrgeDueToEnvironmental
Triggers;
strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse;
isPatientExperiencingWithdrawalSignsSymptoms =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.IsPatientExperiencingWithdrawalSignsSymptoms;
significantPeriodImpairedThoughtInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodImpairedThoughtInLastMonth;
interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery;
closestContactsNeedsAndWillingnessToHelpTreatment =
assessment.FamilyAndSocialHistorySection.ClosestContactsNeedsAndWillingnessToHelpTreatment;
isSupportPersonAvailableFor7Days = assessment.FamilyAndSocialHistorySection.IsSupportPersonAvailableFor7Days;
isOutpatientMonitoringAvailable8To24Hours =
assessment.FamilyAndSocialHistorySection.IsOutpatientMonitoringAvailable8To24Hours;
interviewerScoreOfReadiness =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness;
concernsAboutPursuingTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment;
desireAndExternalFactorsDrivingTreatment = assessment.LegalSection.DesireAndExternalFactorsDrivingTreatment;
helpfulnessOfTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment;
Let possibleFutureRelapseCause =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause;
Let alcoholUseFrequency = Utilities.CalculateFrequency(hasEverUsedAlcohol, lastUsedAlcohol); //ASId01R
Let alcoholUsedToIntoxicationFrequency = Utilities.CalculateFrequency(alcoholUsedToIntoxication,
lastUsedToIntoxification); // ASId02R
if (alcoholUseFrequency > alcoholUsedToIntoxicationFrequency And alcoholUsedToIntoxicationFrequency > 0)
{
alcoholUseFrequency = alcoholUsedToIntoxicationFrequency;
}
Let
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Let
heroinUseFrequency = Utilities.CalculateFrequency(hasEverUsedHeroin, lastUsedHeroin); // ASId03R
methadoneUseFrequency = Utilities.CalculateFrequency(hasEverUsedMethadone, lastUsedMethadone); // ASId04R
otherOpiateUseFrequency = Utilities.CalculateFrequency(hasEverUsedOtherOpiate, lastUsedOtherOpiate); // ASId05R
barbiturateUseFrequency = Utilities.CalculateFrequency(hasEverUsedBarbiturate, lastUsedBarbiturate); // ASId06R
otherSedativeUseFrequency = Utilities.CalculateFrequency(hasEverUsedOtherSedative, lastUsedOtherSedative);
// ASId07R
cocaineUseFrequency = Utilities.CalculateFrequency(hasEverUsedCocaine, lastUsedCocaine); // ASId08R
stimulantUseFrequency = Utilities.CalculateFrequency(hasEverUsedStimulant, lastUsedStimulant); // ASId09R
cannabisUseFrequency = Utilities.CalculateFrequency(hasEverUsedCannabis, lastUsedCannabis); // ASId10R
hallucinogenUseFrequency = Utilities.CalculateFrequency(hasEverUsedHallucinogen, lastUsedHallucinogen); // ASId11R
solventAndInhalantUseFrequency = Utilities.CalculateFrequency(hasEverUsedSolventAndInhalant,
lastUsedSolventAndInhalant); // ASId12R
nicotineUseFrequency = Utilities.CalculateFrequency ( hasEverUsedNicotine, lastUsedNicotine ); // ASId13aR
Let alcoholUse = ( ( ( ( not hasEverUsedAlcohol ) And alcoholUseFrequency <= 3 ) Or
( ( alcoholUsedToIntoxication ?? false ) And alcoholUsedToIntoxicationFrequency <= 3 ) ) And
( numberOfDaysUsedInPast30DaysAlcohol > 14 Or numberOfDaysIntoxicatedInPast30Days > 14 ) ) And
numberOfTimesWithdrawalCausedDeliriumTremensAlcohol = 0
And
numberOfTimesWithdrawalCausedSeizuresAlcohol = 0 And
substanceOverdoseInPast24HoursAlcohol = YesNoNotSure.No And
( ( not experiencesWithdrawalSicknessAlcohol ) Or
( not useSubstanceToPreventWithdrawalSicknessAlcohol ) );
Let ciwa = Utilities.CalculateCiwa(experiencedNauseaOrVomitedRecentlyCiwa,
observedTremorCiwa, observedSweatingCiwa, observedNervousness,
interviewerObservationOfPatientAgitationLevel, observedTactileDisturbances,
auditoryDisturbanceLevel, visualDisturbanceLevel,
headAcheOrFullnessSeverity, interviewerObservationOfPatientSenseOfAwareness );
Let careLevel_II_DetoxScore.AlcoholCIWAScore8To15 =
alcoholUse And
IsBtw ( ciwa, 8, 15 ) And
( (not d2CareLevel_II_1_ScoreIsMet) Or (not d2CareLevel_II_5_ScoreIsMet) ) And
( (not d3CareLevel_II_1_ScoreIsMet) Or (not d3CareLevel_II_5_ScoreIsMet) );
Let alcoholUse = ( ( ( ( not hasEverUsedAlcohol ) And alcoholUseFrequency <= 3 ) Or
( ( not alcoholUsedToIntoxication ) And alcoholUsedToIntoxicationFrequency <= 3 ) ) And
( numberOfDaysUsedInPast30DaysAlcohol > 14 Or numberOfDaysIntoxicatedInPast30Days > 14 ) ) And
numberOfTimesWithdrawalCausedDeliriumTremensAlcohol = 0 And
numberOfTimesWithdrawalCausedSeizuresAlcohol = 0 And
substanceOverdoseInPast24HoursAlcohol = YesNoNotSure.No And
( ( experiencesWithdrawalSicknessAlcohol ?? false ) Or
( not useSubstanceToPreventWithdrawalSicknessAlcohol ) );
Let ciwa = Utilities.CalculateCiwa(experiencedNauseaOrVomitedRecentlyCiwa, observedTremorCiwa,
observedSweatingCiwa, observedNervousness, interviewerObservationOfPatientAgitationLevel,
observedTactileDisturbances, auditoryDisturbanceLevel, visualDisturbanceLevel,
headAcheOrFullnessSeverity, interviewerObservationOfPatientSenseOfAwareness );
Let careLevel_II_DetoxScore.AlcoholCIWAScore8To15 = alcoholUse And
IsBtw ( ciwa, 8, 15 ) And
( (not d2CareLevel_II_1_ScoreIsMet) Or (not d2CareLevel_II_5_ScoreIsMet) ) And
( (not d3CareLevel_II_1_ScoreIsMet) Or (not d3CareLevel_II_5_ScoreIsMet) );
Let careLevel_II_DetoxScore.HistoryOfWithdrawalFromSedativesOtherDrugDependenceRespondedTo =
( ( ( hasEverUsedBarbiturate ?? false ) And barbiturateUseFrequency <= 8 And
numberOfDaysUsedInPast30DaysBarbiturate >= 15 And
( ( not increasedDoseRequiredToGetSameEffectBarbiturate ) Or
( not experiencesWithdrawalSicknessBarbiturate ) Or
( not useSubstanceToPreventWithdrawalSicknessBarbiturate ) ) ) Or
( ( hasEverUsedOtherSedative ?? false ) And otherSedativeUseFrequency <= 8 And
numberOfDaysUsedInPast30DaysOtherSedative >= 15 And
( ( not experiencesWithdrawalSicknessOtherSedative ) Or
( not useSubstanceToPreventWithdrawalSicknessOtherSedative ) Or
( not unableToStopUsingSubstanceOtherSedative ?? false ) ) ) ) And noNonSedativeDiagnosis And
timingOfPositiveResponseToDetoxificationCare = DetoxificationCareResponseTiming.Within4To8Hours;
Let sedativeUse = ( numberOfDaysUsedInPast30DaysBarbiturate > 26 And wasSubstanceTakenAsPrescribedBarbiturate =
SubstanceTakenAsPrescribed.More ) Or ( numberOfDaysUsedInPast30DaysOtherSedative > 26 And
wasSubstanceTakenAsPrescribedOtherSedative = SubstanceTakenAsPrescribed.More );
Let ham = rangeOfMoodInPastWeek + rangeOfGuiltInPastWeek + rangeOfInterestInDoingThingsInPastWeek +
rangeOfEnergyInPastWeek + rangeOfIrritabilityInPastWeek + observedRetardationOfThoughtOrSpeech;
Let lessThanD2LIII = ( d2CareLevel_0_5_ScoreIsMet.Value Or d2CareLevel_I_ScoreIsMet.Value Or
d2CareLevel_II_1_ScoreIsMet.Value Or d2CareLevel_II_5_ScoreIsMet.Value ) And
( !( d2CareLevel_III_1_ScoreIsMet.Value Or d2CareLevel_III_1_ScoreIsMetDim2Level3LowIntensity.Value Or
d2CareLevel_III_3_ScoreIsMet.Value Or
d2CareLevel_III_3_ScoreIsMetDim2Level3ModerateIntensity.Value Or d2CareLevel_III_5_ScoreIsMet.Value Or
d2CareLevel_III_5_ScoreIsMetDim2Level3HighIntensity.Value Or
d2CareLevel_III_7_ScoreIsMet.Value Or d2CareLevel_III_7_ScoreIsMetDim2Level3MedicalMonitoring.Value Or
d2CareLevel_IV_ScoreIsMet.Value ) );
Let lessThanD3LIV = !d3CareLevel_IV_ScoreIsDualDiagnosisEnhanced.Value;
Let careLevel_II_DetoxScore.HasIngestedSedativesExcessTherapeuticLevelAtLeast4WeeksMinimalRisk =
sedativeUse And symptomsLifeThreateningBecauseOfSubstanceUse = YesNoNotSure.No And
observedTremor < TremorObservation.ModerateTremorWithPatientsArmExtended And // TODO: TremorObservation valid
values are 0, 1, 4, 7. Currently using value 4 instead of 3.
observedNervousness < NervousnessObservation.ModerateAnxiety And //TODO: NervousnessObservation valid values are
0, 1, 4, 7. Currently using value 4 instead of 3.
interviewerObservationOfPatientAgitationLevel < 3 And observedTactileDisturbances <
TactileDisturbancesObservation.ModerateItchingPinsAndNeedlesBurningOrNumbness And
auditoryDisturbanceLevel < AuditoryDisturbanceLevel.ModerateHarshnessOrAbilityToFrighten And
visualDisturbanceLevel < VisualDisturbanceLevel.ModerateSensitivity And ham < 10 And
lessThanD2LIII And lessThanD3LIV And ( prnHourlyMonitoringSufficientToDetermineDetoxServiceLevel ?? false ) And
timingOfPositiveResponseToDetoxificationCare < DetoxificationCareResponseTiming.Within8To24Hours;
Let careLevel_II_DetoxScore.HasIngestedSedativesTherapeuticLevelAtLeast6MonthsSymptomMinimalRisk =
( ( wasSubstanceTakenAsPrescribedBarbiturate < SubstanceTakenAsPrescribed.More And
numberOfDaysUsedInPast30DaysBarbiturate > 26 And
numberOfMonthsUsedInLifetimeBarbiturate >= 6 ) Or
( wasSubstanceTakenAsPrescribedOtherSedative < SubstanceTakenAsPrescribed.More And
numberOfDaysUsedInPast30DaysOtherSedative > 26 And
numberOfMonthsUsedInLifetimeOtherSedative >= 6 ) ) And
( numberOfDaysUsedInPast30DaysAlcohol >= 15 Or
numberOfDaysIntoxicatedInPast30Days >= 15 Or
numberOfDaysUsedInPast30DaysHeroin >= 15 Or
numberOfDaysUsedInPast30DaysMethadone >= 15 Or
numberOfDaysUsedInPast30DaysOtherOpiate >= 15 ) And
symptomsLifeThreateningBecauseOfSubstanceUse = YesNoNotSure.No And
observedTremor < TremorObservation.ModerateTremorWithPatientsArmExtended And //TODO: TremorObservation valid
values are 0, 1, 4, 7. CUrrently using value 4 instead of 3.
observedNervousness < NervousnessObservation.ModerateAnxiety And
interviewerObservationOfPatientAgitationLevel < 3 And observedTactileDisturbances <
TactileDisturbancesObservation.ModerateItchingPinsAndNeedlesBurningOrNumbness And
auditoryDisturbanceLevel < AuditoryDisturbanceLevel.ModerateHarshnessOrAbilityToFrighten And
visualDisturbanceLevel < VisualDisturbanceLevel.ModerateSensitivity And ham < 10;
Let opiateUse = ( ( ( hasEverUsedHeroin ?? false ) And heroinUseFrequency < 5 ) Or
( ( hasEverUsedMethadone ?? false ) And methadoneUseFrequency < 5 ) Or
( ( hasEverUsedOtherOpiate ?? false ) And otherOpiateUseFrequency < 5 ) ) And
( numberOfDaysUsedInPast30DaysHeroin > 14 Or
numberOfDaysUsedInPast30DaysMethadone > 14 Or
numberOfDaysUsedInPast30DaysOtherOpiate > 14 );
Let cina = Utilities.CalculateCina(experiencedNauseaOrVomitedRecently, observedGooseFlesh,
observedSweating, observedRestlessness, observedTremor, observedLacrimination, observedNasalCongestion,
observedYawning, hasAbdominalPain, feelsHotOrCold, hasMuscleAches, heartRate );
Let careLevel_II_DetoxScore.AbstinenceSyndromeCanBeStabilizedAtHomeWithAppropriateSupervision =
toBePrescribedOpioidDetoxificationProtocol = OpioidDetoxificationProtocol.NonopioidSubstitution And
opiateUse And IsBtw ( cina, 10, 14 ) And
timingOfPositiveResponseToDetoxificationCare < DetoxificationCareResponseTiming.Within8To24Hours;
Let stimulantUse = ( ( ( hasEverUsedCocaine ?? false ) And cocaineUseFrequency <= 3 ) Or
( ( hasEverUsedStimulant ?? false ) And stimulantUseFrequency <= 3 ) ) And
( numberOfDaysUsedInPast30DaysCocaine >= 15 Or
numberOfDaysUsedInPast30DaysStimulant >= 15 );
Let careLevel_II_DetoxScore.WithdrawalFromOpiatesSymptomsSeverityWarrantsExtendedMonitoring =
toBePrescribedOpioidDetoxificationProtocol = OpioidDetoxificationProtocol.OpioidSubstitution And
stimulantUse And cina > 10 And timingOfPositiveResponseToDetoxificationCare <
DetoxificationCareResponseTiming.Within8To24Hours;
Let careLevel_II_DetoxScore.StimulantsWithdrawalReadinessForAmbulatoryOrClinicallyManagedLevels =
stimulantUse And ( IsBtw ( rangeOfMoodInPastWeek, RangeOfMood.SpontaneouslyReportedVerbally,
RangeOfMood.CommunicatedNonverbally ) Or IsBtw ( observedRetardationOfThoughtOrSpeech,
RetardationOfThoughtOrSpeech.ObviousRetardationAtInterview, RetardationOfThoughtOrSpeech.InterviewDifficult ) Or
interviewerObservationOfPatientAgitationLevel > 3 Or
auditoryDisturbanceLevel > AuditoryDisturbanceLevel.ModerateHarshnessOrAbilityToFrighten Or
visualDisturbanceLevel > VisualDisturbanceLevel.ModerateSensitivity Or
appearanceOfDepressionWithdrawal = 2 Or
appearanceOfHostility = 2 Or
appearanceOfAnxietyNervousness = 2 Or
appearanceOfParanoiaOrImpairedThinking = 2 Or
appearanceOfTroubleConcentratingOrRemembering = 2 Or
hasSuicidalThoughts = 2 ) And
( IsBtw ( (numberOfDaysExperiencedSubstanceProblemsInPast30Days ?? 0), 2, 3 ) Or
IsBtw ( strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers, LikertScale.Moderately, LikertScale.Considerably )
Or IsBtw ( strategyToPreventRelapse, RelapsePreventionStrategies.SomeIdeasAndOccasionalEffort,
RelapsePreventionStrategies.PassiveOrVague ) );
careLevel_II_DetoxScore.ModerateRiskOfSevereWithdrawalOutsideProgramSetting =
isPatientExperiencingWithdrawalSignsSymptoms =
SignsOfWithdrawal.MildRiskOfWithdrawalCanBeManagedAtCareLevel_I;
careLevel_II_DetoxScore.LikelyToCompleteDetoxEnterContinuedTreatmentOrSelfHelpRecovery =
( ( significantPeriodImpairedThoughtInLastMonth = LikertScale.NotAtAll And
observedRetardationOfThoughtOrSpeech = RetardationOfThoughtOrSpeech.NormalSpeechAndThought And
interviewerObservationOfPatientSenseOfAwareness = SenseOfAwareness.
OrientedAndCanDoSerialAdditions ) Or
( livingArrangementAffectOnRecovery <
LivingArrangementAffectOnRecovery.WillPermitRecoveryIfSufficientlyMotivated And
closestContactsNeedsAndWillingnessToHelpTreatment <
NeedsAndWillingnessToHelpTreatment.NeedsCouplesOrFamilyCounselingOrTherapyAndWillParticipate ) Or
( isSupportPersonAvailableFor7Days = YesNoNotSure.NotSure And
isOutpatientMonitoringAvailable8To24Hours = YesNoNotSure.NotSure ) ) And
( ( interviewerScoreOfReadiness < 2 And
concernsAboutPursuingTreatment < ConcernsAboutPursuingTreatment.PassiveOrSomeHesitations And
desireAndExternalFactorsDrivingTreatment <
DesireAndExternalFactorsDrivingTreatment.AmbivalentAndExternallyPersuaded ) Or
( livingArrangementAffectOnRecovery <
LivingArrangementAffectOnRecovery.WillPermitRecoveryIfSufficientlyMotivated And
closestContactsNeedsAndWillingnessToHelpTreatment <
NeedsAndWillingnessToHelpTreatment.NeedsCouplesOrFamilyCounselingOrTherapyAndWillParticipate And
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers < LikertScale.Moderately ) Or
( helpfulnessOfTreatment < HelpfulnessOfTreatment.LimitedSenseOfPersonalResponsibilityForRecovery
And
possibleFutureRelapseCause < RelapseCause.AdmitsRiskPossibleButVagueAboutRiskFactors And
strategyToPreventRelapse < RelapsePreventionStrategies.SomeIdeasAndOccasionalEffort ) );
Let careLevel_II_DetoxScore.IsMet =
(
careLevel_II_DetoxScore.ModerateRiskOfSevereWithdrawalOutsideProgramSetting.Value Or
careLevel_II_DetoxScore.AlcoholCIWAScore8To15.Value Or
careLevel_II_DetoxScore.HistoryOfWithdrawalFromSedativesOtherDrugDependenceRespondedTo.Value Or
careLevel_II_DetoxScore.HasIngestedSedativesExcessTherapeuticLevelAtLeast4WeeksMinimalRisk.Value Or
careLevel_II_DetoxScore.HasIngestedSedativesTherapeuticLevelAtLeast6MonthsSymptomMinimalRisk.Value Or
careLevel_II_DetoxScore.AbstinenceSyndromeCanBeStabilizedAtHomeWithAppropriateSupervision.Value Or
careLevel_II_DetoxScore.WithdrawalFromOpiatesSymptomsSeverityWarrantsExtendedMonitoring.Value Or
careLevel_II_DetoxScore.StimulantsWithdrawalReadinessForAmbulatoryOrClinicallyManagedLevels.Value
)
And careLevel_II_DetoxScore.LikelyToCompleteDetoxEnterContinuedTreatmentOrSelfHelpRecovery.Value;
return careLevel_II_DetoxScore;
Level of Care: Detoxification – Medically Monitored Intensive Inpatient Treatment (III.7-D)
Level III.7-D (Detoxification - Outpatient Treatment) Summary
None
Level III.7-D (Detoxification - Outpatient Treatment) Criteria
Criterion- Alcohol (a)
EITHER (a) The patient is experiencing signs and symptoms of severe withdrawal, or there is evidence (based on history
of substance intake, age, gender, previous withdrawal history, present symptoms, physical condition, and/or emotional,
behavioral or cognitive condition) that a severe withdrawal syndrome is imminent. The severe withdrawal syndrome is
assessed as manageable at this level of service. Examples include, but are not limited to:
Original Equation
If [ASId##R<=3d & ASId##F>=15d & (Any of: CUAD-##01, -##02 or -##03 >0)] where Any ##=Any of Substances 1-12
Criterion- Alcohol (a)
[1] Alcohol: The patient is withdrawing from alcohol, the CIWA-Ar (Clinical Institute Withdrawal Assessment-Alcohol,
Revised) score is 10 or greater (or the equivalent for a standardized scoring system) by the end of the period of
outpatient monitoring available in Level II-D.
Original Equation
D1LID-a1 (Alc.) = TRUE If [(ASId01R or d02R<=3d) & (ASId01F or -d02F >14d)] & ASId17a&c=0 & (CUAD-Alc02 or -03 or Itx02 or -03 =1)& CIWA-Ttl<8
D1LIID-a1 (Alc.) = TRUE If [(ASId01R or d02R <=3d) & (ASId01F or d02F >14d)] & ASId17a&c =0 & (CUAD-Alc02 or -03 or Itx02 or -03 =1)& CIWA-Ttl=8to15 & meets D2LII & D3LII criteria
D1LIIID.2-a1 (Alc.) = TRUE If D1L1Da1 & CIWA-Ttl<8 & ASId25=1
D1LIIID.7-a1 (Alc.) = TRUE If (ImWD+ for ASId01 or d02) & CIWA-Ttl>=10 & Post3>=3
Criterion- Sedatives (a2)
OR (a) [2] Sedative-hypnotics: The patient has ingested sedative-hypnotics at more than therapeutic levels daily for
more than 4 weeks and is not responsive to appropriate recent efforts to maintain the dose at therapeutic levels.
Original Equation
D1LIII.7D-a2 (Sed.) = TRUE If [(ASId06F>26d & d06Q =2) OR (-d07F>26d & d07Q =2)] & (ASId06Qa or d07Qa=0)
Criterion- Sedatives (a3)
OR (a) [3] Sedative-hypnotics: The patient has ingested sedative-hypnotics at more than therapeutic levels daily for
more than 4 weeks, in combination with daily alcohol use or regular use of another mind-altering drug known to pose a
severe risk of withdrawal. Signs and symptoms of withdrawal are of moderate severity, and the patient cannot be
stabilized by the end of the period of outpatient monitoring available at Level II-D.
Original Equation
D1LIII.7D-a3 (Sed.) = TRUE If [(ASId06F>26d & d06Q =2) OR (d07F>26d & d07Q =2)] & (Any of: ASId01thru05F,d08F,d09F, or
d11F or d12F >=15) & CIWA-Ar=8to15 & Post3>2
Criterion- Sedatives (a4)
OR (a) [4] Alcohol and sedative-hypnotics: The patient has marked lethargy or hypersom-nolence due to intoxication
with alcohol or other drugs, and a history of severe withdrawal syndrome, or the patient’s altered level of consciousness
has not stabilized at the end of the period of outpatient monitoring available at Level II-D.
Original Equation
D1LIII.7D-a4 (Sed.) = TRUE If [Phys30>=1 & ASIp18c>4 & ASId17a or c>=1] OR [(CIWA-10>=3 OR ASIp18>3) & Post3>2]
Criterion- Opiates (a5)
OR (a) [5] Opiates (for withdrawal management not using opiate substitution methods of detoxification): The patient
has used injectable opiates daily for more than two weeks and has a history of inability to complete withdrawal as an
outpatient or without medication in a LIII.2-D service.
Original Equation
D1LIII.7D-a5 (Op.) = TRUE If ASId25f=1 & [(Any of: ASId03,4,5R <5d & Any of: ASId03,4,5F >14) & (Any of: ASId03,4,5M
=5)] & (ASId21a<=3.2)
Criterion- Opiates (a6)
OR (a) [6] Opiates: Antagonist medication is to be used in withdrawal in a brief but intensive detoxification (as in
multiday pharmacological induction onto naltrexone).`
Original Equation
D1LIII.7D-a6 (Op.) = TRUE If [(Any of: ASId03,4,5R <5d & Any of: ASId03,4,5F >14)] & ASId25f=3
Criterion- Stimulants (a7)
OR (a) [7] Stimulants: The patient has marked lethargy, hypersomnolence, agitation, paranoia, depression or mild
psychotic symptoms due to stimulant withdrawal, and has poor impulse control and/or coping skills to prevent
immediate continued drug use.
Original Equation
] D1LIII.7D-a7 (Sti.) = TRUE If [(ASId08R or d09R =<3d) & (ASId08F or d09F >=15d)] & [(Any of ASI p14=5to8; p17=3to6;
ASIp18c=5to8; CIWA5,7or8>3 OR ASI p15 or p19 >2) & (Any of: ASId22d,d22f, or d24z =4
Nicotine
None.
Criterion- Psychosocial Issues (b)
OR (b) There is a strong likelihood that the patient (who requires medication) will not complete detoxification at
another level of care and enter into continuing treatment or self-help recovery, as evidenced (for example), by any of
the following:
Criterion- Psychosocial Issues (b1)
EITHER (b) [1] The patient requires medication and has a recent history of detoxification at a less intensive level of care,
marked by past and current inability to complete detoxification and enter into continuing addiction treatment. The
patient continues to have insufficient skills or supports to complete detoxification;
OR (b) [2] The patient has a recent history of detoxification at less intensive levels of service that is marked by inability
to complete detoxification or to enter into continuing addiction treatment, and the patientcontinues to have insufficient
skills to complete detoxification;
OR (b) [3] The patient has a comorbid physical, emotional, behavioral or cognitive condition (such as chronic pain with
active exacerbation or post-traumatic stress disorder with brief dissociative episodes) that is manageable in a Level III.7D setting but which increases the clinical severity of the withdrawal and complicates detoxification.
Original Equations
D1LIII.7D-b = TRUE If (ASId: 19e=1 or 19f=0 or 21a<9) AND (Any of: ASId22f or d23x or d24v,x,y,z >3)
D1LIII.7Da = TRUE If ASId99 = 4
Criteria – All Substances
D1LIII.7D = TRUE If D1LIII.7(any of: a,a1-a7) OR D1LIII.7b
Level of Care: Detoxification – Medically Managed Inpatient Treatment (IV)
Level IV (Medically Managed Inpatient Treatment) Summary
Insert here
Level IV (Medically Managed Inpatient Treatment) Criteria
Criterion- Alcohol (a)
IsExperiencingSevereWithdrawalManageableAtLevelOfService
EITHER (a) The patient is experiencing signs and symptoms of severe withdrawal, or there is evidence (based on history
of substance intake, age, gender, previous withdrawal history, present symptoms, physical condition, and/or emotional,
behavioral or cognitive condition) that a severe withdrawal syndrome is imminent. Examples include, but are not
limited to:
Original Equation
If [ASId##R<=3d & ASId##F>=15d & (Any of: CUAD-##01, -##02 or -##03 >0)] where Any ##=Any of Substances 1-12
D1LIVDa = TRUE If ASId99 = 5
Criterion- Alcohol (a1)
IsWithdrawingFromAlcoholCIWA10OrGreaterMonitoringMoreThanHourly
(a) [1] Alcohol: The patient is withdrawing from alcohol, and the CIWA-Ar score is 10 or greater (or the equivalent for a
comparable standardized scoring system), and the patient requires monitoring more often than hourly, requires
intravenous medication or infusions, or requires close behavioral monitoring because of high levels of agitation,
confusion or extremes of vital signs.
Original Equation
D1LIVD-a1 (Alc.) = TRUE If (ImWD+ for ASI-D01 or -D02) & CIWA-Ttl>=10 & [Any of : PhysPulse>120, SBP>200; DBP>100;
ASIm6: (k,l,m,n,p,or r) >0; CIWA-4=7; CIWA-10=4; ASIp:(15,17,18,or 19)=2]
Criterion- Alcohol and Sedative/Hypnotics (a2)
IsExperiencingSeizuresDeliriumOrSeverePersistentHallucinations
OR (a) [2] Alcohol and sedative-hypnotics: The patient is experiencing seizures, delirium tremens or severe, persistent
hallucinations.
Original Equation
D1LIVD-a2 (Alc./Sed) = TRUE If [ASId01R or d02R or d06R or d07R <=7d] & [Any of : ASIm6:(e,f,g,h,r) >0; CIWA-2=7; CIWA6,7,8>4; CIWA-10=4; ASIp5D>2; ASIp17>4]
Criterion- Sedative/Hypnotics (a3)
HasIngestedSedativesHigherTherapeuticLevelsDailyMoreThan4WeeksWithAcuteDisorders
OR (a) [3] Sedative-hypnotics: The patient has ingested sedative-hypnotics at more than therapeutic levels daily for
more than 4 weeks, and the patient has an accompanying acute mental or physical disorder that is complicating
withdrawal.
Original Equation
D1LIVD-a3 (Sed.) = TRUE If [(ASId06F>26d & d06Q =2) OR (d07F>26d & d07Q =2)] & [(Any of ASIm: 4c,6f,6k,6l,6m,6n,6r >1)
OR (Any of: ASIp15,p17,p18,p19 =2)]
Criterion- Sedative/Hypnotics (a4)
HasIngestedSedativesDailyAtLeast6MonthsWithAcuteDisorders
OR (a) [4] Sedative-hypnotics: The patient has ingested sedative-hypnotics daily for at least6 months, in combination
with daily alcohol use or regular use of another mind-altering drug known to pose a severe withdrawal syndrome, and
the patient has accompanying acute mental or physical disorder that is complicating withdrawal.
Original Equation
D1LIVD-a4 (Sed.) = If [(ASId06F>26 & d06D>=6m) OR (ASId07F>26 & d07D>=6m)] & (Any of: ASId01F through d05F >=15) &
[(ASIm: 4c,6f,6k,6l,6m,6n,6r >1) OR (Any of: ASIp15,p17,p18,p19 =2)]
Criterion- Opiates (a5)
IsExperiencingSevereOpiateWithdrawalNotStabilizedAtLessThanIntensiveLevel
OR (a) [5] Opiates: The patient is experiencing a severe opiate withdrawal syndrome that has not been stabilized or
managed at a less intensive level of service.
Original Equation
D1LIVD-a5 (Op.) = TRUE If [(Any of: ASId03,4,5R <5d & Any of: ASId03,4,5F >14)] & CINA>=20
Criterion- Opiates (a6)
AntagonistMedicationIsToBeUsedInRapidWithdrawal
OR (a) [6] Opiates: Antagonist medication is to be used in rapid withdrawal (as in pharmacological induction and
resolution of opiate withdrawal with naloxone in 6 hours).
Original Equation
D1LIVD-a6 (Op.) = TRUE If [(Any of: ASId03,4,5R <5d & Any of:ASId03,4,5F >14)] & ASId25f=4
Criterion- Stimulants (a7)
RequiresPsychiatricOrMedicalMonitoringPsychoticImpulsiveBehavior
OR (a) [7] Stimulants: Intoxication or withdrawal signs and symptoms require psychiatric or medical monitoring more
frequently than hourly (because of psychotic impulsive behavior or depressive suicidality).
Original Equation
D1LIVD-a7 (Sti.) = TRUE If (ASId08R or d09R =<3d) & [Any of (CIWA7or8>5) OR (ASIp14,p17or p19 >4) OR ASIm6b>0]
Criterion- All Substances (a8)
NeedToCloselyObserveAtLeastHourlyMentalStatusOrNeurologicalChanges
OR (a) [8] All substances: There is recent (within 24 hours) serious head trauma or loss of consciousness, with
persistent mental status or neurological changes resulting in the need to closely observe the patient at least hourly.
Original Equation
D1LIVD-a8 = TRUE If (ASIm: 6c or 6d >0) & [(ASIm: 6b or 6o =1) or CIWA10=4 or (Any of ASIp: 18,18a, 18b,or18c >2)] &
Post4=1
Criterion- All Substances (a9)
MentalStatusCardiacFunctionOrOtherVitalsCompromisedDrugOverdoseOrIntoxication
OR (a) [9] All substances: Drug overdose or intoxication has compromised the patient’s mental status, cardiac function
or other vital signs or functions.
Original Equation
D1LIVD-a9 = TRUE If (ASIm: 6a or 6b =2) & (ASIm: 6o or 6r =2)
Criterion- All Substances (a10)
HasAcuteBiomedicalDisorderPosesSeriousRiskDuringWithdrawal
OR (a) [10] All substances: The patient has a significant acute biomedical disorder that poses substantial risk of serious
or life-threatening consequences during withdrawal (such as significant hypertension or esophageal varices).
Original Equation
D1LIVDa10 = TRUE If Any of: ASIm: 4c,6f,6k,6l,6m,6n,6p,or 6r =2
Criterion- (b)
OR (b) Level IV is the only available level of care that can provide the medical support and comfort care needed by the
patient, as evidenced by:
Criterion- (b1)
DetoxificationRegimenRequiringMonitoringMoreFrequentlyThanHourly
EITHER (b) [1] A detoxification regimen or a patient’s response to that regimen that requires monitoring or intervention
more frequently than hourly;
Original Equation
D1LIVD-b1 = TRUE If Post4=1
Criterion- (b2)
NeedForDetoxOrStabilizationWhilePregnantUntilSafelyTreatedAtLowerLevel
OR (b) [2] The patient’s need for detoxification or stabilization while pregnant, until she can be safely treated in a less
intensive level of care. For example, the patient does not require medical management (as in the case of a patient who
is soon to have the pregnancy terminated), or she no longer is bleeding or leaking amniotic fluid, or an unstable fetal
heartbeat has improved.
Original Equation
D1LIVD-b2 = TRUE If ASI:(m3a=1 & m3b=2) & (D1LID or D1LIID or D1LIII.2D or D1LIII.7D)
Criteria- All Substances
Original Equation
D1LIVD = TRUE If D1LIVD(any of: a,a1-a10) OR D1LIVD(b1 or b2)
Length of Service – All Substances
The patient continues in a Level IV-D detoxification program until withdrawal signs and symptoms are sufficiently
resolved that he or she can be safely managed at a less intensive level of care.
Dimension 1: Level IV Medically Managed Inpatient Treatment
Pseudo Code
D1LIVD VARIABLES:
Let hasEverUsedAlcohol = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedAlcohol;
Let hasAlcoholImminentWithdrawalPotential =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.AlcoholAnyUseScore.
HasImminentWithdrawalPotential;
Let experiencedNauseaOrVomitedRecentlyCiwa =
assessment.DrugAndAlcoholSection.CiwaScale.ExperiencedNauseaOrVomitedRecently;
Let observedTremorCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTremor;
Let observedSweatingCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedSweating;
Let observedNervousness = assessment.DrugAndAlcoholSection.CiwaScale.ObservedNervousness;
Let interviewerObservationOfPatientAgitationLevel =
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel;
Let observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances;
Let auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
Let visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
Let headAcheOrFullnessSeverity = assessment.DrugAndAlcoholSection.CiwaScale.HeadAcheOrFullnessSeverity;
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
Let heartRate = assessment.MedicalSection.HeartRate;
Let bloodPressure = assessment.MedicalSection.BloodPressure;
Let requiresInpatientCardiacMonitoring = assessment.MedicalSection.RequiresInpatientCardiacMonitoring;
Let mayRequireInpatientLiverTreatment = assessment.MedicalSection.MayRequireInpatientLiverTreatment;
Let mayRequireInpatientGastrointestinalBleedingTreatment =
assessment.MedicalSection.MayRequireInpatientGastrointestinalBleedingTreatment;
Let mayRequireInpatientAcutePancreatitisTreatment =
assessment.MedicalSection.MayRequireInpatientAcutePancreatitisTreatment;
Let multipleSeriousMedicalProblemsExist = assessment.MedicalSection.MultipleSeriousMedicalProblemsExist;
Let symptomsLifeThreateningBecauseOfSubstanceUse =
assessment.CompletionSection.SymptomsLifeThreateningBecauseOfSubstanceUse;
Let appearanceOfHostility = assessment.PsychologicalSection.InterviewerRating.AppearanceOfHostility;
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking;
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering;
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts;
Let hasEverUsedAlcohol = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedAlcohol;
Let lastUsedAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.LastUsed;
Let alcoholUsedToIntoxicationAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.AlcoholUsedToIntoxication;
Let lastUsedToIntoxification = assessment.DrugAndAlcoholSection.AlcoholUse.LastUsedToIntoxification;
Let hasEverUsedBarbiturate =
assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedBarbiturates;
Let lastUsedBarbiturate = assessment.DrugAndAlcoholSection.BarbiturateUse.LastUsed;
Let lastUsedOtherSedative = assessment.DrugAndAlcoholSection.OtherSedativeUse.LastUsed;
Let seizureInPast24Hours = assessment.MedicalSection.SeizureInPast24Hours;
Let multipleSeizuresInPast24Hours = assessment.MedicalSection.MultipleSeizuresInPast24Hours;
Let hadDeliriumTremorsInPast24Hours = assessment.DrugAndAlcoholSection.CiwaScale.HadDeliriumTremorsInPast24Hours;
Let feverOf102DegreesOrMoreInPast24Hours = assessment.MedicalSection.FeverOf102DegreesOrMoreInPast24Hours;
Let rangeOfGuiltInPastWeek = assessment.PsychologicalSection.DepressionEvaluation.RangeOfGuiltInPastWeek;
Let observedRetardationOfThoughtOrSpeech =
assessment.PsychologicalSection.DepressionEvaluation.ObservedRetardationOfThoughtOrSpeech;
Let numberOfDaysUsedInPast30DaysBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.NumberOfDaysUsedInPast30Days;
Let wasSubstanceTakenAsPrescribedBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.WasSubstanceTakenAsPrescribed;
Let numberOfDaysUsedInPast30DaysOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.NumberOfDaysUsedInPast30Days;
Let wasSubstanceTakenAsPrescribedOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.WasSubstanceTakenAsPrescribed;
Let medicalProblemThatWouldComplicateDetoxificationStatus =
assessment.MedicalSection.MedicalProblemThatWouldComplicateDetoxificationStatus;
Let numberOfMonthsUsedInLifetimeBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.NumberOfMonthsUsedInLifetime;
Let numberOfMonthsUsedInLifetimeOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.NumberOfMonthsUsedInLifetime;
Let hasEverUsedOtherSedative =
assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedOtherSedatives;
Let numberOfDaysUsedInPast30DaysAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysIntoxicatedInPast30DaysAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfDaysIntoxicatedInPast30Days;
Let numberOfDaysUsedInPast30DaysHeroin = assessment.DrugAndAlcoholSection.HeroinUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.NumberOfDaysUsedInPast30Days;
Let hasEverUsedHeroin = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedHeroin;
Let lastUsedHeroin = assessment.DrugAndAlcoholSection.HeroinUse.LastUsed;
Let hasEverUsedMethadone = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedMethadone;
Let lastUsedMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.LastUsed;
Let hasEverUsedOtherOpiate =
assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedOtherOpiate;
Let lastUsedOtherOpiate = assessment.DrugAndAlcoholSection.OtherOpiateUse.LastUsed;
Let experiencedNauseaOrVomitedRecently = assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
Let observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
Let observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
Let observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
Let observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
Let observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
Let observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
Let observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
Let hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
Let feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
Let hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
Let toBePrescribedOpioidDetoxificationProtocol =
assessment.DrugAndAlcoholSection.OpioidMaintenanceTherapy.ToBePrescribedOpioidDetoxificationProtocol;
Let hasEverUsedCocaine = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedCocaine;
Let lastUsedCocaine = assessment.DrugAndAlcoholSection.CocaineUse.LastUsed;
Let hasEverUsedStimulant = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedStimulate;
Let lastUsedStimulant = assessment.DrugAndAlcoholSection.StimulantUse.LastUsed;
Let appearanceOfDepressionWithdrawal =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfDepressionWithdrawal;
Let signsOfToxicPsychosisExist = assessment.MedicalSection.SignsOfToxicPsychosisExist;
Let sufferedHeadTraumaInPast48Hours = assessment.MedicalSection.SufferedHeadTraumaInPast48Hours;
Let lostConciousnessFromHeadTraumaInPast24Hours =
assessment.MedicalSection.LostConsciousnessFromHeadTraumaInPast24Hours;
Let sufferedSeriousImpairmentFromOverdoseInPast24Hours =
assessment.MedicalSection.SufferedSeriousImpairmentFromOverdoseInPast24Hours;
Let detoxificationRequiredMoreThanHourlyMonitoring =
assessment.CompletionSection.DetoxificationRequiredMoreThanHourlyMonitoring;
Let signsOfIntoxicationExist = assessment.MedicalSection.SignsOfIntoxicationExist;
Let oB_ImminentWD03 =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.HeroinScore.
HasImminentWithdrawalPotential;
Let oB_ImminentWD04 =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.MethadoneScore.
HasImminentWithdrawalPotential;
Let oB_ImminentWD05 = assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.
OtherOpiatesAnalgesicsScore.HasImminentWithdrawalPotential;
Let oB_ImminentWD06 =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.BarbituratesScore.
HasImminentWithdrawalPotential;
Let oB_ImminentWD07 = assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.
OtherSedativesHypnoticsScore.HasImminentWithdrawalPotential;
Let isPatientExperiencingWithdrawalSignsSymptoms =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.IsPatientExperiencingWithdrawalSignsSymptoms;
Let pregnantStatus = assessment.MedicalSection.PregnantStatus;
Let highRiskPregnancyStatus = assessment.MedicalSection.HighRiskPregnancyStatus;
Let d1CareLevel_I_DetoxScoreIMet = assessmentScore.Dimension1WithdrawalScores.CareLevel_I_DetoxificationScore.IsMet;
Let d1CareLevel_II_DetoxScoreIMet = assessmentScore.Dimension1WithdrawalScores.CareLevel_II_DetoxificationScore.IsMet;
Let d1CareLevel_III_2_DetoxScoreIMet =
assessmentScore.Dimension1WithdrawalScores.CareLevel_III_2_DetoxificationScore.IsMet;
Let d1CareLevel_III_7_DetoxScoreIMet =
assessmentScore.Dimension1WithdrawalScores.CareLevel_III_7_DetoxificationScore.IsMet;
Let gender = assessment.Patient.Gender;
D1LIVDa1:
Let alcoholUseFrequency = Utilities.CalculateFrequency(hasEverUsedAlcohol, lastUsedAlcohol); //ASId01R
Let alcoholUsedToIntoxicationFrequency = Utilities.CalculateFrequency(alcoholUsedToIntoxicationAlcohol,
lastUsedToIntoxification); // ASId02R
if (alcoholUseFrequency > alcoholUsedToIntoxicationFrequency And alcoholUsedToIntoxicationFrequency > 0)
{ alcoholUseFrequency = alcoholUsedToIntoxicationFrequency; }
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
heroinUseFrequency = Utilities.CalculateFrequency(hasEverUsedHeroin, lastUsedHeroin); // ASId03R
methadoneUseFrequency = Utilities.CalculateFrequency(hasEverUsedMethadone, lastUsedMethadone); // ASId04R
otherOpiateUseFrequency = Utilities.CalculateFrequency(hasEverUsedOtherOpiate, lastUsedOtherOpiate); // ASId05R
barbiturateUseFrequency = Utilities.CalculateFrequency(hasEverUsedBarbiturate, lastUsedBarbiturate); // ASId06R
otherSedativeUseFrequency = Utilities.CalculateFrequency(hasEverUsedOtherSedative, lastUsedOtherSedative); //
cocaineUseFrequency = Utilities.CalculateFrequency(hasEverUsedCocaine, lastUsedCocaine); // ASId08R
stimulantUseFrequency = Utilities.CalculateFrequency(hasEverUsedStimulant, lastUsedStimulant); // ASId09R
cannabisUseFrequency = Utilities.CalculateFrequency(hasEverUsedCannabis, lastUsedCannabis); // ASId10R
hallucinogenUseFrequency = Utilities.CalculateFrequency(hasEverUsedHallucinogen, lastUsedHallucinogen); // ASId11R
solventAndInhalantUseFrequency = Utilities.CalculateFrequency(hasEverUsedSolventAndInhalant,
lastUsedSolventAndInhalant); // ASId12R
Let nicotineUseFrequency = Utilities.CalculateFrequency ( hasEverUsedNicotine, lastUsedNicotine ); // ASId13aR
Let ciwa = Utilities.CalculateCiwa(experiencedNauseaOrVomitedRecentlyCiwa,
observedTremorCiwa, observedSweatingCiwa, observedNervousness,
interviewerObservationOfPatientAgitationLevel, observedTactileDisturbances, auditoryDisturbanceLevel,
visualDisturbanceLevel, headAcheOrFullnessSeverity, interviewerObservationOfPatientSenseOfAwareness );
D1LIVDa2:
Let careLevel_IV_DetoxScore.IsWithdrawingFromAlcoholCIWA10OrGreaterMonitoringMoreThanHourly =
hasAlcoholImminentWithdrawalPotential.Value And ciwa >= 10 And ( heartRate > 120 Or
bloodPressure.Systolic > 200 Or bloodPressure.Diastolic > 100 Or requiresInpatientCardiacMonitoring >
YesNoNotSure.No Or mayRequireInpatientLiverTreatment > YesNoNotSure.No Or
mayRequireInpatientGastrointestinalBleedingTreatment > YesNoNotSure.No Or
mayRequireInpatientAcutePancreatitisTreatment > YesNoNotSure.No Or
multipleSeriousMedicalProblemsExist > YesNoNotSure.No Or
symptomsLifeThreateningBecauseOfSubstanceUse > YesNoNotSure.No Or
observedNervousness = NervousnessObservation.SevereAnxiety Or
interviewerObservationOfPatientSenseOfAwareness = SenseOfAwareness.DisorientedToPlaceAndOrPerson Or
appearanceOfHostility = 2 Or appearanceOfParanoiaOrImpairedThinking = 2 Or
appearanceOfTroubleConcentratingOrRemembering = 2 Or hasSuicidalThoughts = 2 );
Let careLevel_IV_DetoxScore.IsExperiencingSeizuresDeliriumOrSeverePersistentHallucinations =
( ( ( hasEverUsedAlcohol ?? false ) And alcoholUseFrequency <= 7 ) Or
( ( alcoholUsedToIntoxicationAlcohol ?? false ) And alcoholUsedToIntoxicationFrequency <= 7 ) Or
( ( hasEverUsedBarbiturate ?? false ) And barbiturateUseFrequency <= 7 ) Or
( ( hasEverUsedOtherSedative ?? false ) And otherSedativeUseFrequency <= 7 ) )
And
( seizureInPast24Hours > YesNoNotSure.No Or
multipleSeizuresInPast24Hours > YesNoNotSure.No Or
hadDeliriumTremorsInPast24Hours > YesNoNotSure.No Or
feverOf102DegreesOrMoreInPast24Hours > YesNoNotSure.NotSure Or
symptomsLifeThreateningBecauseOfSubstanceUse > YesNoNotSure.NotSure Or
observedTremor = TremorObservation.SevereEvenWithArmsNotExtendedAndRelaxedAtSides Or
observedTactileDisturbances > TactileDisturbancesObservation.ModeratelySevereHallucinations Or
auditoryDisturbanceLevel > AuditoryDisturbanceLevel.ModeratelySevereHallucinations Or
visualDisturbanceLevel > VisualDisturbanceLevel.ModeratelySevereHallucinations Or
interviewerObservationOfPatientSenseOfAwareness = SenseOfAwareness.DisorientedToPlaceAndOrPerson Or
rangeOfGuiltInPastWeek =
RangeOfGuilt.HearsAccusatoryOrDenunciatoryVoicesAndOrExperiencesThreateningVisualHallucinations Or
observedRetardationOfThoughtOrSpeech = RetardationOfThoughtOrSpeech.CompleteStupor );
D1LIVD-a3:
Let sedativeUse = ( numberOfDaysUsedInPast30DaysBarbiturate > 26 And wasSubstanceTakenAsPrescribedBarbiturate =
SubstanceTakenAsPrescribed.More ) Or (numberOfDaysUsedInPast30DaysOtherSedative > 26 And
wasSubstanceTakenAsPrescribedOtherSedative = SubstanceTakenAsPrescribed.More);
Let symptomIndicator = medicalProblemThatWouldComplicateDetoxificationStatus > YesNoNotSure.NotSure Or
multipleSeizuresInPast24Hours > YesNoNotSure.NotSure Or
requiresInpatientCardiacMonitoring > YesNoNotSure.NotSure Or
mayRequireInpatientLiverTreatment > YesNoNotSure.NotSure Or
mayRequireInpatientGastrointestinalBleedingTreatment > YesNoNotSure.NotSure Or
mayRequireInpatientAcutePancreatitisTreatment > YesNoNotSure.NotSure Or
symptomsLifeThreateningBecauseOfSubstanceUse > YesNoNotSure.NotSure Or
appearanceOfHostility = 2 Or appearanceOfParanoiaOrImpairedThinking = 2 Or
appearanceOfTroubleConcentratingOrRemembering = 2 Or hasSuicidalThoughts = 2;
Let careLevel_IV_DetoxScore.HasIngestedSedativesHigherTherapeuticLevelsDailyMoreThan4WeeksWithAcuteDisorders =
sedativeUse And symptomIndicator;
D1LIVD-a4:
Let careLevel_IV_DetoxScore.HasIngestedSedativesDailyAtLeast6MonthsWithAcuteDisorders =
( ( ( hasEverUsedBarbiturate ?? false ) And numberOfDaysUsedInPast30DaysBarbiturate > 26 And
numberOfMonthsUsedInLifetimeBarbiturate >= 6 ) Or ( ( hasEverUsedOtherSedative ?? false ) And
numberOfDaysUsedInPast30DaysOtherSedative > 26 And numberOfMonthsUsedInLifetimeOtherSedative >= 6 ) )
( numberOfDaysUsedInPast30DaysAlcohol >= 15 Or numberOfDaysIntoxicatedInPast30DaysAlcohol >= 15 Or
numberOfDaysUsedInPast30DaysHeroin >= 15 Or numberOfDaysUsedInPast30DaysMethadone >= 15 Or
numberOfDaysUsedInPast30DaysOtherOpiate >= 15 ) And symptomIndicator;
And
D1LIVD-a5
Let opiateUse = ( ( ( hasEverUsedHeroin ?? false ) And heroinUseFrequency < 5 ) Or
( ( hasEverUsedMethadone ?? false ) And methadoneUseFrequency < 5 ) Or
( ( hasEverUsedOtherOpiate ?? false ) And otherOpiateUseFrequency < 5 ) ) And
( numberOfDaysUsedInPast30DaysHeroin > 14 Or numberOfDaysUsedInPast30DaysMethadone > 14 Or
numberOfDaysUsedInPast30DaysOtherOpiate > 14 );
Let cina = Utilities.CalculateCina(experiencedNauseaOrVomitedRecently,
observedGooseFlesh, observedSweating, observedRestlessness, observedTremor, observedLacrimination,
observedNasalCongestion, observedYawning, hasAbdominalPain, feelsHotOrCold, hasMuscleAches,
heartRate);
Let careLevel_IV_DetoxScore.IsExperiencingSevereOpiateWithdrawalNotStabilizedAtLessThanIntensiveLevel = opiateUse And
cina >= 20;
D1LIVD-a6:
Let careLevel_IV_DetoxScore.AntagonistMedicationIsToBeUsedInRapidWithdrawal = opiateUse And
toBePrescribedOpioidDetoxificationProtocol = OpioidDetoxificationProtocol.OpioidAntagonistRapidDetoxification;
D1LIVD-a7:
Let careLevel_IV_DetoxScore.RequiresPsychiatricOrMedicalMonitoringPsychoticImpulsiveBehavior =
( ( ( hasEverUsedCocaine ?? false ) And cocaineUseFrequency <= 3 ) Or
( ( hasEverUsedStimulant ?? false ) And stimulantUseFrequency <= 3 ) ) And
( rangeOfGuiltInPastWeek =
RangeOfGuilt.HearsAccusatoryOrDenunciatoryVoicesAndOrExperiencesThreateningVisualHallucinations Or
observedRetardationOfThoughtOrSpeech = RetardationOfThoughtOrSpeech.CompleteStupor Or
auditoryDisturbanceLevel > AuditoryDisturbanceLevel.SevereHallucinations Or
visualDisturbanceLevel > VisualDisturbanceLevel.SevereHallucinations Or
appearanceOfDepressionWithdrawal = 4 Or
appearanceOfParanoiaOrImpairedThinking = 4 Or
hasSuicidalThoughts = 4 Or
signsOfToxicPsychosisExist > YesNoNotSure.No );
D1LIVD-a8:
Let careLevel_IV_DetoxScore.NeedToCloselyObserveAtLeastHourlyMentalStatusOrNeurologicalChanges =
( sufferedHeadTraumaInPast48Hours > YesNoNotSure.No Or
lostConciousnessFromHeadTraumaInPast24Hours > YesNoNotSure.No ) And
( signsOfToxicPsychosisExist = YesNoNotSure.NotSure Or
sufferedSeriousImpairmentFromOverdoseInPast24Hours = YesNoNotSure.NotSure Or
interviewerObservationOfPatientSenseOfAwareness = SenseOfAwareness.DisorientedToPlaceAndOrPerson Or
observedRetardationOfThoughtOrSpeech > RetardationOfThoughtOrSpeech.ObviousRetardationAtInterview )
( detoxificationRequiredMoreThanHourlyMonitoring ?? false );
And
D1LIVD-a9:
Let careLevel_IV_DetoxScore.MentalStatusCardiacFunctionOrOtherVitalsCompromisedDrugOverdoseOrIntoxication =
( signsOfIntoxicationExist = YesNoNotSure.Yes Or signsOfToxicPsychosisExist = YesNoNotSure.Yes ) And
(sufferedSeriousImpairmentFromOverdoseInPast24Hours = YesNoNotSure.Yes Or
symptomsLifeThreateningBecauseOfSubstanceUse = YesNoNotSure.Yes);
D1LIVD-a10:
Let imminentWithdrawIndicator =
( (hasAlcoholImminentWithdrawalPotential.Value Or oB_ImminentWD06.Value Or oB_ImminentWD07.Value) And ciwa > 10 )
Or ( ( oB_ImminentWD03.Value Or oB_ImminentWD04.Value Or oB_ImminentWD05.Value ) And ( cina > 10 Or
toBePrescribedOpioidDetoxificationProtocol > OpioidDetoxificationProtocol.No ) );
Let careLevel_IV_DetoxScore.HasAcuteBiomedicalDisorderPosesSeriousRiskDuringWithdrawal =
( medicalProblemThatWouldComplicateDetoxificationStatus = YesNoNotSure.Yes Or
multipleSeizuresInPast24Hours = YesNoNotSure.Yes Or
requiresInpatientCardiacMonitoring = YesNoNotSure.Yes Or
mayRequireInpatientLiverTreatment = YesNoNotSure.Yes Or
mayRequireInpatientGastrointestinalBleedingTreatment = YesNoNotSure.Yes Or
mayRequireInpatientAcutePancreatitisTreatment = YesNoNotSure.Yes Or
symptomsLifeThreateningBecauseOfSubstanceUse = YesNoNotSure.Yes ) And
imminentWithdrawIndicator;
D1LIVD-a:
Let careLevel_IV_DetoxScore.IsExperiencingSevereWithdrawalManageableAtLevelOfService =
isPatientExperiencingWithdrawalSignsSymptoms = SignsOfWithdrawal.CurrentOrImminentSevereWithdrawal;
D1LIVD-b1:
Let careLevel_IV_DetoxScore.DetoxificationRegimenRequiringMonitoringMoreFrequentlyThanHourly =
( detoxificationRequiredMoreThanHourlyMonitoring ?? false );
D1LIVD-b2:
Let careLevel_IV_DetoxScore.NeedForDetoxOrStabilizationWhilePregnantUntilSafelyTreatedAtLowerLevel =
pregnantStatus = YesNoNotSure.NotSure And highRiskPregnancyStatus = HighRiskPregnancyStatus.ImmediatelyUnstable
And ( d1CareLevel_I_DetoxScoreIMet.Value Or d1CareLevel_II_DetoxScoreIMet.Value Or
d1CareLevel_III_2_DetoxScoreIMet.Value Or d1CareLevel_III_7_DetoxScoreIMet.Value ) And
gender = Gender.Female;
D1LIVD IS MET:
Let careLevel_IV_DetoxScore.IsMet =
careLevel_IV_DetoxScore.IsExperiencingSevereWithdrawalManageableAtLevelOfService.Value Or
careLevel_IV_DetoxScore.IsWithdrawingFromAlcoholCIWA10OrGreaterMonitoringMoreThanHourly.Value Or
careLevel_IV_DetoxScore.IsExperiencingSeizuresDeliriumOrSeverePersistentHallucinations.Value Or
careLevel_IV_DetoxScore.HasIngestedSedativesHigherTherapeuticLevelsDailyMoreThan4WeeksWithAcuteDisorders.Value
Or careLevel_IV_DetoxScore.HasIngestedSedativesDailyAtLeast6MonthsWithAcuteDisorders.Value Or
careLevel_IV_DetoxScore.IsExperiencingSevereOpiateWithdrawalNotStabilizedAtLessThanIntensiveLevel.Value Or
careLevel_IV_DetoxScore.AntagonistMedicationIsToBeUsedInRapidWithdrawal.Value Or
careLevel_IV_DetoxScore.RequiresPsychiatricOrMedicalMonitoringPsychoticImpulsiveBehavior.Value Or
careLevel_IV_DetoxScore.NeedToCloselyObserveAtLeastHourlyMentalStatusOrNeurologicalChanges.Value Or
careLevel_IV_DetoxScore.MentalStatusCardiacFunctionOrOtherVitalsCompromisedDrugOverdoseOrIntoxication.Value Or
careLevel_IV_DetoxScore.HasAcuteBiomedicalDisorderPosesSeriousRiskDuringWithdrawal.Value Or
careLevel_IV_DetoxScore.DetoxificationRegimenRequiringMonitoringMoreFrequentlyThanHourly.Value Or
careLevel_IV_DetoxScore.NeedForDetoxOrStabilizationWhilePregnantUntilSafelyTreatedAtLowerLevel.Value;
return careLevel_IV_DetoxScore;
Level of Care: Early Intervention (0.5)
Summary
The patient is not at risk of withdrawal.
Level 0.5 (Early Intervention) Placement Criterion
Original Equation
D1L0.5&I = TRUE If all of D1LID, LIID, LIII.2D, III.7D, IVD, &LM = FALSE
Narrative
Placement criteria are met if either of the following is met:
1) (Dimension 1 Care Level I Detox. A is true or Dimension 1 Care Level I Detox. A1 is true or Dimension 1 Care Level
I Detox. A3 is true or Dimension 1 Care Level I Detox. A4 is true or Dimension 1 Care Level I Detox. A5 is true or
Dimension 1 Care Level I Detox. A6 is true or Dimension 1 Care Level I Detox. A7 is true) and Dimension 1 Care
Level I Detox. B and Dimension 1 Care Level I Detox. C is true or
2) (Dimension 1 Care Level II Detox. A is true or Dimension 1 Care Level II Detox. A1 is true or Dimension 1 Care
Level II Detox. A2 is true or Dimension 1 Care Level II Detox. A3 is true or Dimension 1 Care Level II Detox. A4 is
true or Dimension 1 Care Level II Detox. A5 is true or Dimension 1 Care Level II Detox. A6 is true or Dimension 1
Care Level II A7 is true) and Dimension 1 Care Level II Detox. B is true or
3) (Dimension 1 Care Level III.2 Detox. A is true or Dimension 1 Care Level III.2 Detox. A1 is true or Dimension 1
Care Level III.2 Detox. A2 is true or Dimension 1 Care Level III.2 Detox. A3 is true) and Dimension 1 Care Level
III.2 Detox. B is true or
4) (Dimension 1 Care Level III.7 Detox. A is true or Dimension 1 Care Level Detox. A1 is true or Dimension 1 Care
Level III.7 Detox. A2 is true or Dimension 1 Care Level III.7 Detox. A3 is true or Dimension 1 Care Level III.7 Detox.
A4 is true or Dimension 1 Care Level III.7 A5 Detox. Is true or Dimension 1 Care Level III.7 Detox. A6 is true or
Dimension 1 Care Level III.7 Detox. A7 is true) or Dimension 1 Care Level III.7 Detox. B is true or
5) (Dimension 1 Care Level IV Detox. A is true or Dimension 1 Care Level IV Detox. A1 is true or Dimension 1 Care
Level IV Detox. A2 Dimension 1 Care Level IV Detox. A3 is true or Dimension 1 Care Level IV Detox. A4 is true or
Dimension 1 Care Level IV Detox. A5 is true or Dimension 1 Care Level IV Detox. A6 is true or Dimension 1 Care
Level IV Detox. A7 is true or Dimension 1 Care Level IV Detox. A8 is true or Dimension 1 Care Level IV Detox. A9
is true or Dimension 1 Care Level IV Detox. A10 is true) or Dimension 1 Care Level IV Detox. B1 is true or
Dimension 1 Care Level IV Detox. B2 is true or
6) (Dimension 1 Care Level OMT A is false and Dimension 1 Care Level OMT B is false) or (Dimension 1 Care Level
OMT C is false or Dimension 1 Care Level OMT D is false or Dimension 1 Care Level OMT E is false) and any
opioid addiction diagnosis is true
Level 0.5 (Early Intervention) Placement Criterion
Original Equation
D1L0.5&I = TRUE If all of D1LID, LIID, LIII.2D, III.7D, IVD, &LM = FALSE
Narrative
This criterion is met if the single rule above is met.
Dimension 1: Level 0.5 Early Intervention
Pseudo Code
D1L0.5 VARIABLES:
Let
Let
Let
Let
Let
Let
d1LID = assessmentScore.Dimension1WithdrawalScores.CareLevel_I_DetoxificationScore.IsMet;
d1LIID = assessmentScore.Dimension1WithdrawalScores.CareLevel_II_DetoxificationScore.IsMet;
d1LIII2D = assessmentScore.Dimension1WithdrawalScores.CareLevel_III_2_DetoxificationScore.IsMet;
d1LIII7D = assessmentScore.Dimension1WithdrawalScores.CareLevel_III_7_DetoxificationScore.IsMet;
d1LIVD = assessmentScore.Dimension1WithdrawalScores.CareLevel_IV_DetoxificationScore.IsMet;
d1LM = assessmentScore.Dimension1WithdrawalScores.CareLevelOpioidMaintenanceTherapyScore.IsMet;
return CalculateCareLevel_0_5_EarlyInterventionScore ( d1LID, d1LIID, d1LIII2D, d1LIII7D, d1LIVD, d1LM );
Level of Care: Outpatient Treatement (I)
Summary
The patient is not experiencing significant withdrawal or is at minimal risk of severe withdrawal.
Level I (Outpatient Treatment) Sole Criterion
Original Equation
D1L0.5&I = TRUE If all of D1LID, LIID, LIII.2D, III.7D, IVD, &LM = FALSE
Narrative
Placement criteria are met if either of the following is met:
1) (Dimension 1 Care Level I Detox. A is true or Dimension 1 Care Level I Detox. A1 is true or Dimension 1 Care Level I
Detox. A3 is true or Dimension 1 Care Level I Detox. A4 is true or Dimension 1 Care Level I Detox. A5 is true or
Dimension 1 Care Level I Detox. A6 is true or Dimension 1 Care Level I Detox. A7 is true) and Dimension 1 Care Level I
Detox. B and Dimension 1 Care Level I Detox. C is true or
2) (Dimension 1 Care Level II Detox. A is true or Dimension 1 Care Level II Detox. A1 is true or Dimension 1 Care Level II
Detox. A2 is true or Dimension 1 Care Level II Detox. A3 is true or Dimension 1 Care Level II Detox. A4 is true or
Dimension 1 Care Level II Detox. A5 is true or Dimension 1 Care Level II Detox. A6 is true or Dimension 1 Care Level II
A7 is true) and Dimension 1 Care Level II Detox. B is true or
3) (Dimension 1 Care Level III.2 Detox. A is true or Dimension 1 Care Level III.2 Detox. A1 is true or Dimension 1 Care
Level III.2 Detox. A2 is true or Dimension 1 Care Level III.2 Detox. A3 is true) and Dimension 1 Care Level III.2 Detox.
B is true or
4) (Dimension 1 Care Level III.7 Detox. A is true or Dimension 1 Care Level Detox. A1 is true or Dimension 1 Care Level
III.7 Detox. A2 is true or Dimension 1 Care Level III.7 Detox. A3 is true or Dimension 1 Care Level III.7 Detox. A4 is
true or Dimension 1 Care Level III.7 A5 Detox. Is true or Dimension 1 Care Level III.7 Detox. A6 is true or Dimension 1
Care Level III.7 Detox. A7 is true) or Dimension 1 Care Level III.7 Detox. B is true or
5) (Dimension 1 Care Level IV Detox. A is true or Dimension 1 Care Level IV Detox. A1 is true or Dimension 1 Care Level
IV Detox. A2 Dimension 1 Care Level IV Detox. A3 is true or Dimension 1 Care Level IV Detox. A4 is true or Dimension
1 Care Level IV Detox. A5 is true or Dimension 1 Care Level IV Detox. A6 is true or Dimension 1 Care Level IV Detox.
A7 is true or Dimension 1 Care Level IV Detox. A8 is true or Dimension 1 Care Level IV Detox. A9 is true or Dimension
1 Care Level IV Detox. A10 is true) or Dimension 1 Care Level IV Detox. B1 is true or Dimension 1 Care Level IV Detox.
B2 is true or
6) (Dimension 1 Care Level OMT A is false and Dimension 1 Care Level OMT B is false) or (Dimension 1 Care Level OMT
C is false or Dimension 1 Care Level OMT D is false or Dimension 1 Care Level OMT E is false) and any opioid
addiction diagnosis is true
Level I (Outpatient Treatment) Placement Criterion
Original Equation
D1L0.5&I = TRUE If all of D1LID, LIID, LIII.2D, III.7D, IVD, &LM = FALSE
Narrative
This criterion is met if the single rule above is met.
Dimension 1: Level I Outpatient Treatment
Reference Pseudo Code
Let
Let
Let
Let
Let
Let
d1LID = assessmentScore.Dimension1WithdrawalScores.CareLevel_I_DetoxificationScore.IsMet
d1LIID = assessmentScore.Dimension1WithdrawalScores.CareLevel_II_DetoxificationScore.IsMet
d1LIII2D = assessmentScore.Dimension1WithdrawalScores.CareLevel_III_2_DetoxificationScore.IsMet
d1LIII7D = assessmentScore.Dimension1WithdrawalScores.CareLevel_III_7_DetoxificationScore.IsMet
d1LIVD = assessmentScore.Dimension1WithdrawalScores.CareLevel_IV_DetoxificationScore.IsMet
d1LM = assessmentScore.Dimension1WithdrawalScores.CareLevelOpioidMaintenanceTherapyScore.IsMet
Bool
Bool
Bool
Bool
Bool
Bool
d1LID
d1LIID
d1LIII2D
d1LIII7D
d1LIVD
d1LM
Let careLevel_0_5_Score.IsMet = d1LID And d1LIID And d1LIII2D And d1LIII7D And d1LIVD And Not d1LM
Dimension 1: Level I Outpatient Treatment
Pseudo Code
D1LI VARIABLES:
Let d1L05 = assessmentScore.Dimension1WithdrawalScores.CareLevel_0_5_EarlyInterventionScore.IsMet;
return CalculateCareLevel_I_OutpatientScore ( d1L05 );
Level of Care: Opiate Maintenance Therapy
Level OMT (Opioid Maintenance Therapy) Summary
The patient is physiologically dependent on opiates and requires OMT to prevent withdrawal.
Level OMT (Opioid Maintenance Therapy) Criteria
Criterion- Opiates (a)
PhysiologicallyDependentOpiateDrugAtLeast1YearBeforeMethadoneAdmission
EITHER BOTH (a) A physician determines that the patient is “physiologically dependent upon an opiate drug and became
physiologically dependent at least one year before admission to methadone maintenance.” This means that the patient
was addicted “continuously or episodically for most of the year immediately before admission” [FDA 21 CFR Part 291];
Original Equation
D1LMD-a = TRUE If DxLM & (Any CUAD-01, 02 OR 03 for Subst-03,4,5>0) & (Any of: ASId03,04,05F >26) & (Any of:
ASId03,4,5D >=12 mos)
Narrative
Criterion is met if:
Criterion- Opiates (b)
CurrentPhysiologicalDependenceIsConfirmed
AND (b) The patient’s current physiological dependence (in addition to a history of addiction) is confirmed by vital signs,
early physical signs of narcotic withdrawal, a urine screen that is positive for opiates, the presence of old or fresh needle
marks, and documented reports from medical professionals, the patient or family, treatment history, or (if necessary) a
positive reaction to a naloxone test;
Original Equation
D1LMD-b = TRUE If (HR>=100 or SBP>=150 or DPB>=100 or CINA-Ttl>10 or ASId03,4,5a =1) AND ASId03,4,5b =1
Criterion- Psychosocial Issues (c)
CanBeAdmittedFromCriminalJusticeSettingWithin14DaysOfRelease
OR (c) A patient can be admitted from a criminal justice or chronic care setting within 14 days of release, or up to 6
months after release without documented evidence of physiological dependence if the patient was eligible for
admission prior to incarceration [FDA 21 CFR Part 291];
Original Equation
D1LMD-c = TRUE If ASICntrlEnv=1 & ASICntrlEnv-Dx=1
Criterion- Psychosocial Issues (d)
IsPregnantWithHistoryOfOpiateDependenceTreatmentMedicallyJustified
OR (d) A pregnant women who has a documented history of opiate dependence without physiological dependence can
be admitted if the program physician certifies that the woman is pregnant and finds that treatment is medically justified
[FDA 21 CFR Part 291];
Original Equation
D1LMD-d = TRUE If ASIm3a=1 & [(DSM-IV -SDwP OR -SDoP where ##=03,04,or05 =1) & (ASId03,04or05R <5d)
Criterion- Psychosocial Issues (e)
IsPreviouslyTreatedVoluntarilyDetoxedFromMethadoneWithin2Years
OR (e) A previously treated patient who has been voluntarily detoxified from methadone within two years of discharge
can be admitted, in the absence of current physiological dependence, if the program can document prior methadone
treatment of 6 months’ or more duration and, in the judgment of the program physician, readmission to opioid
maintenance therapy is medically indicated [FDA 21 CFR Part 291].
Original Equation
D1LMD-e = TRUE If All of: ASId25: h,i,or j =1
Criteria- All Substances
Original Equation
D1LM = TRUE If [D1LM(a & b)] OR [D1LM(c OR d OR e)]
Dimension 1: Level OMT Opioid Maintenance Treatment
Pseudo Code
D1LOMT VARIABLES:
Let dxCareLevel_OMT_ScoreIsMet = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsMet;
Let increasedDoseRequiredToGetSameEffectHeroin =
assessment.DrugAndAlcoholSection.HeroinUse.IncreasedDoseRequiredToGetSameEffect;
Let experiencesWithdrawalSicknessHeroin = assessment.DrugAndAlcoholSection.HeroinUse.ExperiencesWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessHeroin =
assessment.DrugAndAlcoholSection.HeroinUse.UseSubstanceToPreventWithdrawalSickness;
Let increasedDoseRequiredToGetSameEffectMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.IncreasedDoseRequiredToGetSameEffect;
Let experiencesWithdrawalSicknessMethadone = .
assessment.DrugAndAlcoholSection.MethadoneUse.ExperiencesWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.UseSubstanceToPreventWithdrawalSickness;
Let increasedDoseRequiredToGetSameEffectOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.IncreasedDoseRequiredToGetSameEffect;
Let experiencesWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.ExperiencesWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.UseSubstanceToPreventWithdrawalSickness;
Let numberOfDaysUsedInPast30DaysHeroin = assessment.DrugAndAlcoholSection.HeroinUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.NumberOfDaysUsedInPast30Days;
Let numberOfMonthsUsedInLifetimeHeroin = assessment.DrugAndAlcoholSection.HeroinUse.NumberOfMonthsUsedInLifetime;
Let numberOfMonthsUsedInLifetimeMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.NumberOfMonthsUsedInLifetime;;
Let numberOfMonthsUsedInLifetimeOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.NumberOfMonthsUsedInLifetime;;
Let heartRate = assessment.MedicalSection.HeartRate;
Let bloodPressure = assessment.MedicalSection.BloodPressure;
Let experiencedNauseaOrVomitedRecently = assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
Let observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
Let observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
Let observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
Let observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
Let observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
Let observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
Let observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
Let hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
Let feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
Let hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
Let evidenceFromUrineScreenOfOpioidDependenceOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.EvidenceFromUrineScreenOfOpioidDependence;
Let documentedEvidenceOfOpioidDependenceAtLeast1YearOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.DocumentedEvidenceOfOpioidDependenceAtLeast1Year;
Let increasedDoseRequiredToGetSameEffect =
assessment.DrugAndAlcoholSection.OpiatesInControlledEnvironment.IncreasedDoseRequiredToGetSameEffect;
Let experiencesWithdrawalSickness =
assessment.DrugAndAlcoholSection.OpiatesInControlledEnvironment.ExperiencesWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSickness =
assessment.DrugAndAlcoholSection.OpiatesInControlledEnvironment.UseSubstanceToPreventWithdrawalSickness;
Let inPenalOrChronicCareSettingRecently = assessment.GeneralInformationSection.InPenalOrChronicCareSettingRecently;
Let pregnantStatus = assessment.MedicalSection.PregnantStatus;
Let isDependentHeroin =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.HeroinScore.IsDependent;
Let isDependentMethadone =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.MethadoneScore.IsDependent
Let isDependentOtherOpiate =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.OtherOpiatesAnalgesics
Score.IsDependent;
Let hasEverUsedHeroin = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedHeroin;
Let lastUsedHeroin = assessment.DrugAndAlcoholSection.HeroinUse.LastUsed;
Let hasEverUsedMethadone = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedMethadone;
Let lastUsedMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.LastUsed;
Let hasEverUsedOtherOpiate =
assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedOtherOpiate;
Let lastUsedOtherOpiate = assessment.DrugAndAlcoholSection.OtherOpiateUse.LastUsed;
Let toBePrescribedOpioidDetoxificationProtocol =
assessment.DrugAndAlcoholSection.OpioidMaintenanceTherapy.ToBePrescribedOpioidDetoxificationProtocol;
Let completedAtLeast6MonthOpioidMaintenanceTherapyVoluntarily =
assessment.DrugAndAlcoholSection.OpioidMaintenanceTherapy.CompletedAtLeast6MonthOpioidMaintenanceTherapy
Voluntarily;
Let detoxificationEndedLessThanOrEqual2YearsAgo =
assessment.DrugAndAlcoholSection.OpioidMaintenanceTherapy.DetoxificationEndedLessThanOrEqual2YearsAgo;
Let opioidMaintenanceTherapyReadmissionMedicallyIndicated =
assessment.DrugAndAlcoholSection.OpioidMaintenanceTherapy.OpioidMaintenanceTherapyReadmissionMedicallyIndicated;
Let anyOpioidAddictionDiagnosis = assessmentScore.DiagnosisResults.AnyOpioidAddictionDiagnosis;
internal CareLevel_0_5_EarlyInterventionScore CalculateCareLevel_0_5_EarlyInterventionScore
(
bool? d1LID,
bool? d1LIID,
bool? d1LIII2D,
bool? d1LIII7D,
bool? d1LIVD,
bool? d1LM
)
Let careLevel_0_5_Score = new CareLevel_0_5_EarlyInterventionScore ( );
D1LOMT Is Met:
careLevel_0_5_Score.IsMet = d1LID.Value And
d1LIVD.Value And
!d1LM.Value;
return careLevel_0_5_Score;
d1LIID.Value And
d1LIII2D.Value And
d1LIII7D.Value And
Level of Care: Intensive Outpatient (II.1)
Summary
The patient is at minimal risk of severe withdrawal.
Level II.1 (Intensive Outpatient) – Alcohol
All programs: The patient has no signs or symptoms of withdrawal, or his or her withdrawal needs can be safely
managed in a Level II.1 setting (see the separate Dimension 1 criteria).
Criteria:
Alcohol
All Programs:
Sedatives
None.
Opiates
None.
Stimulants
None.
Nicotine
None.
Psychosocial Issues
None.
Criteria -- All Substances
As Dimension 1
Dimension 1: Level II.1 Intensive Inpatient
Pseudo Code
No pseudocode
Level of Care: Partial Hospitalization (II.5)
Summary
The patient is at moderate risk of severe withdrawal.
Criterion – All Substances
All Programs:
The patient has no signs or symptoms of withdrawal, or his or her withdrawal needs can be safely
managed in a Level II.1 setting (see the separate Dimension 1 criteria).
Criteria - - All Substances
As for Level I.
Dimension 1: Level II.5 Partial Hospitalization
Pseudo Code
No pseudocode
Level of Care: Clinically Managed Low-Intensity Residential Services (III.1)
Summary – All Substances
The patient is not at risk of withdrawal, or is experiencing minimal or stable withdrawal. The patient is concurrently
receiving Level I-D (minimal) or Level II-D (moderate) services.
Criterion
All Substances
All Programs:
The resident has no signs or symptoms of withdrawal, or his or her withdrawal needs can be
safely managed in a Level III.1 setting (see the separate Dimension 1 criteria).
Criteria
There is no rule provided in the spreadsheet.
Dimension 1: Level III.1 Low-Intensity Residential Services
Pseudo Code
No pseudocode
Level of Care: Clinically Managed Medium-Intensity Residential Services (III.3)
Summary – All Substances
The patient is not at risk of severe withdrawal, or moderate withdrawal is manageable at Level III.2-D.
Criterion – All Substances
The resident has no signs or symptoms of withdrawal, or his or her withdrawal needs can be safely managed in a Level
III.3 setting (see the separate Dimension 1 criteria).
Criteria
None Provided on Spreadsheet.
Dimension 1: Level III.3 Medium-Intensity Residential Services
Pseudo Code
No pseudocode
Level of Care: Clinically Managed High Intensity Residential Treatment (III.5)
Summary –All Substances
The patient is at minimal risk of severe withdrawal at Levels III.3 or III.5. If withdrawal is present, it meets Level III.2-D
criteria.
Criterion – All Substances
The resident has no signs or symptoms of withdrawal, or his or her withdrawal needs can be safely managed in a Level
III.5 setting (see the separate Dimension 1 criteria). NOTE: A resident who is being transferred from a Level III.7 program
should not require medically managed or monitored detoxification services.
Criteria
None provided on spreadsheet
Dimension 1: Level III.5 High-Intensity Residential Services
Pseudo Code
No pseudocode
Level of Care: Medically Monitored Intensive Inpatient Treatement (III.7)
Summary – All Substances
The patient is at high risk of withdrawal, but it is manageable at Level III.7-D and does not require the full resources of a
licensed hospital.
Criterion – All substances
See the separate Dimension 1 Criterion.
Criteria
None provided on spreadsheet.
Dimension 1: Level III.7 Medically Monitored Intensive Inpatient Treatment
Pseudo Code
No pseudocode
Level of Care: Medically Managed Inpatient Treatement (IV)
Summary – All Substances
None provided.
Criterion
See the separate D1 Criterion.
Criteria
None provided.
Dimension 1: Level IV Medically Managed Inpatient Treatment
Pseudo Code
No pseudocode
Dimension1 Withdrawal Scores
Dimension 1: Withdrawal Scores
Pseudo Code
OI_D1Severity
public int SeverityNumber {
get
{
Let levelArray = new[]
{
CareLevel_I_DetoxificationScore.IsMet.Value,
CareLevel_II_DetoxificationScore.IsMet.Value,
CareLevel_III_2_DetoxificationScore.IsMet.Value,
CareLevel_III_7_DetoxificationScore.IsMet.Value,
CareLevel_IV_DetoxificationScore.IsMet.Value
};
return levelArray.Count ( v => v );
}
}
OI_DIM1_Resolve_Count
public int ResolveCount
get
if (CareLevel_IV_DetoxificationScore.IsMet.Value) return 9;
if (CareLevel_III_7_DetoxificationScore.IsMet.Value) return 7;
if (CareLevel_III_2_DetoxificationScore.IsMet.Value) return 5;
if (CareLevel_II_DetoxificationScore.IsMet.Value) return 4;
if (CareLevelOpioidMaintenanceTherapyScore.IsMet.Value) return 3;
if (CareLevel_I_DetoxificationScore.IsMet.Value) return 2; return 0;
public CareLevel_I_DetoxificationScore CareLevel_I_DetoxificationScore { get; private set; }
public CareLevel_II_DetoxificationScore CareLevel_II_DetoxificationScore { get; private set; }
public CareLevel_III_2_DetoxificationScore CareLevel_III_2_DetoxificationScore { get; private set; }
public CareLevel_III_7_DetoxificationScore CareLevel_III_7_DetoxificationScore { get; private set; }
public CareLevel_IV_DetoxificationScore CareLevel_IV_DetoxificationScore { get; private set; }
public CareLevel_0_5_EarlyInterventionScore CareLevel_0_5_EarlyInterventionScore { get; private set; }
public CareLevel_I_OutpatientScore CareLevel_I_OutpatientScore { get; private set; }
public CareLevelOpioidMaintenanceTherapyScore CareLevelOpioidMaintenanceTherapyScore { get; private set; }
public void CalculateScoresStage1(Assessment assessment, AssessmentScore assessmentScore, IDimension1ScoringStrategy
dimension1ScoringStrategy)
Care Level 0.5
CareLevel_0_5_EarlyInterventionScore =
dimension1ScoringStrategy.CalculateCareLevel_0_5_EarlyInterventionScore(assessment, assessmentScore);
public void CalculateScoresStage2(Assessment assessment, AssessmentScore assessmentScore, IDimension1ScoringStrategy
dimension1ScoringStrategy)
Care Level I
CareLevel_I_DetoxificationScore = dimension1ScoringStrategy.CalculateCareLevel_I_DetoxificationScore(assessment,
assessmentScore);
Care Level II
CareLevel_II_DetoxificationScore = dimension1ScoringStrategy.CalculateCareLevel_II_DetoxificationScore(assessment,
assessmentScore);
Care Level III.2
CareLevel_III_2_DetoxificationScore =
dimension1ScoringStrategy.CalculateCareLevel_III_2_DetoxificationScore(assessment, assessmentScore);
Care Level III.7
CareLevel_III_7_DetoxificationScore =
dimension1ScoringStrategy.CalculateCareLevel_III_7_DetoxificationScore(assessment, assessmentScore);
Care Level IV
CareLevel_IV_DetoxificationScore = dimension1ScoringStrategy.CalculateCareLevel_IV_DetoxificationScore(assessment,
assessmentScore);
Care Level I
CareLevel_I_OutpatientScore = dimension1ScoringStrategy.CalculateCareLevel_I_OutpatientScore(assessment,
assessmentScore);
Dimension 2: Biomedical Conditions and Complications
Level of Care: Early Intervention (0.5)
Summary
None or very stable.
Level 0.5 (Early Intervention) Sole Criterion
ShowsBiomedicalStabilityOrProblemsBeingAddressed
The individual’s biomedical conditions and problems, if any, are stable or are being actively addressed and
thus will not interfere with therapeutic interventions.
Original Equation
D2L0.5= TRUE If ASId17e=0 & [All of: ASIm6c,6d,6o,6h =0] & ASIm8b<2 & ASIm9<3
Narrative
This criterion is met if:
7)
8)
9)
10)
11)
Patient has suffered serious head injury and overdoes and
Patient requires 1 to 4 visits a month for medical or nursing care or physical rehabilitation and
Patient’s slight health problems won't interfere with involvement in recovery and
Patient has health issues that require minimal medical treatment and
Patient does not have any addiction diagnosis
Level 0.5 (Early Intervention) Placement Criterion
Original Equation
D2L0.5 = TRUE if D2L0.5 (Same as single rule above)
Narrative
This criterion is met if the single rule above is met.
Dimension 2: Level 0.5 Early Intervention
Reference Pseudo Code
Let sufferedHeadTraumaInPast48Hours = assessment.MedicalSection.SufferedHeadTraumaInPast48Hours
Let lostConsciousnessFromHeadTraumaInPast24Hours =
assessment.MedicalSection.LostConsciousnessFromHeadTraumaInPast24Hours
Let sufferedSeriousImpairmentFromOverdoseInPast24Hours =
assessment.MedicalSection.SufferedSeriousImpairmentFromOverdoseInPast24Hours
Let feverOf102DegreesOrMoreInPast24Hours = assessment.MedicalSection.FeverOf102DegreesOrMoreInPast24Hours
Let substanceOverdoseInPast24Hours =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.SubstanceOverdoseInPast24Hours
Let needForMedicalOrPhysicalRehabilitation = assessment.MedicalSection.NeedForMedicalOrPhysicalRehabilitation
Let physicalHealthsEffectOnSubstanceProblems = assessment.MedicalSection.PhysicalHealthsEffectOnSubstanceProblems
Let interviewerRatingOfPatientNeedForMedicalTreatment =
assessment.MedicalSection.InterviewerRatingOfPatientNeedForMedicalTreatment
Let anyAddictionDiagnosisExceptNicotine = assessmentScore.DiagnosisResults.AnyAddictionDiagnosisExceptNicotine
YesNoNotSure sufferedHeadTraumaInPast48Hours
YesNoNotSure lostConsciousnessFromHeadTraumaInPast24Hours
YesNoNotSure sufferedSeriousImpairmentFromOverdoseInPast24Hours
YesNoNotSure feverOf102DegreesOrMoreInPast24Hours
YesNoNotSure substanceOverdoseInPast24Hours
TreatmentNeedLevel needForMedicalOrPhysicalRehabilitation
PhysicalHealthsEffectOnSubstanceProblems physicalHealthsEffectOnSubstanceProblems
ScaleOf0To8 interviewerRatingOfPatientNeedForMedicalTreatment
Bool anyAddictionDiagnosisExceptNicotine
Let sufferedSeriousHeadInjuryAndOverdose = GetSufferedSeriousHeadInjuryAndOverdose(sufferedSeriousHeadInjury,
substanceOverdoseInPast24Hours)
Let careLevel_0_5_Score.ShowsBiomedicalStabilityOrProblemsBeingAddressed =
sufferedSeriousHeadInjuryAndOverdose And needForMedicalOrPhysicalRehabilitation <
TreatmentNeedLevel.MoreThanOneVisitPerWeek And physicalHealthsEffectOnSubstanceProblems <
PhysicalHealthsEffectOnSubstanceProblems.SomewhatDistractingFromRecovery And
interviewerRatingOfPatientNeedForMedicalTreatment < 3 And !anyAddictionDiagnosisExceptNicotine
Let careLevel_0_5_Score.IsMet = careLevel_0_5_Score.ShowsBiomedicalStabilityOrProblemsBeingAddressed
Level of Care: Outpatient Treatment (I)
Summary
None or very stable.
Level I (Outpatient Treatment) Sole Criterion
ShowsBiomedicalStabilityCanParticipateInPutpatientTreatment
The patient’s status in Dimension 2 is characterized by biomedical conditions and problems,
if any, that are sufficiently stable to permit participation in outpatient treatment. Examples
include uncomplicated pregnancy or asymptomatic HIV disease.
Original Equation
D2LI = TRUE If ASId17e=0 & [All of: ASIm6c,6d,6o,6h =0] & ASIm8b<2 & ASIm9<3
Narrative
This criterion is met if:
1)
2)
3)
4)
5)
Patient has suffered serious head injury and overdoes
Patient requires 1 to 4 visits a month for medical or nursing care or physical rehabilitation
Patient slight health problem won't interfere with involvement in recovery
Patient has health issues that require minimal medical treatment
Patient has addiction diagnosis that doesn't include nicotine
Level I (Outpatient Treatment) Placement Criterion
Original Equation
D2LI = TRUE if D2LI (Same as single rule above)
Narrative
This criterion is met if the single rule above is met.
Dimension 2: Level I Outpatient Treatment
Reference Pseudo Code
Let sufferedHeadTraumaInPast48Hours = assessment.MedicalSection.SufferedHeadTraumaInPast48Hours
Let lostConsciousnessFromHeadTraumaInPast24Hours =
assessment.MedicalSection.LostConsciousnessFromHeadTraumaInPast24Hours
Let sufferedSeriousImpairmentFromOverdoseInPast24Hours =
assessment.MedicalSection.SufferedSeriousImpairmentFromOverdoseInPast24Hours
Let feverOf102DegreesOrMoreInPast24Hours = assessment.MedicalSection.FeverOf102DegreesOrMoreInPast24Hours
Let substanceOverdoseInPast24Hours =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.SubstanceOverdoseInPast24Hours
Let needForMedicalOrPhysicalRehabilitation = assessment.MedicalSection.NeedForMedicalOrPhysicalRehabilitation
Let physicalHealthsEffectOnSubstanceProblems = assessment.MedicalSection.PhysicalHealthsEffectOnSubstanceProblems
Let interviewerRatingOfPatientNeedForMedicalTreatment =
assessment.MedicalSection.InterviewerRatingOfPatientNeedForMedicalTreatment
Let anyAddictionDiagnosisExceptNicotine = assessmentScore.DiagnosisResults.AnyAddictionDiagnosisExceptNicotine
YesNoNotSure sufferedHeadTraumaInPast48Hours
YesNoNotSure lostConsciousnessFromHeadTraumaInPast24Hours
YesNoNotSure sufferedSeriousImpairmentFromOverdoseInPast24Hours
YesNoNotSure feverOf102DegreesOrMoreInPast24Hours
YesNoNotSure substanceOverdoseInPast24Hours
TreatmentNeedLevel needForMedicalOrPhysicalRehabilitation
PhysicalHealthsEffectOnSubstanceProblems physicalHealthsEffectOnSubstanceProblems
ScaleOf0To8 interviewerRatingOfPatientNeedForMedicalTreatment
Bool anyAddictionDiagnosisExceptNicotine
Let sufferedSeriousHeadInjuryAndOverdose = GetSufferedSeriousHeadInjuryAndOverdose(sufferedSeriousHeadInjury
substanceOverdoseInPast24Hours)
Let careLevel_I_Score.ShowsBiomedicalStabilityCanParticipateInPutpatientTreatment =
sufferedSeriousHeadInjuryAndOverdose And needForMedicalOrPhysicalRehabilitation <
TreatmentNeedLevel.MoreThanOneVisitPerWeek And physicalHealthsEffectOnSubstanceProblems <
PhysicalHealthsEffectOnSubstanceProblems.SomewhatDistractingFromRecovery
And interviewerRatingOfPatientNeedForMedicalTreatment < 3 And anyAddictionDiagnosisExceptNicotine
Let careLevel_I_Score.IsMet = careLevel_I_Score.ShowsBiomedicalStabilityCanParticipateInPutpatientTreatment
Level of Care: Opiate Maintenance Therapy
Level OMT (Opioid Maintenance Therapy) Summary
None or manageable with outpatient medical monitoring.
Level IV (Opioid Maintenance Therapy) Criteria
Criterion(a)
MeetsBiomedicalCriteriaForOpiateDependenceRequiresOutpatientMonitoring
EITHER (a) The patient meets the biomedical criteria for opiate dependence, with or without the complications of opiate
addiction, and requires outpatient medical monitoring and skilled care;
Original Equation
D2LM-a = TRUE If DILIMa&b & ASIm9<7
Narrative
Criterion is met if:
1) Patient is physiologically dependent upon an opiate drug became physiologically dependent at least one year before
admission to methadone maintenance and
2) The patient's current physiological dependence is confirmed by vital signs and
3) Patient requires a minimum of 4 visits a month of medical or nursing care, physical rehabilitation and
4) Patient needs a minimal to considerable amount of medical treatment
Criterion(b)
BiomedicalProblemTreatedOutpatientMinimalDailyMonitoring
OR (b) The patient has a concurrent biomedical illness or pregnancy, which can be treated on an outpatient basis with
minimal daily medical monitoring;
Original Equation
D2LM-b = TRUE If ASId17e=0 & [All of:ASIm6c,6d,6o,6h =0] & [ASIm9<7 or ASIm3a=2]
Narrative
Criterion is met if:
1)
2)
3)
4)
Patient has suffered serious head injury and overdoes
Patient needs a minimal to considerable amount of medical treatment
Patient is pregnant
Patient requires a minimum of 4 visits a month of medical or nursing care, physical rehabilitation
Criterion(c)
HasBiomedicalProblemsManagedOutpatientSpecificDiseases
OR (c) The patient has biomedical problems that can be managed on an outpatient basis, such as: [1] liver disease or
problems with potential hepatic decompensation, [2] pancreatitis, [3] gastrointestinal problems, [4] cardiovascular
disorders, HIV and AIDS, [6] sexually transmitted diseases, and [7] tuberculosis.
Original Equation
D2LM-c = TRUE If ASId17e=0 & [All of:ASIm6c,6d,6o,6h =0] & [ASIm9<7 or ASIm3b<2] & [All of: ASIm3c,3d,6f,6g,6k,6l,6m,6n
=0 & ASIm3e=0or2]
Narrative
Criterion is met if:
1) Patient has suffered serious head injury and overdoes and
2) Patient needs a minimal to considerable amount of medical treatment or
3) Patient's pregnancy faces possible high risk such as elevated blood pressure, placenta previa or past high risk
pregnancy and
4) Patient requires a minimum of 4 visits a month of medical or nursing care or physical rehabilitation and
5) Patient does not have any sexually transmitted disease and
6) If the patient has or is thought to have HIV or AIDs, residential medical or nursing care is not required for evaluation,
follow-up or to stabilize a medication regimen and
7) Patient has not had recurrent or multiple seizures during the past 24 hours and
8) Patient has not had Delirium Tremens within the past 24-hours and
9) Patient does not have any cardiovascular problems that require inpatient cardiac monitoring and
10) Patient does not have any liver problems or disease that require inpatient treatment and
11) Patient does not have any serious risk of gastrointestinal bleeding that might require inpatient treatment and
12) Patient does not have acute pancreatitis that might I.V. inpatient treatment and
13) Patient does not have a tuberculosis infection or
14) Patient has a tuberculosis infection that is not being or has not been treated
Level IV (Medically Managed Inpatient Treatment) Placement Criteria
D2LM = TRUE if D2LM-(a OR b OR c)
Narrative
Placement criteria for Level IV are met if criteria a or b or c.
Dimension 2: Level OMT Opioid Maintenance Therapy
Pseudo Code
Let physiologicallyDependentOpiateDrugAtLeast1YearBeforeMethadoneAdmission =
assessmentScore.Dimension1WithdrawalScores.CareLevelOpioidMaintenanceTherapyScore.
PhysiologicallyDependentOpiateDrugAtLeast1YearBeforeMethadoneAdmission
Let currentPhysiologicalDependenceIsConfirmed =
assessmentScore.Dimension1WithdrawalScores.CareLevelOpioidMaintenanceTherapyScore.
CurrentPhysiologicalDependenceIsConfirmed
Let sufferedHeadTraumaInPast48Hours = assessment.MedicalSection.SufferedHeadTraumaInPast48Hours
Let lostConsciousnessFromHeadTraumaInPast24Hours =
assessment.MedicalSection.LostConsciousnessFromHeadTraumaInPast24Hours
Let sufferedSeriousImpairmentFromOverdoseInPast24Hours =
assessment.MedicalSection.SufferedSeriousImpairmentFromOverdoseInPast24Hours
Let feverOf102DegreesOrMoreInPast24Hours = assessment.MedicalSection.FeverOf102DegreesOrMoreInPast24Hours
Let substanceOverdoseInPast24Hours =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.SubstanceOverdoseInPast24Hours
Let needForMedicalOrPhysicalRehabilitation = assessment.MedicalSection.NeedForMedicalOrPhysicalRehabilitation
Let interviewerRatingOfPatientNeedForMedicalTreatment =
assessment.MedicalSection.InterviewerRatingOfPatientNeedForMedicalTreatment
Let pregnantStatus = assessment.MedicalSection.PregnantStatus
Let highRiskPregnancyStatus = assessment.MedicalSection.HighRiskPregnancyStatus
Let hivAidsMedicalTreatmentStatus = assessment.MedicalSection.HivAidsMedicalTreatmentStatus
Let sexuallyTransmittedDiseaseStatus = assessment.MedicalSection.SexuallyTransmittedDiseaseStatus
Let multipleSeizuresInPast24Hours = assessment.MedicalSection.MultipleSeizuresInPast24Hours
Let hadDeliriumTremorsInPast24Hours = assessment.DrugAndAlcoholSection.CiwaScale.HadDeliriumTremorsInPast24Hours
Let requiresInpatientCardiacMonitoring = assessment.MedicalSection.RequiresInpatientCardiacMonitoring
Let mayRequireInpatientLiverTreatment = assessment.MedicalSection.MayRequireInpatientLiverTreatment
Let mayRequireInpatientGastrointestinalBleedingTreatment =
assessment.MedicalSection.MayRequireInpatientGastrointestinalBleedingTreatment
Let mayRequireInpatientAcutePancreatitisTreatment =
assessment.MedicalSection.MayRequireInpatientAcutePancreatitisTreatment
Let tuberculosisInfectionStatus = assessment.MedicalSection.TuberculosisInfectionStatus
Let anyOpioidAddictionDiagnosis = assessmentScore.DiagnosisResults.AnyOpioidAddictionDiagnosis
Let careLevelOmtScore.MeetsBiomedicalCriteriaForOpiateDependenceRequiresOutpatientMonitoring =
physiologicallyDependentOpiateDrugAtLeast1YearBeforeMethadoneAdmission.Value And
currentPhysiologicalDependenceIsConfirmed.Value And
( needForMedicalOrPhysicalRehabilitation < TreatmentNeedLevel.Hospitalization ) And
( interviewerRatingOfPatientNeedForMedicalTreatment < 7 )
Let sufferedSeriousHeadInjury = GetSufferedSeriousHeadInjury(
sufferedHeadTraumaInPast48Hours,
lostConsciousnessFromHeadTraumaInPast24Hours,
sufferedSeriousImpairmentFromOverdoseInPast24Hours,
feverOf102DegreesOrMoreInPast24Hours )
Let sufferedSeriousHeadInjuryAndOverdose =
GetSufferedSeriousHeadInjuryAndOverdose ( sufferedSeriousHeadInjury, substanceOverdoseInPast24Hours )
Let careLevelOmtScore.BiomedicalProblemTreatedOutpatientMinimalDailyMonitoring =
sufferedSeriousHeadInjuryAndOverdose And
( ( interviewerRatingOfPatientNeedForMedicalTreatment < 7 ) Or ( pregnantStatus = YesNoNotSure.Yes ) ) And
( needForMedicalOrPhysicalRehabilitation < TreatmentNeedLevel.Hospitalization )
Let careLevelOmtScore.HasBiomedicalProblemsManagedOutpatientSpecificDiseases =
sufferedSeriousHeadInjuryAndOverdose And
( interviewerRatingOfPatientNeedForMedicalTreatment < 7 Or
highRiskPregnancyStatus < HighRiskPregnancyStatus.ImmediatelyUnstable ) And
needForMedicalOrPhysicalRehabilitation < TreatmentNeedLevel.Hospitalization And
hivAidsMedicalTreatmentStatus = YesNoNotSure.No And
sexuallyTransmittedDiseaseStatus = YesNoNotSure.No And
multipleSeizuresInPast24Hours = YesNoNotSure.No And
hadDeliriumTremorsInPast24Hours = YesNoNotSure.No And
requiresInpatientCardiacMonitoring = YesNoNotSure.No And
mayRequireInpatientLiverTreatment = YesNoNotSure.No And
mayRequireInpatientGastrointestinalBleedingTreatment = YesNoNotSure.No And
mayRequireInpatientAcutePancreatitisTreatment = YesNoNotSure.No And
( tuberculosisInfectionStatus = TuberculosisInfectionStatus.NoKnownInfection Or
tuberculosisInfectionStatus = TuberculosisInfectionStatus.KnownInfectionNotMedicallyTreated )
Let careLevelOmtScore.IsMet =
( careLevelOmtScore.MeetsBiomedicalCriteriaForOpiateDependenceRequiresOutpatientMonitoring.Value Or
careLevelOmtScore.BiomedicalProblemTreatedOutpatientMinimalDailyMonitoring.Value Or
careLevelOmtScore.HasBiomedicalProblemsManagedOutpatientSpecificDiseases.Value ) And
anyOpioidAddictionDiagnosis
return careLevelOmtScore
Level of Care: Intensive Outpatient (II.1)
Level II.1 (Intensive Outpatient) Summary
None or not a distraction from treatment. Such problems are manageable at Level II.1.
Level II.1 (Intensive Outpatient) Criteria
Criterion(a)
BiomedicalStabilityOrAddressedConcurrentlyNotInterfereTreatment
In Dimension 2, the patient's biomedical conditions and problems, if any, are stable or are being addressed concurrently
and thus will not interfere with treatment. Examples include mild pregnancy-related hypertension.
Original Equation
D2LII.1 = TRUE If [All of: ASIm6c,6d,6o,6h =0] & ASIm9<4 & ASIm8b<3
Narrative
Criterion is met if:
1. Patient shows biomedical stability and any problems will not interfere with treatment.
Level II.1 (Intensive Inpatient) Placement Criteria
D2LII.1 = TRUE if D2LII.1 (Same as single rule above)
Narrative
Placement criteria for Level II.1 are met if single rule above is met.
Dimension 2: Level II.1 Intensive Outpatient
Pseudo Code
Let sufferedHeadTraumaInPast48Hours = assessment.MedicalSection.SufferedHeadTraumaInPast48Hours
Let lostConsciousnessFromHeadTraumaInPast24Hours =
assessment.MedicalSection.LostConsciousnessFromHeadTraumaInPast24Hours
Let sufferedSeriousImpairmentFromOverdoseInPast24Hours =
assessment.MedicalSection.SufferedSeriousImpairmentFromOverdoseInPast24Hours
Let feverOf102DegreesOrMoreInPast24Hours = assessment.MedicalSection.FeverOf102DegreesOrMoreInPast24Hours
Let interviewerRatingOfPatientNeedForMedicalTreatment =
assessment.MedicalSection.InterviewerRatingOfPatientNeedForMedicalTreatment
Let needForMedicalOrPhysicalRehabilitation = assessment.MedicalSection.NeedForMedicalOrPhysicalRehabilitation
Let physicalHealthsEffectOnSubstanceProblems = assessment.MedicalSection.PhysicalHealthsEffectOnSubstanceProblems
Let sufferedSeriousHeadInjury = GetSufferedSeriousHeadInjury (
sufferedHeadTraumaInPast48Hours,
lostConsciousnessFromHeadTraumaInPast24Hours,
sufferedSeriousImpairmentFromOverdoseInPast24Hours,
feverOf102DegreesOrMoreInPast24Hours )
Let careLevel_II_1_Score.BiomedicalStabilityOrAddressedConcurrentlyNotInterfereTreatment =
sufferedSeriousHeadInjury And
interviewerRatingOfPatientNeedForMedicalTreatment < 4
And
needForMedicalOrPhysicalRehabilitation < TreatmentNeedLevel.MoreThanOneVisitPerWeek
physicalHealthsEffectOnSubstanceProblems <
PhysicalHealthsEffectOnSubstanceProblems.WillThreatenRecovery
And
Let sufferedSeriousHeadInjury = GetSufferedSeriousHeadInjury (
sufferedHeadTraumaInPast48Hours,
lostConsciousnessFromHeadTraumaInPast24Hours,
sufferedSeriousImpairmentFromOverdoseInPast24Hours,
feverOf102DegreesOrMoreInPast24Hours )
Let careLevel_II_1_Score.BiomedicalStabilityOrAddressedConcurrentlyNotInterfereTreatment =
sufferedSeriousHeadInjury And
interviewerRatingOfPatientNeedForMedicalTreatment < 4 And
needForMedicalOrPhysicalRehabilitation < TreatmentNeedLevel.MoreThanOneVisitPerWeek And
physicalHealthsEffectOnSubstanceProblems <
PhysicalHealthsEffectOnSubstanceProblems.WillThreatenRecovery
Let careLevel_II_1_Score.IsMet = careLevel_II_1_Score.BiomedicalStabilityOrAddressedConcurrentlyNotInterfereTreatment
return careLevel_II_1_Score
Level of Care: Partial Hospitalization (II.5)
Level II.5 (Partial Hospitalization) Summary
None or not sufficient to distract from treatment. Such problems are manageable at Level II.5.
Level II.5 (Partial Hospitalization) Criteria
Sole Criterion
ProblemsNotSufficientInterfereTreatmentSeverityDistractsRecovery
In Dimension 2, the patient's biomedical conditions and problems, if any, are not sufficient to interfere with treatment
but are severe enough to distract from recovery efforts. Examples include unstable hypertension requiring medication
adjustment or chronic back pain that distracts from recovery efforts.
Such problems require medical
monitoring and/or medical management, which can be provided by a Level II.5 program, either directly or through an
arrangement with another treatment provider.
Original Equation
D2LII.5 = TRUE If [All of: ASIm6c,6d,6o,6h =0] & [ASIm9<5 & ASIm8b=2or3] & [ASIm3a=0 or ASIm3b<2]
Narrative
Criterion is met if:
[All of 1 – 4] And [5 And (6a or 6b)] And [7 or 8]
1) No head trauma in past 48 hours
2) No loss of consciousness due to head trauma (not due to intoxication), in past 24 hours
3) No serious impairment of mental status, cardiac, or other function due to substance overdose in past 24 hours
4) No fever of 102F or greater in past 24 hours
5) Interviewer has rated the patient’s need for medical treatment as one of the following:
a) None
b) Minimal health issues
c) Moderate problems require close outpatient follow-up
6) Patient has rated his/her physical health status and it’s affect on recovery as one of the following:
a) Somewhat distracting from recovery
b) Some likelihood to hinder treatment/recovery participation
7) Patient is not pregnant
8) Patient is pregnant and has no immediate unstable problems that require medical monitoring
Level II.5 (Partial Hospitalization) Placement Criteria)
D2LII.5 = TRUE if D2LII.5 (Same as single rule above)
Dimension 2: Level II.5 Partial Hospitalization
Let
Let
sufferedHeadTraumaInPast48Hours = assessment.MedicalSection.SufferedHeadTraumaInPast48Hours
lostConsciousnessFromHeadTraumaInPast24Hours =
assessment.MedicalSection.LostConsciousnessFromHeadTraumaInPast24Hours
Let sufferedSeriousImpairmentFromOverdoseInPast24Hours =
assessment.MedicalSection.SufferedSeriousImpairmentFromOverdoseInPast24Hours
Let feverOf102DegreesOrMoreInPast24Hours = assessment.MedicalSection.FeverOf102DegreesOrMoreInPast24Hours
Let interviewerRatingOfPatientNeedForMedicalTreatment =
assessment.MedicalSection.InterviewerRatingOfPatientNeedForMedicalTreatment
Let needForMedicalOrPhysicalRehabilitation = assessment.MedicalSection.NeedForMedicalOrPhysicalRehabilitation
Let physicalHealthsEffectOnSubstanceProblems = assessment.MedicalSection.PhysicalHealthsEffectOnSubstanceProblems
Let pregnantStatus = assessment.MedicalSection.PregnantStatus
Let highRiskPregnancyStatus = assessment.MedicalSection.HighRiskPregnancyStatus
Let careLevel_II_5_Score = new CareLevel_II_5_PartialHospitalizationScore()
Let sufferedSeriousHeadInjury = GetSufferedSeriousHeadInjury(
sufferedHeadTraumaInPast48Hours,
lostConsciousnessFromHeadTraumaInPast24Hours,
sufferedSeriousImpairmentFromOverdoseInPast24Hours,
feverOf102DegreesOrMoreInPast24Hours)
Let careLevel_II_5_Score.ProblemsNotSufficientInterfereTreatmentSeverityDistractsRecovery =
sufferedSeriousHeadInjury And
interviewerRatingOfPatientNeedForMedicalTreatment < 5 And
needForMedicalOrPhysicalRehabilitation < TreatmentNeedLevel.Hospitalization And
physicalHealthsEffectOnSubstanceProblems <
PhysicalHealthsEffectOnSubstanceProblems.WillThreatenRecovery And
( pregnantStatus = YesNoNotSure.No Or
highRiskPregnancyStatus < HighRiskPregnancyStatus.ImmediatelyUnstable )
Let careLevel_II_5_Score.IsMet = careLevel_II_5_Score.ProblemsNotSufficientInterfereTreatmentSeverityDistractsRecovery
return careLevel_II_5_Score
Level of Care: Clinically Managed Low-Intensity Residential Services (III.1)
Level III.1 (Clinically Managed Low-Intensity Residential Services) Summary
None or stable, or the patient is receiving concurrent medical monitoring.
Level III.1 (Clinically Managed Low-Intensity Residential Services) Criteria
Criterion(a)
BiomedicalStabilityNoMedicalNurseMonitoring
EITHER (a) Biomedical problems, if any, are stable and do not require medical or nurse monitoring, and the resident is
capable of self-administering any prescribed medications
Original Equation
D2LIII.1/.3/.5-a = TRUE If [All of: ASIm6c,6d,6o,6h =0] & [ASIm9<4 & ASIm8a < 4] & [Post6=1 OR Post6=9]
Narrative
Criterion is met if:
[All of 1 – 4] And [5 And 6] And [7 Or 8]
1) No head trauma in past 48 hours
2) No loss of consciousness due to head trauma (not due to intoxication), in past 24 hours
3) No serious impairment of mental status, cardiac, or other function due to substance overdose in past 24 hours
4) No fever of 102F or greater in past 24 hours
5) Interviewer has rated the patient’s need for medical treatment as one of the following:
a) None
b) Minimal Health Problems
6) Patient rates his/her need for medical or nursing care as one of the following:
a) None
b) 1 visit per month
c) 2 to 4 visits per month
d) More than 1 visit per week
7) Patient is willing and able to self-administer medication as prescribed and with good compliance
8) The ability to self-administer medication is not applicable to patient
Criterion(b)
BiomedicalSeverityNotWarrantInpatientTreatmentSufficientDistractRecovery
OR (b) A current biomedical condition is not severe enough to warrant inpatient treatment but is sufficient to distract
from treatment or recovery efforts. The problem requires medical monitoring, which can be provided by the program or
through an established arrangement with another provider.
Original Equation
D2LIII.1/.3/.5-b = TRUE If [All of: ASIm6c,6d,6o,6h =0] & [ASIm9=3to4 & ASIm8a < 4 & ASIm8b>1]
Narrative
Criterion is met if:
[All of 1 – 4] And [5 And 6 And 7]
1) No head trauma in past 48 hours
2) No loss of consciousness due to head trauma (not due to intoxication), in past 24 hours
3) No serious impairment of mental status, cardiac, or other function due to substance overdose in past 24 hours
4) No fever of 102F or greater in past 24 hours
5) Interviewer has rated the patient’s need for medical treatment as moderate, and believes the patient requires close
outpatient follow-up
6) Patient rates his/her need for medical or nursing care as one of the following:
a) None
b) 1 visit per month
c) 2 to 4 visits per month
d) More than 1 visit per week
7) Patient has rated his/her physical health status and it’s affect on recovery as one of the following:
a) Somewhat distracting from recovery
b) Some likelihood to hinder treatment/recovery participation
c) Some likelihood to hinder treatment/recovery participation
d) Will threaten recovery
Criterion(bio)
BiomedicalProblemWarrantsEnhancedStaffAttention
Biomedical Enhanced Services The resident who has a biomedical problem that requires a degree of staff attention
(such as monitoring of medications or assistance with mobility) that is not available in other Level III.1 programs is in
need of Biomedical Enhanced services.
Original Equation
D2LIII.1/.3/.5-bio = TRUE If Post6=0 OR ASIm3d=2 OR ASIm6i>0 OR ASIm6j>0
Narrative
Criterion is met if:
[1 Or 2 Or 3 Or 4] ]
1) Patient is neither willing nor able to self-administer medication as prescribed and with good compliance
2) Patient has or is thought to have HIV or AIDS, is residential medical or nursing care required for evaluation, followup or to stabilize a medication regimen
3) Patient has (or could possibly have) unsteadiness on his/her feet, problems with walking or balance, such that
he/she could easily fall or have trouble getting around or using stairs
4) Patient has (or could possibly have) problems with ambulation or mobility that would make it difficult to attend
treatment
Level III.1 (Clinically Managed Low-Intensity Residential Services) Placement Criteria
D2LIII.1 = TRUE if D2LIII.1/.3/.5-(a OR b)
Narrative
Placement criteria for Level III.1 are met if criterion a Or b is met.
Dimension 2: Level III.1 Clinically Managed Low-Intensity Residential Services
Pseudo Code
Let sufferedHeadTraumaInPast48Hours = assessment.MedicalSection.SufferedHeadTraumaInPast48Hours
Let lostConsciousnessFromHeadTraumaInPast24Hours =
assessment.MedicalSection.LostConsciousnessFromHeadTraumaInPast24Hours
Let sufferedSeriousImpairmentFromOverdoseInPast24Hours =
assessment.MedicalSection.SufferedSeriousImpairmentFromOverdoseInPast24Hours
Let feverOf102DegreesOrMoreInPast24Hours = assessment.MedicalSection.FeverOf102DegreesOrMoreInPast24Hours
Let interviewerRatingOfPatientNeedForMedicalTreatment =
assessment.MedicalSection.InterviewerRatingOfPatientNeedForMedicalTreatment
Let needForMedicalOrPhysicalRehabilitation = assessment.MedicalSection.NeedForMedicalOrPhysicalRehabilitation
Let isAbleToSelfAdministerMedication = assessment.CompletionSection.IsAbleToSelfAdministerMedication
Let physicalHealthsEffectOnSubstanceProblems = assessment.MedicalSection.PhysicalHealthsEffectOnSubstanceProblems
Let sexuallyTransmittedDiseaseStatus = assessment.MedicalSection.SexuallyTransmittedDiseaseStatus
Let unsteadinessOrLossOfBalance = assessment.MedicalSection.UnsteadinessOrLossOfBalance
Let mobilityProblemsMayAffectTreatmentAttendance =
assessment.MedicalSection.MobilityProblemsMayAffectTreatmentAttendance
Let sufferedSeriousHeadInjury = GetSufferedSeriousHeadInjury
( sufferedHeadTraumaInPast48Hours,
lostConsciousnessFromHeadTraumaInPast24Hours,
sufferedSeriousImpairmentFromOverdoseInPast24Hours,
feverOf102DegreesOrMoreInPast24Hours )
Let careLevel_III_1_Score.BiomedicalStabilityNoMedicalNurseMonitoring =
sufferedSeriousHeadInjury And interviewerRatingOfPatientNeedForMedicalTreatment < 4
needForMedicalOrPhysicalRehabilitation < TreatmentNeedLevel.Hospitalization And
( isAbleToSelfAdministerMedication = YesNoNotApplicable.Yes Or
isAbleToSelfAdministerMedication = YesNoNotApplicable.NotApplicable )
And
Let careLevel_III_1_Score.BiomedicalSeverityNotWarrantInpatientTreatmentSufficientDistractRecovery =
sufferedSeriousHeadInjury And
interviewerRatingOfPatientNeedForMedicalTreatment >= 3 And
interviewerRatingOfPatientNeedForMedicalTreatment <= 4 And
needForMedicalOrPhysicalRehabilitation < TreatmentNeedLevel.Hospitalization And
physicalHealthsEffectOnSubstanceProblems >
PhysicalHealthsEffectOnSubstanceProblems.SlightProblemsWontInterfereWithRecovery
Let careLevel_III_1_Score.BiomedicalProblemWarrantsEnhancedStaffAttention =
isAbleToSelfAdministerMedication = YesNoNotApplicable.No Or
sexuallyTransmittedDiseaseStatus > YesNoNotSure.No Or
unsteadinessOrLossOfBalance > YesNoNotSure.No Or
mobilityProblemsMayAffectTreatmentAttendance > YesNoNotSure.No
Let careLevel_III_1_Score.IsMet =
careLevel_III_1_Score.BiomedicalStabilityNoMedicalNurseMonitoring.Value Or
careLevel_III_1_Score.BiomedicalSeverityNotWarrantInpatientTreatmentSufficientDistractRecovery.Value
Let careLevel_III_1_Score.IsMetDim2Level3LowIntensity =
careLevel_III_1_Score.IsMet.Value And
careLevel_III_1_Score.BiomedicalProblemWarrantsEnhancedStaffAttention.Value
return careLevel_III_1_Score
Level of Care: Clinically Managed Medium-Intensity Residential Services (III.3)
Level III.3 (Clinically Managed Medium-Intensity Residential Services) Summary
None or stable, or the patient is receiving concurrent medical monitoring.
Level III.3 (Clinically Managed Medium-Intensity Residential Services) Criteria
Criterion(a)
BiomedicalNotWarrantMedicalNurseMonitoringSelfAdministerMeds
EITHER (a) Biomedical problems, if any, are stable and do not require medical or nurse monitoring, and the resident is
capable of self-administering any prescribed medications
Original Equation
D2LIII.1/.3/.5-a = TRUE If [All of: ASIm6c,6d,6o,6h =0] & [ASIm9<4 & ASIm8a < 4] & [Post6=1 OR Post6=9]
Narrative
Criterion is met if:
[All of 1 – 4] And [ 5 And 6 ] And [7 Or 8]
1) No head trauma in past 48 hours
2) No loss of consciousness due to head trauma (not due to intoxication), in past 24 hours
3) No serious impairment of mental status, cardiac, or other function due to substance overdose in past 24 hours
4) No fever of 102F or greater in past 24 hours
5) Interviewer has rated the patient’s need for medical treatment as one of the following:
a) None
b) Minimal Health Problems
6) Patient rates his/her need for medical or nursing care as one of the following:
a) None
b) 1 visit per month
c) 2 to 4 visits per month
d) More than 1 visit per week
7) Patient is willing and able to self-administer medication as prescribed and with good compliance
8) The ability to self-administer medication is not applicable to patient
Criterion(b)
BiomedicalNotWarrantInpatientTreatmentButRequiresMedicalMirt
OR (b) A current biomedical condition is not severe enough to warrant inpatient treatment but is sufficient to distract
from treatment or recovery efforts. The problem requires medical monitoring, which can be provided by the program or
through an established arrangement with another provider.
Original Equation
D2LIII.1/.3/.5-b = TRUE If [All of: ASIm6c,6d,6o,6h =0] & [ASIm9=3to4 & ASIm8a < 4 & ASIm8b>1]
Narrative
Criterion a is met if:
1) No head trauma in past 48 hours
2) No loss of consciousness due to head trauma (not due to intoxication), in past 24 hours
3) No serious impairment of mental status, cardiac, or other function due to substance overdose in past 24 hours
4) No fever of 102F or greater in past 24 hours
5) Interviewer has rated the patient’s need for medical treatment as moderate, and believes the patient requires close
outpatient follow-up
6) Patient rates his/her need for medical or nursing care as one of the following:
a) None
b) 1 visit per month
c) 2 to 4 visits per month
d) More than 1 visit per week
7) Patient has rated his/her physical health status and it’s affect on recovery as one of the following:
a) Somewhat distracting from recovery
b) Some likelihood to hinder treatment/recovery participation
c) Some likelihood to hinder treatment/recovery participation
d) Will threaten recovery
Criterion(bio)
BiomedicalProblemRequiresEnhancedStaffAttentionMonitoringMeds
Biomedical Enhanced Services The resident who has a biomedical problem that requires a degree of staff attention
(such as monitoring of medications or assistance with mobility) that is not available in other Level III.3 programs is in
need of Biomedical Enhanced services.
Original Equation
D2LIII.1/.3/.5-bio = TRUE If Post6=0 OR ASIm3d=2 OR ASIm6i>0 OR ASIm6j>0]
Narrative
Criterion a is met if:
[1 Or 2 Or 3 Or 4]
1) Patient is not able to self-administer medication as prescribed and in good compliance
2) Patient has HIV or AIDS, is residential medical or nursing care required for evaluation, follow-up or to stabilize a
medication regimen
3) Patient has (or could possibly have) unsteadiness on his/her feet, problems with walking or balance, such that
he/she could easily fall or have trouble getting around or using stairs
4) Patient has (or could possibly have) problems with ambulation or mobility that would make it difficult to attend
treatment
Level III.3 (Clinically Managed Medium-Intensity Residential Services) Placement Criteria
D2LIII.3 = TRUE if D2LIII.1/.3/.5-(a OR b)
Narrative
Placement criteria for Level III.3 are met if criterion a Or b is met.
Dimension 2: Level III.3 Clinically Managed Medium-Intensity Residential Services
Pseudo Code
Let d2LIII_1_a =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
BiomedicalStabilityNoMedicalNurseMonitoring
Let d2LIII_1_b =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
BiomedicalSeverityNotWarrantInpatientTreatmentSufficientDistractRecovery
Let d2LIII_1_bio =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
BiomedicalProblemWarrantsEnhancedStaffAttention
Let d2LIII_1_IsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
IsMet
Let d2LIII_1_IsMetBio =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
IsMetDim2Level3LowIntensity
Let careLevel_III_3_Score = new CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore
{
BiomedicalNotWarrantMedicalNurseMonitoringSelfAdministerMeds = d2LIII_1_a,
BiomedicalNotWarrantInpatientTreatmentButRequiresMedicalMirt = d2LIII_1_b,
BiomedicalProblemRequiresEnhancedStaffAttentionMonitoringMeds = d2LIII_1_bio,
IsMet = d2LIII_1_IsMet,
IsMetDim2Level3ModerateIntensity = d2LIII_1_IsMetBio
}
return careLevel_III_3_Score
Level of Care: Clinically Managed High-Intensity Residential Treatment (III.5)
Level III.5 (Clinically Managed High-Intensity Residential Services) Summary
None or stable, or the patient is receiving concurrent medical monitoring.
Level III.5 (Clinically Managed High-Intensity Residential Services) Criteria
Criterion(a)
BiomedicalStabilityNotRequire24HourMedicalNurse
EITHER (a) Biomedical problems, if any, are stable and do not require 24-hour medical or nurse monitoring, and the
resident is capable of self-administering any prescribed medications
Original Equation
D2LIII.1/.3/.5-a = TRUE If [All of: ASIm6c,6d,6o,6h =0] & [ASIm9<4 & ASIm8a < 4] & [Post6=1 OR Post6=9]
Narrative
Criterion is met if:
[All of 1 – 4] And [ 5 And 6 ] And [7 Or 8]
1) No head trauma in past 48 hours
2) No loss of consciousness due to head trauma (not due to intoxication), in past 24 hours
3) No serious impairment of mental status, cardiac, or other function due to substance overdose in past 24 hours
4) No fever of 102F or greater in past 24 hours
5) Interviewer has rated the patient’s need for medical treatment as mild or moderate, and believes the patient
requires close outpatient follow-up
6) Patient rates his/her need for medical or nursing care as one of the following:
a) None
b) 1 visit per month
c) 2 to 4 visits per month
d) More than 1 visit per week
7)
Patient is willing and able to self-administer medication as prescribed and with good compliance
8) The ability to self-administer medication is not applicable to patient
Criterion(b)
BiomedicalNotWarrantInpatientTreatmentButRequiresMedicalHirt
OR (b) A current biomedical condition is not severe enough to warrant inpatient treatment but is sufficient to distract
from treatment or recovery efforts. The problem requires medical monitoring, which can be provided by the program or
through an established arrangement with another provider.
Original Equation
D2LIII.1/.3/.5-b = TRUE If [All of: ASIm6c,6d,6o,6h =0] & [ASIm9=3to4 & ASIm8a < 4 & ASIm8b>1]
Narrative
Criterion is met if:
[All of 1 – 4] And [ 5 And 6 ] And [7 Andr 8]
1) No head trauma in past 48 hours
2) No loss of consciousness due to head trauma (not due to intoxication), in past 24 hours
3) No serious impairment of mental status, cardiac, or other function due to substance overdose in past 24 hours
4) No fever of 102F or greater in past 24 hours
5) Interviewer has rated the patient’s need for medical treatment as moderate, and believes the patient requires close
outpatient follow-up
6) Patient rates his/her need for medical or nursing care as one of the following:
a) None
b) 1 visit per month
c) 2 to 4 visits per month
d) More than 1 visit per week
7) Patient believes his physical has the potential to hinder recovery efforts
Criterion(bio)
RequiresDegreeStaffAttentionNotAvailableInOtherLevel5Programs
Biomedical Enhanced Services The resident who has a biomedical problem that requires a degree of staff attention
(such as monitoring of medications or assistance with mobility) that is not available in other Level III.5 programs is in
need of Biomedical Enhanced services.
Original Equation
D2LIII.1/.3/.5-bio = TRUE If Post6=0 OR ASIm3d=2 OR ASIm6i>0 OR ASIm6j>0]
Narrative
Criterion is met if:
Level III.5 (Clinically Managed High-Intensity Residential Services) Placement Criteria
D2LIII.5 = TRUE if D2LIII.1/.3/.5-(a OR b)
Narrative
Placement criteria for Level III.5 are met if criterion a Or b is met.
BIO Criteria
D2LIII.5-bio = TRUE if D2LIII.1/.3/.5-(a OR b) & D2LIII.1/.3/.5-bio
Narrative
Biomedical criteria are met if:
[1 Or 2 And 3]
1) The interaction of the patient's biomedical condition and continued alcohol or other drug use places the patient in
imminent danger of serious damage to physical health or
2) The patient's current biomedical condition requires medical monitoring or active treatment but not the full
resources of an acute care hospital and
3) Patient's biomedical problem that requires a degree of staff attention that is not available in other III.7 programs is
in need of biomedical Enhanced services
Dimension 2: Level III.5 Clinically Managed High-Intensity Residential Services
Pseudo Code
Let d2LIII_1_a =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
BiomedicalStabilityNoMedicalNurseMonitoring
Let d2LIII_1_b =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
BiomedicalSeverityNotWarrantInpatientTreatmentSufficientDistractRecovery
Let d2LIII_1_bio =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
BiomedicalProblemWarrantsEnhancedStaffAttention
Let d2LIII_1_IsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
IsMet
Let d2LIII_1_IsMetBio =
assessmentScore.Dimension2BiomedicalScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
IsMetDim2Level3LowIntensity
internal CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore
CalculateCareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore (
bool? d2LIII_1_a,
bool? d2LIII_1_b,
bool? d2LIII_1_bio,
bool? d2LIII_1_IsMet,
bool? d2LIII_1_IsMetBio )
Let careLevel_III_5_Score = new CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore
{
BiomedicalStabilityNotRequire24HourMedicalNurse = d2LIII_1_a,
BiomedicalNotWarrantInpatientTreatmentButRequiresMedicalHirt = d2LIII_1_b,
RequiresDegreeStaffAttentionNotAvailableInOtherLevel5Programs = d2LIII_1_bio,
IsMet = d2LIII_1_IsMet,
IsMetDim2Level3HighIntensity = d2LIII_1_IsMetBio
}
return careLevel_III_5_Score
Level of Care: Medically Monitored Intensive Inpatient Treatment (III.7)
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Summary
The patient requires 24-hour medical monitoring but not intensive treatment.
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Criteria
Criterion(a)
InteractionOfDrugAlcoholAndBiomedicalSeriousDamageToPhysicalHealth
EITHER (a) The interaction of the patient’s biomedical condition and continued alcohol or other drug use places the
patient in imminent danger of serious damage to physical health or concomitant biomedical conditions (such as
pregnancy with vaginal bleeding or ruptured membranes)
Original Equation
D2LIII.7-a = TRUE If [ASIm9=5or6 or ASIm3b=1 or ASIm4c=2] & ASIm6s>0
Narrative
Criterion is met if:
1)
2)
3)
4)
Patient has a considerable need for medical treatment or
Pregnancy involves possible high risk such as elevated blood pressure, placenta previa or past high risk pregnancy or
Patient has medical problem and/or requires medication that would pose a potential danger during detoxification or
Patient's use of substances is likely to cause a severely dangerous exacerbation of a medical condition
Criterion(b)
BiomedicalRequiresMedicalMonitoringNotFullResourcesOfAcuteHospital
OR b) A current biomedical condition requires medical monitoring or active treatment but not the full resources of an
acute care hospital.
Original Equation
D2LIII.7-b = TRUE If ASIm9>5or6
Narrative
Criterion is met if:
1) Patient has a considerable need for medical treatment
2) Patient requires a minimum of 1 visit per week for medical or nursing care or physical rehabilitation
Criterion(bio)
RequiresDegreeStaffAttentionNotAvailableInOtherLevel7Programs
Biomedical Enhanced Services The resident who has a biomedical problem that requires a degree of staff attention
(such as monitoring of medications or assistance with mobility) that is not available in other Level III.7 programs is in
need of Biomedical Enhanced services.
Original Equation
D2LIII.7-bio-a = TRUE If ASIm4c=1 OR Post6=2or3 OR ASIm6i>0 OR ASIm6j>0]
Narrative
Criterion is met if:
1) Not sure of patient has any medical problem or require medication that would pose a potential danger during
detoxification or
2) If any medication are being or will be prescribe, the patient is not will or able to self- administer these with good
compliance or
3) Patient is experiencing unsteadiness on his or her feet, problems with walking and/or balance or
4) Patient has problems with ambulation and/or mobility that would make it difficult to attend treatment
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Placement Criteria
D2LIII.7 = TRUE if D2LIII.7-(a OR b)
Narrative
Placement criteria for Level III.3 are met if criterion a Or b is met.
BIO Criteria
D2LIII.7-bio = TRUE if D2LIII.7-(a OR b) & D2LIII.7-bio-a
Narrative
Biomedical criteria are met if:
4) The interaction of the patient's biomedical condition and continued alcohol or other drug use places the patient in
imminent danger of serious damage to physical health or
5) The patient's current biomedical condition requires medical monitoring or active treatment but not the full
resources of an acute care hospital and
6) Patient's biomedical problem that requires a degree of staff attention that is not available in other III.7 programs is
in need of biomedical Enhanced services
Dimension 2: Level III.7 Medically Monitored Intensive Inpatient Treatment
Pseudo Code
Let interviewerRatingOfPatientNeedForMedicalTreatment =
assessment.MedicalSection.InterviewerRatingOfPatientNeedForMedicalTreatment
Let highRiskPregnancyStatus = assessment.MedicalSection.HighRiskPregnancyStatus
Let medicalProblemThatWouldComplicateDetoxificationStatus =
assessment.MedicalSection.MedicalProblemThatWouldComplicateDetoxificationStatus
Let medicalConditionExacerbatedByContinuedSubstanceUse =
assessment.CompletionSection.MedicalConditionExacerbatedByContinuedSubstanceUse
Let needForMedicalOrPhysicalRehabilitation = assessment.MedicalSection.NeedForMedicalOrPhysicalRehabilitation
Let isAbleToSelfAdministerMedication = assessment.CompletionSection.IsAbleToSelfAdministerMedication
Let unsteadinessOrLossOfBalance = assessment.MedicalSection.UnsteadinessOrLossOfBalance
Let mobilityProblemsMayAffectTreatmentAttendance =
assessment.MedicalSection.MobilityProblemsMayAffectTreatmentAttendance
Let careLevel_III_7_score.InteractionOfDrugAlcoholAndBiomedicalSeriousDamageToPhysicalHealth =
( interviewerRatingOfPatientNeedForMedicalTreatment >= 5 And
interviewerRatingOfPatientNeedForMedicalTreatment <= 6 ) Or
highRiskPregnancyStatus = HighRiskPregnancyStatus.PossibleHighRisk Or
medicalProblemThatWouldComplicateDetoxificationStatus = YesNoNotSure.Yes Or
medicalConditionExacerbatedByContinuedSubstanceUse = YesNoNotSure.Yes
Let careLevel_III_7_score.BiomedicalRequiresMedicalMonitoringNotFullResourcesOfAcuteHospital =
interviewerRatingOfPatientNeedForMedicalTreatment >= 5 And
interviewerRatingOfPatientNeedForMedicalTreatment <= 6 And
needForMedicalOrPhysicalRehabilitation = TreatmentNeedLevel.MoreThanOneVisitPerWeek
Let careLevel_III_7_score.RequiresDegreeStaffAttentionNotAvailableInOtherLevel7Programs =
medicalProblemThatWouldComplicateDetoxificationStatus = YesNoNotSure.NotSure Or
isAbleToSelfAdministerMedication = YesNoNotApplicable.No Or
unsteadinessOrLossOfBalance > YesNoNotSure.No Or
mobilityProblemsMayAffectTreatmentAttendance > YesNoNotSure.NotSure
Let careLevel_III_7_score.IsMet =
careLevel_III_7_score.InteractionOfDrugAlcoholAndBiomedicalSeriousDamageToPhysicalHealth.Value Or
careLevel_III_7_score.BiomedicalRequiresMedicalMonitoringNotFullResourcesOfAcuteHospital.Value
Let careLevel_III_7_score.IsMetDim2Level3MedicalMonitoring =
careLevel_III_7_score.IsMet.Value And
careLevel_III_7_score.RequiresDegreeStaffAttentionNotAvailableInOtherLevel7Programs.Value
return careLevel_III_7_score
Level of Care: Medically Managed Inpatient Treatment (IV)
Level IV (Medically Managed Inpatient Treatment) Summary
The patient requires 24-hour medical and nursing care and the full resources of a licensed hospital.
Level IV (Medically Managed Inpatient Treatment) Criteria
Criteria(ab)
BiomedicalComplicationsAddictiveDisorderRequiresMedicalManagement
EITHER (a) Biomedical complications of the addictive disorder require medical management and skilled nursing care OR
(b) A concurrent biomedical illness or pregnancy requires stabilization and daily medical management, with daily
primary nursing interventions
Original Equation
D2LIV-ab = TRUE If ASIm9>6 OR ASIm8a=4 OR ASIm3b=2 OR ASIm4c=2
Narrative
Criteria are met if:
1) Patient has severe to acute life-threatening health problem that may require physician's change in medical plan at
any time or
2) Patient requires hospitalization or
3) Pregnancy involves high risk such as elevated blood pressure, placenta previa or past high risk pregnancy or
4) Patient has medical problem and/or requires medication that would pose a potential danger during detoxification
Criteria(c-j)
ContinuedUseSeriousDamageToPhysicalHealthOr24HourObservation
OR (c) The patient has a concurrent biomedical condition(s) in which continued alcohol or other drug use presents an
imminent danger to life or severe danger to health (including pregnancy) OR (d) The patient is experiencing recurrent or
multiple seizures OR (e) The patient is experiencing a disulfiram-alcohol reaction OR (f) The patient has life-threatening
symptoms (such as stupor, convulsions, and the like) that are related to use of alcohol or other drugs
OR (g) The patient’s alcohol or other drug use are gravely complicating or exacerbating a previously diagnosed medical
condition OR (h) Changes in the patient’s medical status, such as significant worsening of a medical condition, make
abstinence imperative
OR (i) Significant improvement in a previously unstable medical condition allows the patient to respond to addiction
treatment OR (j) The patient has another biomedical problem(s) that requires 24-hour observation and evaluation.
Original Equation
D2LIV-cj = TRUE If Any of: ASIm4a,6b,6c,6d,6f,6g,6k,6l,6m,6n,6o,6p,6r,6s,6v =2
Narrative
Criteria are met if:
1)
2)
3)
4)
Patient has experienced an acute alcolhol-disulfiram reaction during the past 24 hours
Patient shows symptoms and/or sign of toxic psychosis
Patient has had Delirium Tremens with the past 24-hours
Patient has liver problems or disease that is so serious and worsening to the point that he or she might require
inpatient treatment
5) Patient has suffered a serious impairment of mental status, cardiac and/or other vital function due to substance
overdose in the past 24 hours.
6) Patient shows signs and symptoms of both serious withdrawal and biomedical condition(s).
Level IV (Medically Managed Inpatient Treatment) Placement Criteria
D2LIV = TRUE if D2LIV-(ab OR cj)
Narrative
Placement criteria for Level IV are met if criteria a or b Or any of c through j.
Dimension 2: Level IV Medically Managed Inpatient Treatment
Pseudo Code
Let needForMedicalOrPhysicalRehabilitation = assessment.MedicalSection.NeedForMedicalOrPhysicalRehabilitation
Let interviewerRatingOfPatientNeedForMedicalTreatment =
assessment.MedicalSection.InterviewerRatingOfPatientNeedForMedicalTreatment
Let highRiskPregnancyStatus = assessment.MedicalSection.HighRiskPregnancyStatus
Let medicalProblemThatWouldComplicateDetoxificationStatus =
assessment.MedicalSection.MedicalProblemThatWouldComplicateDetoxificationStatus
Let hasAlcoholImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasAlcoholImminentWithdrawalPotential
Let hasHeroinImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasHeroinImminentWithdrawalPotential
Let hasMethadoneImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasMethadoneImminentWithdrawalPotential
Let hasOtherOpiateImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasOtherOpiateImminentWithdrawalPotential
Let hasBarbiturateImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasBarbiturateImminentWithdrawalPotential
Let hasOtherSedativeHypnoticImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasOtherSedativeHypnoticImminentWithdrawalPotential
Let hasCocaineImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasCocaineImminentWithdrawalPotential
Let hasStimulantImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasStimulantImminentWithdrawalPotential
Let sufferedHeadTraumaInPast48Hours = assessment.MedicalSection.SufferedHeadTraumaInPast48Hours
Let lostConsciousnessFromHeadTraumaInPast24Hours =
assessment.MedicalSection.LostConsciousnessFromHeadTraumaInPast24Hours
Let multipleSeizuresInPast24Hours = assessment.MedicalSection.MultipleSeizuresInPast24Hours
Let requiresInpatientCardiacMonitoring = assessment.MedicalSection.RequiresInpatientCardiacMonitoring
Let mayRequireInpatientGastrointestinalBleedingTreatment =
assessment.MedicalSection.MayRequireInpatientGastrointestinalBleedingTreatment
Let mayRequireInpatientAcutePancreatitisTreatment =
assessment.MedicalSection.MayRequireInpatientAcutePancreatitisTreatment
Let symptomsLifeThreateningBecauseOfSubstanceUse =
assessment.CompletionSection.SymptomsLifeThreateningBecauseOfSubstanceUse
Let medicalConditionExacerbatedByContinuedSubstanceUse =
assessment.CompletionSection.MedicalConditionExacerbatedByContinuedSubstanceUse
Let experiencedAcuteAlcoholDisulfiramReactionInPast24HoursStatus =
assessment.MedicalSection.ExperiencedAcuteAlcoholDisulfiramReactionInPast24HoursStatus
Let signsOfToxicPsychosisExist = assessment.MedicalSection.SignsOfToxicPsychosisExist
Let hadDeliriumTremorsInPast24Hours = assessment.DrugAndAlcoholSection.CiwaScale.HadDeliriumTremorsInPast24Hours
Let mayRequireInpatientLiverTreatment = assessment.MedicalSection.MayRequireInpatientLiverTreatment
Let sufferedSeriousImpairmentFromOverdoseInPast24Hours =
assessment.MedicalSection.SufferedSeriousImpairmentFromOverdoseInPast24Hours
Let careLevel_IV_Score.BiomedicalComplicationsAddictiveDisorderRequiresMedicalManagement =
( interviewerRatingOfPatientNeedForMedicalTreatment >= 7 And
interviewerRatingOfPatientNeedForMedicalTreatment <= 9 ) Or
needForMedicalOrPhysicalRehabilitation = TreatmentNeedLevel.Hospitalization Or
highRiskPregnancyStatus = HighRiskPregnancyStatus.ImmediatelyUnstable Or
medicalProblemThatWouldComplicateDetoxificationStatus = YesNoNotSure.Yes
Let imminentDangerWithdraw =
hasAlcoholImminentWithdrawalPotential.Value Or
hasHeroinImminentWithdrawalPotential.Value Or
hasMethadoneImminentWithdrawalPotential.Value Or
hasOtherOpiateImminentWithdrawalPotential.Value Or
hasBarbiturateImminentWithdrawalPotential.Value Or
hasOtherSedativeHypnoticImminentWithdrawalPotential.Value Or
hasCocaineImminentWithdrawalPotential.Value Or
hasStimulantImminentWithdrawalPotential.Value
Let seriousSymptoms =
sufferedHeadTraumaInPast48Hours = YesNoNotSure.Yes Or
lostConsciousnessFromHeadTraumaInPast24Hours = YesNoNotSure.Yes Or
multipleSeizuresInPast24Hours = YesNoNotSure.Yes Or
requiresInpatientCardiacMonitoring = YesNoNotSure.Yes Or
mayRequireInpatientGastrointestinalBleedingTreatment = YesNoNotSure.Yes Or
mayRequireInpatientAcutePancreatitisTreatment = YesNoNotSure.Yes Or
symptomsLifeThreateningBecauseOfSubstanceUse = YesNoNotSure.Yes Or
medicalConditionExacerbatedByContinuedSubstanceUse = YesNoNotSure.Yes
careLevel_IV_Score.ContinuedUseSeriousDamageToPhysicalHealthOr24HourObservation =
experiencedAcuteAlcoholDisulfiramReactionInPast24HoursStatus = YesNoNotSure.Yes Or
signsOfToxicPsychosisExist = YesNoNotSure.Yes Or
hadDeliriumTremorsInPast24Hours = YesNoNotSure.Yes Or
mayRequireInpatientLiverTreatment = YesNoNotSure.Yes Or
sufferedSeriousImpairmentFromOverdoseInPast24Hours = YesNoNotSure.Yes Or
( seriousSymptoms And imminentDangerWithdraw )
Let careLevel_IV_Score.IsMet =
careLevel_IV_Score.BiomedicalComplicationsAddictiveDisorderRequiresMedicalManagement.Value Or
careLevel_IV_Score.ContinuedUseSeriousDamageToPhysicalHealthOr24HourObservation.Value
return careLevel_IV_Score
Dimension 3: Emotional, Behavioral or Cognitive Conditions and Complications
Level of Care: Dual Diagnosis Enhanced Outpatient Treatment (I)
Level I (Dual Diagnosis Enhanced Outpatient Treatment) Summary
Level I (Dual Diagnosis Enhanced Outpatient Treatment) Criteria
Criterion (DDE-a)
HasSevereMentalDisorderAndAbilityToAccessServices
The patient has a severe and persistent mental illness that impairs his or her ability to follow through consistently with
mental health appointments and psychotropic medication. However, the patient has the ability to access services such
as assertive community treatment and intensive case management or supportive living designed to help the patient
remain engaged in treatment.
Original Equation
D3LIdde-a = TRUE If ASIp: 20a>0 & [p20c=2 or p20d=2]
Narrative
Criterion (DDE-a) is met if:
1 And [2 Or 3]
1) The interviewer believes the patient's current behavior as inconsistent with reliable self-care, safety, or ability to
participate in treatment.
2) The interviewer believes the patient will require treatment modalities that require a 24-hour controlled, supervised
environment,
3) Psychiatric evaluation and treatment services are accessible to the patient PRN.
Criterion (DDE-b)
HasSevereMentalOrSubstanceInducedDisorder
The patient has a severe and persistent mental disorder or other emotional, behavioral or cognitive problems, or
substance-induced disorder.
Original Equation
D3LIdde-b = TRUE If [Dim3Px=1 or ASIp19j>0] & ASIp20=3to5 & ASIp13=2to3
Narrative
Criterion (DDE-b) is met if:
[1 Or 2] And 3 And 4
1) Patient shows withdrawal symptoms and emotional behavioral problems and/or cognitive condition and
complication.
2) Patient is demonstrating or at imminent risk of uncontrolled violent behavior endangering self or others.
3) The interviewer believes the patient’s moderate to considerable problems require close outpatient follow-up and
requires psychiatric/psychological treatment.
4) Interview believes counseling is moderately or considerably important to the patient’s recovery efforts.
Criterion (DDE-c)
LacksAbilityToUnderstandAndParticipateInTreatment
The patient’s mental health functioning is such that he or she has impaired ability to: [1] understand the information
presented, and [2] participate in treatment planning and the treatment process. Mental health management is required
to stabilize mood, cognition and behavior.
Original Equation
D3LIdde-c = TRUE If any of [CIWA10>2 (ASIp: 17,18a,18b,or19b >2), ASIp22=1 ASIp13a>2 or GAF=51-60]
Narrative
Criterion (DDE-c) is met if:
[Any of (1, 2, 3, 4, 5, 6, 7, 8)]
1) The interviewer believes the patient is disoriented to both date/time and people/place.
2) The interviewer believes the patient is having trouble with reality testing, thought disorders, paranoid thinking, and
that these thought disorders will impact recovery efforts.
3) The interviewer believes the patient is lethargic or hypersomnolent, and this state will impact recovery efforts.
4) The interview has observed the patient in a state fluctuating orientation in past 24 hrs, and this state will impact
recovery efforts.
5) The patient is having suicidal thoughts.
Criterion (DDE-d)
PosesNoRiskOfHarmToSelfOrOthersAndWillNotBeVictimized
The patient is assessed as not posing a risk of harm to self or others & is not vulnerable to victimization by another.
Original Equation
D3LIdde-d = Same rule as D3LI-d (directly above)
Narrative
Criterion (DDE-d) is met if:
1) Single rules above is met
Level I (Dual Diagnosis Enhanced Outpatient Treatment) Placement Criteria
Original Equation
D3LIdde = TRUE if D3LIdde- (a OR b) & c & d
Dimension 3: Level I (Dual Diagnosis Enhanced Outpatient Treatment)
Reference Pseudo Code
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let emotionalProblemsCorrelationWithSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.EmotionalProblemsCorrelationWithSubstanceUse
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let significantPeriodImpairedThoughtInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodImpairedThoughtInLast24Hours
Let isPatientUnableToUnderstand = assessment.PsychologicalSection.InterviewerRating.IsPatientUnableToUnderstand
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking
Let appearanceOfLethargy = assessment.PsychologicalSection.InterviewerRating.AppearanceOfLethargy
Let appearanceOfFluctuatingOrientationInLast24Hours =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfFluctuatingOrientationInLast24Hours
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let globalAssessmentOfFunctioningScore =
assessment.PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let significantPeriodCurbingViolentBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorInLast24Hours
Let significantPeriodViolentUrgesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesInLast24Hours
Let significantPeriodSuicidalThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSuicidalThoughtsInLast24Hours
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts
Let demonstratingDangerToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.DemonstratingDangerToSelfOrOthers
Let indicatingRiskOfHarmToOthers = assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToOthers
Let indicatingRiskOfHarmToSelfOrVictimizationByOthers =
assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToSelfOrVictimizationByOthers
Let hasRecentlyNeglectedOrAbusedFamilyMembers =
assessment.FamilyAndSocialHistorySection.HasRecentlyNeglectedOrAbusedFamilyMembers
Let familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II =
assessment.FamilyAndSocialHistorySection.FamilyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II
Let currentBehaviorInconsistentWithSelfCare =
assessment.PsychologicalSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let currentProblemBehaviorsRequireContinuousInterventions =
assessment.PsychologicalSection.InterviewerRating.CurrentProblemBehaviorsRequireContinuousInterventions
Let patientRequires24HourControlledSupervisedEnvironment =
assessment.PsychologicalSection.InterviewerRating.PatientRequires24HourControlledSupervisedEnvironment
Let psychiatricEvaluationAndServicesAccessibleToPatient =
assessment.PsychologicalSection.InterviewerRating.PsychiatricEvaluationAndServicesAccessibleToPatient
Level of Care: Dual Diagnosis Enhanced Intensive Outpatient Treatment (II.1)
Level II.1 (Dual Diagnosis Enhanced Intensive Outpatient Treatment) Summary
Mild severity, with the potential to distract from recovery the patient needs monitoring..
Level II.1 (Dual Diagnosis Enhanced Intensive Outpatient Treatment) Criteria
Criterion (DDE-a)
RequiresStabilizationOfDiagnosedEmotionalDisorder
The patient has a diagnosed emotional, behavioral or cognitive disorder that requires management because the
patient’s history suggests a high potential for distracting him or her from treatment such a disorder requires stabilization
concurrent with addiction treatment (for example, an unstable borderline personality disorder, compulsive personality
disorder, unstable anxiety or mood disorder).
Original Equation
D3LII.1dde-a = TRUE If ASIp(19i or 19j) >0 & (ASIp13a=3 or ASIp20=3to4 or ASIp19f=3to4) & ASIp19g=3to4
Narrative
Criterion (DDE-a) is met if:
(1 Or 2) And [3 Or 4 Or 5] And 6
1) Patient carries a psychiatric diagnosis.
2) Patient has at least one of the following active psychiatric diagnoses:
a) Anxiety disorder
b) Panic Disorder
c) Agoraphobia
d) Post Traumatic Stress Disorder
e) Social Phobia
f) Obsessive-Compulsive Disorder
g) Eating Disorder
h) Depressive Disorder
i) Mania/Bipolar Disorder
j) Schizophrenia/Psychotic/Thought Disorder
k) Borderline/Paranoid/Antisocial/or Other Personality Disorder
l) Other
3) The patient believes emotional problems will hinder treatment/recovery participation.
4) The interviewer believes the patient’s moderate to considerable problems require close outpatient follow-up and
requires psychiatric/psychological treatment.
5) The interviewer believes there is a moderate risk of recurrence of symptoms of psychiatric decompensation.
6) The interviewer believes the patient requires <= 9 hours per week of supervision/structure in order to remain safe.
Criterion (DDE-b)
ShowsMildRiskOfHarmToSelfOrOthersOrProperty
The patient is assessed as at mild risk of behaviors endangering self, others or property (for example, he or she has
suicidal or homicidal thoughts but no active plan).
Original Equation
D3LII.1dde-b = Same rule as D3LM-d
Narrative
Criterion (DDE-b) is met if:
[Any of (1, 2, 3, 4) Or [Any of (5, 6, 7, 8)] Or [9 And 10] And [All of (11, 12, 13, 14, 15)]
1) Patient’s trouble with controlling violent behavior is related to alcohol and/or drug use.
2) Patient’s thoughts or urges to hurt or fight anyone, or to damage anyone's property is related to alcohol and/or drug
use
3) Patient’s thought of suicide or feeling better off dead is related to alcohol and/or drug use.
4) Patient is having suicidal thoughts
5) Patient is demonstrating or at imminent risk of uncontrolled violent behavior endangering self or others.
6) Patient is Indicating risk of causing harm to others.
7) Patient is indicating risk of harm to self or vulnerability to victimization by another.
8) Patient is indicating slight risk of harm to self or vulnerability to victimization by another.
9) Patient is indicating slight risk of recurrence symptoms of psychiatric decompensation.
10) Patient’s risk to self or feeling better off dead is not related to alcohol and/or drug use
11) Patient is not demonstrating or at imminent risk of uncontrolled violent behavior endangering self or others.
12) Patient is not showing insufficient ability or coherence to contract to reliably contact others to report & present for
acute evaluation in the event of onset of active risk of harming self/others.
13) Patient’s current behavior does not seem inconsistent with reliable self-care, safety, or ability to participate in
treatment.
14) Current problem behaviors do not require continuous limit-setting interventions.
`
Criterion (DDE-c)
ShowsSignificantRiskOfBeingVictimizedByOthers
The patient is at significant risk of victimization by another. However, the risk is not severe enough to require 24-hr
supervision (for example, the patient has sufficient coping skills to maintain safety through attendance at treatment
sessions no more than 9-hrs/wk).
Original Equation
D3LII.1dde-c = TRUE If (Any of ASIf19:a,b,c =1to3) & ASIf19j=1to3 & ASIf19l=1
Narrative
Criterion (DDE-c) is met if:
Any of (1, 2, 3) And 4 And 5
1)
2)
3)
4)
5)
Patient has been moderately to considerably abused during the past 30 days emotionally.
Patient has been moderately to considerably abused during the past 30 days physically.
Patient has been moderately to considerably abused during the past 30 days sexually?
There is a slight to considerable risk that the patient could be hurt or victimized by another.
Patient is able to locate and get himself/herself to community resources safely.
Level II.1 (Dual Diagnosis Enhanced Intensive Outpatient Treatment) Placement Criteria
Original Equation
D3LII.1dde = TRUE if D3LII.1dde- (a OR b OR c)
Dimension 3: Level II.1 Dual Diagnosis Enhanced Intensive Outpatient Treatment
Reference Pseudo Code
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let abusesFamilyAndRequiresIntensiveOutpatientTreatment =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevelOpioidMaintenanceTherapyScore.
AbuseOrNeglectOfFamilyRequiresIntensiveOutpatientTreatment
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let likelihoodOfRecurrenceOfPsychiatricDecompensation =
assessment.PsychologicalSection.InterviewerRating.LikelihoodOfRecurrenceOfPsychiatricDecompensation
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let showsMildRiskOfHarmToSelfOrOthersOrProperty =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevelOpioidMaintenanceTherapyScore.
NeedsOutpatientTreatmentDueToRiskOfHarmToSelfOrOthers
Let emotionalAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.EmotionalAbuseInPast30Days
Let physicalAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.PhysicalAbuseInPast30Days
Let sexualAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.SexualAbuseInPast30Days
Let riskPatientHarmedByOther = assessment.FamilyAndSocialHistorySection.RiskPatientHarmedByOther
Let isAbleToLocateAndGetToCommunityResourcesSafely =
assessment.FamilyAndSocialHistorySection.IsAbleToLocateAndGetToCommunityResourcesSafely
Let careLevel_II_1_IntensiveOutpatientScore.RequiresStabilizationOfDiagnosedEmotionalDisorder =
(doesPatientCarryPsychiatricDiagnosis > PatientCarriesPsychiatricDiagnosis.No
Or activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator) And
(howEmotionalProblemsImpactRecoveryEfforts =
EmotionalProblemsImpactRecoveryEffortsScale.WillHinderTreatmentRecoveryParticipation
Or (patientNeedForPsychiatricPsychologicalTreatmentRating >= 3
And patientNeedForPsychiatricPsychologicalTreatmentRating <= 4) Or
(likelihoodOfRecurrenceOfPsychiatricDecompensation >= 3 And
likelihoodOfRecurrenceOfPsychiatricDecompensation <= 4)) And
(levelOfSupervisionNeededForProtectionFromSelfHarm >= 3 And
levelOfSupervisionNeededForProtectionFromSelfHarm <= 4)
Let careLevel_II_1_IntensiveOutpatientScore = new CareLevel_II_1_IntensiveOutpatientScore()
Let activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator =
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max(p => p.Value) > PsychiatricDiagnosis.None
Let careLevel_II_1_IntensiveOutpatientScore.AbusesFamilyAndRequiresIntensiveOutpatientTreatment =
abusesFamilyAndRequiresIntensiveOutpatientTreatment
Let careLevel_II_1_IntensiveOutpatientScore.ShowsMildRiskOfHarmToSelfOrOthersOrProperty =
showsMildRiskOfHarmToSelfOrOthersOrProperty
Let careLevel_II_1_IntensiveOutpatientScore.ShowsSignificantRiskOfBeingVictimizedByOthers =
((emotionalAbuseInPast30Days >= LikertScale.Slightly and emotionalAbuseInPast30Days <= LikertScale.Considerably)
or (physicalAbuseInPast30Days >= LikertScale.Slightly and physicalAbuseInPast30Days <= LikertScale.Considerably)
or (sexualAbuseInPast30Days >= LikertScale.Slightly and sexualAbuseInPast30Days <= LikertScale.Considerably))
and (riskPatientHarmedByOther >= LikertScale.Slightly and riskPatientHarmedByOther <= LikertScale.Considerably)
and (isAbleToLocateAndGetToCommunityResourcesSafely not false)
Let careLevel_II_1_IntensiveOutpatientScore.IsDualDiagnosisEnhanced =
careLevel_II_1_IntensiveOutpatientScore.RequiresStabilizationOfDiagnosedEmotionalDisorder.Value
or careLevel_II_1_IntensiveOutpatientScore.ShowsMildRiskOfHarmToSelfOrOthersOrProperty.Value
or careLevel_II_1_IntensiveOutpatientScore.ShowsSignificantRiskOfBeingVictimizedByOthers.Value
Level of Care: Dual Diagnosis Capable/Enhanced Partial Hospitalization (II.5)
Level II.5 (Partial Hospitalization) Summary
Mild to moderate severity, with the potential to distract from recovery the patient needs stabilization.
Level II.5 (Partial Hospitalization) Criteria
Criterion (ato)
HasNoEmotionalBehavioralConditionsRequiringStabilization
Problems in Dimension 3 are not necessary for admission to a Level II.5 program. However, if any of the Dimension 3
conditions are present, the patient must be admitted to either a Dual Diagnosis Capable or Dual Diagnosis Enhanced
program, depending on the patient's level of function, stability and degree of impairment in this dimension. The
severity of the patient's problems in Dimension 3 may require partial hospitalization or a similar supportive living
environment in conjunction with a Level III.1 program. On the other hand, if the patient receives adequate support from
his or her family or significant other(s), a Level II.5 program may suffice.
Original Equation
D3LII.5ato-a = Same as D3LII.1ato rule, above
Narrative
This criterion is met if:
1) Patient doesn't show any withdrawal symptoms or emotional behavioral problems and/or cognitive and
complication
2) Patient does not carry a psychiatric diagnosis
3) Given the history and new information gathered, the patient doesn’t seem to have any active psychiatric diagnosis
4) Patient doesn’t have any need for psychiatric/psychological treatment
Criterion (ddc-a)
HasMildToModerateParanoiaOnDiscontinuingDrugOfAbuse
Dual Diagnosis Capable Programs The patient’s status in Dimension 3 is characterized by a history of mild to moderate
psychiatric decompensation (marked by paranoia or mild psychotic symptoms) on discontinuation of the drug of abuse.
Such decompensation may occur and requires monitoring to permit early intervention.
Original Equation
D3LII.5ddc-a = TRUE If (Any of ASIp:4xD/M/L,4yD/M/L, or 5D/M/L=1to3 & for Any=1to3, U=2) & ASI-P19f>0
Narrative
This criterion is met if:
1)
2)
3)
4)
5)
6)
Patient has had a significant period of moderate paranoia within the last 24 hours or
Patient has had a significant period of moderate paranoia within the last month or
Patient has had a significant period of moderate paranoia within his or her life time and
Patient has had a significant period of paranoia likely related to substance withdrawal or
Patient has had a significant period of moderate untrue perception within the last 24 hours or
Patient has had a significant period of moderate untrue perception with the last month or
7)
8)
9)
10)
11)
12)
13)
Patient has had a significant period of moderate untrue perception with his or her life time and
Patient has had a significant period of untrue perception likely related to substance withdrawal or
Patient has had a significant period of moderate hallucinations within the last 24 hours or
Patient has had a significant period of moderate hallucinations within the last month or
Patient has had a significant period of moderate hallucinations within his or her life time and
Patient has had a significant period of hallucination like related to substance withdrawal and
There is a likelihood of a recurrence of psychiatric de-compensation
Criterion (ddc-b)
HasProblemsButReceivesAdequateSupportFromFamily
Dual Diagnosis Capable Programs The severity of the patient's problems in Dimension 3 may require partial
hospitalization or a similar supportive living environment in conjunction with a Level III.1 program. On the other hand, if
the patient receives adequate support from his or her family or significant other(s), a Level II.5 program may suffice.
Original Equation
D3LII.5ddc-b = TRUE If [(All of ASIf: 6a,8a,8b,&9b <3) & ASIp19d<3 & p19g<7] ELSE = [D3LII.5ddc-a PLUS D3LIII.1]
Narrative
This criterion is met if:
1) Cohabitants are aware of patient's needs and will be generally supportive, and sober supports are established and
there is no access to substances and
2) Patient's daily routine will shield and distract from substance use and will permit recovery if patient is sufficiently
motivated and
3) Patient has some plans to develop healthy leisure pursuits and patient has minimal ideas for increasing/maintaining
safety and
4) Patient has a healthy social network and skills that will support his or her recovery/treatment and
5) There is a slight indication that the patient is at risk of harming self and/or being vulnerable to victimization by
another and
6) Patient need's supervision/structure 1-2 time a week to remain safe and/or patient needs supervision/structure 6
hours a day, considering coping skills for safety and self-care
Criterion (ddc+III.1)
HasProblemsRequiringSupportiveEnvi ronmentWithLevelIII_1Care
Dual Diagnosis Capable Programs The severity of the patient's problems in Dimension 3 may require partial
hospitalization or a similar supportive living environment in conjunction with a Level III.1 program. On the other hand, if
the patient receives adequate support from his or her family or significant other(s), a Level II.5 program may suffice.
Original Equation
D3LII.5ddc+III.1 = TRUE if D3LII.5ddc-b is FALSE
Narrative
This criterion is met if:
1) Patient has problems but does not receive adequate support from his or her family or significant other(s).
Criterion (dde-a)
CannotMaintainBahavioralStabilityOver48HourPeriod
Dual Diagnosis Enhanced Programs The patient evidences current inability to maintain behavioral stability over a 48hour period (as evidenced by distractibility, negative emotions or generalized anxiety that significantly affects his or her
daily functioning)
Original Equation
D3LII.5dde-a = TRUE If ASIp(19i or 19j) >0 & (ASIp13a=4 or ASIp20=5to6 or ASIp19f=5to6) & ASIp19g=5to6
Narrative
This criterion is met if:
(1 Or 2) And (3 Or 4 Or 5) And 6
1) Patient carry's a psychiatric diagnosis that was implied by collateral or reported by pt. or documented by caregiver.
2) Given the history and new information, the patient seems to have an active psychiatric diagnosis ranging from
anxiety to borderline paranoia.
3) Patient's emotional problems is likely to threaten recovery.
4) Patient has considerable to severe problems and risk that require psychiatric/psychological treatment.
5) There is a likelihood of recurrence of psychiatric de-compensation.
6) Patient requires supervision/structure 6 hours a day in order to remain safe, considering coping skills for safety and
self-care.
Criterion (dde-b)
HasCurrentAndHistoricalModeratePsychiatricDecompensation
Dual Diagnosis Enhanced Programs The patient has a history of moderate psychiatric decompensation (marked by
severe, non-suicidal depression) on discontinuation of the drug of abuse. Such decompensation is currently observable
Original Equation
D3LII.5dde-b = TRUE If (MDDL or ODDL =1) & (ASIp: 3Lor3aL =4) & (ASIp: 3U or 3aU =2) & (ASIp: 3D or 3aD >1) & (All of
ASIp: 8L,8aL &9L <2)
Narrative
This criterion is met if:
(1 Or 2) And (3 Or 4) And (5 Or 6) And (7 Or 8) And all of (9, 10, 11)
1) Patient has life time of major depression disorder.
2) Patient has life time of other depression disorder.
3) Patient shows persistent symptoms with evidence of having significant periods of serious depression in his or her life
time.
4) Patient show's persistent symptoms with evidence of inability to feel pleasure from activities in his or her life time.
5) Patient has experience depression within the last 24 hour which is likely related to substance withdrawal.
6) Patient is unable to feel pleasure from activities which is likely related to substance withdrawal.
7) Patient has observable symptoms of serious depression within the last 24 hours.
8) Patient has observable symptoms of inability to feel pleasure from activities within the last 24 hours.
9) Patient reports thoughts of suicide in his or her life time.
10) Patient reports thoughts of self-injury in his or her life time.
11) Patient reports attempted suicide in his or her life time.
Criterion (dde-c)
LacksCopingSkillsToMaintainSafetyToSelfOthersOrProperty
Dual Diagnosis Enhanced Programs The patient is at mild to moderate risk of behaviors endangering self, others or
property, and is at imminent risk of relapse, with dangerous emotional, behavioral or cognitive consequences, in the
absence of Level II.5 structured services. For example, the patient does not have sufficient internal coping skills to
maintain safety to self, others or property without the consistent structure achieved through attendance at treatment
sessions daily or at least 20 hours per week.
Original Equation
D3LII.5dde-c = TRUE If CurRisk =1to6 & ASId22f=2to3 & ASIp19g=5to6
Narrative
This criterion is met if:
1 And 2 And 3
1) Patient demonstrating slight to considerable risk of current self-harm or harm to others.
2) Patient has a moderate to considerable urge for a drug and/or alcohol when something in the environment reminds
him or her of it.
3) The patient needs supervision/structure 6 hours a day to remain safe, considering coping skills for safety and selfcare.
Criterion (dde-d)
ProblemsSeverityIndicatorForPartialHospitalizationDualDiagnosisEnhanced
Original Equation
D3LII.5dde-d = TRUE If [(All of ASIf: 6a,8a,8b,&9b <3) & ASIp19d<3 & P19g<7] ELSE = [D3LII.5ddc-a PLUS D3LIII.1]
Narrative
This criterion is met if:
[All of (1, 2, 3, 4) And 5 And 6] ELSE Dual Diagnosis Capable Plus Level III.1 (Medically Managed Low Intensity)
1) Cohabitants are aware of patient's needs and will be generally supportive, and sober supports are established and
there is no access to substances.
2) Patient's daily routine will shield and distract from substance use and will permit recovery if patient is sufficiently
motivated.
3) Patient has some plans to develop healthy leisure pursuits and patient has minimal ideas for increasing/maintaining
safety.
4) Patient has a healthy social network and skills that will support his or her recovery/treatment.
5) There is a slight indication that the patient is at risk of harming self and/or being vulnerable to victimization by
another.
6) Patient need's supervision/structure 1-2 time a week to remain safe and/or patient needs supervision/structure 6
hours a day, considering coping skills for safety and self-care.
Criterion (dde+III.1)
RequiresPartialHospitalizationOrOutPatientInConj unctionWithLevel3
Original Equation
D3LII.5dde+III.1 = TRUE if D3LII.5dde-d is FALSE
Narrative
This criterion is met if:
Partial Hospitalization Dual Diagnosis Enhanced is False
Level II.5 (Partial Hospitalization) Placement Criteria
Original Equation
D3LII.5 = TRUE if D3LII.5ato-a
D3LII.5ddc = TRUE if D3LII.5ddc-a or –b
D3LII.5dde = TRUE if D3LII.5dde- (a OR b OR c)
Placement criteria(IsMet) is met if:
1) Patient has no emotional behavioral conditions requiring stabilization
Criteria (Dual Diagnosis Capable) is met if:
1) Patient has mild to moderate paranoia on discontinuing of the drug of abuse or
2) Patient has problems but receives adequate support from his or her family or significant other(s)
Criteria (Dual Diagnosis Enhanced) is met if:
1) The patient evidences current inability to maintain behavioral stability over a 48-hour period or
2) The patient has a history of moderate psychiatric de-compensation on discontinuation of the drug of abuse or
3) The patient lacks coping skills to maintain safety to self, others or property
Dimension 3: Level II.5 Partial Hospitalization
Reference Pseudo Code
Let hasNoEmotionalBehavioralConditionsRequiringStabilization =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_II_1_IntensiveOutpatientScore.
HasNoNeedForEmotionalBehavioralServices
Let significantPeriodParanoiaInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodParanoiaInLast24Hours
Let significantPeriodParanoiaInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodParanoiaInLastMonth
Let significantPeriodParanoiaInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodParanoiaInLifetime
Let significantPeriodParanoiaRelatedToSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodParanoiaRelatedToSubstanceUse
Let significantPeriodUntruePerceptionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodUntruePerceptionInLast24Hours
Let significantPeriodUntruePerceptionInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodUntruePerceptionInLastMonth
Let significantPeriodUntruePerceptionInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodUntruePerceptionInLifetime
Let significantPeriodUntruePerceptionRelatedToSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodUntruePerceptionRelatedToSubstanceUse
Let significantPeriodHallucinationsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodHallucinationsInLast24Hours
Let significantPeriodHallucinationsInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodHallucinationsInLastMonth
Let significantPeriodHallucinationsInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodHallucinationsInLifetime
Let significantPeriodHallucinationsRelatedToSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodHallucinationsRelatedToSubstanceUse
Let likelihoodOfRecurrenceOfPsychiatricDecompensation =
assessment.PsychologicalSection.InterviewerRating.LikelihoodOfRecurrenceOfPsychiatricDecompensation
Let livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let freeTimeAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let dealsWithProblemsInFreeTimeThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let dealsWithProblemsFromFriendsThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsFromFriendsThatRiskRelapse
Let indicatingRiskOfHarmToSelfOrVictimizationByOthers =
assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToSelfOrVictimizationByOthers
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let currentHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.CurrentHarmRiskToSelfOthers
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let hasLifetimeMajorDepressionDisorder =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.HasLifetimeMajorDepressionDisorder
Let hasLifetimeOtherDepressionDisorder =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.HasLifetimeOtherDepressionDisorder
Let significantPeriodOfSeriousDepressionInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodOfSeriousDepressionInLifetime
Let inabilityToFeelPleasureFromActivitiesInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.InabilityToFeelPleasureFromActivitiesInLifetime
Let depressionWithin24HoursRelatedToSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.DepressionWithin24HoursRelatedToSubstanceUse
Let inabilityToFeelPleasureFromActivitiesRelatedToSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.InabilityToFeelPleasureFromActivitiesRelatedToSubstanceUse
Let significantPeriodOfSeriousDepressionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodOfSeriousDepressionInLast24Hours
Let inabilityToFeelPleasureFromActivitiesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.InabilityToFeelPleasureFromActivitiesInLast24Hours
Let significantPeriodSuicidalThoughtsInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSuicidalThoughtsInLifetime
Let significantPeriodThoughtsOfSelfInjuryInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodThoughtsOfSelfInjuryInLifetime
Let significantPeriodAttemptedSuicideInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodAttemptedSuicideInLifetime
Bool hasNoEmotionalBehavioralConditionsRequiringStabilization
LikertScale significantPeriodParanoiaInLast24Hours
LikertScale significantPeriodParanoiaInLastMonth
LikertScale significantPeriodParanoiaInLifetime
RelationToSubstanceUse significantPeriodParanoiaRelatedToSubstanceUse
LikertScale significantPeriodUntruePerceptionInLast24Hours
LikertScale significantPeriodUntruePerceptionInLastMonth
LikertScale significantPeriodUntruePerceptionInLifetime
RelationToSubstanceUse significantPeriodUntruePerceptionRelatedToSubstanceUse
LikertScale significantPeriodHallucinationsInLast24Hours
LikertScale significantPeriodHallucinationsInLastMonth
LikertScale significantPeriodHallucinationsInLifetime
RelationToSubstanceUse significantPeriodHallucinationsRelatedToSubstanceUse
ScaleOf0To8 likelihoodOfRecurrenceOfPsychiatricDecompensation
LivingArrangementAffectOnRecovery livingArrangementAffectOnRecovery
FreeTimeAffectOnRecovery freeTimeAffectOnRecovery
StrategiesToDealWithProblemsInFreeTimeThatRiskRelapse dealsWithProblemsInFreeTimeThatRiskRelapse
StrategiesToDealWithProblemsFromFriendsThatRiskRelapse dealsWithProblemsFromFriendsThatRiskRelapse
ScaleOf0To8 indicatingRiskOfHarmToSelfOrVictimizationByOthers
ScaleOf0To8 levelOfSupervisionNeededForProtectionFromSelfHarm
Int currentHarmRiskToSelfOthers
LikertScale strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
PatientCarriesPsychiatricDiagnosis doesPatientCarryPsychiatricDiagnosis
IEnumerable<PsychiatricDiagnosis> activePsychiatricDiagnosesOtherThanSubstanceAbuse
EmotionalProblemsImpactRecoveryEffortsScale howEmotionalProblemsImpactRecoveryEfforts
ScaleOf0To8 patientNeedForPsychiatricPsychologicalTreatmentRating
Bool hasLifetimeMajorDepressionDisorder
Bool hasLifetimeOtherDepressionDisorder
LikertScale significantPeriodOfSeriousDepressionInLifetime
LikertScale inabilityToFeelPleasureFromActivitiesInLifetime
RelationToSubstanceUse depressionWithin24HoursRelatedToSubstanceUse
RelationToSubstanceUse inabilityToFeelPleasureFromActivitiesRelatedToSubstanceUse
LikertScale significantPeriodOfSeriousDepressionInLast24Hours
LikertScale inabilityToFeelPleasureFromActivitiesInLast24Hours
LikertScale significantPeriodSuicidalThoughtsInLifetime
LikertScale significantPeriodThoughtsOfSelfInjuryInLifetime
LikertScale significantPeriodAttemptedSuicideInLifetime
Let careLevel_II_5_PartialHospitalizationScore.HasNoEmotionalBehavioralConditionsRequiringStabilization =
hasNoEmotionalBehavioralConditionsRequiringStabilization
Let careLevel_II_5_PartialHospitalizationScore.HasMildToModerateParanoiaOnDiscontinuingDrugOfAbuse =
(((IsBtw(significantPeriodParanoiaInLast24Hours, LikertScale.Slightly, LikertScale.Considerably) Or
IsBtw(significantPeriodParanoiaInLastMonth, LikertScale.Slightly, LikertScale.Considerably) Or
IsBtw(significantPeriodParanoiaInLifetime, LikertScale.Slightly, LikertScale.Considerably)) And
significantPeriodParanoiaRelatedToSubstanceUse = RelationToSubstanceUse.LikelyRelatedToSubstanceWithdrawal) Or
((IsBtw(significantPeriodUntruePerceptionInLast24Hours, LikertScale.Slightly, LikertScale.Considerably) Or
IsBtw(significantPeriodUntruePerceptionInLastMonth, LikertScale.Slightly, LikertScale.Considerably) Or
IsBtw(significantPeriodUntruePerceptionInLifetime, LikertScale.Slightly, LikertScale.Considerably)) And
significantPeriodUntruePerceptionRelatedToSubstanceUse = RelationToSubstanceUse.LikelyRelatedToSubstanceWithdrawal) Or
((IsBtw(significantPeriodHallucinationsInLast24Hours, LikertScale.Slightly, LikertScale.Considerably) Or
IsBtw(significantPeriodHallucinationsInLastMonth, LikertScale.Slightly, LikertScale.Considerably) Or
IsBtw(significantPeriodHallucinationsInLifetime, LikertScale.Slightly, LikertScale.Considerably)) And
significantPeriodHallucinationsRelatedToSubstanceUse = RelationToSubstanceUse.LikelyRelatedToSubstanceWithdrawal)) And
likelihoodOfRecurrenceOfPsychiatricDecompensation > 0
Let careLevel_II_5_PartialHospitalizationScore.HasProblemsButReceivesAdequateSupportFromFamily =
livingArrangementAffectOnRecovery < LivingArrangementAffectOnRecovery.WillDiscourageOrHinderTreatment And
freeTimeAffectOnRecovery < FreeTimeAffectOnRecovery.WillDiscourageOrHinderRecovery
And dealsWithProblemsInFreeTimeThatRiskRelapse <
StrategiesToDealWithProblemsInFreeTimeThatRiskRelapse.RejectsNeedToDevelopSafeRecreation
And dealsWithProblemsFromFriendsThatRiskRelapse <
StrategiesToDealWithProblemsFromFriendsThatRiskRelapse.PassiveAboutDevelopingProtectiveRelationships
And indicatingRiskOfHarmToSelfOrVictimizationByOthers < 3
And IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 0, 6)
Let careLevel_II_5_PartialHospitalizationScore.HasProblemsRequiringSupportiveEnvironmentWithLevelIII_1Care = false
Let careLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisCapable =
careLevel_II_5_PartialHospitalizationScore.HasMildToModerateParanoiaOnDiscontinuingDrugOfAbuse
if (careLevel_II_5_PartialHospitalizationScore.HasProblemsButReceivesAdequateSupportFromFamily = false)
{
Let careLevel_II_5_PartialHospitalizationScore.HasProblemsRequiringSupportiveEnvironmentWithLevelIII_1Care =
careLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisCapable
Let careLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisCapable = false
}
Let careLevel_II_5_PartialHospitalizationScore.IsMet =
careLevel_II_5_PartialHospitalizationScore.HasNoEmotionalBehavioralConditionsRequiringStabilization
Let careLevel_II_5_PartialHospitalizationScore.CannotMaintainBahavioralStabilityOver48HourPeriod =
(IsBtw(doesPatientCarryPsychiatricDiagnosis, 1, 8) Or activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max( > 0) And
(howEmotionalProblemsImpactRecoveryEfforts = EmotionalProblemsImpactRecoveryEffortsScale.LikelyToThreatenRecovery Or
IsBtw(patientNeedForPsychiatricPsychologicalTreatmentRating, 5, 6) Or
IsBtw(likelihoodOfRecurrenceOfPsychiatricDecompensation, 5, 6)) And
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 5, 6)
Let careLevel_II_5_PartialHospitalizationScore.HasCurrentAndHistoricalModeratePsychiatricDecompensation =
(hasLifetimeMajorDepressionDisorder Or hasLifetimeOtherDepressionDisorder) And
(significantPeriodOfSeriousDepressionInLifetime = LikertScale.Extremely Or
inabilityToFeelPleasureFromActivitiesInLifetime = LikertScale.Extremely) And
(depressionWithin24HoursRelatedToSubstanceUse = RelationToSubstanceUse.LikelyRelatedToSubstanceWithdrawal Or
inabilityToFeelPleasureFromActivitiesRelatedToSubstanceUse = RelationToSubstanceUse.LikelyRelatedToSubstanceWithdrawal)
And (significantPeriodOfSeriousDepressionInLast24Hours > LikertScale.Slightly Or
inabilityToFeelPleasureFromActivitiesInLast24Hours > LikertScale.Slightly) And
significantPeriodSuicidalThoughtsInLifetime < LikertScale.Moderately And
significantPeriodThoughtsOfSelfInjuryInLifetime < LikertScale.Moderately And
significantPeriodAttemptedSuicideInLifetime < LikertScale.Moderately
Let careLevel_II_5_PartialHospitalizationScore.LacksCopingSkillsToMaintainSafetyToSelfOthersOrProperty =
IsBtw(currentHarmRiskToSelfOthers, 1, 6) And IsBtw(strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers,
LikertScale.Moderately, LikertScale.Considerably) And IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 5, 6)
Let careLevel_II_5_PartialHospitalizationScore.ProblemsSeverityIndicatorForPartialHospitalizationDualDiagnosisEnhanced
= careLevel_II_5_PartialHospitalizationScore.HasProblemsButReceivesAdequateSupportFromFamily
Let careLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisEnhanced =
careLevel_II_5_PartialHospitalizationScore.CannotMaintainBahavioralStabilityOver48HourPeriod Or
careLevel_II_5_PartialHospitalizationScore.HasCurrentAndHistoricalModeratePsychiatricDecompensation Or
careLevel_II_5_PartialHospitalizationScore.LacksCopingSkillsToMaintainSafetyToSelfOthersOrProperty
careLevel_II_5_PartialHospitalizationScore.RequiresPartialHospitalizationOrOutPatientInConjunctionWithLevel3 = false
if (careLevel_II_5_PartialHospitalizationScore.ProblemsSeverityIndicatorForPartialHospitalizationDualDiagnosisEnhanced
= false)
{
careLevel_II_5_PartialHospitalizationScore.RequiresPartialHospitalizationOrOutPatientInConjunctionWithLevel3 =
careLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisEnhanced
Dual Diagnosis Enhanced Clinically Managed Low Intensity Residential Treatment (III.1)
Level III.1 (Dual Diagnosis Enhanced Clinically Managed Low Intensity Residential Treatment) Summary
None or minimal not distracting to recovery. If stable, a Dual Diagnosis Capable program is appropriate. If not, a Dual
Diagnosis Enhanced program is required.
Level III.1 (Dual Diagnosis Enhanced Clinically Managed Low Intensity Residential Treatment) Criteria
Criterion (DDE-a)
HasHistoryOfDisordersRequiringMonitoringOfTreatment
The resident has a diagnosed emotional, behavioral or cognitive disorder that requires monitoring of medications or
assessment of psychiatric symptoms or behavioral management techniques, because the resident’s history suggests that
these disorders are likely to distract him or her from treatment efforts.
Original Equation
D3LIII.1dde-a = TRUE If ASIp(19i or 19j) >0 & (ASIp13a=3 or ASIp20=3to4 or ASIp19f=3to4) & ASIp19g>6
Narrative
Criterion (DDE-a) is met if:
Criterion (DDE-b)
MustMonitorPsychiatricSymptomsConcurrentWithAddictionTreatment
The resident needs monitoring of psychiatric symptoms concurrent with addiction treatment (as may occur in a patient
with borderline or compulsive personality disorder, anxiety or mood disorder, or persistent schizophrenic disorder in
addition to a stabilizing Substance Dependence or Substance-Induced Disorder).
Original Equation
D3LIII.1dde-b = TRUE If Any of ASIp: [(12,12b,or13 =2to3) OR (Any of: 14thru19d =4to6) OR (19i or j >0)] & [19f or20
=3to6]
Narrative
Criterion (DDE-b) is met if:
Criterion (DDE-c)
IsAbleToSafelyAccessCommunityForWorkAndOtherResources
The resident is assessed as able to safely access the community for work, education and other community resources.
NOTE: Such a resident may be receiving specific dual diagnosis services in a Level II.1 or II.5 program, or be receiving
Level I outpatient services with intensive case management.
Original Equation
D3LIII.1dde-c = TRUE If ASIp19h=1
Narrative
Criterion (DDE-c) is met if:
Level III.1 (Dual Diagnosis Enhanced Clinically Managed Low Intensity Residential Treatment)
Placement Criteria
Original Equation
D3LIII.1dde = TRUE if D3LIII.1dde- (a OR b) & c
Narrative
Placement criteria are met if one of the following is met:
Dimension 3: Level III.1 Dual Diagnosis Enhanced Clinically Managed Low-Intensity Residential Treatment
Reference Pseudo Code
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let significantPeriodCurbingViolentBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorInLast24Hours
Let significantPeriodViolentUrgesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesInLast24Hours
Let freeTimeAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let dealsWithProblemsInFreeTimeThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let dealsWithProblemsFromFriendsThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsFromFriendsThatRiskRelapse
Let friendsAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FriendsAffectOnRecovery
Let closestContactsNeedsAndWillingnessToHelpTreatment =
assessment.FamilyAndSocialHistorySection.ClosestContactsNeedsAndWillingnessToHelpTreatment
Let hasOtherAnxietySyndrome = assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.HasOtherAnxietySyndrome
Let appearanceOfDepressionWithdrawal =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfDepressionWithdrawal
Let appearanceOfHostility = assessment.PsychologicalSection.InterviewerRating.AppearanceOfHostility
Let appearanceofAgitation = assessment.PsychologicalSection.InterviewerRating.AppearanceofAgitation
Let appearanceOfAnxietyNervousness = assessment.PsychologicalSection.InterviewerRating.AppearanceOfAnxietyNervousness
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering
Let appearanceOfLethargy = assessment.PsychologicalSection.InterviewerRating.AppearanceOfLethargy
Let appearanceOfFluctuatingOrientationInLast24Hours =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfFluctuatingOrientationInLast24Hours
Let appearanceOfSpeechImpairmentBadPosture =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfSpeechImpairmentBadPosture
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts
Let demonstratingDangerToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.DemonstratingDangerToSelfOrOthers
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let indicatingRiskOfHarmToOthers = assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToOthers
Let indicatingRiskOfHarmToSelfOrVictimizationByOthers =
assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToSelfOrVictimizationByOthers
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let globalAssessmentOfFunctioningScore =
assessment.PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let currentBehaviorInconsistentWithSelfCare =
Let isReceivingNeededCare = assessment.PsychologicalSection.PsychologicalHistory.IsReceivingNeededCare
Let psychiatricEvaluationAndServicesAccessibleToPatient =
assessment.PsychologicalSection.InterviewerRating.PsychiatricEvaluationAndServicesAccessibleToPatient
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let acceptableLevelsOfCare = assessment.CompletionSection.AcceptableLevelsOfCare
Let careLevel_I_OutpatientScoreIsMet =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_I_OutpatientScore.IsMet
Let currentProblemBehaviorsRequireContinuousInterventions =
assessment.PsychologicalSection.InterviewerRating.CurrentProblemBehaviorsRequireContinuousInterventions
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let likelihoodOfRecurrenceOfPsychiatricDecompensation =
assessment.PsychologicalSection.InterviewerRating.LikelihoodOfRecurrenceOfPsychiatricDecompensation
Let howTroubledByPsychologicalEmotionalProblemsLast30Days =
assessment.PsychologicalSection.PsychologicalHistory.HowTroubledByPsychologicalEmotionalProblemsLast30Days
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let patientAbleToSafelyAccessNeededResources =
assessment.PsychologicalSection.InterviewerRating.PatientAbleToSafelyAccessNeededResources
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore = new
CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore()
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasStablePsychiatricConditionAndMinimalProblems =
IsBtw(patientNeedForPsychiatricPsychologicalTreatmentRating, 1, 2) and
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8) and
((significantPeriodCurbingViolentBehaviorInLast24Hours + significantPeriodViolentUrgesInLast24Hours +
demonstratingDangerToSelfOrOthers + limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers +
indicatingRiskOfHarmToOthers + currentBehaviorInconsistentWithSelfCare +
currentProblemBehaviorsRequireContinuousInterventions) = 0)
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasSymptomsInHomeEnvironmentRequiringResidentialTreatment =
(IsBtw(appearanceOfDepressionWithdrawal, 1, 4) or IsBtw(appearanceOfHostility, 1, 4) or
IsBtw(appearanceofAgitation, 1, 4) or IsBtw(appearanceOfAnxietyNervousness, 1, 4) or
IsBtw(appearanceOfParanoiaOrImpairedThinking, 1, 4) or
IsBtw(appearanceOfTroubleConcentratingOrRemembering, 1, 4) or
IsBtw(appearanceOfLethargy, 1, 4) or
IsBtw(appearanceOfFluctuatingOrientationInLast24Hours, 1, 4) or
IsBtw(appearanceOfSpeechImpairmentBadPosture, 1, 4) or IsBtw(hasSuicidalThoughts, 1, 4) or
IsBtw(demonstratingDangerToSelfOrOthers, 1, 4) or
IsBtw(limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers, 1, 4) or
IsBtw(indicatingRiskOfHarmToOthers, 1, 4) or
IsBtw(indicatingRiskOfHarmToSelfOrVictimizationByOthers, 1, 4) or
howDifficultProblemsForWorkHomeAndSocialInteraction = ProblemsForWorkHomeAndSocialInteractionScale.Moderately or
IsBtw(globalAssessmentOfFunctioningScore.Value, 41, 50)) and
( Utilities.Average(livingArrangementAffectOnRecovery, freeTimeAffectOnRecovery,
dealsWithProblemsInFreeTimeThatRiskRelapse, friendsAffectOnRecovery,
dealsWithProblemsFromFriendsThatRiskRelapse,
closestContactsNeedsAndWillingnessToHelpTreatment) > 2)
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasInabilityToMaintain24HourStableBehaviorWithoutAllDaySupport = (hasOtherAnxietySyndrome.Value or
IsBtw(appearanceOfDepressionWithdrawal, 3, 4) or IsBtw(appearanceOfHostility, 3, 4) or
IsBtw(appearanceofAgitation, 3, 4) or IsBtw(appearanceOfAnxietyNervousness, 3, 4) or
IsBtw(appearanceOfParanoiaOrImpairedThinking, 3, 4) or IsBtw(appearanceOfTroubleConcentratingOrRemembering, 3, 4) or
IsBtw(appearanceOfLethargy, 3, 4) or IsBtw(appearanceOfFluctuatingOrientationInLast24Hours, 3, 4) or
IsBtw(appearanceOfSpeechImpairmentBadPosture, 3, 4) or IsBtw(hasSuicidalThoughts, 3, 4) or
IsBtw(demonstratingDangerToSelfOrOthers, 3, 4) or
IsBtw(limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers, 3, 4) or
IsBtw(indicatingRiskOfHarmToOthers, 3, 4) or IsBtw(indicatingRiskOfHarmToSelfOrVictimizationByOthers, 3, 4)) and
(levelOfSupervisionNeededForProtectionFromSelfHarm > 6 or currentBehaviorInconsistentWithSelfCare > YesNoNotSure.No)
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasAppropriatePsychiatricCareForEmotionalBehavioralConditions = isReceivingNeededCare = YesNoNotApplicable.Yes and
psychiatricEvaluationAndServicesAccessibleToPatient = YesNoNotSure.Yes
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasStableMentalStatusToBenefitFromTreatmentAtThisLevel = howEmotionalProblemsImpactRecoveryEfforts <
EmotionalProblemsImpactRecoveryEffortsScale.WillHinderTreatmentRecoveryParticipation and
acceptableLevelsOfCare.Contains( CareLevel.Level_III_1)
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.IsMet =
careLevel_I_OutpatientScoreIsMet
Let isLevel_III_1_required = (IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 1, 2) or
IsBtw(patientNeedForPsychiatricPsychologicalTreatmentRating, 1, 4)) and
currentProblemBehaviorsRequireContinuousInterventions = YesNoNotSure.No and
(IsBtw(appearanceOfDepressionWithdrawal, 1, 2) or IsBtw(appearanceOfHostility, 3, 4)
IsBtw(appearanceofAgitation, 3, 4) or IsBtw(appearanceOfAnxietyNervousness, 3, 4) or
IsBtw(appearanceOfParanoiaOrImpairedThinking, 1, 2) or
IsBtw(appearanceOfTroubleConcentratingOrRemembering, 3, 4) or
IsBtw(appearanceOfLethargy, 3, 4) or
IsBtw(appearanceOfFluctuatingOrientationInLast24Hours, 1, 2) or
IsBtw(appearanceOfSpeechImpairmentBadPosture, 3, 4) Or
IsBtw(hasSuicidalThoughts, 1, 2) Or
IsBtw(demonstratingDangerToSelfOrOthers, 1, 2) Or
IsBtw(limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers, 1, 2) Or
IsBtw(indicatingRiskOfHarmToOthers, 1, 2) Or
IsBtw(indicatingRiskOfHarmToSelfOrVictimizationByOthers, 1, 2))
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.IsDualDiagnosisCapable =
isLevel_III_1_required and
(
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasStablePsychiatricConditionAndMinimalProblems.Value or
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasSymptomsInHomeEnvironmentRequiringResidentialTreatment.Value or
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasInabilityToMaintain24HourStableBehaviorWithoutAllDaySupport.Value or
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasAppropriatePsychiatricCareForEmotionalBehavioralConditions.Value or
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasStableMentalStatusToBenefitFromTreatmentAtThisLevel.Value
)
Let activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator =
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max(p => p.Value) > 0
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasHistoryOfDisordersRequiringMonitoringOfTreatment =
(IsBtw(doesPatientCarryPsychiatricDiagnosis, 1, 8) or
activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator) and
(howEmotionalProblemsImpactRecoveryEfforts =
EmotionalProblemsImpactRecoveryEffortsScale.WillHinderTreatmentRecoveryParticipation or
IsBtw(patientNeedForPsychiatricPsychologicalTreatmentRating, 3, 4) or
IsBtw(likelihoodOfRecurrenceOfPsychiatricDecompensation, 3, 4)) and
levelOfSupervisionNeededForProtectionFromSelfHarm > 6
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
MustMonitorPsychiatricSymptomsConcurrentWithAddictionTreatment =
(IsBtw(howTroubledByPsychologicalEmotionalProblemsLast30Days, 2, 3) or
IsBtw(howDifficultProblemsForWorkHomeAndSocialInteraction, 2, 3) or
IsBtw(howImportantPsychologicalEmotionalCounseling, 2, 3) or
IsBtw(appearanceOfDepressionWithdrawal, 4, 6) or IsBtw(appearanceOfHostility, 4, 6) or
IsBtw(appearanceofAgitation, 4, 6) or IsBtw(appearanceOfAnxietyNervousness, 4, 6) or
IsBtw(appearanceOfParanoiaOrImpairedThinking, 4, 6) or
IsBtw(appearanceOfTroubleConcentratingOrRemembering, 4, 6) or
IsBtw(appearanceOfLethargy, 4, 6) or
IsBtw(appearanceOfFluctuatingOrientationInLast24Hours, 4, 6) or
IsBtw(appearanceOfSpeechImpairmentBadPosture, 4, 6) or
IsBtw(hasSuicidalThoughts, 4, 6) or IsBtw(demonstratingDangerToSelfOrOthers, 4, 6) or
IsBtw(limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers, 4, 6) or
IsBtw(indicatingRiskOfHarmToOthers, 4, 6) or
IsBtw(indicatingRiskOfHarmToSelfOrVictimizationByOthers, 4, 6) or
IsBtw(doesPatientCarryPsychiatricDiagnosis, 1, 8) or
activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator) and
(IsBtw(likelihoodOfRecurrenceOfPsychiatricDecompensation, 3, 6) or
IsBtw(patientNeedForPsychiatricPsychologicalTreatmentRating, 3, 6))
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
IsAbleToSafelyAccessCommunityForWorkAndOtherResources = patientAbleToSafelyAccessNeededResources
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.IsDualDiagnosisEnhanced =
isLevel_III_1_required and (careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasHistoryOfDisordersRequiringMonitoringOfTreatment.Value or
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
MustMonitorPsychiatricSymptomsConcurrentWithAddictionTreatment.Value or
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
IsAbleToSafelyAccessCommunityForWorkAndOtherResources.Value)
Return careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore
Level of Care: Dual Diagnosis Enhanced Clinically Managed Medium-Intensity Residential
Treatment (III.3)
Level III.3 (Dual Diagnosis Enhanced Clinically Managed Medium Intensity Residential Treatment)
Summary
Mild to moderate severity the patient needs structure to focus on recovery. If stable, a Dual Diagnosis Capable
program is appropriate. If not, a Dual Diagnosis Enhanced program is required. Treatment should be designed to
respond to the resident’s cognitive deficits.
Level III.3 (Dual Diagnosis Enhanced Clinically Managed Medium Intensity Residential Treatment) Criteria
Criterion (DDE-a)
NeedsStabilizationOfPsychiatricSymptomsAlongWithTreatment
The resident has a diagnosed emotional, behavioral or cognitive disorder that requires active management (involving
monitoring of medications or assessment of psychiatric symptoms or behavioral management techniques, for example).
Such disorders complicate treatment of the resident’s Substance Dependence or Substance-Induced disorder and
require differential diagnosis. The resident thus is in need of stabilization of psychiatric symptoms concurrent with
addiction treatment (examples include a patient with unstable borderline or compulsive personality disorder, unstable
anxiety or mood disorder, in addition to his or her Substance Dependence or Substance-Induced disorder). Because
cognitive deficits are commonly seen in residents treated at Level III.3, such residents may require treatment that is
delivered at a slower pace or in a more concrete or repetitive fashion.
Original Equation
D3LIII.3dde-a = TRUE If [ASIp19i or 19j >0] & [(Any of ASIp: 13or13a =2to3) or (ASIp: 20a or 20b >0) or (Any of ASIp:
18,18a,b,or c >4)]
Narrative
Criterion (DDE-a) is met if:
Criterion (DDE-b)
HasMildRiskOfHarmfulBehaviorsButNoActivePlan
The resident is assessed as at mild to moderate risk of behaviors endangering self, others or property (for example, he or
she has suicidal or homicidal thoughts, but lacks an active plan).
Original Equation
D3LIII.3dde-b = TRUE If CurRISK=1to6 & ASIp8aD=0
Narrative
Criterion (DDE-b) is met if:
Criterion (DDE-c)
HasSevereDysfunctionRequiringStabilization
NOTE: The resident who has a severe and persistent mental disorder may manifest inadequate skills to manage the
activities of daily living, poor social functioning, disorganized thinking, and/or periods of confusion, disorientation, or
impaired reality testing. The resident’s dysfunction is so severe that 24-hour structure is required to provide sufficient
stabilization so that the resident can safely survive at a less intensive level of care. During the stabilization period,
expectations for the resident’s involvement in group, community and activities therapy are limited. A more highly
individualized regimen of individual, group and activities involvement may be required.
Original Equation
D3LIII.3dde-c = TRUE If [ASIp19j=10 or ASIp19k>0 or (Any of ASIp: 17,18,18a-d, or19f =2to6)] & ASIp20a>0 & GAF=21-50
Narrative
Criterion (DDE-c) is met if:
Level III.3 (Dual Diagnosis Enhanced Clinically Managed Medium Intensity Residential Treatment)
Placement Criteria
Original Equation
D3LIII.3dde = TRUE if D3LIII.3dde- (a OR b OR c)
Narrative
Placement criteria are met if one of (a Or b Or c) is met:
Dimension 3: Level III.3
Dual Diagnosis Enhanced Clinically Managed Medium-Intensity Residential Treatment
Reference Pseudo Code
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let globalAssessmentOfFunctioningScore =
assessment.PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let currentHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.CurrentHarmRiskToSelfOthers
Let riskOfHarmToSelfOrOthersIsHigherWithSubstanceUse =
assessment.PsychologicalSection.InterviewerRating.RiskOfHarmToSelfOrOthersIsHigherWithSubstanceUse
Let concernAboutEmploymentProblemsInPast30Days =
assessment.EmploymentAndSupportSection.ConcernAboutEmploymentProblemsInPast30Days
Let troubledByFamilyProblemsInPast30Days =
assessment.FamilyAndSocialHistorySection.TroubledByFamilyProblemsInPast30Days
Let troubledBySocialProblemsInPast30Days =
assessment.FamilyAndSocialHistorySection.TroubledBySocialProblemsInPast30Days
Let pastPsychologicalOrEmotionalProblems =
assessment.PsychologicalSection.PsychologicalHistory.PastPsychologicalOrEmotionalProblems
Let significantPeriodTroubleWithAttitudeTowardOthersInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodTroubleWithAttitudeTowardOthersInLifetime
Let currentProblemBehaviorsRequireContinuousInterventions =
assessment.PsychologicalSection.InterviewerRating.CurrentProblemBehaviorsRequireContinuousInterventions
Let hasSymptomsInHomeEnvironmentRequiringResidentialTreatment =
assessmentScore.Dimension3EmotionalBehavioralScores.
CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasSymptomsInHomeEnvironmentRequiringResidentialTreatment
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let acceptableLevelsOfCare = assessment.CompletionSection.AcceptableLevelsOfCare
Let careLevel_I_OutpatientScoreIsMet =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_I_OutpatientScore.IsMet
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering
Let appearanceOfDepressionWithdrawal =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfDepressionWithdrawal
Let appearanceOfHostility = assessment.PsychologicalSection.InterviewerRating.AppearanceOfHostility
Let appearanceofAgitation = assessment.PsychologicalSection.InterviewerRating.AppearanceofAgitation
Let appearanceOfAnxietyNervousness = assessment.PsychologicalSection.InterviewerRating.AppearanceOfAnxietyNervousness
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking
Let appearanceOfLethargy = assessment.PsychologicalSection.InterviewerRating.AppearanceOfLethargy
Let appearanceOfFluctuatingOrientationInLast24Hours =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfFluctuatingOrientationInLast24Hours
Let appearanceOfSpeechImpairmentBadPosture =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfSpeechImpairmentBadPosture
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts
Let demonstratingDangerToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.DemonstratingDangerToSelfOrOthers
Let indicatingRiskOfHarmToOthers = assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToOthers
Let indicatingRiskOfHarmToSelfOrVictimizationByOthers =
assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToSelfOrVictimizationByOthers
Let likelihoodOfRecurrenceOfPsychiatricDecompensation =
assessment.PsychologicalSection.InterviewerRating.LikelihoodOfRecurrenceOfPsychiatricDecompensation
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let significantPeriodThoughtsOfSelfInjuryInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodThoughtsOfSelfInjuryInLast24Hours
Let evidenceOfChronicOrganicMentalDisability =
assessment.PsychologicalSection.InterviewerRating.EvidenceOfChronicOrganicMentalDisability
Let currentBehaviorInconsistentWithSelfCare =
assessment.PsychologicalSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let careLevel_III_3_Score = new CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore()
Let activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator =
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max(d => d.Value) > 0
Let careLevel_III_3_Score.HasDepressionOrOtherConditionAndNeeds24HourCare =
(withdrawalSymptomsAndEmotionalBehavioralProblems.Value or
IsBtw(doesPatientCarryPsychiatricDiagnosis, 1, 8) or
activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator) and
(howEmotionalProblemsImpactRecoveryEfforts = EmotionalProblemsImpactRecoveryEffortsScale.ProblemsWontInterfere or
howImportantPsychologicalEmotionalCounseling = PsychologicalEmotionalCounselingImportanceScale.SlightlyImportant)
and (IsBtw(howDifficultProblemsForWorkHomeAndSocialInteraction,
ProblemsForWorkHomeAndSocialInteractionScale.Slightly, ProblemsForWorkHomeAndSocialInteractionScale.Moderately) or
IsBtw(globalAssessmentOfFunctioningScore.Value, 41, 50))
Let careLevel_III_3_Score.ExhibitsViolentBehaviorOnIntoxicationAndIsDangerous =
withdrawalSymptomsAndEmotionalBehavioralProblems.Value And currentHarmRiskToSelfOthers > 2 and
riskOfHarmToSelfOrOthersIsHigherWithSubstanceUse =
RiskOfHarmToSelfOrOthersIsHigherWithSubstanceUse.YesOnlyWithUseOrIntoxication
Let careLevel_III_3_Score.HasStressDueToRecentLossesThatImpairDailyActivities =
(concernAboutEmploymentProblemsInPast30Days > LikertScale.Slightly or
troubledByFamilyProblemsInPast30Days > LikertScale.Slightly or
troubledBySocialProblemsInPast30Days > LikertScale.Slightly) and
(howEmotionalProblemsImpactRecoveryEfforts > EmotionalProblemsImpactRecoveryEffortsScale.ProblemsWontInterfere)
and (IsBtw(howDifficultProblemsForWorkHomeAndSocialInteraction, 2, 4) or
IsBtw(globalAssessmentOfFunctioningScore.Value, 31, 50))
Let careLevel_III_3_Score.HasSevereConcomitantPersonalityDisorders =
(pastPsychologicalOrEmotionalProblems.Contains(PsychologicalOrEmotionalProblems.
BorderlineParanoidAntisocialOrOtherPersonalityDisorder) or
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Contains(PsychiatricDiagnosis.
BorderlineParanoidAntisocialOrOtherPersonalityDisorder) or
significantPeriodTroubleWithAttitudeTowardOthersInLifetime > LikertScale.Moderately) and
(currentProblemBehaviorsRequireContinuousInterventions > YesNoNotSure.No)
Let careLevel_III_3_Score.HasSevereFunctionalDeficitsRequiringResidentialTreatment =
hasSymptomsInHomeEnvironmentRequiringResidentialTreatment
Let careLevel_III_3_Score.NeedsLevelIII_3CareDueToMildHarmRiskAndImminentRelapse =
IsBtw(currentHarmRiskToSelfOthers.Value, 1, 4) and
IsBtw(strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers, LikertScale.Moderately, LikertScale.Considerably) and
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8)
Let careLevel_III_3_Score.HasStableMentalStatusToPermitParticipationInTreatment =
(howEmotionalProblemsImpactRecoveryEfforts <
EmotionalProblemsImpactRecoveryEffortsScale.WillHinderTreatmentRecoveryParticipation) and
acceptableLevelsOfCare.Contains(CareLevel.Level_III_3)
Let careLevel_III_3_Score.IsMet = careLevel_I_OutpatientScoreIsMet
Let (careLevel_III_3_Score.HasDepressionOrOtherConditionAndNeeds24HourCare.Value or
careLevel_III_3_Score.ExhibitsViolentBehaviorOnIntoxicationAndIsDangerous.Value or
careLevel_III_3_Score.HasStressDueToRecentLossesThatImpairDailyActivities.Value or
careLevel_III_3_Score.HasSevereConcomitantPersonalityDisorders.Value or
careLevel_III_3_Score.HasSevereFunctionalDeficitsRequiringResidentialTreatment.Value or
careLevel_III_3_Score.NeedsLevelIII_3CareDueToMildHarmRiskAndImminentRelapse.Value) and
careLevel_III_3_Score.HasStableMentalStatusToPermitParticipationInTreatment.Value
Let careLevel_III_3_Score.NeedsStabilizationOfPsychiatricSymptomsAlongWithTreatment =
(IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 3, 4) or
IsBtw(patientNeedForPsychiatricPsychologicalTreatmentRating, 3, 6) or
currentProblemBehaviorsRequireContinuousInterventions = YesNoNotSure.NotSure) and
(IsBtw(appearanceOfTroubleConcentratingOrRemembering, 5, 6) or
IsBtw(appearanceOfDepressionWithdrawal, 3, 4) or
IsBtw(appearanceOfHostility, 5, 6) or IsBtw(appearanceofAgitation, 5, 6) or
IsBtw(appearanceOfAnxietyNervousness, 5, 6) or
IsBtw(appearanceOfParanoiaOrImpairedThinking, 3, 4) or
IsBtw(appearanceOfTroubleConcentratingOrRemembering, 5, 6) or IsBtw(appearanceOfLethargy, 5, 6) or
IsBtw(appearanceOfFluctuatingOrientationInLast24Hours, 3, 4) or
IsBtw(appearanceOfSpeechImpairmentBadPosture, 5, 6) or
IsBtw(hasSuicidalThoughts, 3, 4) or IsBtw(demonstratingDangerToSelfOrOthers, 3, 4) or
IsBtw(limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers, 3, 4) or
IsBtw(indicatingRiskOfHarmToOthers, 3, 4) or
IsBtw(indicatingRiskOfHarmToSelfOrVictimizationByOthers, 3, 4))
Let careLevel_III_3_Score.HasMildRiskOfHarmfulBehaviorsButNoActivePlan =
IsBtw(currentHarmRiskToSelfOthers.Value, 1, 6) and
(significantPeriodThoughtsOfSelfInjuryInLast24Hours = LikertScale.NotAtAll)
careLevel_III_3_Score.HasSevereDysfunctionRequiringStabilization =
(activePsychiatricDiagnosesOtherThanSubstanceAbuse.Contains(PsychiatricDiagnosis.
SchizophreniaPsychoticOrThoughtDisorder) or
evidenceOfChronicOrganicMentalDisability > YesNoNotSure.No or
IsBtw(appearanceOfParanoiaOrImpairedThinking, 2, 6) or
IsBtw(appearanceOfTroubleConcentratingOrRemembering, 2, 6) or
IsBtw(appearanceOfLethargy, 2, 6) or
IsBtw(appearanceOfFluctuatingOrientationInLast24Hours, 2, 6) or
IsBtw(appearanceOfSpeechImpairmentBadPosture, 2, 6) or
IsBtw(appearanceOfTroubleConcentratingOrRemembering, 2, 6) or
IsBtw(likelihoodOfRecurrenceOfPsychiatricDecompensation, 2, 6)) and
currentBehaviorInconsistentWithSelfCare > YesNoNotSure.No and
IsBtw(globalAssessmentOfFunctioningScore.Value, 21, 50)
Let careLevel_III_3_Score.IsDualDiagnosisEnhanced =
careLevel_III_3_Score.NeedsStabilizationOfPsychiatricSymptomsAlongWithTreatment.Value or
careLevel_III_3_Score.HasMildRiskOfHarmfulBehaviorsButNoActivePlan.Value or
careLevel_III_3_Score.HasSevereDysfunctionRequiringStabilization.Value
return careLevel_III_3_Score
Level of Care: Dual Diagnosis Enhanced Clinically Managed High Intensity Residential
Treatment (III.5)
Level III.5 (Dual Diagnosis Enhanced Clinically Managed High Intensity Residential Treatment) Summary
The patient demonstrates repeated inability to control impulses, or a personality disorder requires structure to shape
behavior. Other functional deficits require a 24-hour setting to teach coping skills. A Dual Diagnosis Enhanced setting is
required for the patient who is severely and persistently mentally ill.
Level III.3 (Dual Diagnosis Enhanced Clinically Managed High Intensity Residential Treatment) Criteria
Sole Criterion (DDE)
HasHarmRiskAndRequiresImpulseControlManagement
The resident has a diagnosed emotional, behavioral or cognitive disorder that requires active management (involving
monitoring of medications or assessment of psychiatric symptoms or behavioral management techniques, for example).
Such disorders complicate treatment of the resident’s Substance Dependence or Substance-Induced disorder and
require differential diagnosis. The resident thus is in need of stabilization of psychiatric symptoms concurrent with
addiction treatment (examples include a patient with unstable borderline or compulsive personality disorder, unstable
anxiety or mood disorder, in addition to his or her Substance Dependence or Substance-Induced disorder). Because
cognitive deficits are commonly seen in residents treated at Level III.3, such residents may require treatment that is
delivered at a slower pace or in a more concrete or repetitive fashion.
Original Equation
D3LIII.5dde = TRUE If [meets D3LIII.5ddc] & [(Any of ASIp: 3thru8D >2) OR (CurRisk>4 & ASIp19b=1to4)]
Narrative
Criterion (DDE) is met if:
Level III.5 (Dual Diagnosis Enhanced Clinically Managed High Intensity Residential Treatment)
Placement Criteria
Original Equation
D3LIII.5dde = TRUE if D3LIII.5dde (single rule)
Narrative
Placement criteria are met if the single rule above is met.
Dimension 3: Level III.5 Dual Diagnosis Enhanced Clinically Managed High-Intensity Residential Treatment
Reference Pseudo Code
Let currentHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.CurrentHarmRiskToSelfOthers
Let likelihoodPreviousEnvironmentWillInduceSubstanceUse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
LikelihoodPreviousEnvironmentWillInduceSubstanceUse
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II =
assessment.FamilyAndSocialHistorySection.FamilyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let numberOfTimesTreatedForAlcoholAbuseLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesTreatedForAlcoholAbuseLifetime
Let numberOfTimesDrugTreatmentLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesDrugTreatmentLifetime
Let historyOfHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.HistoryOfHarmRiskToSelfOthers
Let numberOfTimesArrestedForShopliftingVandalism =
assessment.LegalSection.NumberOfTimesArrestedForShopliftingVandalism
Let numberOfTimesArrestedForParoleProbationViolation =
assessment.LegalSection.NumberOfTimesArrestedForParoleProbationViolation
Let numberOfTimesArrestedForDrugCharges = assessment.LegalSection.NumberOfTimesArrestedForDrugCharges
Let numberOfTimesArrestedForForgery = assessment.LegalSection.NumberOfTimesArrestedForForgery
Let numberOfTimesArrestedForWeaponsOffense = assessment.LegalSection.NumberOfTimesArrestedForWeaponsOffense
Let numberOfTimesArrestedForBurglaryLarceny = assessment.LegalSection.NumberOfTimesArrestedForBurglaryLarceny
Let numberOfTimesArrestedForRobbery = assessment.LegalSection.NumberOfTimesArrestedForRobbery
Let numberOfTimesArrestedForAssault = assessment.LegalSection.NumberOfTimesArrestedForAssault
Let numberOfTimesArrestedForArson = assessment.LegalSection.NumberOfTimesArrestedForArson
Let numberOfTimesArrestedForRape = assessment.LegalSection.NumberOfTimesArrestedForRape
Let numberOfTimesArrestedForHomicide = assessment.LegalSection.NumberOfTimesArrestedForHomicide
Let numberOfTimesArrestedForProstitution = assessment.LegalSection.NumberOfTimesArrestedForProstitution
Let interviewerScoreOfAttitude =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
Let desireAndExternalFactorsDrivingTreatment = assessment.LegalSection.DesireAndExternalFactorsDrivingTreatment
Let numberOfTimesArrestedForContemptOfCourt = assessment.LegalSection.NumberOfTimesArrestedForContemptOfCourt
Let significantPeriodTroubleWithAttitudeTowardOthersInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodTroubleWithAttitudeTowardOthersInLifetime
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let globalAssessmentOfFunctioningScore =
assessment.PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let freeTimeAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let dealsWithProblemsInFreeTimeThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let friendsAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FriendsAffectOnRecovery
Let dealsWithProblemsFromFriendsThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsFromFriendsThatRiskRelapse
Let closestContactsNeedsAndWillingnessToHelpTreatment =
assessment.FamilyAndSocialHistorySection.ClosestContactsNeedsAndWillingnessToHelpTreatment
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let currentProblemBehaviorsRequireContinuousInterventions =
assessment.PsychologicalSection.InterviewerRating.CurrentProblemBehaviorsRequireContinuousInterventions
Let acceptableLevelsOfCare = assessment.CompletionSection.AcceptableLevelsOfCare
Let careLevel_I_OutpatientScoreIsMet =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_I_OutpatientScore.IsMet
Let significantPeriodOfSeriousDepressionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodOfSeriousDepressionInLast24Hours
Let inabilityToFeelPleasureFromActivitiesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.InabilityToFeelPleasureFromActivitiesInLast24Hours
Let poorAppetiteOrOvereatingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.PoorAppetiteOrOvereatingInLast24Hours
Let feelLikeFailureInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.FeelLikeFailureInLast24Hours
Let movingSpeakingSlowlyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.MovingSpeakingSlowlyInLast24Hours
Let anxietyTensionWorryInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyTensionWorryInLast24Hours
Let anxietyAttackInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackInLast24Hours
Let anxietyAttackMoreThanOnceInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackMoreThanOnceInLast24Hours
Let anxietyAttackRandomInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackRandomInLast24Hours
Let worriedAboutAnxietyAttackInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.WorriedAboutAnxietyAttackInLast24Hours
Let anxietyAttackPalpitationsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackPalpitationsInLast24Hours
Let anxietyAttackChestPainsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChestPainsInLast24Hours
Let anxietyAttackShortnessBreathInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackShortnessBreathInLast24Hours
Let anxietyAttackChokingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChokingInLast24Hours
Let anxietyAttackSweatyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackSweatyInLast24Hours
Let anxietyAttackTremblingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackTremblingInLast24Hours
Let anxietyAttackNauseaDiarrheaInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackNauseaDiarrheaInLast24Hours
Let anxietyAttackDizzinessFaintnessInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDizzinessFaintnessInLast24Hours
Let anxietyAttackDistortedRealityInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDistortedRealityInLast24Hours
Let anxietyAttackNumbnessInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackNumbnessInLast24Hours
Let anxietyAttackChillsHotFlashesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChillsHotFlashesInLast24Hours
Let anxietyAttackLoseControlInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackLoseControlInLast24Hours
Let anxietyAttackDyingSensationInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDyingSensationInLast24Hours
Let significantPeriodFidgetingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodFidgetingInLast24Hours
Let significantPeriodSleepDisorderInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSleepDisorderInLast24Hours
Let significantPeriodLethargyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodLethargyInLast24Hours
Let significantPeriodMuscleTensionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodMuscleTensionInLast24Hours
Let significantPeriodNegativeThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodNegativeThoughtsInLast24Hours
Let significantPeriodExcessiveBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodExcessiveBehaviorInLast24Hours
Let significantPeriodParanoiaInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodParanoiaInLast24Hours
Let significantPeriodUntruePerceptionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodUntruePerceptionInLast24Hours
Let significantPeriodHallucinationsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodHallucinationsInLast24Hours
Let significantPeriodFlashbacksInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodFlashbacksInLast24Hours
Let significantPeriodImpairedThoughtInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodImpairedThoughtInLast24Hours
Let significantPeriodIrritabilityInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodIrritabilityInLast24Hours
Let significantPeriodCurbingViolentBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorInLast24Hours
Let significantPeriodViolentUrgesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesInLast24Hours
Let significantPeriodTroubleWithAttitudeTowardOthersInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodTroubleWithAttitudeTowardOthersInLast24Hours
Let significantPeriodSuicidalThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSuicidalThoughtsInLast24Hours
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let careLevel_III_5_Score = new CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore()
Let careLevel_III_5_Score.HasSevereDysfunctionAndCannotControlBehavior =
currentHarmRiskToSelfOthers > 4 and
(likelihoodPreviousEnvironmentWillInduceSubstanceUse > LikertScale.Slightly or
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers > LikertScale.Slightly or
familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II > LikertScale.Moderately) and
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8)
Let careLevel_III_5_Score.CannotControlDrugUsageAndInImminentDangerOfRelapse =
(numberOfTimesTreatedForAlcoholAbuseLifetime > 2 or numberOfTimesDrugTreatmentLifetime > 2 or
historyOfHarmRiskToSelfOthers > 2) and
(likelihoodPreviousEnvironmentWillInduceSubstanceUse > LikertScale.Slightly or
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers > LikertScale.Slightly) and
IsBtw(currentHarmRiskToSelfOthers.Value, 2, 3) and
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8)
Let badBehavioralCountList = new[]
{
numberOfTimesArrestedForShopliftingVandalism,
numberOfTimesArrestedForParoleProbationViolation,
numberOfTimesArrestedForDrugCharges,
numberOfTimesArrestedForForgery,
numberOfTimesArrestedForWeaponsOffense,
numberOfTimesArrestedForBurglaryLarceny,
numberOfTimesArrestedForRobbery,
numberOfTimesArrestedForAssault,
numberOfTimesArrestedForArson,
numberOfTimesArrestedForRape,
numberOfTimesArrestedForHomicide,
numberOfTimesArrestedForProstitution
}
Let careLevel_III_5_Score.HasCriminalBehaviorAndLackOfRegardForAuthorityOrOthers =
badBehavioralCountList.Sum(c => c.Value) > 3 and (interviewerScoreOfAttitude > 5 or
desireAndExternalFactorsDrivingTreatment =
DesireAndExternalFactorsDrivingTreatment.ResentfulAndWishesToRejectTreatmentDespiteCoercion or
numberOfTimesArrestedForContemptOfCourt > 0 or
significantPeriodTroubleWithAttitudeTowardOthersInLifetime = LikertScale.Extremely)
Let averageOfRecovery = Utilities.Average(livingArrangementAffectOnRecovery,
freeTimeAffectOnRecovery, dealsWithProblemsInFreeTimeThatRiskRelapse, friendsAffectOnRecovery,
dealsWithProblemsFromFriendsThatRiskRelapse, closestContactsNeedsAndWillingnessToHelpTreatment)
Let careLevel_III_5_Score.HasSignificantDeficitsButLikelyResponsiveToResidentialTreatment =
(howDifficultProblemsForWorkHomeAndSocialInteraction > ProblemsForWorkHomeAndSocialInteractionScale.Slightly or
IsBtw(globalAssessmentOfFunctioningScore.Value, 21, 40)) and averageOfRecovery > 2
Let careLevel_III_5_Score.HasConcomitantDisordersRequiringContinuousBoundarySettingCare =
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Contains(PsychiatricDiagnosis.
BorderlineParanoidAntisocialOrOtherPersonalityDisorder) and
(currentProblemBehaviorsRequireContinuousInterventions = YesNoNotSure.Yes)
Let careLevel_III_5_Score.HasStableMentalStatusPermittingParticipationinTreatment =
acceptableLevelsOfCare.Contains(CareLevel.Level_III_5)
Let careLevel_III_5_Score.IsMet = careLevel_I_OutpatientScoreIsMet
Let careLevel_III_5_Score.IsDualDiagnosisCapable =
( careLevel_III_5_Score.HasSevereDysfunctionAndCannotControlBehavior.Value or
careLevel_III_5_Score.CannotControlDrugUsageAndInImminentDangerOfRelapse.Value or
careLevel_III_5_Score.HasCriminalBehaviorAndLackOfRegardForAuthorityOrOthers.Value or
careLevel_III_5_Score.HasSignificantDeficitsButLikelyResponsiveToResidentialTreatment.Value or
careLevel_III_5_Score.HasConcomitantDisordersRequiringContinuousBoundarySettingCare.Value
) and
careLevel_III_5_Score.HasStableMentalStatusPermittingParticipationinTreatment.Value
Let dailySymptomCount = Utilities.GetSymptomsCount ( LikertScale.Moderately,
significantPeriodOfSeriousDepressionInLast24Hours, inabilityToFeelPleasureFromActivitiesInLast24Hours,
poorAppetiteOrOvereatingInLast24Hours, feelLikeFailureInLast24Hours, movingSpeakingSlowlyInLast24Hours,
anxietyTensionWorryInLast24Hours, anxietyAttackInLast24Hours, anxietyAttackMoreThanOnceInLast24Hours,
anxietyAttackRandomInLast24Hours, worriedAboutAnxietyAttackInLast24Hours,
anxietyAttackPalpitationsInLast24Hours, anxietyAttackChestPainsInLast24Hours,
anxietyAttackShortnessBreathInLast24Hours, anxietyAttackChokingInLast24Hours,
anxietyAttackSweatyInLast24Hours, anxietyAttackTremblingInLast24Hours,
anxietyAttackNauseaDiarrheaInLast24Hours, anxietyAttackDizzinessFaintnessInLast24Hours,
anxietyAttackDistortedRealityInLast24Hours, anxietyAttackNumbnessInLast24Hours,
anxietyAttackChillsHotFlashesInLast24Hours, anxietyAttackLoseControlInLast24Hours,
anxietyAttackDyingSensationInLast24Hours, significantPeriodFidgetingInLast24Hours,
significantPeriodSleepDisorderInLast24Hours, significantPeriodLethargyInLast24Hours,
significantPeriodMuscleTensionInLast24Hours, significantPeriodNegativeThoughtsInLast24Hours,
significantPeriodExcessiveBehaviorInLast24Hours, significantPeriodParanoiaInLast24Hours,
significantPeriodUntruePerceptionInLast24Hours, significantPeriodHallucinationsInLast24Hours,
significantPeriodFlashbacksInLast24Hours, significantPeriodImpairedThoughtInLast24Hours,
significantPeriodIrritabilityInLast24Hours, significantPeriodCurbingViolentBehaviorInLast24Hours,
significantPeriodViolentUrgesInLast24Hours, significantPeriodTroubleWithAttitudeTowardOthersInLast24Hours,
significantPeriodSuicidalThoughtsInLast24Hours )
Let careLevel_III_5_Score.IsDualDiagnosisEnhanced =
careLevel_III_5_Score.HasHarmRiskAndRequiresImpulseControlManagement =
careLevel_III_5_Score.IsDualDiagnosisCapable.Value and
(dailySymptomCount > 0 or currentHarmRiskToSelfOthers > 4) and
IsBtw(limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers, 1, 4)
return careLevel_III_5_Score
Level of Care: Dual Diagnosis Enhanced Medically Monitored Intensive Inpatient
Treatment (III.7)
Level III.7 (Dual Diagnosis Enhanced Medically Monitored Intensive Inpatient) Summary
Moderate severity the patient needs a 24-hour structured setting. If the patient has a co-occurring mental disorder, he
or she requires concurrent mental health services in a medically monitored setting.
Level III.7 (Dual Diagnosis Enhanced Medically Monitored Intensive Inpatient) Criteria
Criterion (DDE-a)
HasHistoryOfAndNowHasModerateDecompensationFromStoppingDrugs
The patient has a history of moderate psychiatric decompensation (involving paranoia, moderate psychotic symptoms or
severe, non-suicidal depression) on discontinuation of drugs of abuse, and such decompensation is present.
Original Equation
D3LIII.7dde-a = TRUE If Dim3Px=1 & HxWdPsSxs=1 & ASIp20>4 & ImWD(for ASId 1thru13or13b) =1
Narrative
Criterion (DDE-a) is met if:
Criterion (DDE-b)
HasModerateToHighHarmRiskAndImminentRelapseDanger
The patient is assessed as at moderate to high risk of behaviors endangering self, others or property, and is in imminent
danger of relapse (with dangerous emotional, behavioral or cognitive consequences) without 24-hour structure and
support and medically monitored treatment. For example, without medically monitored inpatient treatment, the
patient does not have sufficient coping skills to avoid harm to self, others or property because of co-occurring mania.
Original Equation
D3LIII.7dde-b = TRUE If CurRisk=3to6 & [ASI: d22e or d22f >2 or f19f>2] & ASIp19f=7or8
Narrative
Criterion (DDE-b) is met if:
Criterion (DDE-c)
HasSuicidalImpulsesAndPlanButDoesNotNeedOneOnOneSuicideWatch
The patient is severely depressed, with suicidal impulses and a plan. However, he or she is able to contract to reach out
for help as needed and does not require a one-on-one suicide watch.
Original Equation
D3LIII.7dde-c = TRUE If [All of ASIp: 14>4 & (8D>2 or 19>4) & 8aD>2] & P19b=0
Narrative
Criterion (DDE-c) is met if:
Criterion (DDE-d)
HasCoOccurringPsychiatricDisorderAndNeedsPsychotropicMeds
The patient has a co-occurring psychiatric disorder (such as anxiety, distractibility or depression) that is interfering with
his or her addiction treatment and thus requires stabilization with psychotropic medications.
Original Equation
D3LIII.7dde-d = TRUE If [Dim3Px=1 or ASip19i or 19j >0] & [(Any of ASIp: 13or13a =4) or (ASIp20>6)] & [(ASIp12b=1to4 or
GAF=21-50)] & ASIp19b=0
Narrative
Criterion (DDE-d) is met if:
Criterion (DDE-e)
HasSevereCoOccurringDisorderAndNeedsIntegratedDualTreatment
The patient has a co-occurring psychiatric disorder of moderate to high severity that is marginally and tenuously stable
and which requires care to prevent exacerbation. The patient thus requires the type of close management available
only in an addiction treatment program with integrated mental health services, or in a mental health program with
integrated addiction treatment services.
Original Equation
D3LIII.7dde-e = TRUE If [Dim3Px=1 or ASip19i or 19j >0] & [(Any of ASIp: 12,13,or13a =4) or (Any of ASIp:
14,15,15a,16,17,18, 18a,18b,18c,19,19a,19c,19d,19f or 20>6)] & ASI-P19b<5
Narrative
Criterion (DDE-e) is met if:
Level III.7 (Dual Diagnosis Enhanced Medically Monitored Intensive Inpatient)
Placement Criteria
Original Equation
D3LIII.7dde = TRUE if D3LIII.7dde- (a, b, c, d, OR e)
Narrative
Placement criteria are met if (a Or b Or c Or d Or e) is met:
Dimension 3: Level III.7 Dual Diagnosis Enhanced Clinically Managed High-Intensity Residential Treatment
Reference Pseudo Code
Let currentHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.CurrentHarmRiskToSelfOthers
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let globalAssessmentOfFunctioningScore =
assessment.PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let significantPeriodThoughtsOfSelfInjuryInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodThoughtsOfSelfInjuryInLast24Hours
Let likelihoodOfRecurrenceOfPsychiatricDecompensation =
assessment.PsychologicalSection.InterviewerRating.LikelihoodOfRecurrenceOfPsychiatricDecompensation
Let concernAboutEmploymentProblemsInPast30Days =
assessment.EmploymentAndSupportSection.ConcernAboutEmploymentProblemsInPast30Days
Let troubledByFamilyProblemsInPast30Days =
assessment.FamilyAndSocialHistorySection.TroubledByFamilyProblemsInPast30Days
Let troubledBySocialProblemsInPast30Days =
assessment.FamilyAndSocialHistorySection.TroubledBySocialProblemsInPast30Days
Let significantPeriodOfSeriousDepressionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodOfSeriousDepressionInLast24Hours
Let inabilityToFeelPleasureFromActivitiesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.InabilityToFeelPleasureFromActivitiesInLast24Hours
Let poorAppetiteOrOvereatingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.PoorAppetiteOrOvereatingInLast24Hours
Let feelLikeFailureInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.FeelLikeFailureInLast24Hours
Let movingSpeakingSlowlyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.MovingSpeakingSlowlyInLast24Hours
Let anxietyTensionWorryInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyTensionWorryInLast24Hours
Let anxietyAttackInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackInLast24Hours
Let anxietyAttackMoreThanOnceInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackMoreThanOnceInLast24Hours
Let anxietyAttackRandomInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackRandomInLast24Hours
Let worriedAboutAnxietyAttackInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.WorriedAboutAnxietyAttackInLast24Hours
Let anxietyAttackPalpitationsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackPalpitationsInLast24Hours
Let anxietyAttackChestPainsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChestPainsInLast24Hours
Let anxietyAttackShortnessBreathInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackShortnessBreathInLast24Hours
Let anxietyAttackChokingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChokingInLast24Hours
Let anxietyAttackSweatyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackSweatyInLast24Hours
Let anxietyAttackTremblingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackTremblingInLast24Hours
Let anxietyAttackNauseaDiarrheaInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackNauseaDiarrheaInLast24Hours
Let anxietyAttackDizzinessFaintnessInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDizzinessFaintnessInLast24Hours
Let anxietyAttackDistortedRealityInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDistortedRealityInLast24Hours
Let anxietyAttackNumbnessInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackNumbnessInLast24Hours
Let anxietyAttackChillsHotFlashesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChillsHotFlashesInLast24Hours
Let anxietyAttackLoseControlInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackLoseControlInLast24Hours
Let anxietyAttackDyingSensationInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDyingSensationInLast24Hours
Let significantPeriodFidgetingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodFidgetingInLast24Hours
Let significantPeriodSleepDisorderInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSleepDisorderInLast24Hours
Let significantPeriodLethargyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodLethargyInLast24Hours
Let significantPeriodMuscleTensionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodMuscleTensionInLast24Hours
Let significantPeriodNegativeThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodNegativeThoughtsInLast24Hours
Let significantPeriodExcessiveBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodExcessiveBehaviorInLast24Hours
Let significantPeriodParanoiaInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodParanoiaInLast24Hours
Let significantPeriodUntruePerceptionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodUntruePerceptionInLast24Hours
Let significantPeriodHallucinationsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodHallucinationsInLast24Hours
Let significantPeriodFlashbacksInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodFlashbacksInLast24Hours
Let significantPeriodImpairedThoughtInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodImpairedThoughtInLast24Hours
Let significantPeriodCurbingViolentBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorInLast24Hours
Let significantPeriodIrritabilityInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodIrritabilityInLast24Hours
Let significantPeriodViolentUrgesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesInLast24Hours
Let significantPeriodTroubleWithAttitudeTowardOthersInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodTroubleWithAttitudeTowardOthersInLast24Hours
Let significantPeriodSuicidalThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSuicidalThoughtsInLast24Hours
Let currentHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.CurrentHarmRiskToSelfOthers
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let patientAbleToSafelyAccessNeededResources =
assessment.PsychologicalSection.InterviewerRating.PatientAbleToSafelyAccessNeededResources
Let currentBehaviorInconsistentWithSelfCare =
assessment.PsychologicalSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let likelihoodPreviousEnvironmentWillInduceSubstanceUse = assessment.DrugAndAlcoholSection.
AdditionalAddictionAndTreatmentItems.LikelihoodPreviousEnvironmentWillInduceSubstanceUse
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers = assessment.DrugAndAlcoholSection.
AdditionalAddictionAndTreatmentItems.StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II =
assessment.FamilyAndSocialHistorySection.FamilyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II
Let riskOfHarmToSelfOrOthersIsHigherWithSubstanceUse =
assessment.PsychologicalSection.InterviewerRating.RiskOfHarmToSelfOrOthersIsHigherWithSubstanceUse
Let historyOfHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.HistoryOfHarmRiskToSelfOthers
Let significantPeriodCurbingViolentBehaviorRelatedToSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorRelatedToSubstanceUse
Let significantPeriodViolentUrgesRelatedToSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesRelatedToSubstanceUse
Let significantPeriodAttemptedSuicideRelatedToSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodAttemptedSuicideRelatedToSubstanceUse
Let signsOfIntoxicationExist = assessment.MedicalSection.SignsOfIntoxicationExist
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering
Let appearanceOfLethargy = assessment.PsychologicalSection.InterviewerRating.AppearanceOfLethargy
Let appearanceOfFluctuatingOrientationInLast24Hours =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfFluctuatingOrientationInLast24Hours
Let appearanceOfSpeechImpairmentBadPosture =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfSpeechImpairmentBadPosture
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness
Let observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances
Let auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel
Let visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let careLevel_I_OutpatientScoreIsMet =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_I_OutpatientScore.IsMet
Let historyOfWithdrawalRelatedSymptoms =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.HistoryOfWithdrawalRelatedSymptoms
Let hasAlcoholImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasAlcoholImminentWithdrawalPotential
Let hasHeroinImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasHeroinImminentWithdrawalPotential
Let hasMethadoneImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasMethadoneImminentWithdrawalPotential
Let hasOtherOpiateImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasOtherOpiateImminentWithdrawalPotential
Let hasBarbiturateImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasBarbiturateImminentWithdrawalPotential
Let hasOtherSedativeHypnoticImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasOtherSedativeHypnoticImminentWithdrawalPotential
Let hasCocaineImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasCocaineImminentWithdrawalPotential
Let hasStimulantImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasStimulantImminentWithdrawalPotential
Let hasCannabisImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasCannabisImminentWithdrawalPotential
Let hasHallucinogenImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasHallucinogenImminentWithdrawalPotential
Let hasInhalantImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasInhalantImminentWithdrawalPotential
Let hasOtherSubstanceImminentWithdrawalPotential =
assessmentScore.Dimension1WithdrawalScores.CommonScores.HasOtherSubstanceImminentWithdrawalPotential
Let appearanceOfDepressionWithdrawal =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfDepressionWithdrawal
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let howTroubledByPsychologicalEmotionalProblemsLast30Days =
assessment.PsychologicalSection.PsychologicalHistory.HowTroubledByPsychologicalEmotionalProblemsLast30Days
Let appearanceOfHostility = assessment.PsychologicalSection.InterviewerRating.AppearanceOfHostility
Let appearanceofAgitation = assessment.PsychologicalSection.InterviewerRating.AppearanceofAgitation
Let appearanceOfAnxietyNervousness = assessment.PsychologicalSection.InterviewerRating.AppearanceOfAnxietyNervousness
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking
Let demonstratingDangerToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.DemonstratingDangerToSelfOrOthers
Let indicatingRiskOfHarmToOthers = assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToOthers
Let indicatingRiskOfHarmToSelfOrVictimizationByOthers =
assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToSelfOrVictimizationByOthers
Let activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator =
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max(d => d.Value) > 0
Let careLevel_III_7_Score.HasUnstablePsychiatricStateThatInterferesWithRecovery =
(withdrawalSymptomsAndEmotionalBehavioralProblems.Value or IsBtw(doesPatientCarryPsychiatricDiagnosis, 1, 8) or
activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator) and
(IsBtw(howEmotionalProblemsImpactRecoveryEfforts,
EmotionalProblemsImpactRecoveryEffortsScale.WillHinderTreatmentRecoveryParticipation,
EmotionalProblemsImpactRecoveryEffortsScale.LikelyToThreatenRecovery) or
IsBtw(howImportantPsychologicalEmotionalCounseling,
PsychologicalEmotionalCounselingImportanceScale.ConsiderablyImportant,
PsychologicalEmotionalCounselingImportanceScale.ExtremelyImportant)) and
(IsBtw(howDifficultProblemsForWorkHomeAndSocialInteraction,
ProblemsForWorkHomeAndSocialInteractionScale.Slightly,
ProblemsForWorkHomeAndSocialInteractionScale.Extremely) or
IsBtw(globalAssessmentOfFunctioningScore.Value, 21, 50)) and
(significantPeriodThoughtsOfSelfInjuryInLast24Hours = LikertScale.NotAtAll) and
(likelihoodOfRecurrenceOfPsychiatricDecompensation < 5)
Let dailySymptomCount = Utilities.GetSymptomsCount
(
LikertScale.Moderately, significantPeriodOfSeriousDepressionInLast24Hours,
inabilityToFeelPleasureFromActivitiesInLast24Hours, poorAppetiteOrOvereatingInLast24Hours,
feelLikeFailureInLast24Hours, movingSpeakingSlowlyInLast24Hours, anxietyTensionWorryInLast24Hours,
anxietyAttackInLast24Hours, anxietyAttackMoreThanOnceInLast24Hours, anxietyAttackRandomInLast24Hours,
worriedAboutAnxietyAttackInLast24Hours, anxietyAttackPalpitationsInLast24Hours,
anxietyAttackChestPainsInLast24Hours, anxietyAttackShortnessBreathInLast24Hours,
anxietyAttackChokingInLast24Hours, anxietyAttackSweatyInLast24Hours, anxietyAttackTremblingInLast24Hours,
anxietyAttackNauseaDiarrheaInLast24Hours, anxietyAttackDizzinessFaintnessInLast24Hours,
anxietyAttackDistortedRealityInLast24Hours, anxietyAttackNumbnessInLast24Hours,
anxietyAttackChillsHotFlashesInLast24Hours, anxietyAttackLoseControlInLast24Hours,
anxietyAttackDyingSensationInLast24Hours, significantPeriodFidgetingInLast24Hours,
significantPeriodSleepDisorderInLast24Hours, significantPeriodLethargyInLast24Hours,
significantPeriodMuscleTensionInLast24Hours, significantPeriodNegativeThoughtsInLast24Hours,
significantPeriodExcessiveBehaviorInLast24Hours, significantPeriodParanoiaInLast24Hours,
significantPeriodUntruePerceptionInLast24Hours, significantPeriodHallucinationsInLast24Hours,
significantPeriodFlashbacksInLast24Hours, significantPeriodImpairedThoughtInLast24Hours,
significantPeriodCurbingViolentBehaviorInLast24Hours, significantPeriodIrritabilityInLast24Hours,
significantPeriodViolentUrgesInLast24Hours,
significantPeriodTroubleWithAttitudeTowardOthersInLast24Hours,
significantPeriodSuicidalThoughtsInLast24Hours)
Let careLevel_III_7_Score.HasStressDependenceBehaviorRequiresSecureEnvironmentForSelfCare =
(concernAboutEmploymentProblemsInPast30Days > LikertScale.Slightly or
troubledByFamilyProblemsInPast30Days > LikertScale.Slightly or
troubledBySocialProblemsInPast30Days > LikertScale.Slightly)
and dailySymptomCount > 1 and howEmotionalProblemsImpactRecoveryEfforts >
EmotionalProblemsImpactRecoveryEffortsScale.SomewhatDistractingFromRecovery
and (IsBtw(howDifficultProblemsForWorkHomeAndSocialInteraction,
ProblemsForWorkHomeAndSocialInteractionScale.Moderately,
ProblemsForWorkHomeAndSocialInteractionScale.Extremely) or
IsBtw(globalAssessmentOfFunctioningScore.Value, 31, 50))
Let careLevel_III_7_Score.RequiresActivePsychiatricMonitoringForSignificantDeficits =
(IsBtw(currentHarmRiskToSelfOthers.Value, 2, 4) or
IsBtw(globalAssessmentOfFunctioningScore.Value, 21, 40)) and
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8) and
patientAbleToSafelyAccessNeededResources.Value and
currentBehaviorInconsistentWithSelfCare = YesNoNotSure.Yes
Let careLevel_III_7_Score.HasModerateRiskOfHarmToSelfOtherAndPropertyAndRelapsePossible =
IsBtw(currentHarmRiskToSelfOthers.Value, 3, 6) and
(likelihoodPreviousEnvironmentWillInduceSubstanceUse > LikertScale.Moderately or
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers > LikertScale.Moderately or
familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II > LikertScale.Moderately) and
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8)
Let careLevel_III_7_Score.IsActivelyIntoxicatedWithViolentBehaviorPosingImminentDanger =
((currentHarmRiskToSelfOthers > 4 and
IsBtw(riskOfHarmToSelfOrOthersIsHigherWithSubstanceUse,
RiskOfHarmToSelfOrOthersIsHigherWithSubstanceUse.YesOnlyWithUseOrIntoxication,
RiskOfHarmToSelfOrOthersIsHigherWithSubstanceUse.BothWithAndWithoutSubstanceUse)) or
(historyOfHarmRiskToSelfOthers > 0 and
(significantPeriodCurbingViolentBehaviorRelatedToSubstanceUse =
RelationToSubstanceUse.LikelyRelatedToActiveSubstanceUseOrIntoxication or
significantPeriodViolentUrgesRelatedToSubstanceUse =
RelationToSubstanceUse.LikelyRelatedToActiveSubstanceUseOrIntoxication or
significantPeriodAttemptedSuicideRelatedToSubstanceUse =
RelationToSubstanceUse.LikelyRelatedToActiveSubstanceUseOrIntoxication))) and
signsOfIntoxicationExist = YesNoNotSure.Yes
Let careLevel_III_7_Score.HasCognitiveProblemsRequiringStabilizationButNoMedicalManagement =
significantPeriodImpairedThoughtInLast24Hours > LikertScale.Moderately or
appearanceOfTroubleConcentratingOrRemembering > 4 or
appearanceOfLethargy > 4 or
appearanceOfFluctuatingOrientationInLast24Hours > 4 or
appearanceOfSpeechImpairmentBadPosture > 4 or
interviewerObservationOfPatientSenseOfAwareness =
SenseOfAwareness.DisorientedForDateByMoreThan2CalendarDays or
observedTactileDisturbances = TactileDisturbancesObservation.ModeratelySevereHallucinations or
auditoryDisturbanceLevel = AuditoryDisturbanceLevel.ModeratelySevereHallucinations or
visualDisturbanceLevel = VisualDisturbanceLevel.ModeratelySevereHallucinations
or IsBtw(globalAssessmentOfFunctioningScore.Value, 31, 40
Let careLevel_III_7_Score.IsDualDiagnosisCapable =
(careLevel_III_7_Score.HasUnstablePsychiatricStateThatInterferesWithRecovery.Value or
careLevel_III_7_Score.HasStressDependenceBehaviorRequiresSecureEnvironmentForSelfCare.Value or
careLevel_III_7_Score.RequiresActivePsychiatricMonitoringForSignificantDeficits.Value or
careLevel_III_7_Score.HasModerateRiskOfHarmToSelfOtherAndPropertyAndRelapsePossible.Value or
careLevel_III_7_Score.IsActivelyIntoxicatedWithViolentBehaviorPosingImminentDanger.Value or
careLevel_III_7_Score.HasCognitiveProblemsRequiringStabilizationButNoMedicalManagement.Value) and
patientNeedForPsychiatricPsychologicalTreatmentRating > 4
Let careLevel_III_7_Score.IsMet = careLevel_I_OutpatientScoreIsMet
Let careLevel_III_7_Score.HasHistoryOfAndNowHasModerateDecompensationFromStoppingDrugs =
withdrawalSymptomsAndEmotionalBehavioralProblems.Value and historyOfWithdrawalRelatedSymptoms.Value and
patientNeedForPsychiatricPsychologicalTreatmentRating > 4 and
(hasAlcoholImminentWithdrawalPotential.Value or
hasHeroinImminentWithdrawalPotential.Value or
hasMethadoneImminentWithdrawalPotential.Value or
hasOtherOpiateImminentWithdrawalPotential.Value or
hasBarbiturateImminentWithdrawalPotential.Value or
hasOtherSedativeHypnoticImminentWithdrawalPotential.Value or
hasCocaineImminentWithdrawalPotential.Value or
hasStimulantImminentWithdrawalPotential.Value or
hasCannabisImminentWithdrawalPotential.Value or
hasHallucinogenImminentWithdrawalPotential.Value or
hasInhalantImminentWithdrawalPotential.Value or
hasOtherSubstanceImminentWithdrawalPotential.Value)
Let careLevel_III_7_Score.HasModerateToHighHarmRiskAndImminentRelapseDanger =
careLevel_III_7_Score.HasModerateRiskOfHarmToSelfOtherAndPropertyAndRelapsePossible
Let careLevel_III_7_Score.HasSuicidalImpulsesAndPlanButDoesNotNeedOneOnOneSuicideWatch =
appearanceOfDepressionWithdrawal > 4 and
(significantPeriodSuicidalThoughtsInLast24Hours > LikertScale.Moderately or hasSuicidalThoughts > 4)
and
significantPeriodThoughtsOfSelfInjuryInLast24Hours > LikertScale.Moderately and
limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers = 0
Let careLevel_III_7_Score.HasCoOccurringPsychiatricDisorderAndNeedsPsychotropicMeds =
(withdrawalSymptomsAndEmotionalBehavioralProblems.Value or
IsBtw(doesPatientCarryPsychiatricDiagnosis, 1, 8) or
activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator) and
(howImportantPsychologicalEmotionalCounseling =
PsychologicalEmotionalCounselingImportanceScale.ExtremelyImportant or
howEmotionalProblemsImpactRecoveryEfforts =
PsychologicalEmotionalCounselingImportanceScale.ExtremelyImportant or
patientNeedForPsychiatricPsychologicalTreatmentRating > 6) and
(IsBtw(howDifficultProblemsForWorkHomeAndSocialInteraction,
ProblemsForWorkHomeAndSocialInteractionScale.Slightly,
ProblemsForWorkHomeAndSocialInteractionScale.Extremely) or
IsBtw(globalAssessmentOfFunctioningScore.Value, 21, 50)) and
limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers = 0
Let appearenceSymptomCount = Utilities.GetSymptomsCount(6U,
appearanceOfDepressionWithdrawal, appearanceOfHostility,
appearanceofAgitation,appearanceOfAnxietyNervousness, appearanceOfParanoiaOrImpairedThinking,
appearanceOfTroubleConcentratingOrRemembering, appearanceOfLethargy,
appearanceOfFluctuatingOrientationInLast24Hours, hasSuicidalThoughts,
demonstratingDangerToSelfOrOthers, indicatingRiskOfHarmToOthers,
indicatingRiskOfHarmToSelfOrVictimizationByOthers,
likelihoodOfRecurrenceOfPsychiatricDecompensation,
patientNeedForPsychiatricPsychologicalTreatmentRating)
Let careLevel_III_7_Score.HasSevereCoOccurringDisorderAndNeedsIntegratedDualTreatment =
(withdrawalSymptomsAndEmotionalBehavioralProblems.Value or
IsBtw(doesPatientCarryPsychiatricDiagnosis, 1, 8) or
activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator) and
(howTroubledByPsychologicalEmotionalProblemsLast30Days = LikertScale.Extremely or
howImportantPsychologicalEmotionalCounseling =
PsychologicalEmotionalCounselingImportanceScale.ExtremelyImportant or
howEmotionalProblemsImpactRecoveryEfforts =
EmotionalProblemsImpactRecoveryEffortsScale.LikelyToThreatenRecovery or
appearenceSymptomCount > 1)
and
limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers < 5
Let careLevel_III_7_Score.IsDualDiagnosisEnhanced =
careLevel_III_7_Score.HasHistoryOfAndNowHasModerateDecompensationFromStoppingDrugs.Value or
careLevel_III_7_Score.HasModerateToHighHarmRiskAndImminentRelapseDanger.Value or
careLevel_III_7_Score.HasSuicidalImpulsesAndPlanButDoesNotNeedOneOnOneSuicideWatch.Value or
careLevel_III_7_Score.HasCoOccurringPsychiatricDisorderAndNeedsPsychotropicMeds.Value or
careLevel_III_7_Score.HasSevereCoOccurringDisorderAndNeedsIntegratedDualTreatment.Value
return careLevel_III_7_Score
Level of Care: Dual Diagnosis Capable/ATO Intensive Outpatient (II.1)
Level II.1 (Dual Diagnosis Capable/ATO Intensive Outpatient) Summary
Mild severity, with the potential to distract from recovery the patient needs monitoring.
Level II.1 (Dual Diagnosis Capable/ATO Intensive Outpatient) Criteria
Criterion (ato)
HasNoNeedForEmotionalBehavioralServices
All Programs:
Problems in Dimension 3 are not necessary for admission to a Level II.1 program. However, if any
of the Dimension 3 conditions are present, the patient must be admitted to either a Dual Diagnosis Capable or Dual
Diagnosis Enhanced program, depending on the patient’s level of function, stability and degree of impairment in this
dimension.
Original Equation
D3LII.1ato = TRUE If [Dim3Px=0 & (All of ASIp: 19i,19j & 20 =0)]
Narrative
Criterion (ato) is met if:
Criterion (DDC-a)
AbusesFamilyAndRequiresIntensiveOutpatientTreatment
The patient engages in abuse of family members or significant others, and requires intensive outpatient treatment to
reduce the risk of further deterioration.
Original Equation
D3LII.1ddc-a = TRUE If Any of ASIf: 19d,19f, or 19i >0
Narrative
Criterion (DDC-a) is met if:
Criterion (DDC-b)
RequiresManagementForDiagnosedEmotionalProblems
The patient has a diagnosed emotional, behavioral or cognitive disorder that requires intensive outpatient monitoring to
minimize distractions from his or her treatment or recovery.
Original Equation
D3LII.1ddc-b = TRUE If ASIp(19i or 19j) >0 & ASIp13a=1to3 & ASIp20=1to4
Narrative
Criterion (DDC-b) is met if:
Level II.1 (Dual Diagnosis Capable/ATO Intensive Outpatient) Placement Criteria
Original Equation
D3LII.1 = TRUE if D3LII.1ato (Single rule above)
D3LII.1ddc = TRUE if D3LII.1ddc- (a OR b)
Narrative
Placement criteria are met if one of the following is met:
1) Insert here
Dimension 3: Level II.1 Dual Diagnosis Capable Intensive Outpatient Treatment
Reference Pseudo Code
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let abusesFamilyAndRequiresIntensiveOutpatientTreatment =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevelOpioidMaintenanceTherapyScore.
AbuseOrNeglectOfFamilyRequiresIntensiveOutpatientTreatment
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let likelihoodOfRecurrenceOfPsychiatricDecompensation =
assessment.PsychologicalSection.InterviewerRating.LikelihoodOfRecurrenceOfPsychiatricDecompensation
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let showsMildRiskOfHarmToSelfOrOthersOrProperty =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevelOpioidMaintenanceTherapyScore.
NeedsOutpatientTreatmentDueToRiskOfHarmToSelfOrOthers
Let emotionalAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.EmotionalAbuseInPast30Days
Let physicalAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.PhysicalAbuseInPast30Days
Let sexualAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.SexualAbuseInPast30Days
Let riskPatientHarmedByOther = assessment.FamilyAndSocialHistorySection.RiskPatientHarmedByOther
Let isAbleToLocateAndGetToCommunityResourcesSafely =
assessment.FamilyAndSocialHistorySection.IsAbleToLocateAndGetToCommunityResourcesSafely
Let careLevel_II_1_IntensiveOutpatientScore = new CareLevel_II_1_IntensiveOutpatientScore()
Let activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator =
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max(p => p.Value) > PsychiatricDiagnosis.None
Let careLevel_II_1_IntensiveOutpatientScore.HasNoNeedForEmotionalBehavioralServices =
not withdrawalSymptomsAndEmotionalBehavioralProblems and
doesPatientCarryPsychiatricDiagnosis = PatientCarriesPsychiatricDiagnosis.No and
not activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator and
patientNeedForPsychiatricPsychologicalTreatmentRating = 0
Let careLevel_II_1_IntensiveOutpatientScore.AbusesFamilyAndRequiresIntensiveOutpatientTreatment =
abusesFamilyAndRequiresIntensiveOutpatientTreatment
Let careLevel_II_1_IntensiveOutpatientScore.RequiresManagementForDiagnosedEmotionalProblems =
(doesPatientCarryPsychiatricDiagnosis > PatientCarriesPsychiatricDiagnosis.No or
activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator) and
howEmotionalProblemsImpactRecoveryEfforts >=
EmotionalProblemsImpactRecoveryEffortsScale.ProblemsWontInterfere and
howEmotionalProblemsImpactRecoveryEfforts <=
EmotionalProblemsImpactRecoveryEffortsScale.WillHinderTreatmentRecoveryParticipation and
patientNeedForPsychiatricPsychologicalTreatmentRating >= 1 and
patientNeedForPsychiatricPsychologicalTreatmentRating <= 4
Let careLevel_II_1_IntensiveOutpatientScore.IsMet =
careLevel_II_1_IntensiveOutpatientScore.HasNoNeedForEmotionalBehavioralServices
Let careLevel_II_1_IntensiveOutpatientScore.IsDualDiagnosisCapable =
(careLevel_II_1_IntensiveOutpatientScore.AbusesFamilyAndRequiresIntensiveOutpatientTreatment ?? false)
(careLevel_II_1_IntensiveOutpatientScore.RequiresManagementForDiagnosedEmotionalProblems ?? false)
or
Level of Care: Dual Diagnosis Capable/ATO Clinically Managed Low-Intensity Residential
Treatment (III.1)
Level III.1 (Dual Diagnosis Capable/ATO Clinically Managed Low-Intensity Residential Treatment)
Summary
Mild to moderate severity the patient needs structure to focus on recovery. If stable, a Dual Diagnosis Capable program
is appropriate. If not, a Dual Diagnosis Enhanced program is required. Treatment should be designed to respond to the
resident’s cognitive deficits.
Level III.1 (Dual Diagnosis Capable/ATO Clinically Managed Low-Intensity Residential Treatment) Criteria
Segment I: Conditions and Stability
Dual Diagnosis Capable Programs The resident’s status in Dimension 3 is characterized by (a) or (b) or (c) and (d):
Criteria (DDC-a1, a3, a4)
HasStablePsychiatricConditionsAndMinimalProblems
EITHER (a) The resident’s psychiatric condition is stabilizing, but he or she is assessed as in need of a 24-hour structured
environment, as evidenced by one of the following: [1] depression or other emotional, behavioral or cognitive
conditions significantly interfere with activities of daily living and recovery OR [4] concomitant personality disorders are
of such severity that the accompanying dysfunctional behaviors require continuing structured interventions
OR (a)[3] the resident exhibits stress behaviors related to recent or threatened losses in work, family or social arenas,
such that activities of daily living are significantly impaired and the resident requires a secure environment to focus on
the substance dependence or mental health problem
Original Equation
D3LIII.1,3,5, or 7 = same as D3LI
D3LIII.3ddc-a1 = TRUE If [Dim3Px=1or ASIp19i or 19j >0] & [(Any of ASIp: 13or13a =1) & (ASIp12b=1to2 or GAF=41-50)]
D3LIII.3ddc-a3 = TRUE If [Any of ASI: e20,f20,f21 >1] & [ASIp13a>1] & [ASIp12b=2to4 or GAF=31-50]
D3LIII.3ddc-a4 = TRUE If (ASIp: 1c or19j =11 or 7cL>2) & ASIp20b>0
Narrative
Criteria (DDC-a1, a3, a4) are met if:
Segment II: Danger and Impulsivity
Criteria (DDC-b, a2, c)
HasSymptomsInHomeEnvironmentequiringResidentialTreatment
OR (b) The resident’s symptoms and functional deficits, when considered in the context of his or her home environment,
are assessed as sufficiently severe that the resident is not likely to maintain mental stability and/or abstinence if
treatment is provided in a non-residential setting. Functional deficits may include—but are not limited to—cognitive
impairment, developmental disability, manifest chronicity and intensity of the primary addictive disease process,
residual psychiatric symptoms, cognitive deficits resulting from traumatic brain injury, limited educational achievement,
poor vocational skills, inadequate anger management skills, and other equivalent indications that services need to be
presented at a pace that is slower and/or more repetitive and concrete than is found at other levels of care. These
deficits may be complicated by problems in Dimensions 2 through 6
OR (a)[2] the resident exhibits violent or disruptive behavior when intoxicated and is assessed as posing a danger to self
or others
OR (c) The resident is at mild risk of behaviors endangering self, others or property, and is in imminent danger of relapse
(with dangerous emotional, behavioral or cognitive consequences) without the 24-hour support and structure of a Level
III.3 program
Original Equation
D3LIII.3ddc-b = Same as LIII.1ddc-b
D3LIII.3ddc-a2 = TRUE If Dim3Px=1 & CurRisk>2 & ASIp19e=1
D3LIII.3ddc-c = TRUE If CurRisk=1to4 & ASId22f=2to3 & ASIp19g=7to8
Segment III: Distractibility, Mental Status, and Cognitive Function
Criteria (DDC-d)
HasAppropriatePsychiatricCareForEmotionalBehavioralConditions
AND (d) The resident’s mental status (including emotional stability and cognitive functioning) is assessed as sufficiently
stable to permit the resident to participate in the therapeutic interventions provided at this level of care and to benefit
from treatment.
Original Equation
D3LIII.3ddc-d = TRUE If ASIp13a<3 & Post7 includes 10
Level III.1 (Dual Diagnosis Capable/ATO Clinically Managed Low-Intensity Residential Treatment)
Placement Criteria
Original Equation
D3LIII.3 = TRUE if D3LI true
D3LIII.3ddc-a = TRUE if D3LIII.3ddc-a (1 OR 2 OR 3 OR 4)
D3LIII.3ddc = TRUE if D3LIII.3ddc- (a OR b OR c) & d
Narrative
Placement criteria are met if one of the following is met:
Dimension 3: Level III.1 Dual Diagnosis Capable Clinically Managed Low-Intensity Residential Treatment
Reference Pseudo Code
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let significantPeriodCurbingViolentBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorInLast24Hours
Let significantPeriodViolentUrgesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesInLast24Hours
Let freeTimeAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let dealsWithProblemsInFreeTimeThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let dealsWithProblemsFromFriendsThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsFromFriendsThatRiskRelapse
Let friendsAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FriendsAffectOnRecovery
Let closestContactsNeedsAndWillingnessToHelpTreatment =
assessment.FamilyAndSocialHistorySection.ClosestContactsNeedsAndWillingnessToHelpTreatment
Let hasOtherAnxietySyndrome = assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.HasOtherAnxietySyndrome
Let appearanceOfDepressionWithdrawal =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfDepressionWithdrawal
Let appearanceOfHostility = assessment.PsychologicalSection.InterviewerRating.AppearanceOfHostility
Let appearanceofAgitation = assessment.PsychologicalSection.InterviewerRating.AppearanceofAgitation
Let appearanceOfAnxietyNervousness = assessment.PsychologicalSection.InterviewerRating.AppearanceOfAnxietyNervousness
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering
Let appearanceOfLethargy = assessment.PsychologicalSection.InterviewerRating.AppearanceOfLethargy
Let appearanceOfFluctuatingOrientationInLast24Hours =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfFluctuatingOrientationInLast24Hours
Let appearanceOfSpeechImpairmentBadPosture =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfSpeechImpairmentBadPosture
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts
Let demonstratingDangerToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.DemonstratingDangerToSelfOrOthers
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let indicatingRiskOfHarmToOthers = assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToOthers
Let indicatingRiskOfHarmToSelfOrVictimizationByOthers =
assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToSelfOrVictimizationByOthers
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let globalAssessmentOfFunctioningScore =
assessment.PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let currentBehaviorInconsistentWithSelfCare =
Let isReceivingNeededCare = assessment.PsychologicalSection.PsychologicalHistory.IsReceivingNeededCare
Let psychiatricEvaluationAndServicesAccessibleToPatient =
assessment.PsychologicalSection.InterviewerRating.PsychiatricEvaluationAndServicesAccessibleToPatient
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let acceptableLevelsOfCare = assessment.CompletionSection.AcceptableLevelsOfCare
Let careLevel_I_OutpatientScoreIsMet =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_I_OutpatientScore.IsMet
Let currentProblemBehaviorsRequireContinuousInterventions =
assessment.PsychologicalSection.InterviewerRating.CurrentProblemBehaviorsRequireContinuousInterventions
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let likelihoodOfRecurrenceOfPsychiatricDecompensation =
assessment.PsychologicalSection.InterviewerRating.LikelihoodOfRecurrenceOfPsychiatricDecompensation
Let howTroubledByPsychologicalEmotionalProblemsLast30Days =
assessment.PsychologicalSection.PsychologicalHistory.HowTroubledByPsychologicalEmotionalProblemsLast30Days
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let patientAbleToSafelyAccessNeededResources =
assessment.PsychologicalSection.InterviewerRating.PatientAbleToSafelyAccessNeededResources
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore = new
CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore()
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.HasStablePsychiatricConditionAndMinimalProblems
= IsBtw(patientNeedForPsychiatricPsychologicalTreatmentRating, 1, 2) And
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8) And
((significantPeriodCurbingViolentBehaviorInLast24Hours + significantPeriodViolentUrgesInLast24Hours +
demonstratingDangerToSelfOrOthers + limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers +
indicatingRiskOfHarmToOthers + currentBehaviorInconsistentWithSelfCare +
currentProblemBehaviorsRequireContinuousInterventions) = 0)
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasSymptomsInHomeEnvironmentRequiringResidentialTreatment =
(IsBtw(appearanceOfDepressionWithdrawal, 1, 4) Or IsBtw(appearanceOfHostility, 1, 4) Or
IsBtw(appearanceofAgitation, 1, 4) Or IsBtw(appearanceOfAnxietyNervousness, 1, 4) Or
IsBtw(appearanceOfParanoiaOrImpairedThinking, 1, 4) Or
IsBtw(appearanceOfTroubleConcentratingOrRemembering, 1, 4) Or
IsBtw(appearanceOfLethargy, 1, 4) Or
IsBtw(appearanceOfFluctuatingOrientationInLast24Hours, 1, 4) Or
IsBtw(appearanceOfSpeechImpairmentBadPosture, 1, 4) Or IsBtw(hasSuicidalThoughts, 1, 4) Or
IsBtw(demonstratingDangerToSelfOrOthers, 1, 4) Or
IsBtw(limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers, 1, 4) Or
IsBtw(indicatingRiskOfHarmToOthers, 1, 4) Or
IsBtw(indicatingRiskOfHarmToSelfOrVictimizationByOthers, 1, 4) Or
howDifficultProblemsForWorkHomeAndSocialInteraction
=ProblemsForWorkHomeAndSocialInteractionScale.Moderately Or
IsBtw(globalAssessmentOfFunctioningScore.Value, 41, 50)) And
(
Utilities.Average(livingArrangementAffectOnRecovery,
freeTimeAffectOnRecovery,
dealsWithProblemsInFreeTimeThatRiskRelapse,
friendsAffectOnRecovery,
dealsWithProblemsFromFriendsThatRiskRelapse,
closestContactsNeedsAndWillingnessToHelpTreatment) > 2)
Let
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.HasInabilityToMaintain24HourStableBehaviorWithou
tAllDaySupport =
(hasOtherAnxietySyndrome.Value Or
IsBtw(appearanceOfDepressionWithdrawal, 3, 4) Or IsBtw(appearanceOfHostility, 3, 4) Or
IsBtw(appearanceofAgitation, 3, 4) Or
IsBtw(appearanceOfAnxietyNervousness, 3, 4) Or
IsBtw(appearanceOfParanoiaOrImpairedThinking, 3, 4) Or
IsBtw(appearanceOfTroubleConcentratingOrRemembering, 3, 4) Or
IsBtw(appearanceOfLethargy, 3, 4) Or
IsBtw(appearanceOfFluctuatingOrientationInLast24Hours, 3, 4) Or
IsBtw(appearanceOfSpeechImpairmentBadPosture, 3, 4) Or
IsBtw(hasSuicidalThoughts, 3, 4) Or IsBtw(demonstratingDangerToSelfOrOthers, 3, 4) Or
IsBtw(limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers, 3, 4) Or
IsBtw(indicatingRiskOfHarmToOthers, 3, 4) Or
IsBtw(indicatingRiskOfHarmToSelfOrVictimizationByOthers, 3, 4)) And
(levelOfSupervisionNeededForProtectionFromSelfHarm > 6 Or
currentBehaviorInconsistentWithSelfCare > YesNoNotSure.No)
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasAppropriatePsychiatricCareForEmotionalBehavioralConditions =
isReceivingNeededCare = YesNoNotApplicable.Yes And
psychiatricEvaluationAndServicesAccessibleToPatient = YesNoNotSure.Yes
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasStableMentalStatusToBenefitFromTreatmentAtThisLevel =
howEmotionalProblemsImpactRecoveryEfforts <
EmotionalProblemsImpactRecoveryEffortsScale.WillHinderTreatmentRecoveryParticipation And
acceptableLevelsOfCare.Contains( CareLevel.Level_III_1)
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.IsMet =
careLevel_I_OutpatientScoreIsMet
Let Let isLevel_III_1_required = (IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 1, 2) Or
IsBtw(patientNeedForPsychiatricPsychologicalTreatmentRating, 1, 4)) And
currentProblemBehaviorsRequireContinuousInterventions = YesNoNotSure.No And
(IsBtw(appearanceOfDepressionWithdrawal, 1, 2) Or
IsBtw(appearanceOfHostility, 3, 4) Or
IsBtw(appearanceofAgitation, 3, 4) Or
IsBtw(appearanceOfAnxietyNervousness, 3, 4) Or
IsBtw(appearanceOfParanoiaOrImpairedThinking, 1, 2) Or
IsBtw(appearanceOfTroubleConcentratingOrRemembering, 3, 4) Or
IsBtw(appearanceOfLethargy, 3, 4) Or
IsBtw(appearanceOfFluctuatingOrientationInLast24Hours, 1, 2) Or
IsBtw(appearanceOfSpeechImpairmentBadPosture, 3, 4) Or
IsBtw(hasSuicidalThoughts, 1, 2) Or
IsBtw(demonstratingDangerToSelfOrOthers, 1, 2) Or
IsBtw(limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers, 1, 2) Or
IsBtw(indicatingRiskOfHarmToOthers, 1, 2) Or
IsBtw(indicatingRiskOfHarmToSelfOrVictimizationByOthers, 1, 2))
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.IsDualDiagnosisCapable =
isLevel_III_1_required And (
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasStablePsychiatricConditionAndMinimalProblems.Value Or
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasSymptomsInHomeEnvironmentRequiringResidentialTreatment.Value Or
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasInabilityToMaintain24HourStableBehaviorWithoutAllDaySupport.Value Or
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasAppropriatePsychiatricCareForEmotionalBehavioralConditions.Value Or
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.
HasStableMentalStatusToBenefitFromTreatmentAtThisLevel.Value)
Level of Care: Dual Diagnosis Capable Clinically Managed Medium-Intensity Care (III.3)
Level III.3 (Dual Diagnosis Capable Clinically Managed Medium-Intensity Care) Summary
Mild to moderate severity the patient needs structure to focus on recovery. If stable, a Dual Diagnosis Capable program
is appropriate. If not, a Dual Diagnosis Enhanced program is required. Treatment should be designed to respond to the
resident’s cognitive deficits.
Level III.3 (Dual Diagnosis Capable Clinically Managed Medium-Intensity Care) Criteria
Dual Diagnosis Capable Programs The resident’s status in Dimension 3 is characterized by (a) or (b) or (c) and (d):
Segment I: Conditions and Stability
Criteria (DDC-a1, a4)
HasDepressionOrOtherConditionAndNeeds24HourCare – a1
HasSevereConcomitantPersonalityDisorders – a4
EITHER (a) The resident’s psychiatric condition is stabilizing, but he or she is assessed as in need of a 24-hour structured
environment, as evidenced by one of the following: [1] depression or other emotional, behavioral or cognitive
conditions significantly interfere with activities of daily living and recovery OR [4] concomitant personality disorders are
of such severity that the accompanying dysfunctional behaviors require continuing structured interventions
Original Equations
D3LIII.3ddc-a1 = TRUE If [Dim3Px=1or ASIp19i or 19j >0] & [(Any of ASIp: 13or13a =1) & (ASIp12b=1to2 or GAF=41-50)]
D3LIII.3ddc-a4 = TRUE If (ASIp: 1c or19j =11 or 7cL>2) & ASIp20b>0
Narrative
Criteria (DDC-a1, a4) are met if:
Criterion (DDC-a3)
HasStressDueToRecentLossesThatImpairDailyActivitie s
OR (a)[3] the resident exhibits stress behaviors related to recent or threatened losses in work, family or social arenas,
such that activities of daily living are significantly impaired and the resident requires a secure environment to focus on
the substance dependence or mental health problem
Original Equation
D3LIII.3ddc-a3 = TRUE If [Any of ASI: e20,f20,f21 >1] & [ASIp13a>1] & [ASIp12b=2to4 or GAF=31-50]
Narrative
Criteria (DDC-a3) are met if:
Segment II: Danger and Impulsivity
Criterion (DDC-b)
HasSevereFunctionalDeficitsRequiringResidentialTreatment
OR (b) The resident’s symptoms and functional deficits, when considered in the context of his or her home environment,
are assessed as sufficiently severe that the resident is not likely to maintain mental stability and/or abstinence if
treatment is provided in a non-residential setting. Functional deficits may include—but are not limited to—cognitive
impairment, developmental disability, manifest chronicity and intensity of the primary addictive disease process,
residual psychiatric symptoms, cognitive deficits resulting from traumatic brain injury, limited educational achievement,
poor vocational skills, inadequate anger management skills, and other equivalent indications that services need to be
presented at a pace that is slower and/or more repetitive and concrete than is found at other levels of care. These
deficits may be complicated by problems in Dimensions 2 through 6
Original Equation
D3LIII.3ddc-b = Same as LIII.1ddc-b
Narrative
Criteria (DDC-b) are met if:
Criterion (DDC-a2)
ExhibitsViolentBehaviorOnIntoxicationAndIsDangerous
OR (a)[2] the resident exhibits violent or disruptive behavior when intoxicated and is assessed as posing a danger to self
or others
Original Equation
D3LIII.3ddc-a2 = TRUE If Dim3Px=1 & CurRisk>2 & ASIp19e=1
Narrative
Criteria (DDC-a2) are met if:
Criterion (DDC-c)
ExhibitsViolentBehaviorOnIntoxicationAndIsDangerous
OR (c) The resident is at mild risk of behaviors endangering self, others or property, and is in imminent danger of relapse
(with dangerous emotional, behavioral or cognitive consequences) without the 24-hour support and structure of a Level
III.3 program
Original Equation
D3LIII.3ddc-c = TRUE If CurRisk=1to4 & ASId22f=2to3 & ASIp19g=7to8
Narrative
Criteria (DDC-c) are met if:
Segment III: Distractibility, Mental Status, and Cognitive Function
Criterion (DDC-d)
HasStableMentalStatusToPermitParticipationInTreatment
AND (d) The resident’s mental status (including emotional stability and cognitive functioning) is assessed as sufficiently
stable to permit the resident to participate in the therapeutic interventions provided at this level of care and to benefit
from treatment.
Original Equation
D3LIII.3ddc-d = TRUE If ASIp13a<3 & Post7 includes 10
Level III.3 (Dual Diagnosis Capable/ATO Clinically Managed Low-Intensity Residential Treatment)
Placement Criteria
Original Equation
D3LIII.3 = TRUE if D3LI true
D3LIII.3ddc-a = TRUE if D3LIII.3ddc-a (1 OR 2 OR 3 OR 4)
D3LIII.3ddc = TRUE if D3LIII.3ddc- (a OR b OR c) & d
Narrative
Placement criteria are met if one of the following is met:
Dimension 3: Level III.3 Dual Diagnosis Capable Clinically Managed Medium-Intensity Care
Reference Pseudo Code
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let globalAssessmentOfFunctioningScore =
assessment.PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let currentHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.CurrentHarmRiskToSelfOthers
Let riskOfHarmToSelfOrOthersIsHigherWithSubstanceUse =
assessment.PsychologicalSection.InterviewerRating.RiskOfHarmToSelfOrOthersIsHigherWithSubstanceUse
Let concernAboutEmploymentProblemsInPast30Days =
assessment.EmploymentAndSupportSection.ConcernAboutEmploymentProblemsInPast30Days
Let troubledByFamilyProblemsInPast30Days =
assessment.FamilyAndSocialHistorySection.TroubledByFamilyProblemsInPast30Days
Let troubledBySocialProblemsInPast30Days =
assessment.FamilyAndSocialHistorySection.TroubledBySocialProblemsInPast30Days
Let pastPsychologicalOrEmotionalProblems =
assessment.PsychologicalSection.PsychologicalHistory.PastPsychologicalOrEmotionalProblems
Let significantPeriodTroubleWithAttitudeTowardOthersInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodTroubleWithAttitudeTowardOthersInLifetime
Let currentProblemBehaviorsRequireContinuousInterventions =
assessment.PsychologicalSection.InterviewerRating.CurrentProblemBehaviorsRequireContinuousInterventions
bool? hasSymptomsInHomeEnvironmentRequiringResidentialTreatment =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_III_1_ClinicallyManagedLowIntensity
ResidentialTreatmentScore.HasSymptomsInHomeEnvironmentRequiringResidentialTreatment
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrengthOfSubstanceUseUrge
DueToEnvironmentalTriggers
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let acceptableLevelsOfCare = assessment.CompletionSection.AcceptableLevelsOfCare
Let careLevel_I_OutpatientScoreIsMet =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_I_OutpatientScore.IsMet
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering
Let appearanceOfDepressionWithdrawal =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfDepressionWithdrawal
Let appearanceOfHostility = assessment.PsychologicalSection.InterviewerRating.AppearanceOfHostility
Let appearanceofAgitation = assessment.PsychologicalSection.InterviewerRating.AppearanceofAgitation
Let appearanceOfAnxietyNervousness = assessment.PsychologicalSection.InterviewerRating.AppearanceOfAnxietyNervousness
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking
Let appearanceOfLethargy = assessment.PsychologicalSection.InterviewerRating.AppearanceOfLethargy
Let appearanceOfFluctuatingOrientationInLast24Hours =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfFluctuatingOrientationInLast24Hours
Let appearanceOfSpeechImpairmentBadPosture =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfSpeechImpairmentBadPosture
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts
Let demonstratingDangerToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.DemonstratingDangerToSelfOrOthers
Let indicatingRiskOfHarmToOthers = assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToOthers
Let indicatingRiskOfHarmToSelfOrVictimizationByOthers =
assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToSelfOrVictimizationByOthers
Let likelihoodOfRecurrenceOfPsychiatricDecompensation =
assessment.PsychologicalSection.InterviewerRating.LikelihoodOfRecurrenceOfPsychiatricDecompensation
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let significantPeriodThoughtsOfSelfInjuryInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodThoughtsOfSelfInjuryInLast24Hours
Let evidenceOfChronicOrganicMentalDisability =
assessment.PsychologicalSection.InterviewerRating.EvidenceOfChronicOrganicMentalDisability
Let currentBehaviorInconsistentWithSelfCare =
assessment.PsychologicalSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let
activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator =
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max(d => d.Value) > 0
Let careLevel_III_3_Score.HasDepressionOrOtherConditionAndNeeds24HourCare =
(withdrawalSymptomsAndEmotionalBehavioralProblems.Value or
IsBtw(doesPatientCarryPsychiatricDiagnosis, 1, 8) or
activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator) and
(howEmotionalProblemsImpactRecoveryEfforts = EmotionalProblemsImpactRecoveryEffortsScale.ProblemsWontInterfere or
howImportantPsychologicalEmotionalCounseling = PsychologicalEmotionalCounselingImportanceScale.SlightlyImportant)
and (IsBtw(howDifficultProblemsForWorkHomeAndSocialInteraction,
ProblemsForWorkHomeAndSocialInteractionScale.Slightly, ProblemsForWorkHomeAndSocialInteractionScale.Moderately) or
IsBtw(globalAssessmentOfFunctioningScore.Value, 41, 50))
Let careLevel_III_3_Score.ExhibitsViolentBehaviorOnIntoxicationAndIsDangerous =
withdrawalSymptomsAndEmotionalBehavioralProblems.Value and currentHarmRiskToSelfOthers > 2 and
riskOfHarmToSelfOrOthersIsHigherWithSubstanceUse =
RiskOfHarmToSelfOrOthersIsHigherWithSubstanceUse.YesOnlyWithUseOrIntoxication
Let careLevel_III_3_Score.HasStressDueToRecentLossesThatImpairDailyActivities =
(concernAboutEmploymentProblemsInPast30Days > LikertScale.Slightly or
troubledByFamilyProblemsInPast30Days > LikertScale.Slightly or
troubledBySocialProblemsInPast30Days > LikertScale.Slightly) and
(howEmotionalProblemsImpactRecoveryEfforts > EmotionalProblemsImpactRecoveryEffortsScale.ProblemsWontInterfere)
and (IsBtw(howDifficultProblemsForWorkHomeAndSocialInteraction, 2, 4) or
IsBtw(globalAssessmentOfFunctioningScore.Value, 31, 50))
Let careLevel_III_3_Score.HasSevereConcomitantPersonalityDisorders =
(pastPsychologicalOrEmotionalProblems.Contains(PsychologicalOrEmotionalProblems.
BorderlineParanoidAntisocialOrOtherPersonalityDisorder) or
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Contains(PsychiatricDiagnosis.
BorderlineParanoidAntisocialOrOtherPersonalityDisorder) or
significantPeriodTroubleWithAttitudeTowardOthersInLifetime > LikertScale.Moderately) and
(currentProblemBehaviorsRequireContinuousInterventions > YesNoNotSure.No)
Let careLevel_III_3_Score.HasSevereFunctionalDeficitsRequiringResidentialTreatment =
hasSymptomsInHomeEnvironmentRequiringResidentialTreatment
Let careLevel_III_3_Score.NeedsLevelIII_3CareDueToMildHarmRiskAndImminentRelapse =
IsBtw(currentHarmRiskToSelfOthers.Value, 1, 4) and
IsBtw(strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers, LikertScale.Moderately, LikertScale.Considerably) and
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8)
Let careLevel_III_3_Score.HasStableMentalStatusToPermitParticipationInTreatment =
(howEmotionalProblemsImpactRecoveryEfforts <
EmotionalProblemsImpactRecoveryEffortsScale.WillHinderTreatmentRecoveryParticipation) and
acceptableLevelsOfCare.Contains(CareLevel.Level_III_3)
Let careLevel_III_3_Score.IsMet = careLevel_I_OutpatientScoreIsMet
Let careLevel_III_3_Score.IsDualDiagnosisCapable =
(careLevel_III_3_Score.HasDepressionOrOtherConditionAndNeeds24HourCare.Value or
careLevel_III_3_Score.ExhibitsViolentBehaviorOnIntoxicationAndIsDangerous.Value or
careLevel_III_3_Score.HasStressDueToRecentLossesThatImpairDailyActivities.Value or
careLevel_III_3_Score.HasSevereConcomitantPersonalityDisorders.Value or
careLevel_III_3_Score.HasSevereFunctionalDeficitsRequiringResidentialTreatment.Value or
careLevel_III_3_Score.NeedsLevelIII_3CareDueToMildHarmRiskAndImminentRelapse.Value) and
careLevel_III_3_Score.HasStableMentalStatusToPermitParticipationInTreatment.Value
Level of Care: Dual Diagnosis Capable Clinically Managed High-Intensity Residential
Treatment (III.5)
Level III.5 (Dual Diagnosis Capable Clinically Managed High-Intensity Residential Treatment) Summary
The patient demonstrates repeated inability to control impulses, or a personality disorder requires structure to shape
behavior. Other functional deficits require a 24-hour setting to teach coping skills. A Dual Diagnosis Enhanced setting is
required for the patient who is severely and persistently mentally ill.
Level III.5 (Dual Diagnosis Capable Clinically Managed High-Intensity Residential Treatment) Criteria
Dual Diagnosis Capable Programs The resident’s status in Dimension 3 is characterized by (a) or (b) or (c) or (d) or (e)
and (f):
Segment I: Conditions and Stability
Criterion (DDC-d)
HasSignificantDeficitsButLikelyResponsiveToResidentialTreatment
OR (d) The resident has significant functional deficits, which are likely to respond to staff interventions. These
symptoms and deficits, when considered in the context of his or her home environment, are sufficiently severe that the
resident is not likely to maintain mental stability and/or abstinence if treatment is provided in a non-residential setting.
The functional deficits are of a pervasive nature, requiring treatment that is primarily habilitative in focus they do not
require medical monitoring or management. They may include—but are not limited to— residual psychiatric symptoms,
chronic addictive disorder, history of criminality, marginal intellectual ability, limited educational achievement, poor
vocational skills, inadequate anger management skills, poor impulse control, and the sequelae of physical, sexual or
emotional trauma. These deficits may be complicated by problems in Dimensions 2 through 6
Original Equation
D3LIII.5ddc-d = TRUE If [ASIp12b>1 or GAF=21to40] & (Mean of ASIf: 6a,8a,8b,9a,9b,19h >2)]
Narrative
Criteria (DDC-d) are met if:
Criterion (DDC-e)
HasConcomitantDisordersRequiringContinuousBoundarySettingCare
OR (e) The resident’s concomitant personality disorders (e.g., antisocial personality disorder with verbal aggressive
behavior requiring consistent limit-setting) are of such severity that the accompanying dysfunctional behaviors require
continuous boundary-setting interventions
Original Equation
D3LIII.5ddc-e = TRUE If ASIp: 19j=11 & 20b=2
Narrative
Criteria (DDC-e) are met if:
1. Insert here
Segment II: Danger and Impulsivity
Criterion (DDC-a)
HasSevereDysfunctionAndCannotControlBehavior
EITHER (a) The resident’s psychiatric condition is stabilizing. However, despite his or her best efforts, the resident is
unable to control his or her use of alcohol or other drugs and/or antisocial behaviors, with attendant probability of harm
to self or others. The resulting level of dysfunction is so severe that it precludes the resident’s participation in a less
structured and intensive level of care
Original Equation
D3LIII.5ddc-a = TRUE If CurRisk>4 & [ASI: d22e or d22f >1 or f19f>2] & ASIp19g=7or8
Narrative
Criterion (DDC-a) is met if:
Criterion (DDC-b)
CannotControlDrugUsageAndInImminentDangerOfRelapse
OR (b) The resident demonstrates repeated inability to control his or her impulses to use alcohol or other drugs and/or
to engage in antisocial behavior, and is in imminent danger of relapse, with attendant likelihood of harm to self, others
or property. The resulting level of dysfunction is of such severity that it precludes participation in the absence of the 24hour support and structure of a Level III.5 program
Original Equation
D3LIII.5ddc-b = TRUE If [ASId18aORd >2 OR HxRisk>2] & [ASId: 22e or 22f >1] & [CurRisk=2to3] & ASIp19g=7or8
Narrative
Criterion (DDC-b) is met if:
Criterion (DDC-c)
CannotControlDrugUsageAndInImminentDangerOfRelapse
OR (c) The resident demonstrates antisocial behavior patterns (as evidenced by criminal activity) that have led or could
lead to significant criminal justice problems, lack of concern for others and extreme lack of regard for authority
(expressed through distrust, conflict or opposition), and which precludes participation in a less structured and intensive
level of care
Original Equation
D3LIII.5ddc-c = TRUE If [sum ASIl3-14a>3] & [ASI: d23x>5 or l1x=4 or l14b>0 or p7cL=4]
Narrative
Criterion (DDC-c) is met if:
Segment III: Distractibility, Mental Status, and Cognitive Function
Criterion (DDC-f)
HasStableMentalStatusPermittingParticipationInTreatment
AND (f) The resident’s mental status (including emotional stability and cognitive functioning) is assessed as sufficiently
stable to permit the resident to participate in the therapeutic interventions provided at this level of care and to benefit
from treatment.
Original Equation
D3LIII.5ddc-f = TRUE If Post7 includes 11
Narrative
Criterion (DDC-f) is met if:
Level III.5 (Dual Diagnosis Capable Clinically Managed High-Intensity Residential Treatment) Placement
Criteria
Original Equation
D3LIII.5 = TRUE if D3LI true
D3LIII.5ddc= TRUE if D3LIII.5ddc- (a, b, c, d, OR e) & f
Narrative
Placement criteria are met if one of the following is met:
Dimension 3: Level III.5 Dual Diagnosis Capable Clinically Managed High-Intensity Care
Reference Pseudo Code
Let currentHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.CurrentHarmRiskToSelfOthers
Let likelihoodPreviousEnvironmentWillInduceSubstanceUse = assessment.DrugAndAlcoholSection.
AdditionalAddictionAndTreatmentItems.LikelihoodPreviousEnvironmentWillInduceSubstanceUse
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers = assessment.DrugAndAlcoholSection.
AdditionalAddictionAndTreatmentItems.StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II =
assessment.FamilyAndSocialHistorySection.FamilyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let numberOfTimesTreatedForAlcoholAbuseLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesTreatedForAlcoholAbuseLifetime
Let numberOfTimesDrugTreatmentLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesDrugTreatmentLifetime
Let historyOfHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.HistoryOfHarmRiskToSelfOthers
Let numberOfTimesArrestedForShopliftingVandalism = assessment.LegalSection.NumberOfTimesArrestedForShopliftingVandalism
Let numberOfTimesArrestedForParoleProbationViolation =
assessment.LegalSection.NumberOfTimesArrestedForParoleProbationViolation
Let numberOfTimesArrestedForDrugCharges = assessment.LegalSection.NumberOfTimesArrestedForDrugCharges
Let numberOfTimesArrestedForForgery = assessment.LegalSection.NumberOfTimesArrestedForForgery
Let numberOfTimesArrestedForWeaponsOffense = assessment.LegalSection.NumberOfTimesArrestedForWeaponsOffense
Let numberOfTimesArrestedForBurglaryLarceny = assessment.LegalSection.NumberOfTimesArrestedForBurglaryLarceny
Let numberOfTimesArrestedForRobbery = assessment.LegalSection.NumberOfTimesArrestedForRobbery
Let numberOfTimesArrestedForAssault = assessment.LegalSection.NumberOfTimesArrestedForAssault
Let numberOfTimesArrestedForArson = assessment.LegalSection.NumberOfTimesArrestedForArson
Let numberOfTimesArrestedForRape = assessment.LegalSection.NumberOfTimesArrestedForRape
Let numberOfTimesArrestedForHomicide = assessment.LegalSection.NumberOfTimesArrestedForHomicide
Let numberOfTimesArrestedForProstitution = assessment.LegalSection.NumberOfTimesArrestedForProstitution
Let interviewerScoreOfAttitude =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
Let desireAndExternalFactorsDrivingTreatment = assessment.LegalSection.DesireAndExternalFactorsDrivingTreatment
Let numberOfTimesArrestedForContemptOfCourt = assessment.LegalSection.NumberOfTimesArrestedForContemptOfCourt
Let significantPeriodTroubleWithAttitudeTowardOthersInLifetime =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodTroubleWithAttitudeTowardOthersInLifetime
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let globalAssessmentOfFunctioningScore =
assessment.PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let freeTimeAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let dealsWithProblemsInFreeTimeThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let friendsAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FriendsAffectOnRecovery
Let dealsWithProblemsFromFriendsThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsFromFriendsThatRiskRelapse
Let closestContactsNeedsAndWillingnessToHelpTreatment =
assessment.FamilyAndSocialHistorySection.ClosestContactsNeedsAndWillingnessToHelpTreatment
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let currentProblemBehaviorsRequireContinuousInterventions =
assessment.PsychologicalSection.InterviewerRating.CurrentProblemBehaviorsRequireContinuousInterventions
Let acceptableLevelsOfCare = assessment.CompletionSection.AcceptableLevelsOfCare
Let careLevel_I_OutpatientScoreIsMet =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_I_OutpatientScore.IsMet
Let significantPeriodOfSeriousDepressionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodOfSeriousDepressionInLast24Hours
Let inabilityToFeelPleasureFromActivitiesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.InabilityToFeelPleasureFromActivitiesInLast24Hours
Let poorAppetiteOrOvereatingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.PoorAppetiteOrOvereatingInLast24Hours
Let feelLikeFailureInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.FeelLikeFailureInLast24Hours
Let movingSpeakingSlowlyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.MovingSpeakingSlowlyInLast24Hours
Let anxietyTensionWorryInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyTensionWorryInLast24Hours
Let anxietyAttackInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackInLast24Hours
Let anxietyAttackMoreThanOnceInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackMoreThanOnceInLast24Hours
Let anxietyAttackRandomInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackRandomInLast24Hours
Let worriedAboutAnxietyAttackInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.WorriedAboutAnxietyAttackInLast24Hours
Let anxietyAttackPalpitationsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackPalpitationsInLast24Hours
Let anxietyAttackChestPainsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChestPainsInLast24Hours
Let anxietyAttackShortnessBreathInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackShortnessBreathInLast24Hours
Let anxietyAttackChokingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChokingInLast24Hours
Let anxietyAttackSweatyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackSweatyInLast24Hours
Let anxietyAttackTremblingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackTremblingInLast24Hours
Let anxietyAttackNauseaDiarrheaInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackNauseaDiarrheaInLast24Hours
Let anxietyAttackDizzinessFaintnessInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDizzinessFaintnessInLast24Hours
Let anxietyAttackDistortedRealityInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDistortedRealityInLast24Hours
Let anxietyAttackNumbnessInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackNumbnessInLast24Hours
Let anxietyAttackChillsHotFlashesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChillsHotFlashesInLast24Hours
Let anxietyAttackLoseControlInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackLoseControlInLast24Hours
Let anxietyAttackDyingSensationInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDyingSensationInLast24Hours
Let significantPeriodFidgetingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodFidgetingInLast24Hours
Let significantPeriodSleepDisorderInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSleepDisorderInLast24Hours
Let significantPeriodLethargyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodLethargyInLast24Hours
Let significantPeriodMuscleTensionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodMuscleTensionInLast24Hours
Let significantPeriodNegativeThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodNegativeThoughtsInLast24Hours
Let significantPeriodExcessiveBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodExcessiveBehaviorInLast24Hours
Let significantPeriodParanoiaInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodParanoiaInLast24Hours
Let significantPeriodUntruePerceptionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodUntruePerceptionInLast24Hours
Let significantPeriodHallucinationsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodHallucinationsInLast24Hours
Let significantPeriodFlashbacksInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodFlashbacksInLast24Hours
Let significantPeriodImpairedThoughtInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodImpairedThoughtInLast24Hours
Let significantPeriodIrritabilityInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodIrritabilityInLast24Hours
Let significantPeriodCurbingViolentBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorInLast24Hours
Let significantPeriodViolentUrgesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesInLast24Hours
Let significantPeriodTroubleWithAttitudeTowardOthersInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodTroubleWithAttitudeTowardOthersInLast24Hours
Let significantPeriodSuicidalThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSuicidalThoughtsInLast24Hours
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let careLevel_III_5_Score.HasSevereDysfunctionAndCannotControlBehavior =
currentHarmRiskToSelfOthers > 4 and (likelihoodPreviousEnvironmentWillInduceSubstanceUse > LikertScale.Slightly or
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers > LikertScale.Slightly or
familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II > LikertScale.Moderately) and
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8)
Let careLevel_III_5_Score.CannotControlDrugUsageAndInImminentDangerOfRelapse =
(numberOfTimesTreatedForAlcoholAbuseLifetime > 2 Or numberOfTimesDrugTreatmentLifetime > 2 Or
historyOfHarmRiskToSelfOthers > 2) and (likelihoodPreviousEnvironmentWillInduceSubstanceUse > LikertScale.Slightly
or strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers > LikertScale.Slightly) and
IsBtw(currentHarmRiskToSelfOthers.Value, 2, 3) and
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8)
Let badBehavioralCountList = new[]
{
numberOfTimesArrestedForShopliftingVandalism,
numberOfTimesArrestedForParoleProbationViolation,
numberOfTimesArrestedForDrugCharges,
numberOfTimesArrestedForForgery,
numberOfTimesArrestedForWeaponsOffense,
numberOfTimesArrestedForBurglaryLarceny,
numberOfTimesArrestedForRobbery,
numberOfTimesArrestedForAssault,
numberOfTimesArrestedForArson,
numberOfTimesArrestedForRape,
numberOfTimesArrestedForHomicide,
numberOfTimesArrestedForProstitution
}
Let careLevel_III_5_Score.HasCriminalBehaviorAndLackOfRegardForAuthorityOrOthers =
badBehavioralCountList.Sum(c => c.Value) > 3 and (interviewerScoreOfAttitude > 5 or
desireAndExternalFactorsDrivingTreatment =
DesireAndExternalFactorsDrivingTreatment.ResentfulAndWishesToRejectTreatmentDespiteCoercion or
numberOfTimesArrestedForContemptOfCourt > 0 or
significantPeriodTroubleWithAttitudeTowardOthersInLifetime = LikertScale.Extremely)
Let averageOfRecovery = Utilities.Average(livingArrangementAffectOnRecovery,
freeTimeAffectOnRecovery, dealsWithProblemsInFreeTimeThatRiskRelapse,
friendsAffectOnRecovery, dealsWithProblemsFromFriendsThatRiskRelapse,
closestContactsNeedsAndWillingnessToHelpTreatment)
Let careLevel_III_5_Score.HasSignificantDeficitsButLikelyResponsiveToResidentialTreatment =
(howDifficultProblemsForWorkHomeAndSocialInteraction > ProblemsForWorkHomeAndSocialInteractionScale.Slightly or
IsBtw(globalAssessmentOfFunctioningScore.Value, 21, 40)) and averageOfRecovery > 2
Let careLevel_III_5_Score.HasConcomitantDisordersRequiringContinuousBoundarySettingCare =
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Contains(PsychiatricDiagnosis.
BorderlineParanoidAntisocialOrOtherPersonalityDisorder) and
(currentProblemBehaviorsRequireContinuousInterventions = YesNoNotSure.Yes)
Let careLevel_III_5_Score.HasStableMentalStatusPermittingParticipationinTreatment =
acceptableLevelsOfCare.Contains(CareLevel.Level_III_5)
Let careLevel_III_5_Score.IsMet = careLevel_I_OutpatientScoreIsMet
Let careLevel_III_5_Score.IsDualDiagnosisCapable =
(careLevel_III_5_Score.HasSevereDysfunctionAndCannotControlBehavior.Value or
careLevel_III_5_Score.CannotControlDrugUsageAndInImminentDangerOfRelapse.Value or
careLevel_III_5_Score.HasCriminalBehaviorAndLackOfRegardForAuthorityOrOthers.Value or
careLevel_III_5_Score.HasSignificantDeficitsButLikelyResponsiveToResidentialTreatment.Value or
careLevel_III_5_Score.HasConcomitantDisordersRequiringContinuousBoundarySettingCare.Value ) and
careLevel_III_5_Score.HasStableMentalStatusPermittingParticipationinTreatment.Value
Level of Care: Dual Diagnosis Capable Medically Monitored High-Intensity Residential
Treatment (III.7)
Level III.7 (Dual Diagnosis Capable Medically Monitored High-Intensity Residential Treatment) Summary
Moderate severity the patient needs a 24-hour structured setting. If the patient has a co-occurring mental disorder, he
or she requires concurrent mental health services in a medically monitored setting.
Level III.7 (Dual Diagnosis Capable Medically Monitored High-Intensity Residential Treatment) Criteria
Dual Diagnosis Capable Programs The patient's status in Dimension 3 is characterized by one of the following [(a) or (b)
or (c) or (d) or (e) or (f)]:
Segment I: Conditions and Stability
D3LIII.1,3,5, or 7 = same as D3LI
Criterion (DDC-a)
HasUnstablePsychiatricStateThatInterferesWithRecovery
EITHER (a) The patient’s psychiatric condition is unstable. Depression and/or other emotional, behavioral or cognitive
symptoms (which may include compulsive behaviors, suicidal or homicidal ideation with a recent history of attempts but
no specific plan, or hallucinations and delusions without acute risk to self or others) are interfering with abstinence,
recovery and stability to such a degree that the patient needs a structured 24-hour, medically monitored (but not
medically managed) environment to address recovery efforts
Original Equation
D3LIII.7ddc-a = TRUE If [Dim3Px=1or ASIp19i or 19j >0] & [(Any of ASIp: 13or13a =2to3) or (ASIp20=3-6)] &
[(ASIp12b=1to4 or GAF=21-50)] & ASIp8aD=0 & ASIp19f<5
Narrative
Criterion (DDC-a) is met if:
Criterion (DDC-b)
HasStressDependenceBehaviorRequiresSecureEnvironmentForSelfCare
OR (b) The patient exhibits stress dependence behaviors associated with recent or threatened losses in work, family or
social domains, to a degree that his or her ability to managed the activities of daily living are significantly impaired. The
patient thus requires a secure, medically monitored environment in which to address self-care problems (such as those
associated with eating, weight loss, sleeplessness or personal hygiene) and to focus on his or her substance abuse or
mental health problems
Original Equation
D3LIII.7ddc-b = TRUE If [Any of ASI: e20,f20,f21 >1] & [Any of ASIp: 3thru8D >2] & [ASIp13a>2] & [ASIp12b=2to4 or
GAF=31-50]
Narrative
Criterion (DDC-b) is met if:
Segment II: Danger and Impulsivity
Criterion (DDC-c)
RequiresActivePsychiatricMonitoringForSignificantDeficits
OR (c) The patient has significant functional deficits that require active psychiatric monitoring. They may include—but
are not limited to—problems with activities of daily living, problems with self-care, lethality or dangerousness, and
problems with social functioning. These deficits may be complicated by problems in Dimensions 2 through 6
Original Equation
D3LIII.7ddc-c = TRUE If [CurRisk=2to4 or GAF=21-40 & [All of ASIp: 19g=7to8 & 19h=0 & 20a=2]
Narrative
Criterion (DDC-c) is met if:
Criterion (DDC-d)
HasModerateRiskOfHarmToSelfOtherAndPropertyAndRelapsePossible
OR (d) The patient is at moderate risk of behaviors endangering self, others or property, and is in imminent danger of
relapse (with dangerous emotional, behavioral or cognitive consequences) without the 24-hour support and structure of
a Level III.7 program
Original Equation
D3LIII.7ddc-d = TRUE If CurRisk=3to6 & [ASI: d22e or d22f >2 or f19f>2] & ASIp19g=7or8
Narrative
Criterion (DDC-d) is met if:
Criterion (DDC-e)
IsActivelyIntoxicatedWithViolentBehaviorPosingImminentDanger
OR (e) The patient is actively intoxicated, with resulting violent or disruptive behavior that poses imminent danger to self
or others
Original Equation
D3LIII.7ddc-e = TRUE If [(CurRisk>4 & ASIp19e=1or2) or {HxRisk>0 & (Any of ASIp: 7L,7bL,or9L U=1)}] & ASIm6a=2
Narrative
Criterion (DDC-e) is met if:
Segment III: Distractibility, Mental Status, and Cognitive Function
Criterion (DDC-f)
HasCognitiveProblemsRequiringStabilizationButNoMedicalManagement
OR (f) The patient has a thought disorder or cognitive limitations that require stabilization but not medical management.
Original Equation
D3LIII.7ddc-f = TRUE If ASIp6>2 or [Any of ASIp: 18,18a,b,c >4] or CIWA10=3 or [any of CIWA6/7/8=4] or GAF=31-40
Narrative
Criterion (DDC-f) is met if:
Level III.7 (Dual Diagnosis Capable Medically Monitored High-Intensity Residential Treatment) Placement
Criteria
Original Equation
D3LIII.7 = TRUE if D3LI
D3LIII.7ddc = TRUE if D3LIII.7ddc- (a, b, c, d, e, OR f)
Narrative
Placement criteria are met if DL3I And (a Or b Or c Or d Or e Or f)
Dimension 3: Level III.7 Dual Diagnosis Capable Medically Monitored High-Intensity Care
Reference Pseudo Code
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let globalAssessmentOfFunctioningScore =
assessment.PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let significantPeriodThoughtsOfSelfInjuryInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodThoughtsOfSelfInjuryInLast24Hours
Let likelihoodOfRecurrenceOfPsychiatricDecompensation =
assessment.PsychologicalSection.InterviewerRating.LikelihoodOfRecurrenceOfPsychiatricDecompensation
Let concernAboutEmploymentProblemsInPast30Days =
assessment.EmploymentAndSupportSection.ConcernAboutEmploymentProblemsInPast30Days
Let troubledByFamilyProblemsInPast30Days =
assessment.FamilyAndSocialHistorySection.TroubledByFamilyProblemsInPast30Days
Let troubledBySocialProblemsInPast30Days =
assessment.FamilyAndSocialHistorySection.TroubledBySocialProblemsInPast30Days
Let significantPeriodOfSeriousDepressionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodOfSeriousDepressionInLast24Hours
Let inabilityToFeelPleasureFromActivitiesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.InabilityToFeelPleasureFromActivitiesInLast24Hours
Let poorAppetiteOrOvereatingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.PoorAppetiteOrOvereatingInLast24Hours
Let feelLikeFailureInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.FeelLikeFailureInLast24Hours
Let movingSpeakingSlowlyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.MovingSpeakingSlowlyInLast24Hours
Let anxietyTensionWorryInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyTensionWorryInLast24Hours
Let anxietyAttackInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackInLast24Hours
Let anxietyAttackMoreThanOnceInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackMoreThanOnceInLast24Hours
Let anxietyAttackRandomInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackRandomInLast24Hours
Let worriedAboutAnxietyAttackInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.WorriedAboutAnxietyAttackInLast24Hours
Let anxietyAttackPalpitationsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackPalpitationsInLast24Hours
Let anxietyAttackChestPainsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChestPainsInLast24Hours
Let anxietyAttackShortnessBreathInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackShortnessBreathInLast24Hours
Let anxietyAttackChokingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChokingInLast24Hours
Let anxietyAttackSweatyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackSweatyInLast24Hours
Let anxietyAttackTremblingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackTremblingInLast24Hours
Let anxietyAttackNauseaDiarrheaInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackNauseaDiarrheaInLast24Hours
Let anxietyAttackDizzinessFaintnessInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDizzinessFaintnessInLast24Hours
Let anxietyAttackDistortedRealityInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDistortedRealityInLast24Hours
Let anxietyAttackNumbnessInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackNumbnessInLast24Hours
Let anxietyAttackChillsHotFlashesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackChillsHotFlashesInLast24Hours
Let anxietyAttackLoseControlInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackLoseControlInLast24Hours
Let anxietyAttackDyingSensationInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyAttackDyingSensationInLast24Hours
Let significantPeriodFidgetingInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodFidgetingInLast24Hours
Let significantPeriodSleepDisorderInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSleepDisorderInLast24Hours
Let significantPeriodLethargyInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodLethargyInLast24Hours
Let significantPeriodMuscleTensionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodMuscleTensionInLast24Hours
Let significantPeriodNegativeThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodNegativeThoughtsInLast24Hours
Let significantPeriodExcessiveBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodExcessiveBehaviorInLast24Hours
Let significantPeriodParanoiaInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodParanoiaInLast24Hours
Let significantPeriodUntruePerceptionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodUntruePerceptionInLast24Hours
Let significantPeriodHallucinationsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodHallucinationsInLast24Hours
Let significantPeriodFlashbacksInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodFlashbacksInLast24Hours
Let significantPeriodImpairedThoughtInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodImpairedThoughtInLast24Hours
Let significantPeriodCurbingViolentBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorInLast24Hours
Let significantPeriodIrritabilityInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodIrritabilityInLast24Hours
Let significantPeriodViolentUrgesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesInLast24Hours
Let significantPeriodTroubleWithAttitudeTowardOthersInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodTroubleWithAttitudeTowardOthersInLast24Hours
Let significantPeriodSuicidalThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSuicidalThoughtsInLast24Hours
Let currentHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.CurrentHarmRiskToSelfOthers
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let patientAbleToSafelyAccessNeededResources =
assessment.PsychologicalSection.InterviewerRating.PatientAbleToSafelyAccessNeededResources
Let currentBehaviorInconsistentWithSelfCare =
assessment.PsychologicalSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let likelihoodPreviousEnvironmentWillInduceSubstanceUse = assessment.DrugAndAlcoholSection.
AdditionalAddictionAndTreatmentItems.LikelihoodPreviousEnvironmentWillInduceSubstanceUse
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers = assessment.DrugAndAlcoholSection.
AdditionalAddictionAndTreatmentItems.StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II =
assessment.FamilyAndSocialHistorySection.FamilyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II
Let riskOfHarmToSelfOrOthersIsHigherWithSubstanceUse =
assessment.PsychologicalSection.InterviewerRating.RiskOfHarmToSelfOrOthersIsHigherWithSubstanceUse
Let historyOfHarmRiskToSelfOthers =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.HistoryOfHarmRiskToSelfOthers
Let significantPeriodCurbingViolentBehaviorRelatedToSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorRelatedToSubstanceUse
Let significantPeriodViolentUrgesRelatedToSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesRelatedToSubstanceUse
Let significantPeriodAttemptedSuicideRelatedToSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodAttemptedSuicideRelatedToSubstanceUse
Let signsOfIntoxicationExist = assessment.MedicalSection.SignsOfIntoxicationExist
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering
Let appearanceOfLethargy = assessment.PsychologicalSection.InterviewerRating.AppearanceOfLethargy
Let appearanceOfFluctuatingOrientationInLast24Hours =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfFluctuatingOrientationInLast24Hours
Let appearanceOfSpeechImpairmentBadPosture = assessment.PsychologicalSection.
InterviewerRating.AppearanceOfSpeechImpairmentBadPosture
Let interviewerObservationOfPatientSenseOfAwareness = assessment.MedicalSection.
InterviewerObservationOfPatientSenseOfAwareness
Let observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances
Let auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel
Let visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel
Let patientNeedForPsychiatricPsychologicalTreatmentRating = assessment.PsychologicalSection.
InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let careLevel_I_OutpatientScoreIsMet = assessmentScore.Dimension3EmotionalBehavioralScores.
CareLevel_I_OutpatientScore.IsMet
Let historyOfWithdrawalRelatedSymptoms = assessmentScore.Dimension3EmotionalBehavioralScores.
CommonScores.HistoryOfWithdrawalRelatedSymptoms
Let hasAlcoholImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasAlcoholImminentWithdrawalPotential
Let hasHeroinImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasHeroinImminentWithdrawalPotential
Let hasMethadoneImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasMethadoneImminentWithdrawalPotential
Let hasOtherOpiateImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasOtherOpiateImminentWithdrawalPotential
Let hasBarbiturateImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasBarbiturateImminentWithdrawalPotential
Let hasOtherSedativeHypnoticImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasOtherSedativeHypnoticImminentWithdrawalPotential
Let hasCocaineImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasCocaineImminentWithdrawalPotential
Let hasStimulantImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasStimulantImminentWithdrawalPotential
Let hasCannabisImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasCannabisImminentWithdrawalPotential
Let hasHallucinogenImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasHallucinogenImminentWithdrawalPotential
Let hasInhalantImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasInhalantImminentWithdrawalPotential
Let hasOtherSubstanceImminentWithdrawalPotential = assessmentScore.Dimension1WithdrawalScores.
CommonScores.HasOtherSubstanceImminentWithdrawalPotential
Let appearanceOfDepressionWithdrawal = assessment.PsychologicalSection.InterviewerRating.
AppearanceOfDepressionWithdrawal
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers = assessment.PsychologicalSection.InterviewerRating.
LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let howTroubledByPsychologicalEmotionalProblemsLast30Days =
assessment.PsychologicalSection.PsychologicalHistory.HowTroubledByPsychologicalEmotionalProblemsLast30Days
Let appearanceOfHostility = assessment.PsychologicalSection.InterviewerRating.AppearanceOfHostility
Let appearanceofAgitation = assessment.PsychologicalSection.InterviewerRating.AppearanceofAgitation
Let appearanceOfAnxietyNervousness = assessment.PsychologicalSection.InterviewerRating.AppearanceOfAnxietyNervousness
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking
Let demonstratingDangerToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.DemonstratingDangerToSelfOrOthers
Let indicatingRiskOfHarmToOthers = assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToOthers
Let indicatingRiskOfHarmToSelfOrVictimizationByOthers =
assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToSelfOrVictimizationByOthers
Let activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator =
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max(d => d.Value) > 0
careLevel_III_7_Score.HasUnstablePsychiatricStateThatInterferesWithRecovery =
(withdrawalSymptomsAndEmotionalBehavioralProblems.Value or
IsBtw(doesPatientCarryPsychiatricDiagnosis, 1, 8) or
activePsychiatricDiagnosesOtherThanSubstanceAbuseIndicator) and
(IsBtw(howEmotionalProblemsImpactRecoveryEfforts,
EmotionalProblemsImpactRecoveryEffortsScale.WillHinderTreatmentRecoveryParticipation,
EmotionalProblemsImpactRecoveryEffortsScale.LikelyToThreatenRecovery) or
IsBtw(howImportantPsychologicalEmotionalCounseling,
PsychologicalEmotionalCounselingImportanceScale.ConsiderablyImportant,
PsychologicalEmotionalCounselingImportanceScale.ExtremelyImportant)) and
(IsBtw(howDifficultProblemsForWorkHomeAndSocialInteraction,
ProblemsForWorkHomeAndSocialInteractionScale.Slightly,
ProblemsForWorkHomeAndSocialInteractionScale.Extremely) or
IsBtw(globalAssessmentOfFunctioningScore.Value, 21, 50)) and
(significantPeriodThoughtsOfSelfInjuryInLast24Hours = LikertScale.NotAtAll) and
(likelihoodOfRecurrenceOfPsychiatricDecompensation < 5)
Let dailySymptomCount = Utilities.GetSymptomsCount(
LikertScale.Moderately,
significantPeriodOfSeriousDepressionInLast24Hours,
inabilityToFeelPleasureFromActivitiesInLast24Hours,
poorAppetiteOrOvereatingInLast24Hours,
feelLikeFailureInLast24Hours,
movingSpeakingSlowlyInLast24Hours,
anxietyTensionWorryInLast24Hours,
anxietyAttackInLast24Hours,
anxietyAttackMoreThanOnceInLast24Hours,
anxietyAttackRandomInLast24Hours,
worriedAboutAnxietyAttackInLast24Hours,
anxietyAttackPalpitationsInLast24Hours,
anxietyAttackChestPainsInLast24Hours,
anxietyAttackShortnessBreathInLast24Hours,
anxietyAttackChokingInLast24Hours,
anxietyAttackSweatyInLast24Hours,
anxietyAttackTremblingInLast24Hours,
anxietyAttackNauseaDiarrheaInLast24Hours,
anxietyAttackDizzinessFaintnessInLast24Hours,
anxietyAttackDistortedRealityInLast24Hours,
anxietyAttackNumbnessInLast24Hours,
anxietyAttackChillsHotFlashesInLast24Hours,
anxietyAttackLoseControlInLast24Hours,
anxietyAttackDyingSensationInLast24Hours,
significantPeriodFidgetingInLast24Hours,
significantPeriodSleepDisorderInLast24Hours,
significantPeriodLethargyInLast24Hours,
significantPeriodMuscleTensionInLast24Hours,
significantPeriodNegativeThoughtsInLast24Hours,
significantPeriodExcessiveBehaviorInLast24Hours,
significantPeriodParanoiaInLast24Hours,
significantPeriodUntruePerceptionInLast24Hours,
significantPeriodHallucinationsInLast24Hours,
significantPeriodFlashbacksInLast24Hours,
significantPeriodImpairedThoughtInLast24Hours,
significantPeriodCurbingViolentBehaviorInLast24Hours,
significantPeriodIrritabilityInLast24Hours,
significantPeriodViolentUrgesInLast24Hours,
significantPeriodTroubleWithAttitudeTowardOthersInLast24Hours,
significantPeriodSuicidalThoughtsInLast24Hours)
careLevel_III_7_Score.HasStressDependenceBehaviorRequiresSecureEnvironmentForSelfCare =
(concernAboutEmploymentProblemsInPast30Days > LikertScale.Slightly or
troubledByFamilyProblemsInPast30Days > LikertScale.Slightly or
troubledBySocialProblemsInPast30Days > LikertScale.Slightly)
and dailySymptomCount > 1
and howEmotionalProblemsImpactRecoveryEfforts >
EmotionalProblemsImpactRecoveryEffortsScale.SomewhatDistractingFromRecovery
and (IsBtw(howDifficultProblemsForWorkHomeAndSocialInteraction,
ProblemsForWorkHomeAndSocialInteractionScale.Moderately,
ProblemsForWorkHomeAndSocialInteractionScale.Extremely) or
IsBtw(globalAssessmentOfFunctioningScore.Value, 31, 50))
Let careLevel_III_7_Score.RequiresActivePsychiatricMonitoringForSignificantDeficits =
(IsBtw(currentHarmRiskToSelfOthers.Value, 2, 4) or
IsBtw(globalAssessmentOfFunctioningScore.Value, 21, 40)) and
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8) and
patientAbleToSafelyAccessNeededResources.Value and
currentBehaviorInconsistentWithSelfCare = YesNoNotSure.Yes
Let careLevel_III_7_Score.HasModerateRiskOfHarmToSelfOtherAndPropertyAndRelapsePossible =
IsBtw(currentHarmRiskToSelfOthers.Value, 3, 6) and
(likelihoodPreviousEnvironmentWillInduceSubstanceUse > LikertScale.Moderately or
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers > LikertScale.Moderately or
familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II > LikertScale.Moderately) and
IsBtw(levelOfSupervisionNeededForProtectionFromSelfHarm, 7, 8)
Let careLevel_III_7_Score.IsActivelyIntoxicatedWithViolentBehaviorPosingImminentDanger =
((currentHarmRiskToSelfOthers > 4 and
IsBtw(riskOfHarmToSelfOrOthersIsHigherWithSubstanceUse,
RiskOfHarmToSelfOrOthersIsHigherWithSubstanceUse.YesOnlyWithUseOrIntoxication,
RiskOfHarmToSelfOrOthersIsHigherWithSubstanceUse.BothWithAndWithoutSubstanceUse)) or
(historyOfHarmRiskToSelfOthers > 0 and
(significantPeriodCurbingViolentBehaviorRelatedToSubstanceUse =
RelationToSubstanceUse.LikelyRelatedToActiveSubstanceUseOrIntoxication or
significantPeriodViolentUrgesRelatedToSubstanceUse =
RelationToSubstanceUse.LikelyRelatedToActiveSubstanceUseOrIntoxication or
significantPeriodAttemptedSuicideRelatedToSubstanceUse =
RelationToSubstanceUse.LikelyRelatedToActiveSubstanceUseOrIntoxication))) and
signsOfIntoxicationExist = YesNoNotSure.Yes
Let careLevel_III_7_Score.HasCognitiveProblemsRequiringStabilizationButNoMedicalManagement =
significantPeriodImpairedThoughtInLast24Hours > LikertScale.Moderately or
appearanceOfTroubleConcentratingOrRemembering > 4 or
appearanceOfLethargy > 4 or
appearanceOfFluctuatingOrientationInLast24Hours > 4 or
appearanceOfSpeechImpairmentBadPosture > 4 or
interviewerObservationOfPatientSenseOfAwareness =
SenseOfAwareness.DisorientedForDateByMoreThan2CalendarDays or
observedTactileDisturbances = TactileDisturbancesObservation.ModeratelySevereHallucinations or
auditoryDisturbanceLevel = AuditoryDisturbanceLevel.ModeratelySevereHallucinations or
visualDisturbanceLevel = VisualDisturbanceLevel.ModeratelySevereHallucinations
or IsBtw(globalAssessmentOfFunctioningScore.Value, 31, 40)
Let careLevel_III_7_Score.IsDualDiagnosisCapable =
(careLevel_III_7_Score.HasUnstablePsychiatricStateThatInterferesWithRecovery.Value or
careLevel_III_7_Score.HasStressDependenceBehaviorRequiresSecureEnvironmentForSelfCare.Value or
careLevel_III_7_Score.RequiresActivePsychiatricMonitoringForSignificantDeficits.Value or
careLevel_III_7_Score.HasModerateRiskOfHarmToSelfOtherAndPropertyAndRelapsePossible.Value or
careLevel_III_7_Score.IsActivelyIntoxicatedWithViolentBehaviorPosingImminentDanger.Value or
careLevel_III_7_Score.HasCognitiveProblemsRequiringStabilizationButNoMedicalManagement.Value) and
patientNeedForPsychiatricPsychologicalTreatmentRating > 4
Let careLevel_III_7_Score.IsMet = careLevel_I_OutpatientScoreIsMet
Level of Care: Early Intervention (0.5)
Level 0.5 (Early Intervention) Summary
The resident is willing to explore how current alcohol or drug use may affect personal goals.
Level 0.5 (Early Intervention) Sole Criterion
HasNoInterferenceFromEmotionalAndBehavioralConditions
In Dimension 3, the individual’s emotional, behavioral or cognitive conditions and complications, if any, are being
addressed through appropriate mental health services and thus will not interfere with therapeutic interventions.
Original Equation
D3L0.5 = TRUE If [Dim3Px=0 & (All of ASIp: 19i,19j & 20 =0)] OR [(Dim3Px=1 OR ASIp20=1to2) & ASIp13a<2 & ASIp20d=2]
Narrative
This criterion is met if:
1) Given the history and any new information, patient doesn’t seem to have any psychiatric diagnosis and doesn’t have
any need for psychiatric/ psychological treatment
2) Patient shows withdrawal symptoms and emotional behavioral problems and/or cognitive condition and
complication
3) Patient shows signs of minimal psych. issues and/or patient has moderate issues that require close outpatient
follow-up
4) Patient doesn’t have any emotional problems
5) Psychiatric evaluation and treatment services are accessible to the patient PRN
Level 0.5 (Early Intervention) Placement Criterion
Original Equation
D3L0.5 = TRUE If single rule, D3L0.5, above, is true
Narrative
This criterion is met if the single rule above is met.
Dimension 3: Level 0.5 Early Intervention
Reference Pseudo Code
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let psychiatricEvaluationAndServicesAccessibleToPatient =
assessment.PsychologicalSection.InterviewerRating.PsychiatricEvaluationAndServicesAccessibleToPatient
Let preliminaryNoInterferenceFromEmotionalAndBehavioralIndicator =
CalculatePreliminaryNoInterferenceFromEmotionalAndBehavioralIndicator(
withdrawalSymptomsAndEmotionalBehavioralProblems,doesPatientCarryPsychiatricDiagnosis,
activePsychiatricDiagnosesOtherThanSubstanceAbuse, patientNeedForPsychiatricPsychologicalTreatmentRating)
Let careLevel05EarlyInterventionScore.HasNoInterferenceFromEmotionalAndBehavioralConditions =
preliminaryNoInterferenceFromEmotionalAndBehavioralIndicator
Or ((Not(withdrawalSymptomsAndEmotionalBehavioralProblems) Or
(patientNeedForPsychiatricPsychologicalTreatmentRating >= new ScaleOf0To8(1) And
patientNeedForPsychiatricPsychologicalTreatmentRating <= new ScaleOf0To8(2)))
And howEmotionalProblemsImpactRecoveryEfforts <
EmotionalProblemsImpactRecoveryEffortsScale.SomewhatDistractingFromRecovery
And psychiatricEvaluationAndServicesAccessibleToPatient = YesNoNotSure.Yes)
Let careLevel05EarlyInterventionScore.IsMet =
careLevel05EarlyInterventionScore.HasNoInterferenceFromEmotionalAndBehavioralConditions
Level of Care: Outpatient Treatment (I)
Level I (Outpatient Treatment) Summary
None provided
Level I (Outpatient Treatment) Criteria
Criterion (a)
HasNoInterferenceFromCoexistingMentalDisorder
The patient has no symptoms of a co-occurring mental disorder, or any symptoms are mild, stable,
fully related to substance use, and do not interfere with the patient’s ability to focus on addiction.
Original Equation
D3LIa = TRUE If [Dim3Px=0 & (All of ASIp: 19i,19j & 20 =0)] OR [(ASIp20=1to2) & ASIp12a<2 & ASIp13a<2]
Narrative
Criterion (a) is met if:
1) Given the history and any new information, patient doesn’t seem to have any psychiatric diagnosis and doesn’t have
any need for psychiatric/ psychological treatment
2) Patient shows signs of minimal psych. issues and/or patient has moderate issues that require close outpatient
follow-up
3) Symptoms of emotional problems have only been related to substance use
4) Patient doesn’t have any emotional problems
Criterion (b)
HasMildSymptomsFromSubstanceUseOrCoexistingMentalDisorder
The patient’s psychiatric symptoms (such as anxiety, guilt, or thought disorders) are mild, mostly stable, and primarily
related to substance use or to a co-occurring cognitive, emotional or behavioral condition. Mental health monitoring is
needed to maintain stable mood, cognition and behavior for example,fluctuations in mood only recently stabilized with
medication, substance-induced depression that is resolving but still significant, or a patient with schizophrenic disorder
recently released from hospital.
Original Equation
D3LIb = TRUE If [ASIp20<3] & [(ASIp13<3)]
Narrative
Criterion (b) is met if:
1) Severity of patient receiving psychiatric/ psychological treatment has a minimal too moderate rating
2) Patient receiving counseling for psychological problems is slightly too moderately important
Criterion (c)
MentalStatusAllowsUnderstandingAndParticipationInTreatment
The patient’s mental status does not preclude his or her ability to: (1) understand the information
presented and (2) participate in treatment planning and the treatment process.
Original Equation
D3LIc = TRUE If ASIp6d=0 & ASIp22=0 & CIWA10<3 & (All of ASIp: 17, 18a,b, & 19b <3) & ASIp13a<2 & GAF>=61
Narrative
Criterion (c) is met if:
1) Patient does not show any signs of slowness of thought and speech, impaired ability to concentrate, or decreased
motor activity.
2) Patient is not unable to understand
3) From interviewer's observation of patient's sense of awareness, patient is disoriented for date by no more than 2
calendar days or patient cannot do serial additions or is uncertain about date
4) Patient shows slight symptomatic appearance of paranoia or impaired thinking
5) Patient shows slight symptomatic appearance of lethargy
6) Patient shows slight ability to contract for safety if risk of harm to self or others
7) Patient's emotional problems won't interfere with recovery
8) Global assessment of functioning score is less than or equal to 61
Criterion (d)
WillNotBeVictimizedAndPosesNoRiskOfHarmToSelfOrOthers
The patient is assessed as not posing a risk of harm to self or others and is not vulnerable to victimization by another.
Original Equation
D3LId = TRUE If (All of ASIp: 7D,7bD,8D,8aD <2) & (All of ASIp: 19,19a,b,c,&d =0) & (ASIf19d&19f =0) & (ASIp20a&b =0)
Narrative
Criterion (d) is met if:
1)
2)
3)
4)
5)
6)
7)
8)
9)
Patient shows slight period curbing violent behavior in last 24 hours
Patient is not having suicidal thoughts
Patient is not at all demonstrating or at imminent risk of uncontrolled violent behavior endangering self or others
Patient is slightly too moderately limited in the ability to contract for safety if at risk of harm to self or others
Patient is not at all becoming easily annoyed or irritable
Patient is not at all indicating any risk of harm to self or vulnerability to victimization by another
Patient has not recently neglected/abuse family members?
It is not likely that the patient’s abuse/neglect of family will worsen without level II care
Patient's current behavior does not seem inconsistent with reliable self-care, safety, or ability to participate in
treatment
10) Current problem behaviors are not so severe as to require continuous limit-setting interventions
Criterion (dde-a)
HasSevereMentalDisorderAndAbilityToAccessServices
The patient has a severe and persistent mental illness that impairs his or her ability to follow through consistently with
mental health appointments and psychotropic medication. However, the patient has the ability to access services such
as assertive community treatment and intensive case management or supportive living designed to help the patient
remain engaged in treatment.
Original Equation
D3LIdde-a = TRUE If ASIp: 20a>0 & [p20c=2 or p20d=2]
Narrative
Criterion (dde-a) is met if:
1) Patient's current behavior seems inconsistent with reliable self-care, safety, or ability to participate in treatment
2) Patient requires treatment modalities that require a 24-hour controlled, supervised environment
3) Psychiatric evaluation and treatment services are accessible to the patient PRN
Criterion (dde-b)
HasSevereMentalOrSubstanceInducedDisorder
The patient has a severe and persistent mental disorder or other emotional, behavioral or cognitive problems,
or substance-induced disorder.
Original Equation
D3LIdde-b = TRUE If [Dim3Px=1 or ASIp19j>0] & ASIp20=3to5 & ASIp13=2to3]
Narrative
Criterion (dde-b) is met if:
1) Given the history any new information patient seems to have an active psychiatric diagnoses ranging from anxiety
disorder too borderline/paranoid/antisocial/or other personality disorder
2) Patient has considerable problems & risk, especially if patient uses substances that require psychiatric/psychological
treatment
3) Patient considers counseling for psychological problems moderately too considerably important
Criterion (dde-c)
LacksAbilityToUnderstandAndParticipateInTreatment
The patient’s mental health functioning is such that he or she has impaired ability to: [1] understand the information
presented, and [2] participate in treatment planning and the treatment process. Mental health management is required
to stabilize mood, cognition and behavior.
Original Equation
D3LIdde-c = TRUE If any of [CIWA10>2 (ASIp: 17,18a,18b,or19b >2), ASIp22=1 ASIp13a>2 or GAF=51-60]
Narrative
Criterion (dde-c) is met if:
1) Base on the interviewer's observation of patient's sense of awareness, the patient is disoriented for date by more
than 2 calendar days
2) Patient shows moderate too extreme appearance of paranoia or impaired thinking
3) Patient shows moderate too extreme appearance of lethargy
4) Patients shows moderate too extreme appearance of fluctuating orientation in last 24 hours
5) Patient is moderately too extremely limited in ability to contract for safety if risk of harm to self or others
6) There is a possibility that the patient is unable to understand
7) Patient's emotional problems will hinder treatment/recovery participation
8) Global assessment of functioning score is between 51 and 60
Criterion (dde-d)
PosesNoRiskOfHarmToSelfOrOthersAndWillNotBeVictimized
The patient is assessed as not posing a risk of harm to self or others & is not vulnerable to victimization
by another.
Original Equation
D3LIdde-d = Same rule as D3LI-d (directly above)
Narrative
Criterion (dde-d) is met if:
1) Patient will not be victimized and poses no risk of harm to self or others
Level I (Outpatient Treatment) Placement Criteria
Original Equation
D3LI = TRUE if D3LI-a
Narrative
Placement criteria are met if either of the following is met:
1) The patient has no symptoms of a co-occurring mental disorder, or any symptoms are mild stable, fully related to
substance use, and do not interfere with the patient’s ability to focus on addiction
Dual Diagnosis Enhanced Criteria
Original Equation
D3LIdde = TRUE if D3LIdde- (a OR b) & c & d
Narrative
The dual diagnosis criteria are met if the following are met:
1) The patient has a severe and persistent mental illness that impairs his or her ability to follow through consistently
with mental health appointments and psychotropic medication
2) The patient has a severe and persistent mental disorder or other emotional, behavioral or cognitive problems or
substance-induced disorder
3) The patient has impaired ability to understand the information presented, and participate in treatment planning and
the treatment process
4) The patient is assessed as not posing a risk of harm to self or other & is not vulnerable to victimization by another
Dual Diagnosis Capable Criteria
Original Equation
OB_D3LIddc := (not OB_D3LI) and (OB_D3LIb and OB_D3LIc and OB_D3LId)
Narrative
The dual diagnosis criteria are met if the following are met
1) The patient's psychiatric symptoms (such as anxiety, guilt, or thought disorders) are mild, mostly stable, and
primarily related to substance use or to a co-occurring cognitive, emotional or behavioral condition
2) The patient's mental status does not preclude his or her ability to understand the information presented and
participate in treatment planning and the treatment process
3) The patient is assessed as not posing a risk of harm to self or others and is not vulnerable to victimization by another
Dimension 3: Level 0.5 Early Intervention
Reference Pseudo Code
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let emotionalProblemsCorrelationWithSubstanceUse =
assessment.PsychologicalSection.PsychologicalHistory.EmotionalProblemsCorrelationWithSubstanceUse
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let significantPeriodImpairedThoughtInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodImpairedThoughtInLast24Hours
Let isPatientUnableToUnderstand = assessment.PsychologicalSection.InterviewerRating.IsPatientUnableToUnderstand
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking
Let appearanceOfLethargy = assessment.PsychologicalSection.InterviewerRating.AppearanceOfLethargy
Let appearanceOfFluctuatingOrientationInLast24Hours =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfFluctuatingOrientationInLast24Hours
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let globalAssessmentOfFunctioningScore =
assessment.PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let significantPeriodCurbingViolentBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorInLast24Hours
Let significantPeriodViolentUrgesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesInLast24Hours
Let significantPeriodSuicidalThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSuicidalThoughtsInLast24Hours
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts
Let demonstratingDangerToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.DemonstratingDangerToSelfOrOthers
Let indicatingRiskOfHarmToOthers = assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToOthers
Let indicatingRiskOfHarmToSelfOrVictimizationByOthers =
assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToSelfOrVictimizationByOthers
Let hasRecentlyNeglectedOrAbusedFamilyMembers =
assessment.FamilyAndSocialHistorySection.HasRecentlyNeglectedOrAbusedFamilyMembers
Let familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II =
assessment.FamilyAndSocialHistorySection.FamilyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II
Let currentBehaviorInconsistentWithSelfCare =
assessment.PsychologicalSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let currentProblemBehaviorsRequireContinuousInterventions =
assessment.PsychologicalSection.InterviewerRating.CurrentProblemBehaviorsRequireContinuousInterventions
Let patientRequires24HourControlledSupervisedEnvironment =
assessment.PsychologicalSection.InterviewerRating.PatientRequires24HourControlledSupervisedEnvironment
Let psychiatricEvaluationAndServicesAccessibleToPatient =
assessment.PsychologicalSection.InterviewerRating.PsychiatricEvaluationAndServicesAccessibleToPatient
bool? withdrawalSymptomsAndEmotionalBehavioralProblems,
PatientCarriesPsychiatricDiagnosis doesPatientCarryPsychiatricDiagnosis,
IEnumerable<PsychiatricDiagnosis> activePsychiatricDiagnosesOtherThanSubstanceAbuse,
ScaleOf0To8 patientNeedForPsychiatricPsychologicalTreatmentRating,
EmotionalProblemsImpactRecoveryEffortsScale howEmotionalProblemsImpactRecoveryEfforts,
EmotionalProblemsCorrelationWithSubstanceUse emotionalProblemsCorrelationWithSubstanceUse,
PsychologicalEmotionalCounselingImportanceScale howImportantPsychologicalEmotionalCounseling,
LikertScale significantPeriodImpairedThoughtInLast24Hours,
YesNoNotSure isPatientUnableToUnderstand,
SenseOfAwareness interviewerObservationOfPatientSenseOfAwareness,
ScaleOf0To8 appearanceOfParanoiaOrImpairedThinking,
ScaleOf0To8 appearanceOfLethargy,
ScaleOf0To8 appearanceOfFluctuatingOrientationInLast24Hours,
ScaleOf0To8 limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers,
uint? globalAssessmentOfFunctioningScore,
LikertScale significantPeriodCurbingViolentBehaviorInLast24Hours,
LikertScale significantPeriodViolentUrgesInLast24Hours,
LikertScale significantPeriodSuicidalThoughtsInLast24Hours,
ScaleOf0To8 hasSuicidalThoughts,
ScaleOf0To8 demonstratingDangerToSelfOrOthers,
ScaleOf0To8 indicatingRiskOfHarmToOthers,
ScaleOf0To8 indicatingRiskOfHarmToSelfOrVictimizationByOthers,
LikertScale hasRecentlyNeglectedOrAbusedFamilyMembers,
LikertScale familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II,
YesNoNotSure currentBehaviorInconsistentWithSelfCare,
YesNoNotSure currentProblemBehaviorsRequireContinuousInterventions,
YesNoNotSure patientRequires24HourControlledSupervisedEnvironment,
YesNoNotSure psychiatricEvaluationAndServicesAccessibleToPatient
----------------------------------------------------------Let preliminaryNoInterferenceFromEmotionalAndBehavioralIndicator =
CalculatePreliminaryNoInterferenceFromEmotionalAndBehavioralIndicator(
withdrawalSymptomsAndEmotionalBehavioralProblems,doesPatientCarryPsychiatricDiagnosis,
activePsychiatricDiagnosesOtherThanSubstanceAbuse,patientNeedForPsychiatricPsychologicalTreatmentRating)
Let careLevelIOutpatientScore.HasNoInterferenceFromCoexistingMentalDisorder =
preliminaryNoInterferenceFromEmotionalAndBehavioralIndicator Or
((patientNeedForPsychiatricPsychologicalTreatmentRating >= 1 And
patientNeedForPsychiatricPsychologicalTreatmentRating <= 2)
And emotionalProblemsCorrelationWithSubstanceUse <
EmotionalProblemsCorrelationWithSubstanceUse.RelationToSubstanceUseIsUnclear
And howEmotionalProblemsImpactRecoveryEfforts <
EmotionalProblemsImpactRecoveryEffortsScale.SomewhatDistractingFromRecovery)
Let careLevelIOutpatientScore.HasMildSymptomsFromSubstanceUseOrCoexistingMentalDisorder =
(patientNeedForPsychiatricPsychologicalTreatmentRating >= 0
And patientNeedForPsychiatricPsychologicalTreatmentRating <= 2)
And howImportantPsychologicalEmotionalCounseling <
PsychologicalEmotionalCounselingImportanceScale.ConsiderablyImportant
Let careLevelIOutpatientScore.MentalStatusAllowsUnderstandingAndParticipationInTreatment =
significantPeriodImpairedThoughtInLast24Hours = LikertScale.NotAtAll
And isPatientUnableToUnderstand = YesNoNotSure.No
And interviewerObservationOfPatientSenseOfAwareness < SenseOfAwareness.DisorientedForDateByMoreThan2CalendarDays
And appearanceOfParanoiaOrImpairedThinking < 3 And appearanceOfLethargy < 3
And appearanceOfFluctuatingOrientationInLast24Hours < 3
And limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers < 3
And howEmotionalProblemsImpactRecoveryEfforts <
EmotionalProblemsImpactRecoveryEffortsScale.SomewhatDistractingFromRecovery
And globalAssessmentOfFunctioningScore >= 61
Let careLevelIOutpatientScore.WillNotBeVictimizedAndPosesNoRiskOfHarmToSelfOrOthers =
significantPeriodCurbingViolentBehaviorInLast24Hours < LikertScale.Moderately
And significantPeriodViolentUrgesInLast24Hours < LikertScale.Moderately
And significantPeriodSuicidalThoughtsInLast24Hours < LikertScale.Moderately
And hasSuicidalThoughts = 0 And demonstratingDangerToSelfOrOthers = 0
And limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers = 0
And indicatingRiskOfHarmToOthers = 0 And indicatingRiskOfHarmToSelfOrVictimizationByOthers = 0
And hasRecentlyNeglectedOrAbusedFamilyMembers = LikertScale.NotAtAll
And familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II = LikertScale.NotAtAll
And currentBehaviorInconsistentWithSelfCare = YesNoNotSure.No
And currentProblemBehaviorsRequireContinuousInterventions = YesNoNotSure.No
Let careLevelIOutpatientScore.IsMet = careLevelIOutpatientScore.HasNoInterferenceFromCoexistingMentalDisorder
Let careLevelIOutpatientScore.HasSevereMentalDisorderAndAbilityToAccessServices =
currentBehaviorInconsistentWithSelfCare > YesNoNotSure.No
And (patientRequires24HourControlledSupervisedEnvironment = YesNoNotSure.Yes
Or psychiatricEvaluationAndServicesAccessibleToPatient = YesNoNotSure.Yes)
Let careLevelIOutpatientScore.HasSevereMentalOrSubstanceInducedDisorder =
(withdrawalSymptomsAndEmotionalBehavioralProblems Or preliminaryNoInterferenceFromEmotionalAndBehavioralIndicator)
And patientNeedForPsychiatricPsychologicalTreatmentRating >= 3
And patientNeedForPsychiatricPsychologicalTreatmentRating <= 5
And howImportantPsychologicalEmotionalCounseling >= PsychologicalEmotionalCounselingImportanceScale.ModeratelyImportant
And howImportantPsychologicalEmotionalCounseling <=
PsychologicalEmotionalCounselingImportanceScale.ConsiderablyImportant
Let careLevelIOutpatientScore.LacksAbilityToUnderstandAndParticipateInTreatment =
interviewerObservationOfPatientSenseOfAwareness > SenseOfAwareness.DisorientedForDateByNoMoreThan2CalendarDays
Or appearanceOfParanoiaOrImpairedThinking > 2 Or appearanceOfLethargy > 2
Or appearanceOfFluctuatingOrientationInLast24Hours > 2
Or limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers > 2
Or isPatientUnableToUnderstand = YesNoNotSure.NotSure
Or howEmotionalProblemsImpactRecoveryEfforts >
Or EmotionalProblemsImpactRecoveryEffortsScale.SomewhatDistractingFromRecovery
Or (globalAssessmentOfFunctioningScore >= 52 And globalAssessmentOfFunctioningScore <= 60)
Let careLevelIOutpatientScore.PosesNoRiskOfHarmToSelfOrOthersAndWillNotBeVictimized =
careLevelIOutpatientScore.WillNotBeVictimizedAndPosesNoRiskOfHarmToSelfOrOthers
Let careLevelIOutpatientScore.IsDualDiagnosisEnhanced =
(careLevelIOutpatientScore.HasSevereMentalDisorderAndAbilityToAccessServices
Or careLevelIOutpatientScore.HasSevereMentalOrSubstanceInducedDisorder)
And careLevelIOutpatientScore.LacksAbilityToUnderstandAndParticipateInTreatment
And careLevelIOutpatientScore.PosesNoRiskOfHarmToSelfOrOthersAndWillNotBeVictimized
Let careLevelIOutpatientScore.IsDualDiagnosisCapable =
Not(careLevelIOutpatientScore.IsMet) And
careLevelIOutpatientScore.HasMildSymptomsFromSubstanceUseOrCoexistingMentalDisorder And
careLevelIOutpatientScore.MentalStatusAllowsUnderstandingAndParticipationInTreatment And
careLevelIOutpatientScore.WillNotBeVictimizedAndPosesNoRiskOfHarmToSelfOrOthers
Level of Care: Opiate Maintenance Therapy
Level OMT (Opiate Maintenance Therapy) Summary
None or manageable in an outpatient structured environment.
Level I (Outpatient Treatment) Criteria
Criterion (a)
EmotionalBevahioralProblemsManageableAsOutpatient
The patient’s emotional, behavioral or cognitive problems, if present, are manageable in an outpatient structured
environment.
Original Equation
D3LMa = Same as D3LIa rule, above
Narrative
Criterion (a) is met if:
Criterion (b)
AbuseOrNeglectOfFamilyRequiresIntensiveOutpatientTreatment
The patient’s substance-related abuse or neglect of his or her spouse, children or significant others require intensive
outpatient treatment to reduce the risk of further deterioration.
Original Equation
D3LM-b = TRUE If Any of ASIf: 19d,19f, or 19i >0
Narrative
Criterion (b) is met if:
Criterion (c)
RequiresManagementForDiagnosedStableEmotionalProblems
The patient has a diagnosed and stable emotional, behavioral or cognitive problem or thought disorder (such as stable
borderline personality disorder or obsessive-compulsive disorder) that requires monitoring, management or medication
because of the risk that the problem(s) will distract the patient from his or her focus on treatment.
Original Equation
D3LM-c = TRUE If ASIp(19i or 19j) >0 & ASIp(13a & 20) =1to3
Narrative
Criterion (c) is met if:
Criterion (d)
NeedsOutpatientTreatmentDueToRiskOfHarmToSelfOrOthers
The patient poses a mild risk of harm to self or others, with or without a history of severe depression, suicidal or
homicidal behavior, but can be managed safely in a structured outpatient environment.
Original Equation
D3LM-d = TRUE If [(Any of ASIp: 7D,7bD,8D,or 8aD =1to2) OR (Any of ASIp: 19,19a,c,or d =1to4) OR (ASIf19d&19f =1)] &
(All of ASIp: 8aD,19a,19b,20a&b =0)
Narrative
Criterion (d) is met if:
Criterion (e)
ShowsStabilityButNeedsMorePharmacotherapyToStopRelapse
The patient demonstrates emotional and behavioral stability but requires continued pharmacotherapy to prevent
relapse to opiate use.
Original Equation
D3LMe = Same as D3LIb rule, above
Narrative
Criterion (e) is met if:
Level OMT (Opiate Maintenance Therapy) Placement Criteria
Original Equation
D3LM = TRUE if Any one of: D3LM-(a OR b OR c OR d OR e)
Narrative
Placement criteria are met if one of the following is met:
2) Insert text here.
Dimension 3: Level OMT (Opiate Maintenance Therapy)
Reference Pseudo Code
Let emotionalBehavioralProblemsManageableAsOutpatient =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_I_OutpatientScore.
HasNoInterferenceFromCoexistingMentalDisorder
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let hasRecentlyNeglectedOrAbusedFamilyMembers =
assessment.FamilyAndSocialHistorySection.HasRecentlyNeglectedOrAbusedFamilyMembers
Let familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II =
assessment.FamilyAndSocialHistorySection.FamilyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II
Let howLikelyToCauseHarmNeglectOthers = assessment.FamilyAndSocialHistorySection.HowLikelyToCauseHarmNeglectOthers
Let significantPeriodCurbingViolentBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorInLast24Hours
Let significantPeriodViolentUrgesInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesInLast24Hours
Let significantPeriodSuicidalThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSuicidalThoughtsInLast24Hours
Let significantPeriodThoughtsOfSelfInjuryInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodThoughtsOfSelfInjuryInLast24Hours
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts
Let demonstratingDangerToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.DemonstratingDangerToSelfOrOthers
Let indicatingRiskOfHarmToOthers = assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToOthers
Let indicatingRiskOfHarmToSelfOrVictimizationByOthers =
assessment.PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToSelfOrVictimizationByOthers
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let currentBehaviorInconsistentWithSelfCare =
assessment.PsychologicalSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let currentProblemBehaviorsRequireContinuousInterventions =
assessment.PsychologicalSection.InterviewerRating.CurrentProblemBehaviorsRequireContinuousInterventions
Let showsStabilityButNeedsMorePharmacotherapyToStopRelapse =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_I_OutpatientScore.
HasMildSymptomsFromSubstanceUseOrCoexistingMentalDisorder
Let careLevelOpioidMaintenanceTherapyScore = new CareLevelOpioidMaintenanceTherapyScore
Let careLevelOpioidMaintenanceTherapyScore.EmotionalBehavioralProblemsManageableAsOutpatient =
emotionalBehavioralProblemsManageableAsOutpatient
Let careLevelOpioidMaintenanceTherapyScore.AbuseOrNeglectOfFamilyRequiresIntensiveOutpatientTreatment =
hasRecentlyNeglectedOrAbusedFamilyMembers > LikertScale.NotAtAll
or familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II > LikertScale.NotAtAll
or howLikelyToCauseHarmNeglectOthers > LikertScale.NotAtAll
Let careLevelOpioidMaintenanceTherapyScore.RequiresManagementForDiagnosedStableEmotionalProblems =
(doesPatientCarryPsychiatricDiagnosis > PatientCarriesPsychiatricDiagnosis.No or
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max(p => p.Value) > PsychiatricDiagnosis.None) and
howEmotionalProblemsImpactRecoveryEfforts >= EmotionalProblemsImpactRecoveryEffortsScale.ProblemsWontInterfere
and howEmotionalProblemsImpactRecoveryEfforts <=
EmotionalProblemsImpactRecoveryEffortsScale.WillHinderTreatmentRecoveryParticipation and
patientNeedForPsychiatricPsychologicalTreatmentRating >= 1 and
patientNeedForPsychiatricPsychologicalTreatmentRating <= 3
Let careLevelOpioidMaintenanceTherapyScore.NeedsOutpatientTreatmentDueToRiskOfHarmToSelfOrOthers =
((significantPeriodCurbingViolentBehaviorInLast24Hours >= LikertScale.Slightly and
significantPeriodCurbingViolentBehaviorInLast24Hours <= LikertScale.Moderately) or
(significantPeriodViolentUrgesInLast24Hours >= LikertScale.Slightly and
significantPeriodViolentUrgesInLast24Hours <= LikertScale.Moderately) or
(significantPeriodSuicidalThoughtsInLast24Hours >= LikertScale.Slightly and
significantPeriodSuicidalThoughtsInLast24Hours <= LikertScale.Moderately) or
(significantPeriodThoughtsOfSelfInjuryInLast24Hours >= LikertScale.Slightly and
significantPeriodThoughtsOfSelfInjuryInLast24Hours <= LikertScale.Moderately)
(hasSuicidalThoughts >= 1 and hasSuicidalThoughts <= 4) or
(demonstratingDangerToSelfOrOthers >= 1 and demonstratingDangerToSelfOrOthers <= 4) or
(indicatingRiskOfHarmToOthers >= 1 and indicatingRiskOfHarmToOthers <= 4) or
(indicatingRiskOfHarmToSelfOrVictimizationByOthers >= 1 and
indicatingRiskOfHarmToSelfOrVictimizationByOthers <= 4) or
(hasRecentlyNeglectedOrAbusedFamilyMembers = LikertScale.Slightly and
familyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II = LikertScale.Slightly)) and
significantPeriodThoughtsOfSelfInjuryInLast24Hours = LikertScale.NotAtAll and
demonstratingDangerToSelfOrOthers = 0 and
limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers = 0 and
currentBehaviorInconsistentWithSelfCare = YesNoNotSure.No and
currentProblemBehaviorsRequireContinuousInterventions = YesNoNotSure.No
Let careLevelOpioidMaintenanceTherapyScore.ShowsStabilityButNeedsMorePharmacotherapyToStopRelapse =
showsStabilityButNeedsMorePharmacotherapyToStopRelapse
Let careLevelOpioidMaintenanceTherapyScore.IsMet =
(careLevelOpioidMaintenanceTherapyScore.EmotionalBehavioralProblemsManageableAsOutpatient.Value or
careLevelOpioidMaintenanceTherapyScore.AbuseOrNeglectOfFamilyRequiresIntensiveOutpatientTreatment.Value
careLevelOpioidMaintenanceTherapyScore.RequiresManagementForDiagnosedStableEmotionalProblems.Value or
careLevelOpioidMaintenanceTherapyScore.NeedsOutpatientTreatmentDueToRiskOfHarmToSelfOrOthers.Value or
careLevelOpioidMaintenanceTherapyScore.ShowsStabilityButNeedsMorePharmacotherapyToStopRelapse.Value)
or
Level of Care: Medically Managed Intensive Inpatient Treatement (IV)
Level IV (Medically Managed Medium Intensive Inpatient Treatment) Summary
Because of severe and unstable problems, the patient requires 24-hour psychiatric care with concomitant addiction
treatment (Dual Diagnosis Enhanced).
Level IV (Medically Managed Medium Intensive Inpatient Treatment) Criteria
Criteria (DDE-a/b/e)
INSERT HERE
(a) Emotional, behavioral or cognitive complications of the patient’s addictive disorder require psychiatric management
and skilled nursing care OR
(b) A concurrent emotional, behavioral or cognitive illness requires stabilization, daily psychiatric management and
primary nursing interventions OR
(e) A coexisting serious emotional, behavioral or cognitive disorder complicates the treatment of addiction and requires
differential diagnosis and treatment.
Original Equation
D3LIVdde-a/b/e = TRUE If [[(Any of ASIp: {3,4,4v,4x,4y,5,6,7,7b,8,or9}D =4 or 8aD>2) & (ASIp:12&13a =4)] or [ASIp: Any
of: 14thru19d,or19f >6] or ASIp19b>0]] & [ASIp19g&20=8 or Post4=1 or Post7>13]
Narrative
Criteria (DDE-a/b/e) are met if:
Criterion (DDE-c)
INSERT HERE
The patient’s uncontrolled behavior poses an imminent danger to self or others.
Original Equation
D3LIVdde-c = TRUE If CurRisk>6
Narrative
Criterion (DDE-c) is met if:
Criterion (DDE-d)
INSERT HERE
The patient’s mental confusion or fluctuating orientation poses an imminent danger to self or others (for example,
severe self-care problems, violence or suicide).
Original Equation
D3LIVdde-d = TRUE If [GAF<21 or (ASIp18,18b >6) or ASIp22=1 or ASIm6b or 6c>0 or CIWA10>2] & [CurRisk>4]
Narrative
Criterion (DDE-d) is met if:
Criterion (DDE-f)
INSERT HERE
The patient’s extreme depression poses an imminent risk to his or her safety OR (h) The patient’s continued alcohol or
drug use is causing grave complications or exacerbation of a previously diagnosed psychiatric or emotional or behavioral
condition.
Original Equation
D3LIVdde-f = TRUE If [MDDI or ODDI =1] & [ASI: p8aD>2 or p19b>4]
Narrative
Criterion (DDE-f) is met if:
Criterion (DDE-g)
INSERT HERE
Impairment of the patient’s thought processes or abstract thinking, limitations in his or her ability to conceptualize, and
impairment in the patient’s ability to manage the activities of daily living pose an imminent risk to his or her safety.
Original Equation
D3LIVdde-g = TRUE If [GAF<21 or ASI-P17=4] & [P19c or d=4]
Narrative
Criterion (DDE-g) is met if:
Criterion (DDE-h)
INSERT HERE
INSERT HERE.
Original Equation
D3LIVdde-h = TRUE If [ASIp19i or 19j >0] & [ASId1thru12R<2d] & CurRisk>4
Narrative
Criterion (DDE-h) is met if:
Criterion (DDE-i)
INSERT HERE
The patient is experiencing altered mental status, with or without delirium, as manifested by: [1] disorientation to self,
or [2] alcoholic hallucinosis, or [3] toxic psychosis.
Original Equation
D3LIVdde-i = TRUE If ASIp18b=8 or CIWA10=4 or ASIm6b=2 or [any of CIWA 6,7,or8 >4]
Narrative
Criterion (DDE-h) is met if:
Level IV (Medically ManagedIntensive Inpatient Treatment) Placement Criteria
Original Equation
D3LIVdde= TRUE if D3LIVdde- (a, b, c, d, e, f, g, h, OR i)
Narrative
Placement criteria are met if one of the following is met:
1) Insert text here.
Dimension 3: Level IV (Medically Managed Intensive Inpatient Treatment)
Reference Pseudo Code
Let
Let careLevel_IVScore.HasEmotionalBehavioralComplicationsOfAddictiveDisorder =
((significantPeriodOfSeriousDepressionInLast24Hours = LikertScale.Extremely or
anxietyTensionWorryInLast24Hours = LikertScale.Extremely or
significantPeriodNegativeThoughtsInLast24Hours = LikertScale.Extremely or
significantPeriodParanoiaInLast24Hours = LikertScale.Extremely or
significantPeriodUntruePerceptionInLast24Hours = LikertScale.Extremely or
significantPeriodHallucinationsInLast24Hours = LikertScale.Extremely or
significantPeriodImpairedThoughtInLast24Hours = LikertScale.Extremely or
significantPeriodCurbingViolentBehaviorInLast24Hours = LikertScale.Extremely or
significantPeriodViolentUrgesInLast24Hours = LikertScale.Extremely or
significantPeriodSuicidalThoughtsInLast24Hours = LikertScale.Extremely or
significantPeriodAttemptedSuicideInLast24Hours = LikertScale.Extremely or
significantPeriodThoughtsOfSelfInjuryInLast24Hours > LikertScale.Moderately) and
howTroubledByPsychologicalEmotionalProblemsLast30Days = LikertScale.Extremely and
howEmotionalProblemsImpactRecoveryEfforts = LikertScale.Extremely or
(appearanceOfDepressionWithdrawal > 6 or appearanceOfHostility > 6 or
appearanceofAgitation > 6 or appearanceOfAnxietyNervousness > 6 or
appearanceOfParanoiaOrImpairedThinking > 6 or
appearanceOfTroubleConcentratingOrRemembering > 6 or
appearanceOfLethargy > 6 or appearanceOfFluctuatingOrientationInLast24Hours > 6 or
appearanceOfSpeechImpairmentBadPosture > 6 or hasSuicidalThoughts > 6 or
demonstratingDangerToSelfOrOthers > 6 or
limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers > 6 or
indicatingRiskOfHarmToOthers > 6 or indicatingRiskOfHarmToSelfOrVictimizationByOthers > 6 or
likelihoodOfRecurrenceOfPsychiatricDecompensation > 6 or
limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers > 0)) and
((levelOfSupervisionNeededForProtectionFromSelfHarm = 8
and
patientNeedForPsychiatricPsychologicalTreatmentRating = 8) or
detoxificationRequiredMoreThanHourlyMonitoring.Value or
acceptableLevelsOfCare.Max(l => l.Value) > CareLevel.Level_III_7_D)
Let careLevel_IVScore.HasConcurrentEmotionalBehavioralIllnessNeedingDailyStabilization =
careLevel_IVScore.HasEmotionalBehavioralComplicationsOfAddictiveDisorder
Let careLevel_IVScore.ExhibitsBehaviorPosingImminentDangerToSelfOrOthers = currentHarmRiskToSelfOthers > 6
Let careLevel_IVScore.HasMentalConfusionPosingImminentDangerToSelfOrOthers =
(globalAssessmentOfFunctioningScore < 21 or
appearanceOfTroubleConcentratingOrRemembering > 6 or
appearanceOfFluctuatingOrientationInLast24Hours > 6 or
isPatientUnableToUnderstand = YesNoNotSure.NotSure or
signsOfToxicPsychosisExist > YesNoNotSure.No or sufferedHeadTraumaInPast48Hours > YesNoNotSure.No or
interviewerObservationOfPatientSenseOfAwareness >
SenseOfAwareness.DisorientedForDateByNoMoreThan2CalendarDays) and currentHarmRiskToSelfOthers > 4
Let careLevel_IVScore.HasExtremeDepressionPosingImminentRiskToPersonalSafety =
(hasImmediateMajorDepressionDisorder.Value or hasImmediateOtherDepressionDisorder.Value)
(significantPeriodThoughtsOfSelfInjuryInLast24Hours > LikertScale.Moderately or
limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers > 4)
and
Let careLevel_IVScore.HasImpairedThoughtAndDailyLifePosesRiskToPersonalSafety =
(globalAssessmentOfFunctioningScore < 21 or appearanceOfParanoiaOrImpairedThinking = 4) and
(indicatingRiskOfHarmToOthers = 4 or indicatingRiskOfHarmToSelfOrVictimizationByOthers = 4)
Let alcoholUseFrequency = Utilities.CalculateFrequency(hasEverUsedAlcohol, lastUsedAlcohol)
Let alcoholUsedToIntoxicationFrequency = Utilities.CalculateFrequency(alcoholUsedToIntoxication,
numberOfMonthsSinceLastAlcoholIntoxication)
if (alcoholUseFrequency > alcoholUsedToIntoxicationFrequency and alcoholUsedToIntoxicationFrequency > 0)
{
alcoholUseFrequency = alcoholUsedToIntoxicationFrequency
}
Let
Let
Let
Let
Let
Let
Let
Let
Let
heroinUseFrequency = Utilities.CalculateFrequency(hasEverUsedHeroin, lastUsedHeroin)
methadoneUseFrequency = Utilities.CalculateFrequency(hasEverUsedMethadone, lastUsedMethadone)
otherOpiateUseFrequency = Utilities.CalculateFrequency(hasEverUsedOtherOpiate, lastUsedOtherOpiate)
barbiturateUseFrequency = Utilities.CalculateFrequency(hasEverUsedBarbiturate, lastUsedBarbiturate)
otherSedativeUseFrequency = Utilities.CalculateFrequency(hasEverUsedOtherSedative, lastUsedOtherSedative)
cocaineUseFrequency = Utilities.CalculateFrequency(hasEverUsedCocaine, lastUsedCocaine)
stimulantUseFrequency = Utilities.CalculateFrequency(hasEverUsedStimulant, lastUsedStimulant)
cannabisUseFrequency = Utilities.CalculateFrequency(hasEverUsedCannabis, lastUsedCannabis)
hallucinogenUseFrequency = Utilities.CalculateFrequency(hasEverUsedHallucinogen, lastUsedHallucinogen)
Let solventAndInhalantUseFrequency = Utilities.CalculateFrequency(hasEverUsedSolventAndInhalant,
lastUsedSolventAndInhalant)
Let careLevel_IVScore.UseOfAlcoholOrDrugsCausesComplicationsOfPreviousEmotionalProblems =
(IsBtw(doesPatientCarryPsychiatricDiagnosis, 1, 8) or
(activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max(v => v.Value) > 0)) and
(
((hasEverUsedAlcohol ?? false) and alcoholUseFrequency < 2) or
((alcoholUsedToIntoxication ?? false) and alcoholUsedToIntoxicationFrequency < 2) or
((hasEverUsedHeroin ?? false) and heroinUseFrequency < 2) or
((hasEverUsedMethadone ?? false) and methadoneUseFrequency < 2) or
((hasEverUsedOtherOpiate ?? false) and otherOpiateUseFrequency < 2) or
((hasEverUsedBarbiturate ?? false) and barbiturateUseFrequency < 2) or
((hasEverUsedOtherSedative ?? false) and otherSedativeUseFrequency < 2) or
((hasEverUsedCocaine ?? false) and cocaineUseFrequency < 2) or
((hasEverUsedStimulant ?? false) and stimulantUseFrequency < 2) or
((hasEverUsedCannabis ?? false) and cannabisUseFrequency < 2) or
((hasEverUsedHallucinogen ?? false) and hallucinogenUseFrequency < 2) or
((hasEverUsedSolventAndInhalant ?? false) and solventAndInhalantUseFrequency < 2)
) and currentHarmRiskToSelfOthers > 4
Let careLevel_IVScore.IsExperiencingAlteredMentalStatus =
appearanceOfFluctuatingOrientationInLast24Hours = 8 or
interviewerObservationOfPatientSenseOfAwareness = SenseOfAwareness.DisorientedToPlaceAndOrPerson or
signsOfToxicPsychosisExist = YesNoNotSure.Yes or
observedTactileDisturbances > TactileDisturbancesObservation.ModeratelySevereHallucinations or
auditoryDisturbanceLevel > AuditoryDisturbanceLevel.ModeratelySevereHallucinations or
visualDisturbanceLevel > VisualDisturbanceLevel.ModeratelySevereHallucinations
Let careLevel_IVScore.IsDualDiagnosisEnhanced
= careLevel_IVScore.HasEmotionalBehavioralComplicationsOfAddictiveDisorder.Value or
careLevel_IVScore.ExhibitsBehaviorPosingImminentDangerToSelfOrOthers.Value or
careLevel_IVScore.HasMentalConfusionPosingImminentDangerToSelfOrOthers.Value or
careLevel_IVScore.HasExtremeDepressionPosingImminentRiskToPersonalSafety.Value or
careLevel_IVScore.HasImpairedThoughtAndDailyLifePosesRiskToPersonalSafety.Value or
careLevel_IVScore.UseOfAlcoholOrDrugsCausesComplicationsOfPreviousEmotionalProblems.Value or
careLevel_IVScore.IsExperiencingAlteredMentalStatus.Value
return careLevel_IVScore
Dimension 4: Readiness to Change
Level of Care: Early Intervention (0.5)
Level 0.5 (Early Intervention) Summary
The resident is willing to explore how current alcohol or drug use may affect personal goals.
Level 0.5 (Early Intervention) Sole Criterion
WillingToGainUnderstandingOfSubstanceUseHarmfulness
In Dimension 4, the individual expresses willingness to gain an understanding of how his or her current use of alcohol or
other drugs may be harmful or impair his or her ability to meet responsibilities and achieve personal goals.
Original Equation
D4L0.5 = TRUE If [sum ASId23 a+d >0] & ASId23x<8 & d24v<8
Note: Current source code is out of sync with original equation.
Narrative
This criterion is met if:
1)
2)
3)
4)
The resident states that they are in some way troubled by their alcohol or drug use.
The interviewer believes that the resident is open to the idea that they may have an addiction problem.
The interviewer believes that the resident is ready and willing to enter treatment.
The resident has not been diagnosed with a drug or alcohol addiction other than nicotine.
Level 0.5 (Early Intervention) Placement Criterion
Original Equation
D4L0.5 = TRUE If single rule, D4L0.5, above, is true
Narrative
This criterion is met if the single rule above is met.
Dimension 4: Level 0.5 Early Intervention
Reference Pseudo Code
Let
Let
Let
Let
Let
troubledByAlc = DrugAndAlcoholSection.AlcoholUse.TroubledInLast30DaysBySubstanceProblems
troubledByDrug = DrugAndAlcoholSection.DrugConsequences.TroubledInLast30DaysBySubstanceProblems
attitudeScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
readinessScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness
nonNicotineDiagnosis = AssessmentScores.DiagnosisResults.AnyAddictionDiagnosisExceptNicotine
Let WillingToGainUnderstandingOfSubstanceUseHarmfulness =
( troubledByAlc > LikertScale.NotAtAll or troubledByDrug > LikertScale.NotAtAll ) and
( attitudeScore < InterviewerScoreOfAttitudeScale.OpenlyRejectsEvidenceOfAddiction ) and
( readinessScore < InterviewerScoreOfReadinessScale.WantsToDropTreatment ) and
( nonNicotineDiagnosis is false )
Let IsMet = WillingToGainUnderstandingOfSubstanceUseHarmfulness
Level of Care: Outpatient Treatment (I)
Level I (Outpatient Treatment) Summary
The patient is ready for recovery, but needs motivating and monitoring strategies to strengthen readiness. Or there is
high severity in this dimension but not in other dimensions. The patient therefore needs a Level I motivational
enhancement program.
Level I (Outpatient Treatment) Criteria
Criterion (a)
ExpressesWillingnessToParticipateInTreatment
The patient expresses willingness to participate in treatment planning and to attend all scheduled activities mutually
agreed upon in the treatment plan.
Original Equation
D4LI-a = TRUE If ASId24v<4 & d24w<2
Narrative
Criterion (a) is met if:
1) The interviewer believes that the patient is ready and willing to enter treatment.
2) The patient has not expressed concerns about pursuing treatment.
Criterion (b)
AcknowledgesProblemAndWantsHelp
The patient acknowledges that he or she has a substance-related and/or mental health problem and wants help to
change.
Original Equation
D4LI-b = TRUE If [sum ASId23 a+d>0] & [sum ASId24 a+d >0] & [ASId23x<4 OR ASIp13>2]
Narrative
Criterion (b) is met if:
1) The patient states that they are in some way troubled by their alcohol or drug use.
2) The patient understands the importance of treatment for their alcohol or drug problems.
3) The interviewer believes that the patient has a positive attitude toward treatment or that the patient has expressed
that they understand the importance of psychological or emotional counseling.
Criterion (c)
AmbivalentAboutProblemRequiresMonitoringInUnstructuredProgram
The patient is ambivalent about a substance-related and/or mental health problem. He or she requires monitoring and
motivating strategies, but not a structured milieu program. For example, the patient has sufficient awareness and
recognition of a substance use and/or mental health problems to allow engagement and follow-through with
attendance at intermittent treatment sessions as scheduled.
Original Equation
D4LI-c = TRUE If ASId23x=2to5 & (All of ASI: d24w,l1x& p13 <3)
Narrative
Criterion (c) is met if:
a)
b)
c)
d)
The interviewer believes that the patient is ambivalent toward their substance problems.
The patient has expressed resistance toward entering treatment.
The patient has expressed that they are only in treatment by coercion.
The patient has expressed that they do not see the importance of psychological or emotional counseling.
Criterion (d)
DoesNotRecognizeProblemRequiresMonitoringInUnstructuredProgram
The patient may not recognize that he or she has a substance-related and/or mental health problem. For example, he or
she is more invested in avoiding a negative consequence than in the recovery effort. Such a patient may require
monitoring and motivating strategies to engage in treatment and to progress through the stages of change.
Original Equation
D4LI-d = TRUE If ASIl1x=1,2or3
Narrative
Criterion (d) is met if:
1) The patient has expressed that the factors driving their treatment are one of:
a) They want treatment but are under outside pressure to resist.
b) They are ambivalent about receiving treatment but they are being externally persuaded to enter treatment.
c) They are only in treatment by coercion.
Level I (Outpatient Treatment) Placement Criteria
Original Equation
D4LI = TRUE If D4LI-(a&b) or c or d
Narrative
Placement criteria are met if one of the following is met:
2) Patient acknowledges problem, wants help, and expresses willingness to participate in treatment.
3) Patient is ambivalent about problem and requires monitoring and motivating, but not rigid structure.
4) Patient does not recognize he/she has a problem and requires monitoring and motivating.
Dimension 4: Level I Outpatient Treatment
Reference Pseudo Code
Let
Let
Let
Let
Let
Let
Let
Let
Let
readinessScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness
attitudeScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
concerns = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
troubledByAlc = DrugAndAlcoholSection.AlcoholUse.TroubledInLast30DaysBySubstanceProblems
troubledByDrug = DrugAndAlcoholSection.DrugConsequences.TroubledInLast30DaysBySubstanceProblems
importanceOfAlcTx = DrugAndAlcoholSection.AlcoholUse.ImportanceOfTreatmentForSubstanceProblems
importanceOfDrugTx = DrugAndAlcoholSection.DrugConsequences.ImportanceOfTreatmentForSubstanceProblem
importanceOfCouncl = PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
factors = LegalSection.DesireAndExternalFactorsDrivingTreatment
Let readinessIsAmbivalentOrUnclearOfPlans = 6
Let attitudeIsAmbivalentSomewhatLessConcerned = 2
Let ExpressesWillingnessToParticipateInTreatment =
readinessScore < readinessIsAmbivalentOrUnclearOfPlans and
concerns < ConcernsAboutPursuingTreatment.PassiveOrSomeHesitations
Let AcknowledgesProblemAndWantsHelp =
( troubledByAlc > LikertScale.NotAtAll or troubledByDrug > LikertScale.NotAtAll ) and
( importanceOfAlcTx > LikertScale.NotAtAll or importanceOfDrugTx > LikertScale.NotAtAll ) and
( attitudeScore < attitudeIsAmbivalentSomewhatLessConcerned or
importanceOfCouncl > PsychologicalEmotionalCounselingImportanceScale.ModeratelyImportant )
Let AmbivalentAboutProblemRequiresMonitoringInUnstructuredProgram =
attitudeScore in ( 2, 3 ) and
concerns < ConcernsAboutPursuingTreatment.ResistsImportantComponents and
factors < DesireAndExternalFactorsDrivingTreatment.OnlyInTreatmentByCoercion and
importanceOfCouncl < PsychologicalEmotionalCounselingImportanceScale.ConsiderablyImportant
Let DoesNotRecognizeProblemRequiresMonitoringInUnstructuredProgram =
factors in (
DesireAndExternalFactorsDrivingTreatment.WantsRecoveryButSomePressure,
DesireAndExternalFactorsDrivingTreatment.AmbivalentAndExternallyPersuaded,
DesireAndExternalFactorsDrivingTreatment.OnlyInTreatmentByCoercion
)
Let IsMet =
( ExpressesWillingnessToParticipateInTreatment and AcknowledgesProblemAndWantsHelp ) or
AmbivalentAboutProblemRequiresMonitoringInUnstructuredProgram or
DoesNotRecognizeProblemRequiresMonitoringInUnstructuredProgram
Level of Care: Intensive Outpatient (II.1)
Level II.1 (Intensive Outpatient) Summary
The patient has Letiable engagement in treatment, ambivalence, or lack of awareness of the substance use or mental
health problem, and requires a structured program several times a week to promote progress through the stages of
change.
Level II.1 (Intensive Outpatient) Criteria
Criterion(a)
RequiresMoreThanLevelOPTherapySinceOtherCareLevelFailed
The patient requires structured therapy and a programmatic milieu to promote treatment progress and recovery
because motivational interventions at another level of care have failed. Such interventions are not feasible or are not
likely to succeed in a Level I program.
Original Equation
D4LII.1-a=TRUE if [ASId21a>0 & either<5 or =8] & ASId24v<6
Narrative
Criterion (a) is met if:
1) The patient has relapsed, been discharged or dropped out of another treatment level.
2) The patient has completed, is completing, or is open to treatment.
Criterion(b)
RequiresRepeatedInterventoinButWillingToParticipate
The patient’s perspective inhibits his or her ability to make behavioral changes without repeated, structured, clinically
directed motivational interventions. (For example, the patient attributes his or her alcohol or other drug and mental
health problems to other persons or external events rather than to an addictive or mental disorder.) Such interventions
are not feasible or are not likely to succeed in a Level I program. However, the patient’s willingness to participate in
treatment and to explore his or her level of awareness and readiness to change suggest that treatment at Level II.1 can
be effective.
Original Equation
D4LII.1-b = TRUE If mean of ASI [{(4/9)*d23x} & d24w & l1x >=2.0 & <2.25] or [d24x,y,z >=1.5 & <2.5]
Narrative
Criterion (b) is met if:
1) The patient is less concerned than circumstances warrant, passive to pursuing treatment and unsure as to prevent
relapses.
2) The patient is thoughtfully committed but has limited sense of responsibility.
3) The patient has vague concept of relapse risk and is unsure of risk factors.
Criterion(dde)
AmbivalentOrInconsistentOrUnawareOfNecessaryTreatment
Dual Diagnosis Enhanced Programs : The patient is reluctant to agree to treatment and is ambivalent about his or her
commitment to change a co-occurring mental health problem OR (b) The patient’s follow-through in treatment is so
poor or inconsistent that Level I services are not succeeding or are not feasible OR (c) The patient is assessed as
requiring intensive services to improve his or her awareness of the need to change. The patient has such limited
awareness of or commitment to change that he or she cannot maintain an adequate level of functioning without Level
II.1 services (for example, the patient continues to experience mild to moderate depression, anxiety or mood swings,
and is inconsistent in taking medication, keeping appointments and completing mental health assignments).
Original Equation
D4LII.1dde-a/b/c = TRUE If [(Dim3Px=1 & ASIp20=2to5) & (ASIp20a>0 or p21>0 or d21a=2or3)]
Narrative
Dual Diagnosis Enhanced criterion is met if a and b and (c or d or e):
1) The patient experiencing withdrawal/emotional/behavioral symptoms, including: mild to moderate anxiety,
depression, mood swings, disorientation lasting at least 2 calendar days, moderate to severe auditory and/or visual
disturbances, possible or confirmed toxic psychosis.
2) The patient’s need for psychiatric/psychological treatment is found to be between a range of:
a) Problems that require a close outpatient follow-up and
b) Considerable problems and risk, especially if substance abuse is present.
3) Patient behavior seems inconsistent with the ability to administer self-care or participate in treatment.
4) It is either possible or confirmed that the information has been distorted by patient misrepresentation.
5) Patient previously failed treatment at levels of care LI (Outpatient) or LI-D (Ambulatory Detox)
Level II.1 (Intensive Outpatient) Placement Criteria
Original Equation
D4LII.1 = TRUE If D4LII.1-a OR b
Narrative
Placement criteria are met if either of the following is met:
1) Patient requires higher level of care than Level I (Outpatient) due to previous treatment failures.
2) Patient demonstrates passivity and vague awareness of both problem and relapse potential, but is willing to
participate in treatment
Dual Diagnosis Criteria
Original Equation
D4LII.1dde = TRUE If D4LII.1 & D4LII.1dde-a/b/c
Narrative
The dual diagnosis criteria are met if both of the following are met:
a) RequiresMoreThanLevelOPTherapySinceOtherCareLevelFailed is met
b) RequiresRepeatedInterventionButWillingToParticipate is met
c) AmbivalentOrInconsistentOrUnawareOfNecessaryTreatment is met
Dimension 4: Level II.1 Intensive Outpatient
Reference Pseudo Code
Let
Let
Let
Let
Let
Let
Let
previousLevelFailed = DrugAndAlcoholSection.AddictionTreatmentHistory.HighestCareLevelFailedFromInPast90Days
readinessScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness
attitudeScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
concerns = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
relapseCause = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
preventRelapse = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
withdrawalProblems =
AssessmentScores.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let severityRating = PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let selfCare = PsychologialSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let misrepresenting = PsychologicalSection.InterviewerRating.IsPatientMisrepresentingInformation
Let RequiresMoreThanLevelOPTherapySinceOtherCareLevelFailed =
( previousLevelFailed > CareLevel.None and previousLevelFailed < CareLevel.Level_II_1 or
previousLevelFailed = CareLevel.Level_III_1 ) and
( readinessScore < InterviewerScoreOfReadinessScale.SlightlyLessIsAmbivalentOrUnclearOfPlans )
Let normalizedInterviewerScoreOfAttitude = interviewerScoreOfAttitude (Scale 0 to 9)
Let avgOfAttitudeConcernsAndDesire = Utilities.Average(InterviewerScoreOfAttitudeFactor *
(double)normalizedInterviewerScoreOfAttitude, (doube)concernsAboutPursuingTreatment,
(double)desireAndExternalFactorsDrivingTreatment)
Let avgOfHelpfullnessFutureRelapseAndStrategy = Utilities.Average((double)helpfullnessOfTreatment,
(double)possibleFutureRelapseCause, (double)strategyToPreventRelapse
Let RequiresRepeatedInterventionButWillingToParticipate =
(avgOfAttitudeConcernsAndDesire >= 2.0 And avgOfAttitudeAndDesire < 2.25) or
(avgOfHhelpfullnessOfTreatment >= 1.5 And avgOfHelpfullnessFutureRelapseAndStrategy < 2.5)
Let AmbivalentOrInconsistentOrUnawareOfNecessaryTreatment =
( withdrawalProblems = bool.TRUE ) and ( severityRating =
PatientNeedForPsychiatricPsychologicalTreatmentScale.MinimalPsychologicalIssues and
PatientNeedForPsychiatricPsychologicalTreatmentScale.SlightlyLessConsiderableProblemsAndRisks )
( selfCare > YesNoNotSure.No ) or ( mispresenting > YesNoNotSure.No ) or
( previouslevelFailed >= CareLevel.Level_I or previousLevelFailed <= CareLevel.Level_ID )
and
Let careLevel_II_1_IntensiveOutpatientScore.IsMet = RequiresMoreThanLevelOPTherapySinceOtherCareLevelFailed or
RequiresRepeatedInterventionButWillingToParticipate
Let DdeIsMet = careLevel_II_1_IntensiveOutpatientScore.IsMet and AmbivalentOrInconsistentOrUnawareOfNecessaryTreatment
Level of Care: Partial Hospitalization (II.5)
Level II.5 (Partial Hospitalization) Summary
The patient has poor engagement in treatment, significant ambivalence, or lack of awareness of the substance use or
mental health problem, requiring a near-daily structured program or intensive engagement services to promote
progress through the stages of change.
Level II.1 (Intensive Outpatient) Criteria
Criterion(a)
RequiresMoreThanLevelOPTherapySinceOtherCareLevelFailed
The patient requires structured therapy and a programmatic milieu to promote treatment progress and recovery
because motivational interventions at another level of care have failed. Such interventions are not feasible or are not
likely to succeed in a Level II.1 program.
Original Equation
D4LII.5-a = TRUE If [ASId21a>0 & <7 or =8] & ASId24v=4to7
Narrative
Criterion (a) is met if:
5) The patient previously failed treatment at the following levels of care: 0.5 (Early Intervention), LI (Outpatient),
LI-D (Ambulatory Detox With On-site Monitoring), LM (Opiate Maintenance Therapy), LII-1 (Intensive Outpatient),
LII-D (Ambulatory Detoxification Without On-site Monitoring).
6) The patient is open to treatment with prompting or demonstrates an ambivalence of plans.
Criterion(b)
InabilityToChangeWithoutStructureButWillingToParticipate
The patient’s perspective and lack of impulse control inhibit his or her ability to make behavioral changes without
repeated, structured, clinically directed motivational interventions. (For example, the patient has unrealistic
expectations that his or her alcohol, drug or mental health problem will resolve quickly, with little or no effort, or the
patient experiences frequent impulses to harm himself or herself. He or she is willing to reach out but has poor ability to
ask for help.) Such interventions are not feasible or are not likely to succeed in a Level I or Level II.1 program. However,
the patient’s willingness to participate in treatment and to explore his or her level of awareness and readiness to change
suggest that treatment at Level II.5 can be effective.
Original Equation
D4LII.5-b = TRUE If mean of ASI [{(4/9)*d23x} & d24w & l1x >=2.25 & <3.0] or [d24x,y,z >=2.5 & <3.0]
Narrative
Criterion (b) is met if:
1) Patient is strongely passive or hesitant in regards to pursuing treatment and resists important components of
treatment or
2) Patient admits risk of relapse is possible but is vague about risk factors.
Criterion(c)
PoorAwarenessOfDisorderOrFollowThruInTreatmentOrHarmfulImpulses
Dual Diagnosis Enhanced Programs : The patient has little awareness of his or her co-occurring mental disorder OR (b)
The patient’s follow-through in treatment is so poor or inconsistent that Level II.1 services are not succeeding or are not
feasible OR (c) The patient is assessed as requiring more intensive engagement, community or case management
services than are available at Level II.1 in order to maintain an adequate level of functioning (for example, the patient
experiences frequent impulses to harm himself or herself, with poor commitment to reach out for help).
Original Equation
D4LII.5dde-a/b/c = TRUE If [(Dim3Px=1 & ASIp20=4to7) & (ASIp20a>0 or p21>0 or d21a=2to5)]
Narrative
Dual Diagnosis Enhanced criterion is met if:
1) The patient experiencing withdrawal/emotional/behavioral symptoms, including: mild to moderate anxiety,
depression, mood swings, disorientation lasting at least 2 calendar days, moderate to severe auditory and/or visual
disturbances, possible or confirmed toxic psychosis.
2) The patient’s need for psychiatric/psychological treatment is found to be between a range of:
a) Considerable problems and risk, especially if substance abuse is present.
b) Severe psychological problems (manic, suicidal ideation or fixed delusions).
3) Patient behavior seems inconsistent with the ability to administer self-care or participate in treatment.
4) It is either possible or confirmed that the information has been distorted by patient mispresentation.
5) The patient previously failed treatment at levels of care LI (Outpatient), LI-D (Ambulatory Detox), LM (Opiate
Maintenance Therapy), LII.1 (Intensive Outpatient).
Level II.5 (Partial Hospitalization) Placement Criteria)
D4LII.5 = TRUE If D4LII.5-a OR b
Dimension 4: Level II.5 Partial Hospitalization
Let previousLevelFailed = DrugAndAlcoholSection.AddictionTreatmentHistory.HighestCareLevelFailedFromInPast90Days
Let readinessScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness
Let attitudeScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
Let concerns = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
Let factors = LegalSection.DesireAndExternalFactorsDrivingTreatment
Let helpfulnessOfTx = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let relapseCause = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
Let preventRelapse = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let withdrawalProblems =
AssessmentScores.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let severityRating = PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let selfCare = PsychologialSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let misrepresenting = PsychologicalSection.InterviewerRating.IsPatientMisrepresentingInformation
Let RequiresMoreThanLevelOPTherapySinceOtherCareLevelFailed =
( previousLevelFailed >= CareLevel.Level_05
and previousLevelFailed <= CareLevel.Level_II.D ) or
previousLevelFailed = CareLevel.Level_III_1 ) and
( readinessScore >= InterviewerScoreOfReadinessScale.SlightlyLessIsOpenToTreatmentWhenPrompted and
readinessScore <= InterviewerScoreOfReadinessScale.IsAmbivalentOrUnclearOfPlans )
Let normalizedInterviewerScoreOfAttitude = interviewerScoreOfAttitude ScaleOf0To9
Let avgOfAttitudeConcernsAndDesire = Utilities.Average(InterviewerScoreOfAttitudeFactor *
(double)normalizedInterviewerScoreOfAttitude, (double)concernsAboutPursuingTreatment,
(double)desireAndExternalFactorsDrivingTreatment
Let avgOfHelpfullnessFutureRelapseAndStrategy = Utilities.Average((double)helpfullnessOfTreatment, (double)
possibleFutureRelapseCause, (double)strategyToPreventRelapse
Let InabilityToChangeWithoutStructureButWillingToParticipate =
( avgOfAttitudeConcernsAndDesire >= 2.25 and avgOfAttitudeConcernsAndDesire < 3 ) or
( avgOfHelpfullnessFutureRelapseAndStrategy >= 2.5 and avgOfHelpfulnessFutureRelapseAndStrategy < 3 )
Let PoorAwarenessOfDisorderOrFollowThruInTreatmentOrHarmfulImpulses = ( withdrawalProblems = bool.TRUE and
severityRating = >= PatientNeedForPsychiatricPsychologicalTreatmentScale.ModerateProblemsRequireOutpatient
and severityRating <=
PatientNeedForPsychiatricPsychologicalTreatmentScale.SlightlyLessSeverePsychologicalProblems)
and ( selfCare > YesNoNotSure.No ) or mispresenting > YesNoNotSure.No
or
( previouslevelFailed >= CareLevel.Level_I
and previousLevelFailed <= CareLevel.Level_II_1 )
Let careLevel_II_5_PartialHospitalization.IsMet = RequiresMoreThanLevelIOPTherapySinceOtherCareLevelFailed or
InabilityToChangeWithoutStructureButWillingToParticipate
Let DdeIsMet = careLevel_II_5_ PartialHospitalization.IsMet and
PoorAwarenessOfDisorderOrFollowThruInTreatmentOrHarmfulImpulses
Level of Care: Clinically Managed Low-Intensity Residential Services (III.1)
Level III.1 (Clinically Managed Low-Intensity Residential Services) Summary
The patient is open to recovery, but needs a structured environment to maintain therapeutic gains.
Level II.1 (Intensive Outpatient) Criteria
Criterion(a)
AcknowledgesProblemRecognizesConsequencesAndIsCooperative
The resident acknowledges the existence of a psychiatric condition and/or substance use problem. He or she recognizes
specific negative consequences and dysfunctional behaviors and their effect on his or her desire to change. He or she is
sufficiently ready to change and cooperative enough to respond to treatment at Level III.1
Original Equation
D4LIII.1a = TRUE If ASI: d23x<2 & d24v<6 & Post8≠8
Narrative
Criterion (a) is met if:
1) Patient shows signs of acceptance of addiction problem(s) and
2) Patient has completed treatment and actively mainteing recovery efforts, is actively participating in treatment,
spontaneously seeking treatment, or is open to treatment with prompting.
Criterion(b)
InTreatmentAtThisndLowerLevelAndNeedsMotivationStrategy
The resident is assessed as appropriately placed at Level I or II and is receiving Level III.1 services concurrently. The
resident may be at an early stage of readiness to change and thus in need of engagement and motivational strategies
Original Equation
D4LIII.1b = TRUE If [Dac: (LI or -LII.1/ddc/dde or -LII.5/ddc/dde) =True] & Post5=1
Narrative
Criterion (b) is met if:
1) The patient is receiving:
a) Level I care
b) Level II.1 or Level II.1 Dual Diagnosis Capable/Enhanced care
c) Level II.5 care
d) Level II.5 Dual Diagnosis Capable/Enhanced care
2) Patient shows readiness to change, but needs external motivation
Criterion(c)
Requires24HourCarePreviouslyFailedTreatment
The resident requires a 24-hour structured milieu to promote treatment progress and recovery, because motivating
interventions have failed in the past and are assessed as not likely to succeed in the future in an outpatient setting.
Original Equation
D4LIII.1c = TRUE If ASId21a>0 & [mean of ASI: {(4/9)*d23x},d24w,l1x >2.5 & <3.5]
Narrative
Criterion (c) is met if:
1) The patient has failed a level (or levels) of care within the last 90 days
and
2) The patient is strongely passive or hesitant in regards to pursuing treatment and strongely resists important
components of treatment.
Criterion(d)
PerspectiveImpairsCareWithoutStructured Environment
The resident’s perspective impairs his or her ability to make behavior changes without the support of a structured
environment. For example, the resident attributes his or her alcohol, drug or mental health problem to other persons or
external events, rather than to a substance dependence or mental disorder. Interventions are assessed as not likely to
succeed in an outpatient setting.
Original Equation
D4LIII.1d = TRUE If mean of ASId24x,y,z >=2.5 & <3.0
Narrative
Criterion (d) is met if:
1) The patient is strongely ambivalent and less concerned than circumstances warrant
2) The patient admits risk possible but strongely vague about risk factors
3) The patient has some ideas makes an occasional effort to prevent relapses
Criterion(d)
AmbivalentOrPoorFollowThruRequiresExternalInterventions
Dual Diagnosis Enhanced Programs The resident’s status in Dimension 4 is characterized by ambivalence in his or her
commitment to change a co-occurring mental health problem. Similarly, the resident who is not consistently able to
follow through with treatment, or who demonstrates minimal awareness of a problem, or who is unaware of the need
to change requires active interventions with family, significant others and other external systems to create leverage and
align incentives so as to promote engagement in treatment is appropriately placed in a Level III.1 Dual Diagnosis
Enhanced program.
Original Equation
D4LIII.1dde-a = TRUE If [(Dim3Px=1 & ASIp20=4to7) & (ASIp20a>0 or p21>0 or d21a=2to7)]
Narrative
Dual Diagnosis Enhanced criterion is met if:
1) The patient displays signs of withdrawal symptoms coupled with emotional and/or behavioral problems
2) The interviewer rates the need for psychological/psychiatric treatment as moderate (requiring close outpatient
followup).
3) Patient behavior seems inconsistent with the ability to administer self-care or participate in treatment.
4) The information gathered has not been distorted by patient misrepresentation.
5) The patient has failed treatment at one, many or all of the following levels of care: LI, LI-D, LM, LII.1, LII.5.
Level III.1 (Clinically Managed Low-Intensity Residential Services) Placement Criteria
Original Equation
D4LIII.1 = TRUE If D4LIII.1-a,b,c, OR d
D4LIII.1dde = TRUE If D4LIII.1 & D4LIII.1dde-a
Dimension 4: Level III_1 Clinically Managed Low Intensity Treatment
Reference Pseudo Code
Let attitudeScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
Let readinessScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness
Let meetsLevelI_OP = AssessmentScores.DimensionalAdmissionCriteriaResults.MeetsCareLevel_I_Outpatient
Let meetsLevelII1-IOP
AssessmentScores.DimensionalAdmissionCriteriaResults.MeetsCareLevel_II_1_IntensiveOutpatientTreatment
Let meetsLevelII1-IOP-DDC =
AssessmentScores.DimensionalAdmissionCriteriaResults.MeetsCareLevel_II_1_IntensiveOutpatientTreatmentDualDIagnosisCapable
Let meetsLevelII1-IOP-DDE =
AssessmentScores.DimensionalAdmissionCriteriaResults.MeetsCareLevel_II_1_IntensiveOutpatientTreatmentDualDIagnosisEnhanced
Let meetsLevelII5-PH = AssessmentScores.DimensionalAdmissionCriteriaResults.MeetsCareLevel_II_5_PartialHospitalization
Let meetsLevelII5-PH-DDC =
AssessmentScores.DimensionalAdmissionCriteriaResults.MeetsCareLevel_II_5_PartialHospitalizationDualDiagnosisCapable
Let meetsLevelII5-PH-DDE =
AssessmentScores.DimensionalAdmissionCriteriaResults.MeetsCareLevel_II_5_PartialHospitalizationDualDiagnosisEnhanced
Let
Let
Let
Let
Let
Let
Let
meetsLevelIII1 = CompleteSection.IsCurrentlyResidingInCareLevel_III_1
previousLevelFailed = DrugAndAlcoholSection.AddictionTreatmentHistory.HighestCareLevelFailedFromInPast90Days
concerns = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
factors = LegalSection.DesireAndExternalFactorsDrivingTreatment
helpfulnessOfTx = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
relapseCause = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
preventRelapse = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let withdrawalProblems =
AssessmentScores.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let severityRating = PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let selfCare = PsychologialSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let misrepresenting = PsychologicalSection.InterviewerRating.IsPatientMisrepresentingInformation
Let AcknowledgesProblemsRecognizesConsequencesAndIsCooperative = attitudeScore < Is ambivalent, somewhat less concerned
than circumstances warrant
ScaleOf0To9 interviewerScoreOfAttitude
ScaleOf0To9 interviewerScoreOfReadiness
ScaleOf0To8 patientNeedForPsychiatricPsychologicalTreatmentRating
YesNoNotSure currentBehaviorInconsistentWithSelfCare
YesNoNotSure isPatientMisrepresentingInformation
-------------Let AcknowledgesProblemRecognizesConsequencesAndIsCooperative =
attitudeScore < InterviewerScoreOfAttitudeScale.IsAmbivalentSomewhatLessConcerned
And
readinessScore < InterviewerScoreOfReadinessScale.SlightlyLessIsAmbivalentOrUnclearOfPlans
Let InTreatmentAtThisndLowerLevelAndNeedsMotivationStrategy = ( meetsCareLevel_I_Outpatient.Value Or
meetsCareLevel_II_1_IntensiveOutPatientTreatment.Value Or
meetsCareLevel_II_1_IntensiveOutPatientTreatmentDualDiagnosisCapable.Value Or
meetsCareLevel_II_1_IntensiveOutPatientTreatmentDualDiagnosisEnhanced.Value Or
meetsCareLevel_II_5_PartialHospitalization.Value Or
meetsCareLevel_II_5_PartialHospitalizationDualDiagnosisCapable.Value
Or
meetsCareLevel_II_5_PartialHospitalizationDualDiagnosisEnhanced.Value ) And
isCurrentlyResidingInCareLevel_III_1.Value
Let normalizedInterviewerScoreOfAttitude = interviewerScoreOfAttitude ScaleOf0To9
Let avgOfAttitudeConcernsAndDesire = Utilities.Average(InterviewerScoreOfAttitudeFactor *
(double)normalizedInterviewerScoreOfAttitude, (double)ConcernsAboutPursuingTreatment,
(double)desireAndExternalFactorsDrivingTreatment
Let Requires24HourCarePreviouslyFailedTreatment = previousLevelFailed > CareLevel.None
> 2.5 And avgOfAttitudeConcernsAndDesire < 3.5
And avgOfAttitudeCOncernsAndDesire
Let avgOfHelpfullnessFutureRelapseAndStrategy = Utilities.Average((double)helpfullnessOfTreatment,
(double)possibleFutureRelapseCause, (double)strategy.ToPreventRelapse)
Let PerspectiveImpairsCareWithoutStructuredEnvironment = avgOfHelpfullnessFutureRelapseAndStrategy >= 2.5
avgOfHelpfullnessFutureRelapseAndStrategy < 3
And
Let AmbivalentOrPoorFollowThruRequiresExternalInterventions = withdrawalSymptomsAndBehavioralProblems.Value And
severityRating >= PatientNeedForPsychiatricPsychologicalTreatmentScale.ModerateProblemsRequireOutpatient
And
severityRating <= PatientNeedForPsychiatricPsychologicalTreatmentScale.SlightlyLessSeverePsychologicalProblems
And (selfCare > YesNoNotSure.No Or mispresenting > YesNoNotSure.No Or previousLevelFailed >= CareLevel.LI And
previousLavelFailed <= CareLevel.LII_5
Let IsMet =
AcknowledgesProblemRecognizesCOnsequencesAndIsCooperative
InTreatmentAtThisndLowerLevelAndNeedsMotivationalStrategy
PerspectiveImpairsCareWithoutStructuredEnvironment Or
Requires24HourCarePreviouslyFailedTreatment
Or
Or
Let DdeIsMet = careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.IsMet
AmbivalentOrPoorFollowThruRequiresExternalInterventions
And
Level of Care: Clinically Managed Medium-Intensity Residential Treatment (III.3)
Level III.3 (Clinically Managed Medium-Intensity Residential Treatment) Summary
The patient has little awareness and needs interventions available only at Level III.3 to engage and stay in treatment. Or
there is high severity in this dimension but not in other dimensions. The patient therefore needs a Level I motivational
enhancement program.
Level III.3 (Clinically Managed Medium-Intensity Residential Treatment) Criteria
Criterion(a)
LittleAwarenessOfNeedForTreatmentAndLimitedReadinessToChange
Because of the intensity and chronicity of the addictive disorder or the resident’s cognitive limitations, he or she has
little awareness of the need for continuing care or the existence of his or her substance use or mental health problem
and need for treatment, and thus has limited readiness to change.
Original Equation
D4LIII.3-a = TRUE If mean of ASId[{(4/9)*23x},d24v,x,y,z]=3to3.5
Criterion (a) is met if:
1)
2)
3)
4)
The patient displays no signs of a readiness to change.
The patient has limited sense of severity of addiction.
The patient does not believe there is a serious risk of relapse.
The patient is strongely ambivalent about preventing relapse.
Criterion(b)
DifficultyUnderstandingRelationOfSubstanceAbuseAndFunctionalLevel
Despite experiencing serious consequences or effects of the addictive disorder or mental health problem, the resident
has marked difficulty in understanding the relationship between his or her substance use, addiction, mental health or
life problems, and impaired coping skills and level of functioning.
Original Equation
D4LIII.3-b = TRUE If ASId23x>5 & ASIp12b>2 & GAF=21to40
Criterion (b) is met if:
1) The patient displays no concern at all regarding substance abuse problems.
2) Substance abuse problems have made it considerably difficult for resident to work, take care of home and get along
with others.
Criterion(c)
PosesPersonalDangerOfHarmWithNoAwarenessOfNeedForTreatment
The resident’s continued substance use poses a danger of harm to self or others, and he or she demonstrates no
awareness of the need to address the severity of his or her addiction or psychiatric problem or does not recognize the
need for treatment. However, assessment indicates that treatment interventions available at Level III.3 may increase
the resident’s degree of readiness to change.
Original Equation
D4LIII.3-c = TRUE If [mean of ASI{(4/9)*d23x},ASId24w items =6to7] & ASI l1x=3or4
Criterion (c) is met if:
1) The patient rejects or obstructs recovery plan.
2) The patient is only in treatment by coercion.
3) The patient is resentful and rejects treatment despite coercion.
Criterion(d)
CognitiveDeficitsRequireImpatientTreatmentToChangeBehavior
The resident’s perspective impairs his or her ability to make behavior changes without repeated, structured, clinically
directed motivational interventions, delivered in a 24-hour milieu. For example, because of cognitive deficits, the
resident attributes his or her alcohol, drug or mental health problem to other persons or external events, rather than to
a substance dependence or mental disorder. Interventions are assessed as not feasible or likely to succeed in an
outpatient setting.
Original Equation
D4LIII.3-d = TRUE If mean of ASId24x,y,z >=3
Criterion (d) is met if:
1) The patient holds others responsible for addiction.
2) The patient doubts risk of relapse is serious.
3) The patient is ambivalent about preventing relapses.
Criterion(dde)
AmbivalentOrReluctantToAddressCoexistingMentalHealthProblem
Dual Diagnosis Enhanced Programs The resident’s status in Dimension 4 is characterized by ambivalence in his or her
commitment to change and reluctance to engage in activities necessary to address a co-occurring mental health
problem. For example, such a resident does not understand the need for antipsychotic medications, so that his or her
compliance with the medication regimen is inconsistent. Similarly, the resident who is not consistently able to follow
through with treatment, or who demonstrates minimal awareness of a problem, or who is unaware of the need to
change, requires active interventions with family, significant others and other external systems to create leverage and
align incentives so as to promote engagement in treatment is appropriately placed in a Level III.3 Dual Diagnosis
Enhanced program.
Original Equation
D4LIII.3dde-a = TRUE If [(Dim3Px=1 & ASIp20=2to3) & (ASIp13<2 or p20a>0 or p21>0 or Post6=0)]
Dual Diagnosis Enhanced criterion is met if:
1)
2)
3)
4)
The need for psychological/psychiatric treatment is high.
Current behavior not inconsistent with the ability to administer self-care or participate in treatment.
The information gathered has not been distorted by patient misrepresentation.
The patient is able to self-administer medication.
Level III.3 (Clinically Managed Medium-Intensity Residential Treatment) Placement Criteria
Original Equation
D4LIII.3 = TRUE If D4LIII.3-a,b,c, OR d
Placement criteria are met met if:
1) The patient shows little awareness of addiction and readiness to change.
2) The patient is impaired to the point of not understanding relation of substance abuse and its impact on
ability to function or negative consequences.
3) The patient is impaired to the point of requiring inpatient treatment to change behaviors.
Dimension 4: Level III_3 Clinically Managed Medium Intensity Treatment:
Reference Pseudo Code
Let attitudeScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
Let readinessScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness
Let concerns = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
Let factors = LegalSection.DesireAndExternalFactorsDrivingTreatment
Let helpfulnessOfTx = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let relapseCause = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
Let preventRelapse = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let withdrawalProblems =
AssessmentScores.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let severityRating = PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let selfCare = PsychologialSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let misrepresenting = PsychologicalSection.InterviewerRating.IsPatientMisrepresentingInformation
Let problemsWorkHomeSocial = PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let functioningScore = PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let impPsyEmoCounseling = PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let ableSelfMedicate = CompletionSection.IsAbleToSelfAdministerMedication
Let normalizedInterviewerScoreOfAttitude = interviewerScoreOfAttitude ScaleOf0To9
Let avgOfAttitudeAwarenessOfNeedForTreatment = Utilities.Average(InterviewerScoreOfAttitudeFactor * (double)
normalizedInterviewerScoreOfAttitude, (double)interviewerScoreOfReadiness, (double)helpfullnessOfTreatment,
(double)possibleFutureRelapseCause, (double) strategyToPreventRelapse
Let LittleAwarenessOfNeedForTreatmentAndLimitedReadinessToChange = avgOfAttitudeAwarenessOfNeedForTreatment >= 3.0
avgOfAttitudeAwarenessOfNeedForTreatment <= 3.5
And
Let DifficultyUnderstandingRelationOfSubstanceAbuseAndFunctionalLevel = normalizedInterviewerScoreOfAttitude >
ScaleOf0To9(5) And problemsWorkHomeSocial > ProblemsForWorkHomeAndSocialInteraction.Moderately And
functioningScore >= 21 And functioningScore <= 40
Let avgOfConcernsAttitude = Utilities.Average(InterviewerScoreOfAttitudeFactor *
(double)normalizedInterviewerScoreOfAttitude, (double)concernsAboutPursuingTreatment
Let PosesPersonalDangerOfHarmWithNoAwarenessOfNeedForTreatment = avgOfCOncernsAttitude >= 6
And avgOfConcernsAttitude <= 7 And factors >= DesireAndExternalFactorsDrivingTreatment.OnlyInTreatmentByCoercion
Factors <= ResentfulAndWishesToRejectTreatmentDespiteCoercion
And
Let avgOfHelpfullnessFutureRelapseAndStrategy = Utilities.Average((double)helpfullnessOfTreatment,
(double)possibleFutureRelapseCause, (double)strategyToPreventRelapse
Let CognitiveDeficitsRequireImpatientTreatmentToChangeBehavior = avhOfHelpfullnessFutureRelapseAndStrategy >= 3
Let AmbivalentOrReluctantToAddressCoexistingMentalHealthProblem = withdrawalSymptomsAndEmotionalBehavioralProblems.Value
And severityRating >= ScaleOf0To8 (2) And severityRating <= ScaleOf0To8 (3) And
impPsyEmoCounseling < PsychologicalEmotionalCounselingImportanceScale.ModeratelyImportant Or
selfCare > YesNoNotSure.No Or misrepresenting > YesNoNotSure.No
Or ableSelfMedicate = YesNoNotApplicable.No
careLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatScore.IsMet =
LittleAwarenessOfNeedForTreatmentAndLimitedReadinessToChange Or
DifficultyUnderstandingRelationOfSubstanceAbuseAndFUnctionalLevel Or
PosesPersonalDangerOfHarmWithNoAwarenessOfNeedForTreatment Or CognitiveDeficitsRequireImpatientTreatmentToChangeBehavior
Let DdeIsMet = careLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatScore.IsMet
LittleAwarenessOfNeedDForTreatmentAndLimitedReadinessToChange
And
Level of Care: Clinically Managed High-Intensity Residential Treatment (III.5)
Level III.5 (Clinically Managed High-Intensity Residential Treatment) Summary
The patient has marked difficulty with or opposition to treatment, with dangerous consequences. Or there is high
severity in this dimension but not in other dimensions. The patient therefore needs a Level I motivational enhancement
program.
Level II.5 (Clinically Managed High-Intensity Residential Treatment) Criteria
Criterion(a)
LittleAcuityOfNeedForTreatmentAndLimitedReadinessToChange
Because of the intensity and chronicity of the addictive disorder or the resident’s mental health problems, he or she has
little awareness of the need for continuing care or the existence of his or her substance use or mental health problem
and need for treatment, and thus has limited readiness to change
Original Equation
D4LIII.5-a = TRUE If mean of ASId[{(4/9)*23x},d24v,x,y,z]=3to3.5
Criterion (a) is met if:
1) The patient holds others responsible for addiction.
2) The patient doubts risk of relapse is serious.
3) The patient is ambivalent about preventing relapses.
Criterion(b)
DifficultyComprehendingRelationOfSubstanceAbuseAndFunctionalLevel
Despite experiencing serious consequences or effects of the addictive disorder or mental health problem, the resident
has marked difficulty in understanding the relationship between his or her substance use, addiction, mental health or
life problems and his or her impaired coping skills and level of functioning, often blaming others for his or her substance
dependence.
Original Equation
D4LIII.5-b = TRUE If ASId23x>5 & ASIp12b>2 & GAF=21to40
Criterion (b) is met if:
1) Substance abuse problems has made it considerably difficult for resident to work, take care of home and get along
with others
2) The psychological, social, and occupational functioning on a hypothetical contiuum is rated at a GAF range
>=21 and <= 40
Criterion(c)
PosesPersonalDangerOfHarmWithOppositionToAddressProblems
The resident demonstrates passive or active opposition to addressing the severity of his or her mental or addiction
problem, or does not recognize the need for treatment. Such continued substance use or inability to follow through
with mental health treatment poses a danger of harm to self or others. However, assessment indicates that treatment
inter-ventions available at Level III.5 may increase the resident’s degree of readiness to change.
Original Equation
D4LIII.5-c = TRUE If [mean of ASI{(4/9)*d23x},ASId24w items >7] & ASI l1x=3or4
Criterion (c) is met if:
1) The patient has only agreed to treatment by coercion.
2) The patient is resentful and rejects treatment despite coercion.
Criterion(d)
PreviousFailedInterventionsIndicateCareRequiredAtThisLevel
The resident requires structured therapy and a 24-hour programmatic milieu to promote treatment progress and
recovery, because motivational interventions have failed at less intensive levels of care and are assessed as not likely to
succeed in the future at a less intensive level of care.
Original Equation
D4LIII.5-d = TRUE If ASId21a >0&<11 & [mean of ASI: {(4/9)*d23x},d24w,l1x >2.5]
Criterion (d) is met if:
1) Resident previously failed treatment any of the following levels of care: L0.5, (Early Intervention), LI (Outpatient), LID (Ambulatory Detox), LM (Opiate Maintenance Therapy), LII.1 (Intensive Outpatient), LIID (Outpatient Detox), LII.5
(Partial Hospitalization), LIII.1 (Clinically Managed Low-Intensity Residential Treatment), LIII.1D (Clinically Managed
Low-Intensity Residential Treatment Detox), LIII.3 (Clinically Managed Medium-Intensity Residential Treatment).
2) The patient is strongely passive or hesitant about pursuing treatment.
Criterion(e)
AttributesProblemsToExternalCausesAndNeeds24HourCare
The resident’s perspective impairs his or her ability to make behavior changes without repeated, structured, clinically
directed motivational interventions, delivered in a 24-hour milieu. For example, the resident attributes his or her
alcohol, drug or mental health problem to other persons or external events, rather than to a substance dependence or
mental disorder. Interventions are adjudged as not feasible or likely to succeed at a less intensive level of care.
Original Equation
D4LIII.5-e = TRUE If mean of ASId24x,y,z >=3
Criterion (e) is met if:
1) The patient holds others responsible for addiction.
2) The patient doubts risk of relapse is serious.
3) The patient is ambivalent about preventing relapses.
Criterion(dde)
WillNotCommitToChangeOrAddressCoexistingMentalHelathProblem
Dual Diagnosis Enhanced Programs: The resident’s status in Dimension 4 is characterized by a lack of commitment to
change and reluctance to engage in activities necessary to address a co-occurring mental health problem. For example,
the resident does not understand the need for antidepressant or antimania medications and so refuses to comply with
the medication regimen. Similarly, the resident who is not consistently able to follow through with treatment, or who
demonstrates minimal awareness of a problem, or who is unaware of the need to change, requires active interventions
with family, significant others and other external systems to create leverage and align incentives so as to promote
engagement in treatment is appropriately placed in a Level III.5 Dual Diagnosis Enhanced program.
Original Equation
D4LIII.5dde-a = TRUE If [(Dim3Px=1 & ASIp20=4to5) & (ASIp13<2 or p20a>0 or p21>0 or Post6=0)]
Dual Diagnosis Enhanced criterion is met if:
1) The patient shows signs of withdrawal symptoms coupled with emotional and/or behavioral problems.
2) The interviewer believes the patient shows considerable problems & risk, especially if uses substancesand requires
3)
4)
5)
6)
psychiatric/psychological treatment.
The patient believes that it is moderately important to seek counseling for psychological problems.
Patient behavior is not inconsistent with the ability to administer self-care or participate in treatment.
The information gathered has not been distorted by patient misrepresentation.
The patient is not able to self-administer medication.
Dimension 4: Level III_5 Clinically Managed High Intensity Treatment:
Reference Pseudo Code
Let attitudeScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
Let readinessScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness
Let concerns = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
Let factors = LegalSection.DesireAndExternalFactorsDrivingTreatment
Let helpfulnessOfTx = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let relapseCause = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
Let preventRelapse = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let withdrawalProblems =
AssessmentScores.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let severityRating = PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let selfCare = PsychologialSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let misrepresenting = PsychologicalSection.InterviewerRating.IsPatientMisrepresentingInformation
Let problemsWorkHomeSocial = PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let functioningScore = PsychologicalSection.InterviewerRating.GlobalAssessmentOfFunctioningScore
Let impPsyEmoCounseling = PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let ableSelfMedicate = CompletionSection.IsAbleToSelfAdministerMedication
Let previousLevelFailed = DrugAndSlcoholSection.AddictionTreatmentHistory.HighestLevelFailedFromInPast90Days
Let normalizedInterviewerScoreOfAttitude = interviewerScoreOfAttitude ScaleOf0To9
Let avgOfAttitudeAwarenessOfNeedForTreatment = Utilities.Average(InterviewerScoreOfAttitudeFactor * (double)
normalizedInterviewerScoreOfAttitude, (double)interviewerScoreOfReadiness, (double)helpfullnessOfTreatment,
(double)possibleFutureRelapseCause, (double) strategyToPreventRelapse
Let LittleAcuityOfNeedForTreatmentAndLimitedReadinessToChange = avgOfAttitudeAwarenessOfNeedForTreatment >= 3
And avgOfAttitudeAwarenessOfNeedForTreatment <= 3.5
Let DifficultyComprehendingRelationOfSubstanceAbuseAndFunctionalLevel = normalizedInterviewerScoreOfAttitude >
ScaleOf0To9(5) And problemsWorkHomeSocial > ProblemsForWorkHomeAndSocialInteractionScale.Moderately And
functioningScore >= 21 And functioningScore <= 40
Let avgOfConcernsAttitude = Utilities.Average(InterviewerScoreOfAttitudeFactor *
(double)normalizedInterviewerScoreOfAttitude, (double)concernsAboutPursuingTreatment
LetPosesPersonalDangerOfHarmWithOppositionToAddressProblems = avgOfConcernsAttitude > 7 And
DesireAndExternalFactorsDrivingTreatment.OnlyInTreatmentByCoercion And factors <=
DesireAndExternalFactorsDrivingTreatment.ResentfulAndWishesToRejectTreatmentDespiteCoercion
factors >=
Let avgOfCOncernsAndDesire = Utilities.Average(InterviewerScoreOfAttitudeFactor *
(double)normalizedInterviewerScoreOfAttitude, (double)concernsAboutPursuingTreatment,
(double)desireAndExternalFactorsDrivingTreatment
Let PreviousFailedInterventionsIndicateCareRequiredAtThisLevel = previousLevelFailed > CareLevel.None
previousLevelFailed < CareLevel.LIII5 And avgOfConcernsAndDesire > 2.5
And
Let avgOfHelpfullnessFutureRelapseStrategy = Utilities.Average((double)helpfullnessOfTreatment,
(double)possibleFutureRelapseCause, (double)strategyToPreventRelapse
Let AttributesProblemsToExternalCausesAndNeeds24HourCare = avgOfHelpfullnessFutureRelapseAndStrategy >= 3
Let WillNotCommitToChangeOrAddressCoexistingMentalHealthProblem = withdrawalSymptomsAndEmotionalBehavioralProblems
severityRating >= new ScaleOf0To8 (4) And severityRating <= new ScaleOf0To8 (5)
And ( impPsyEmoCounseling < PsychologicalEmotionalCOunselingImportanceScale.ModeratelyImportant Or
selfCare > YesNoNotSure.No Or misrepresenting > YesNoNotSure.No Or ableSelfMedicate = YesNoNotApplicable.No)
And
Let careLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatScore.IsMet =
LittleAcuityOfNeedForTreatmentAndLimitedReadniessToCHange Or
DifficultyCOmprehendingRelationOfSubstanceAbuseAndFunctionalLevel Or
PosesPersonalDangerOfHarmWithOppositionToAddressProblems Or PreviousFailedInterventionsIndicateCareRequiredAtThisLevel
Or AttributesProblemsToExternalCausesAndNeeds24HourCare
Let DdeIsMet = careLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatScore.IsMet
WillNotCommitToChangeOrAddressCoexistingMentalHealthProblem
And
Level of Care: Medically Monitored Intensive Inpatient Treatment (III.7)
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Summary
The patient’s resistance is high and impulse control poor, despite negative consequences he or she needs motivating
strategies available only in a 24-hour structured setting. Or, if a 24-hour setting is not required, the patient needs a
Level I motivational enhancement program.
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Criteria
Criterion(a)
DoesNot AcceptOrRelateAddictiveDisordersToSevereProblems
Despite experiencing serious consequences or effects of the addictive disorder or mental health problem, the patient
does not accept or relate the addictive disorder to the severity of these problems.
Original Equation
D4LIII.7-a = TRUE If ASId23x>5
Criterion (a) is met if:
1) The patient shows shows no evidence of concern at all or openly rejects evidence of apparent addiction problems.
Criterion(b)
Resident shows NeedsIntensiveCareOnlyAvailableIn24HourMedicalSetting
The patient is in need of intensive motivating strategies, activities and processes available only in a 24-hour structured,
medically monitored setting.
Original Equation
D4LIII.7-b = TRUE If ASIl1x=4
Criterion (b) is met if:
1) The patient is resentful and rejects treatment despite coercion.
Criterion(c)
Needs24HourPsychiatricMonitoringToCOmplyWithMedications
The patient needs ongoing 24-hour psychiatric monitoring to assure follow-through with the treatment regimen and to
deal with issues such as ambivalence about compliance with psychiatric medications.
Original Equation
D4LIII.7-c = TRUE If ASIp20c=2 & Post6 =0
Criterion (c) is met if:
1) The patient requires 24-Hour controlled environment.
2) The patient is not able to self-administer medication.
Criterion(dde)
RefusesToAddressCoexistingMentalHealthProblemsOrCommitToChange
Dual Diagnosis Enhanced Programs The patient’s status in Dimension 4 is characterized by a lack of commitment to
change and refusal to engage in activities necessary to address a co-occurring mental health problem. For example, the
patient with bipolar affective disorder desires his or her manic states and thus refuses to comply with a regimen of
mood-stabilizing medications. Similarly, the patient who is not consistently able to follow through with treatment, or
who demonstrates minimal awareness of a problem, or who is unaware of the need to change, requires active
interventions with family, significant others and other external systems to create leverage and align incentives so as to
promote engagement in treatment is appropriately placed in a Level III.7 Dual Diagnosis Enhanced program.
Original Equation
D4LIII.7dde-a = TRUE If [(Dim3Px=1 & ASIp20=6to7) & (ASIp13<2 or p20a>0 or p21>0 or Post6=0)]
Dual Diagnosis Enhanced criterion is met if:
1) The patient shows signs of withdrawal symptoms coupled with emotional and/or behavioral problems.
2) The interviewer believes the patient shows severe psychological problems and requires psychiatric/psychological
treatment.
3) The patient believes psychological counseling is moderately important.
4) Patient’s bevahior is not inconsistent with the ability to administer self-care or participate in treatment.
5) The information gathered has not been distorted by patient misrepresentation.
6) The patient not able to self-administer medication
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Placement Criteria
Original Equation
D4LIII.7 = TRUE If D4LIII.7-a,b, OR c
Placement criteria are met if:
1) The patient shows no evidence of concern at all, openly rejects evidence of apparent addiction problems.
2) The patient needs 24-hour care in a controlled setting.
3) The patient needs 24-hour psychiatric and medication monitoring.
Dual Diagnosis Criterion (Final Rules)
Original Equation
D4LIII.7dde = TRUE If D4LIII.7 & D4LIII.7dde-a
Dual Diagnosis criteria are met if:
1) The patient meets all criteria for Level III.7 intake and care.
2) The patient refuses to address coexisting mental health problems or commit to change.
Dimension 4: Level III_7 Medically Monitored Intensive Inpatient Treatment:
Reference Pseudo Code
Let attitudeScore = DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
Let factors = LegalSection.DesireAndExternalFactorsDrivingTreatment
Let withdrawalProblems =
AssessmentScores.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let severityRating = PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let selfCare = PsychologialSection.InterviewerRating.CurrentBehaviorInconsistentWithSelfCare
Let misrepresenting = PsychologicalSection.InterviewerRating.IsPatientMisrepresentingInformation
Let impPsyEmoCounseling = PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let ableSelfMedicate = CompletionSection.IsAbleToSelfAdministerMedication
Let req24HourSetting = PsychologicalSection.InterviewerRating.PatientRequires24HourControlledSupervisedEnvironment
Let DoesNotAcceptOrRelateAddictiveDisordersToSevereProblems = attitudeScore >
InterviewerScoreOfAttitudeScale.RationalizesAddictionProblemsDueToOtherCauses
Let NeedsIntensiveCareOnlyAvailableIn24HourMedicalSetting = factors =
DesireAndExternalFactorsDrivingTreatment.ResentfulAndWishesToRejectTreatmentDespiteCoercion
Let Needs24HourPsychiatricMonitoringToComplyWithMedications = req24HourSetting = YesNoNotSure.Yes
ableSelfMedicate = YesNoNotSure.No
And
Let RefusesToAddressCoexistingMentalHealthProblemOrCommitToCHange = withdrawalSymptomsAndEmotionalBehavioralProblems.Value
And severityRating >= new ScaleOf0To8 (6) And severityRating <= new ScaleOf0To8 (7) And
(impPsyEmoCounseling < PsychologicalEmotionalCounselingImportanceScale.ModeratelyImportant Or selfCare > YesNoNotSure.No
Or misrepresenting > YesNoNotSure.No Or ableSelfMedicate = YesNoNotApplicable.No
Let careLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore.IsMet =
DoesNotAcceptOrRelateAddictiveDisordersToSevereProblems Or NeedsIntensiveCareOnlyAvailableIn24HourMedicalSetting
Needs24HourPsychiatricMonitoringToComplyWithMedications
Let DdeIsMet = careLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore.IsMet
RefusesToAddressCoexistingMentalHealthProblemOrCommitToChange
And
Or
Level of Care: Medically Managed Intensive Inpatient Treatment (IV)
Summary
Problems in this dimension do not qualify the patient for Level IV services.
Dimension 5: Relapse, Continued Use, or Continued Problem Potential
Level of Care: Early Intervention (0.5)
Level 0.5 (Early Intervention) Summary
The patient’s social support system or significant others increase the risk of personal conflict about alcohol or drug use.
Level 0.5 (Early Intervention)
Criterion(a)
DoesNotUnderstandNeedToAlterCurrentDrugPattern
The individual does not understand the need to alter his or her current pattern of use of alcohol or other drugs to
prevent harm that may be related to such use.
Original Equation
D5L0.5-a = TRUE If ASId23x>1
Narrative
This criterion is met if:
1) The interviewer scores the patient’s attitude concerning his/her substance problems:
a) Ambivalent
b) Rationalizes problems as mostly due to external causes
c) Not concerned at all
d) Openly rejects the evidence of addiction problems
Criterion(b)
NeedsToAcquireSkillsToChangeCurrentDrugUsePattern
The individual needs to acquire the specific skills to change his or her current pattern of use.
Original Equation
D5L0.5-b = TRUE If ASId24z>2 OR d22e>2 or ASIf8a or b >1
Narrative
This criterion is met if:
1) Individual is passive, highly ambivalent, or rejects need to establish and follow a plan to prevent relapses or
2) Individual expresses a considerable or extreme risk for relapse if he/she returns to the environment in which he/she
previously used drugs.
Level 0.5 (Early Intervention) Placement Criteria
Original Equation
D5L0.5 = TRUE If D5L0.5-a OR -b
Narrative
This Level 0.5 placement criterion is met if:
1) Patient does not understand the need to alter current drug pattern or
2) Patient needs to acquire skills to change current drug use pattern.
Dimension 5: Level 0.5 (Early Intervention)
Reference Pseudo Code
Let interviewerScoreOfAttitude =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
Let strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let likelihoodPreviousEnvironmentWillInduceSubstanceUse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
LikelihoodPreviousEnvironmentWillInduceSubstanceUse
Let freeTimeAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let dealsWithProblemsInFreeTimeThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let anyAddictionDiagnosisExceptNicotine = assessmentScore.DiagnosisResults.AnyAddictionDiagnosisExceptNicotine
Let careLevel_0_5_Score.DoesNotUnderstandNeedToAlterCurrentDrugUsePattern = interviewerScoreOfAttitude > 1
Let careLevel_0_5_Score.NeedsToAcquireSkillsToChangeCurrentDrugUsePattern =
strategyToPreventRelapse > RelapsePreventionStrategies.SomeIdeasAndOccasionalEffort or
likelihoodPreviousEnvironmentWillInduceSubstanceUse > LikertScale.Moderately or
freeTimeAffectOnRecovery > FreeTimeAffectOnRecovery.FreeTimeActivitiesWillSupportAndDistractFromSubstanceUse or
dealsWithProblemsInFreeTimeThatRiskRelapse >
StrategiesToDealWithProblemsInFreeTimeThatRiskRelapse.HasSomePlansToDevelopHealthyLeisurePursuits
Let careLevel_0_5_Score.IsMet =
( careLevel_0_5_Score.DoesNotUnderstandNeedToAlterCurrentDrugUsePattern.Value or
careLevel_0_5_Score.NeedsToAcquireSkillsToChangeCurrentDrugUsePattern.Value ) and not
anyAddictionDiagnosisExceptNicotine
Level of Care: Outpatient Treatment (I)
Level I (Outpatient Treatment) Summary
The patient is able to maintain abstinence or control use and pursue recovery or motivational goals with minimal
support.
Level I (Outpatient Treatment)
Sole Criterion
IsAbleToAchieveRecoveryGoalsOrAwarenessOfDrugProblem
The patient is assessed as able to achieve or maintain abstinence and related recovery goals, or to achieve awareness of
a substance problem and related motivational enhancement goals, only with support and scheduled therapeutic contact
to assist him or her in dealing with issues that include (but are not limited to) concern or ambivalence about
preoccupation with alcohol or other drug use, craving, peer pressure, and lifestyle and attitude changes.
Original Equation
D5LI = TRUE If [{ASIl1x>0 OR (Mean ASId24x,y,z >1 & <2) OR ASId22e>0} & ASIf6a<3 & ASId22k<2] & [ASId22e & f <2]
Narrative
This criterion is met if:
1) The admission or visit was prompted or suggested by the criminal justice system or
2) The patient’s attitude about treatment efficacy and relapse potential is vague or passive or
3) The patient believes there is a slight to extreme chance he/she will resume drug and/or alcohol use if he/she returns
to the environment where he/she used drugs and/or alcohol and
4) The patient believes his/her current living environment is generally supportive and will permit recovery and
5) The patient believes there is no immediate risk or that a risk of relapse could occur over next month without
treatment and
6) The patient believes there is a zero to slight chance he/she will resume drug and/or alcohol use if he/she returns to
the environment where he/she used drugs and/or alcohol and
7) The patient believes there is a zero to slight chance that something in the environment will trigger the urge to use
drugs and/or alcohol
Criterion(dde)
IsAbleToAchieveMentalHealthGoalsOnlyWithTherapeuticContact
Dual Diagnosis Programs: In addition to the foregoing criteria, the patient is assessed as able to achieve or maintain
mental health functioning and related goals only with support and scheduled therapeutic contact to assist him or her in
dealing with issues that include (but are not limited to) impulses to harm self or others and difficulty in coping with his
or her affects, impulses or cognition. While such impulses and difficulty in coping may apply to patients in both Dual
Diagnosis Capable and Dual Diagnosis Enhanced programs, DDE: patients in need of Dual Diagnosis Enhanced program
services are more unstable and require the outreach and support of assertive community treatment and intensive case
management to maintain their mental health function. For example, such a patient may be unable to reliably keep
mental health appointments because of instability in cognition, behavior or mood.
Original Equation
D5LIdde = TRUE If mean of ASIp (12,12b,13,13a) =1.5to<2 OR ASIp20=2to3
Narrative
Dual Diagnosis criterion is met if:
1) The patient is slightly to moderately bothered by psychological problems and these problems have made it
somewhat difficult to work, take care of home, or get along with others.
2) The patient believes he/she is slightly to moderately in need of counseling for psychological problems because they
are somewhat distracting to efforts in recovery or
3) The interviewer believes the patient’s moderate problems require close outpatient follow-up via
psychological/psychiatric treatment.
Level I (Outpatient Treatment) Placement Criteria
Original Equation
D5LI = TRUE If D5LI (single rule above)
D5LIdde = TRUE If D5LI & D5LIdde (single rule above)
Narrative
The Level I placement criteria are met if:
1) The patient is able to achieve goals or awareness of drug problem
Narrative
The Level I placement criteria for Dual Diagnosis Enhanced are met if:
1) The patient is able to achieve goals or awareness of drug problem and
2) Is able to achieve mental health goals with therapeutic contact
Dimension 5: Level I (Outpatient Treatment)
Reference Pseudo Code
Let helpfulnessOfTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let possibleFutureRelapseCause =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
Let strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let desireAndExternalFactorsDrivingTreatment = assessment.LegalSection.DesireAndExternalFactorsDrivingTreatment
Let likelihoodPreviousEnvironmentWillInduceSubstanceUse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
LikelihoodPreviousEnvironmentWillInduceSubstanceUse
Let howTroubledByPsychologicalEmotionalProblemsLast30Days =
assessment.PsychologicalSection.PsychologicalHistory.HowTroubledByPsychologicalEmotionalProblemsLast30Days
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let careLevel_I_Score = new CareLevel_I_OutpatientScore
Let Let avg = Utilities.Average ( helpfulnessOfTreatment, possibleFutureRelapseCause, strategyToPreventRelapse )
careLevel_I_Score.IsAbleToAchieveRecoveryGoalsOrAwarenessOfDrugProblem =
desireAndExternalFactorsDrivingTreatment > DesireAndExternalFactorsDrivingTreatment.CommittedNoExternalPressures
or ( avg > 1 and avg < 2 ) or
likelihoodPreviousEnvironmentWillInduceSubstanceUse < LikertScale.Moderately
Let avg = Utilities.Average ( howTroubledByPsychologicalEmotionalProblemsLast30Days,
howDifficultProblemsForWorkHomeAndSocialInteraction,
howImportantPsychologicalEmotionalCounseling,
howEmotionalProblemsImpactRecoveryEfforts )
Let careLevel_I_Score.IsAbleToAchieveMentalHealthGoalsOnlyWithTherapeuticContact =
( avg >= 1.5 and avg < 2 ) or ( patientNeedForPsychiatricPsychologicalTreatmentRating >= 2 and
patientNeedForPsychiatricPsychologicalTreatmentRating <= 3 )
Let careLevel_I_Score.IsMet = careLevel_I_Score.IsAbleToAchieveRecoveryGoalsOrAwarenessOfDrugProblem
careLevel_I_Score.IsDualDiagnosisEnhanced =
careLevel_I_Score.IsAbleToAchieveRecoveryGoalsOrAwarenessOfDrugProblem.Value
and careLevel_I_Score.IsAbleToAchieveMentalHealthGoalsOnlyWithTherapeuticContact.Value
return careLevel_I_Score
Level of Care: Opiate Maintenance Therapy
Level OMT (Opioid Maintenance Therapy)
Criterion(a)
RequiresStructuredTherapyForRecoveryDueToOpiateCravings
The patient requires structured therapy, pharmacotherapy and programmatic milieu to promote treatment progress
because he or she attributes continued relapse to physiologic craving or the need for opiates.
Original Equation
D5LM-a = TRUE If ASId22h >1
Narrative
This criterion is met if:
1) Patient has been assessed as meeting the diagnostic criteria for Opioid Dependence Disorder and
2) Patient believes there is a risk of relapse due to cravings or need for opiates.
Criterion(b)
ExperiencingIntensifiedAddictionSymptomsWithDeterioratingFunctions
Despite active participation in other treatment interventions without provision for opioid maintenance therapy, the
patient is experiencing an intensification of addiction symptoms (such as difficulty in postponing immediate gratification
and related drug-seeking behavior) or continued high-risk behaviors (such as shared needle use), and his or her level of
functioning is deteriorating, despite revisions of the treatment plan.
Original Equation
D5LM-b = TRUE If [ASId21a >0&≠4] & [ASId22h>1 OR (Any of ASId22: e,f,g,OR i,k >1)] & ASIf8b>1
Narrative
This criterion is met if:
1) Patient has relapsed after being discharged from, or dropping out of at least one of the following treatment
programs:
a) L0.5 (Early Intervention)
b) LI (Outpatient Therapy)
c) LI-D (Outpatient Therapy – Detox)
2) Patient believes there is a risk of relapse due to cravings or need for opiates or
Criterion(c)
HasHighRiskOfRelapseWithoutOpioidMaintenanceTherapy
The patient is at high risk of relapse to opiate use without opioid maintenance therapy, close outpatient monitoring and
structured support, as indicated by his or her lack of awareness of relapse triggers, difficulty in postponing immediate
gratification or ambivalence toward or resistance to treatment.
Original Equation
D5LM-c = TRUE If (mean of ASI: d23x,d24v,d24w,l1x,d24x, d24y,d24z =1.5to3) OR (ASId21cORd =1)
Narrative
This criterion is met if:
Mean of 1 through 4:
1) Interviewer believes patient’s attitude toward treatment is ambivalent and shows little readiness
2) Patient shows a lack of personal responsibility for recovery efforts and may rely on program only
3) Patient has been externally persuaded or coerced into treatment
4) Patient shows passivity and ambivalence towards preventing relapses or
5) Patient believes that he/she cannot wait for things that he/she wants badly or
6) Patient believes it is hard for him/her to make an effort for something that will only reap future benefit
Level OMT (Opoiod Maintenance Therapy) Placement Criteria
Original Equation
D5LM = TRUE If D5LM-a OR -b OR -c
Narrative
The Level OMT placement criterion is met if:
1) Patient requires structured therapy for recovery due to opiate cravings or
2) Patient is experiencing intensified addiction symptoms with deteriorating functions or
3) Patient has high risk of relapse without opioid maintenance therapy
Dimension 5: Level OMT (Opioid Maintenance Therapy)
Reference Pseudo Code
Let opioidRelapseLikelyIndicator = assessment.DrugAndAlcoholSection.OtherOpiateUse.OpioidRelapseLikelyIndicator
Let highestCareLevelFailedFromInPast90Days =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.HighestCareLevelFailedFromInPast90Days
Let likelihoodPreviousEnvironmentWillInduceSubstanceUse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
LikelihoodPreviousEnvironmentWillInduceSubstanceUse
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let currentStrengthOfSubstanceUseDesire =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.CurrentStrengthOfSubstanceUseDesire
Let addictionSymptomsIncreasedRecently =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.AddictionSymptomsIncreasedRecently
Let feelLikelyToContinueSubstanceUseOrRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.FeelLikelyToContinueSubstanceUseOrRelapse
Let dealsWithProblemsInFreeTimeThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let interviewerScoreOfAttitude =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
Let interviewerScoreOfReadiness =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness
Let concernsAboutPursuingTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
Let desireAndExternalFactorsDrivingTreatment = assessment.LegalSection.DesireAndExternalFactorsDrivingTreatment
Let helpfulnessOfTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let possibleFutureRelapseCause =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
Let strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let cantWaitForThingsWantedBadly = assessment.PsychologicalSection.PsychologicalHistory.CantWaitForThingsWantedBadly
Let difficultToWorkNowForFutureGain =
assessment.PsychologicalSection.PsychologicalHistory.DifficultToWorkNowForFutureGain
Let anyOpioidAddictionDiagnosis = assessmentScore.DiagnosisResults.AnyOpioidAddictionDiagnosis
Let careLevel_OMT_Score.RequiresStructuredTherapyForRecoveryDueToOpiateCravings =
opioidRelapseLikelyIndicator > LikertScale.Slightly
Let careLevel_OMT_Score.ExperiencingIntensifiedAddictionSymptomsWithDeterioratingFunctions =
( highestCareLevelFailedFromInPast90Days > CareLevel.None and
highestCareLevelFailedFromInPast90Days != CareLevel.Level_M ) and
( opioidRelapseLikelyIndicator > LikertScale.Slightly or
likelihoodPreviousEnvironmentWillInduceSubstanceUse > LikertScale.Slightly or
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers > LikertScale.Slightly or
currentStrengthOfSubstanceUseDesire > LikertScale.Slightly or
addictionSymptomsIncreasedRecently > IncreaseInAddictionSymptoms.IncreasedThoughtsOrCraving or
feelLikelyToContinueSubstanceUseOrRelapse > SubstanceUseOrRelapseLikelihood.FeelsAtRiskWithinAMonth ) and
dealsWithProblemsInFreeTimeThatRiskRelapse >
StrategiesToDealWithProblemsInFreeTimeThatRiskRelapse.HasSomePlansToDevelopHealthyLeisurePursuits
if(interviewerScoreOfAttitude = -1)
{
interviewerScoreOfAttitude = new ScaleOf0To9(0)
}
let avg = Utilities.Average ( interviewerScoreOfAttitude,
interviewerScoreOfReadiness,
concernsAboutPursuingTreatment,
desireAndExternalFactorsDrivingTreatment,
helpfulnessOfTreatment,
possibleFutureRelapseCause,
strategyToPreventRelapse )
careLevel_OMT_Score.HasHighRiskOfRelapseWithoutOpioidMaintenanceTherapy =
( avg >= 1.5 and avg <= 3.0 ) or
( cantWaitForThingsWantedBadly not false ) or
( difficultToWorkNowForFutureGain not false )
Let careLevel_OMT_Score.IsMet =
( careLevel_OMT_Score.RequiresStructuredTherapyForRecoveryDueToOpiateCravings.Value or
careLevel_OMT_Score.ExperiencingIntensifiedAddictionSymptomsWithDeterioratingFunctions.Value or
careLevel_OMT_Score.HasHighRiskOfRelapseWithoutOpioidMaintenanceTherapy.Value ) and anyOpioidAddictionDiagnosis
Level of Care: Intensive Outpatient (II.1)
Level II.1 (Intensive Outpatient) Summary
Intensification of the patient’s addiction or mental health symptoms indicate a high likelihood of relapse or continued
use or continued problems without close monitoring and support several times a week.
Criterion(a)
ActiveParticipantWithIntensifiedSymptomsAndDeterioratingFunctions
Although the patient has been an active participant at a less intensive level of care, he or she is experiencing an
intensification of symptoms of the substance-related disorder (such as difficulty postponing immediate gratification and
related drug-seeking behavior) and his or her level of functioning is deteriorating despite modification of the treatment
plan.
Original Equation
D5LII.1 = TRUE If [ASId21a >0&<5] & [Any of ASId22: e,f,g,h,i,or k >2]
Narrative
This criterion is met if:
1) In the past 90 days, the patient has relapsed after being discharged from, or dropping out of at least one of the
following treatment programs:
a) L0.5 (Early Intervention)
b) LI (Outpatient Therapy)
2)
3)
4)
5)
6)
7)
c) LI-D (Outpatient Therapy – Detox)
d) LM (Opioid Maintenance Therapy) and any of the following:
Patient believes there is a considerable to extreme risk of relapse if he/she returns to the environment where drugs
and/or alcohol were previously used or
The patient believes there is a considerable to extreme risk that something in the environment will trigger the urge
to use drugs and/or alcohol or
Patient is experiencing a considerable or extreme desire to use drugs right now or
The patient is assessed as meeting the diagnostic criteria for Opioid Dependence Disorder and believes there is a
considerable to extreme risk for relapse due to cravings or need for opiates or
The patient’s symptoms have increased to the point of relapse that can be less or more than route of administration
before treatment
Patient believes the danger of relapse could be imminent within days, or on current day
Criterion(dde)
HasImpairedRecognitionAndModerateRiskOfRelapse
Dual Diagnosis Enhanced Programs
The patient’s status in Dimension 5 is characterized by psychiatric symptoms
that pose a moderate risk of relapse to the alcohol, drug or psychiatric disorder. Such a patient has impaired recognition
or understanding of—and difficulty in managing—relapse issues and requires Level II.1 Dual Diagnosis Enhanced
program services to maintain an adequate level of functioning. For example, the patient may have persistent difficulty
in controlling his or her anger, with impulses to damage property, or the patient continues to increase his or her
medication dose beyond the prescribed level in an attempt to control continued symptoms of anxiety or panic.
Original Equation
D5LII.1dde = TRUE If [mean of ASIp (12,12b,13,13a) =2to<2.5] OR ASIp20=3to4
Narrative
This Dual Diagnosis Enhanced criterion is met if:
1) Patient is bothered by psychological or emotional problems in the past 30 days
2) Psychological or emotional problems are causing patient some difficulty taking care of at work, home or ability to
get along with others
3) Patient feels it is important to seek counseling for psychological or emotional problems
4) Psychological or emotional problems will prove distracting to recovery or
5) Interviewer believes that moderate to considerable problems require the need for psychiatric/psychological
counseling
Level II.1 (Intensive Outpatient) Placement Criteria
Original Equation
D5LII.1 = TRUE If D5LII.1 (single rule above)
D5LII.1dde = TRUE If D5LII.1 & D5LII.1dde
Narrative
The Level II.1 placement criterion is met if:
1) Patient is an active participant in recovery efforts, but shows signs of intensified symptoms and deteriorating
functions.
Narrative
The Level II.1 placement criterion for Dual Diagnosis Enhanced are met if:
1) Patient is an active participant in recovery efforts, but shows signs of intensified symptoms and deteriorating
functions and
2) Patient has impaired recognition and moderate risk of relapse
Dimension 5: Level II.1 (Intensive Outpatient)
Reference Pseudo Code
Let d5_CareLevel_I_OutpatientScoreIsMet =
assessmentScore.Dimension5RelapsePotentialScores.CareLevel_I_OutpatientScore.IsMet
Let likelihoodPreviousEnvironmentWillInduceSubstanceUse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
LikelihoodPreviousEnvironmentWillInduceSubstanceUse
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let currentStrengthOfSubstanceUseDesire =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.CurrentStrengthOfSubstanceUseDesire
Let opioidRelapseLikelyIndicator = assessment.DrugAndAlcoholSection.OtherOpiateUse.OpioidRelapseLikelyIndicator
Let feelLikelyToContinueSubstanceUseOrRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.FeelLikelyToContinueSubstanceUseOrRelapse
Let howTroubledByPsychologicalEmotionalProblemsLast30Days =
assessment.PsychologicalSection.PsychologicalHistory.HowTroubledByPsychologicalEmotionalProblemsLast30Days
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let careLevel_II_1_Score.ActiveParticipantWithIntensifiedSymptomsAndDeterioratingFunctions =
not d5_CareLevel_I_OutpatientScoreIsMet.Value and
( likelihoodPreviousEnvironmentWillInduceSubstanceUse > LikertScale.Slightly or
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers > LikertScale.Slightly or
currentStrengthOfSubstanceUseDesire > LikertScale.Slightly or
opioidRelapseLikelyIndicator > LikertScale.Slightly or
feelLikelyToContinueSubstanceUseOrRelapse > SubstanceUseOrRelapseLikelihood.FeelsAtRiskWithinAMonth )
Let avg = Utilities.Average ( howTroubledByPsychologicalEmotionalProblemsLast30Days,
howDifficultProblemsForWorkHomeAndSocialInteraction, howImportantPsychologicalEmotionalCounseling,
howEmotionalProblemsImpactRecoveryEfforts )
Let careLevel_II_1_Score.HasImpairedRecognitionAndModerateRiskOfRelapse = ( avg >= 2 and avg < 2.5 ) or
( patientNeedForPsychiatricPsychologicalTreatmentRating >= 3 and
patientNeedForPsychiatricPsychologicalTreatmentRating <= 4 )
Let careLevel_II_1_Score.IsMet =
careLevel_II_1_Score.ActiveParticipantWithIntensifiedSymptomsAndDeterioratingFunctions.Value
Let careLevel_II_1_Score.IsDualDiagnosisEnhanced = careLevel_II_1_Score.IsMet.Value and
careLevel_II_1_Score.HasImpairedRecognitionAndModerateRiskOfRelapse.Value
Level of Care: Partial Hospitalization (II.5)
Level II.5 (Partial Hospitalization) Summary
Intensification of the patient’s addiction or mental health symptoms, despite active participation in a Level I or II.1
program, indicates a high likelihood of relapse or continued use or continued problems without near-daily monitoring
and support.
Criterion(a)
ActiveParticipantWithIntensifiedSymptomsDespiteModifiedTreatmentPlan
Although the patient has been an active participant at a less intensive level of care, he or she is experiencing an
intensification of symptoms of the substance-related disorder (such as difficulty postponing immediate gratification and
related drug-seeking behavior) and his or her level of functioning is deteriorating despite modification of the treatment
plan.
Original Equation
D5LII.5-a = TRUE If ASId21a >0&<7 & [ASId22 e,f,g,h, or k >1] & ASId22i>1
Narrative
This criterion is met if:
1) In the past 90 days, the patient has relapsed after being discharged from, or dropping out of at least one of the
following treatment programs:
a) L0.5 (Early Intervention)
b) LI (Outpatient Therapy)
2)
3)
4)
5)
6)
c) LI-D (Outpatient Therapy – Detox)
d) LM (Opioid Maintenance Therapy)
e) LII.1 (Intensive Outpatient)
f) LII-D (Intensive Outpatient – Detox) and any of the following:
Patient believes there is a slight to extreme risk of relapse if he/she returns to the environment where drugs and/or
alcohol were previously used or
The patient believes there is a slight to extreme risk that something in the environment will trigger the urge to use
drugs and/or alcohol or
Patient is experiencing a slight to extreme desire to use drugs right now or
The patient is assessed as meeting the diagnostic criteria for Opioid Dependence Disorder and believes there is a
slight to extreme risk for relapse due to cravings or need for opiates or
Patient believes the danger of relapse could occur within the next month, weeks, days, or on current day
Criterion(b)
HasHighLikelihoodForContinuousUseOrRelapseNeedsCloseOutpatientMonitoring
There is a high likelihood that the patient will continue to use or relapse to use of alcohol or other drugs without close
outpatient monitoring and structured therapeutic services, as indicated by his or her lack of awareness of relapse
triggers, difficulty in coping or in postponing immediate gratification or ambivalence toward treatment. The patient has
unsuccessfully attempted treatment at a less intensive level of care, or such treatment is adjudged insufficient to
stabilize the patient’s condition.
Original Equation
D5LII.5-b = TRUE If [Mean ASId24x,y,z =2to<3] & ASIf6a>=3 & [(ASId22 e,f,g,h,i or k >1) or (ASId21c OR d=1)]
Narrative
This criterion is met if:
1) Patient shows a limited sense of personal responsibility for recovery
2) Patient is vague or passive regarding relapse potential and prevention and (3 through 6)
3) Patient believes there is a slight to extreme risk of relapse if he/she returns to the environment where drugs and/or
alcohol were previously used or
4) The patient believes there is a slight to extreme risk that something in the environment will trigger the urge to use
drugs and/or alcohol or
5) Patient is experiencing a slight to extreme desire to use drugs right now or
6) The patient is assessed as meeting the diagnostic criteria for Opioid Dependence Disorder and believes there is a
slight to extreme risk for relapse due to cravings or need for opiates or
7) Patient believes the danger of relapse could occur within the next month, weeks, days, or on current day or
8) Patient believes that he/she cannot wait for things that he/she wants badly or
9) Patient believes it is hard for him/her to make an effort for something that will only reap future benefit
Criterion(dde)
HasPsychiatricSymptomsHighRiskOfAlcoholDrugMentalDisorderRelapse
Dual Diagnosis Enhanced Programs
The patient’s status in Dimension 5 is characterized by psychiatric symptoms
that pose a high risk of relapse to the alcohol,drug or psychiatric disorder. Such a patient has impaired recognition or
understanding of relapse issues and poor skills in coping with and interrupting mental disorders and/or avoiding or
limiting relapse. Such a patient’s follow-through in treatment is so poor or inconsistent, and his or her relapse problems
are escalating to such a degree, that treatment at Level II.1 is not succeeding or not feasible. For example, the patient
may continue to inflict superficial wounds on himself or herself and have continuing suicidal ideation and impulses.
However, he or she has no specific suicide plan and agrees to reach out for help if seriously suicidal. Or the patient’s
continuing substance-induced psychotic symptoms are resolving, but difficulties in controlling his or her substance use
exacerbate the psychotic symptoms.
Original Equation
D5LII.5dde = TRUE If [mean of ASIp (12,12b,13,13a) =2.5to<3] OR ASIp20=5to6
Narrative
This Dual Diagnosis Enhanced criterion is met if:
1) Patient is bothered by psychological or emotional problems in the past 30 days
2) Psychological or emotional problems are causing patient some difficulty taking care of at work, home or ability to
get along with others
3) Patient feels it is important to seek counseling for psychological or emotional problems or
4) Interviewer believes that considerable to extreme problems require the need for psychiatric/psychological
counseling
Level II.5 (Partial Hospitalization) Placement Criteria
Original Equation
D5LII.5 = TRUE If D5LII.5-a OR -b
D5LII.5dde = TRUE If D5LII.5 & D5LII.5dde
Narrative
The Level II.5 placement criterion is met if:
1) Patient is an active participant in a treatment program but is experiencing intensified symptoms despite
modifications to the treatment plan
2) Patient has high likelihood for continuous use or relapse and requires close outpatient monitoring
Narrative
The Level II.5 placement criterion for Dual Diagnosis Enhanced are met if:
1) Patient assessed for placement in Level II.5 treatment
2) Patient is exhibiting psychiatric symptoms that pose a high risk of relapse to the alcohol,drug or psychiatric disorder
Dimension 5: Level II.5 (Partial Hospitalization)
Reference Pseudo Code
Let d5_CareLevel_I_OutpatientScoreIsMet =
assessmentScore.Dimension5RelapsePotentialScores.CareLevel_I_OutpatientScore.IsMet
Let likelihoodPreviousEnvironmentWillInduceSubstanceUse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
LikelihoodPreviousEnvironmentWillInduceSubstanceUse
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let currentStrengthOfSubstanceUseDesire =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.CurrentStrengthOfSubstanceUseDesire
Let opioidRelapseLikelyIndicator = assessment.DrugAndAlcoholSection.OtherOpiateUse.OpioidRelapseLikelyIndicator
Let feelLikelyToContinueSubstanceUseOrRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.FeelLikelyToContinueSubstanceUseOrRelapse
Let addictionSymptomsIncreasedRecently =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.AddictionSymptomsIncreasedRecently
Let helpfulnessOfTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let possibleFutureRelapseCause =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
Let strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let cantWaitForThingsWantedBadly = assessment.PsychologicalSection.PsychologicalHistory.CantWaitForThingsWantedBadly
Let difficultToWorkNowForFutureGain =
assessment.PsychologicalSection.PsychologicalHistory.DifficultToWorkNowForFutureGain
Let howTroubledByPsychologicalEmotionalProblemsLast30Days =
assessment.PsychologicalSection.PsychologicalHistory.HowTroubledByPsychologicalEmotionalProblemsLast30Days
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let careLevel_II_5_score.ActiveParticipantWithIntensifiedSymptomsDespiteModifiedTreatmentPlan =
not d5_CareLevel_I_OutpatientScoreIsMet.Value and
( likelihoodPreviousEnvironmentWillInduceSubstanceUse > LikertScale.Moderately or
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers > LikertScale.Moderately or
currentStrengthOfSubstanceUseDesire > LikertScale.Moderately or
opioidRelapseLikelyIndicator > LikertScale.Moderately or
feelLikelyToContinueSubstanceUseOrRelapse > SubstanceUseOrRelapseLikelihood.FeelsAtRiskWithinAWeek ) and
addictionSymptomsIncreasedRecently > IncreaseInAddictionSymptoms.IncreasedThoughtsOrCraving
Let avg = Utilities.Average ( helpfulnessOfTreatment, possibleFutureRelapseCause, strategyToPreventRelapse )
Let careLevel_II_5_score.HasHighLikelihoodForContinueUseOrRelapseNeedsCloseOutpatientMonitoring =
( avg >= 2 and avg < 3 ) and
livingArrangementAffectOnRecovery >= LivingArrangementAffectOnRecovery.WillDiscourageOrHinderTreatment and
( likelihoodPreviousEnvironmentWillInduceSubstanceUse > LikertScale.Slightly or
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers > LikertScale.Slightly or
currentStrengthOfSubstanceUseDesire > LikertScale.Slightly or
opioidRelapseLikelyIndicator > LikertScale.Slightly or
addictionSymptomsIncreasedRecently > IncreaseInAddictionSymptoms.IncreasedThoughtsOrCraving or
feelLikelyToContinueSubstanceUseOrRelapse > SubstanceUseOrRelapseLikelihood.FeelsAtRiskWithinAMonth or
( cantWaitForThingsWantedBadly not false ) or ( difficultToWorkNowForFutureGain ?? false ) )
Let avg = Utilities.Average ( howTroubledByPsychologicalEmotionalProblemsLast30Days,
howDifficultProblemsForWorkHomeAndSocialInteraction, howImportantPsychologicalEmotionalCounseling,
howEmotionalProblemsImpactRecoveryEfforts )
Let careLevel_II_5_score.HasPsychiatricSymptomsHighRiskOfAlcoholDrugMentalDisorderRelapse =
( avg >= 2.5 and avg < 3 ) or ( patientNeedForPsychiatricPsychologicalTreatmentRating >= 5 and
patientNeedForPsychiatricPsychologicalTreatmentRating <= 6 )
Let careLevel_II_5_score.IsMet =
careLevel_II_5_score.ActiveParticipantWithIntensifiedSymptomsDespiteModifiedTreatmentPlan.Value or
careLevel_II_5_score.HasHighLikelihoodForContinueUseOrRelapseNeedsCloseOutpatientMonitoring.Value
Let careLevel_II_5_score.IsDualDiagnosisEnhanced = careLevel_II_5_score.IsMet.Value and
careLevel_II_5_score.HasPsychiatricSymptomsHighRiskOfAlcoholDrugMentalDisorderRelapse.Value
Level of Care: Clinically Managed Low-Intensity Residential Treatment (III.1)
Level III.1 (Clinically Managed Low-Intensity Residential Treatment) Summary
The patient understands relapse but needs structure to maintain therapeutic gains.
Criterion(a)
HasLimitedSkillsImminentDangerOfRelapseWithDangerousConsequences
The resident demonstrates limited coping skills to address relapse triggers and urges and/or deteriorating mental
functioning. He or she thus is in imminent danger of relapse, with dangerous emotional, behavioral or cognitive
consequences, and needs 24-hour structure to help him or her apply recovery and coping skills.
Original Equation
D5LIII.1-a = TRUE If [(mean ASId24x,y,z =2to<2.5) or (mean ASI: f6a,f8a, f8b,&d22f >2) or (ASIp13a=4 or ASIp17 or 18
>4)] & ImSevCon
Narrative
This criterion is met if:
Criterion(b)
UnderstandsPsychiatricAndSubstanceAbuseRiskOfRelapseAtLowerLevelOfCare
The resident understands his or her substance dependence and/or mental disorder but is at risk of relapse in a less
structured level of care because he or she is unable to consistently address either or both.
Original Equation
D5LIII.1-b = TRUE If [(Mean ASI d23x,d24v,d24w,l1x <3 & ASId24 x,y,z >2&<=3)] OR [(ASIp19g>4 & ASIp19h=0]
Narrative
Criterion(c)
RequiresStaffSupportInRecoveryEffortAndTransitionToCommunityLife
The resident needs staff support to maintain engagement in his or her recovery program while transitioning to life in the
community.
Original Equation
D5LIII.1-c = TRUE If ASIf24d>1
Criterion(d)
HighRiskOfPsychiatricAndSubstanceAbuseWithDangerousConsequencesNeeds24HourCare
The resident is at high risk of substance use or deteriorated mental functioning, with dangerous emotional, behavioral or
cognitive consequences, in the absence of close 24-hour structured support (as evidenced, for example, by lack of
awareness of relapse triggers, difficulty in postponing immediate gratification or ambivalence toward or resistance to
treatment), and these issues are being addressed concurrently in a Level II program.
Original Equation
D5LIII.1-d = TRUE If (D5LIII.3-a OR -b OR D5LIII.5-a OR -b OR -c is met) AND [(Post8 & Post9 ≠5) or (Post8 & Post9 ≠7)]
Criterion(dde)
HighRiskOfPsychiatricAndSubstanceAbuseWithDangerousConsequencesNeeds24HourCare
Dual Diagnosis Enhanced Programs The resident’s status is characterized by psychiatric symptoms that pose a
moderate risk of relapse to a substance dependence or mental disorder. Such a resident demonstrates limited ability to
apply relapse prevention skills, as well as deteriorating psychiatric functioning, which increases his or her risk of serious
consequences and requires the types of services and 24-hour structure of a Level III.1 Dual Diagnosis Enhanced program
in order to maintain an adequate level of functioning. For example, the resident demonstrates deteriorating functioning
during outpatient treatment or while in a Halfway House that does not provide Dual Diagnosis Enhanced services. The
resident who is receiving concurrent Level II and Level III.1 services requires case management to coordinate the
services across levels of care. Specifically, case management and collaboration across levels of care may be necessary in
managing anti-craving, psychotropic or opioid maintenance medications. Case management and collaboration across
levels of care may be needed to manage anti-craving, psychotropic or opioid maintenance medications. For example,
the resident may have only recently developed the ability to control his or her anger and impulses to damage property.
Or the resident may have only recently become compliant in taking psychotropic medications as prescribed and is not
increasing the dose to control continuing symptoms of anxiety or panic. Preparation for transfer of the resident to a less
intensive level of care and/or reentry into the community requires case management and staff exploration of supportive
living environments, separately from their therapeutic work with the resident..
Original Equation
D5LII.1dde = TRUE If [mean of ASIp (12,12b,13,13a) =2to<2.5] OR ASIp20=3to4
Level III.1 (Clinically Managed Low-Intensity Residential Treatment) Placement Criteria
Original Equation
D5LIII.1 = TRUE If D5LIII.1 -a, -b, OR -c
D5LIII.1dde = TRUE If D5LIII.1 & D5LIII.1dde
D5LIII.1 PLUS D5LII.5 = D5LIII.1-d
Narrative
The Level III.1 placement criterion is met a Or b Or c:
Dimension 5: Level III.1 (Clinically Managed Low-Intensity Residential Treatment)
Reference Pseudo Code
Let helpfulnessOfTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let possibleFutureRelapseCause =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
Let strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let freeTimeAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let dealsWithProblemsInFreeTimeThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering
Let hasImminentSevereConsequences = assessmentScore.Dimension5RelapsePotentialScores.HasImminentSevereConsequences
Let interviewerScoreOfAttitude =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAttitude
Let interviewerScoreOfReadiness =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfReadiness
Let concernsAboutPursuingTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
Let desireAndExternalFactorsDrivingTreatment = assessment.LegalSection.DesireAndExternalFactorsDrivingTreatment
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let patientAbleToSafelyAccessNeededResources =
assessment.PsychologicalSection.InterviewerRating.PatientAbleToSafelyAccessNeededResources
Let needForStaffSupportToMaintainRecovery =
assessment.FamilyAndSocialHistorySection.NeedForStaffSupportToMaintainRecovery
Let unacceptableCareLevels = assessment.CompletionSection.UnacceptableCareLevels
Let noRelapseRecognitionImminentDangerPsychiatricProblems = assessmentScore.Dimension5RelapsePotentialScores.
CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore.
NoRelapseRecognitionImminentDangerPsychiatricProblemsAndSubstanceAbuse
Let experiencingIntensifiedAddictionSymptomsOrPsychiatric = assessmentScore.Dimension5RelapsePotentialScores.
CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore.
ExperiencingIntensifiedAddictionSymptomsOrPsychiatricProblemsDespiteAmendedTreatmentPlan
Let noRecognitionOfRelapseHarmToSelfNeeds2HourCare = assessmentScore.Dimension5RelapsePotentialScores.
CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore.
NoRecognitionOfRelapseHarmToSelfNeeds2HourCare
Let isStabilizingUnableToStopUseOrPsychiatricProblems = assessmentScore.Dimension5RelapsePotentialScores.
CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore.
IsStabilizingUnableToStopUseOrPsychiatricProblemsNeeds24HourCare
Let experiencingPsychiatricOrAddictionSymptomsHarm = assessmentScore.Dimension5RelapsePotentialScores.
CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore.
ExperiencingPsychiatricOrAddictionSymptomsHarmToSelfNeeds24HourCare
Let hasImpairedRecognitionAndModerateRiskOfRelapse =
assessmentScore.Dimension5RelapsePotentialScores.CareLevel_II_1_IntensiveOutpatientScore.
HasImpairedRecognitionAndModerateRiskOfRelapse
Let x = Utilities.Average ( helpfulnessOfTreatment, possibleFutureRelapseCause, strategyToPreventRelapse )
Let y = Utilities.Average ( livingArrangementAffectOnRecovery, freeTimeAffectOnRecovery,
dealsWithProblemsInFreeTimeThatRiskRelapse, strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers )
Let careLevel_III_1_Score.HasLimitedSkillsImminentDangerOfRelapseWithDangerousConsequences =
( ( x >= 2 and x < 2.5 ) or y > 2 or howEmotionalProblemsImpactRecoveryEfforts =
EmotionalProblemsImpactRecoveryEffortsScale.LikelyToThreatenRecovery or
appearanceOfParanoiaOrImpairedThinking > 4 or appearanceOfTroubleConcentratingOrRemembering > 4 )
and hasImminentSevereConsequences.Value
if(interviewerScoreOfAttitude = -1)
{
interviewerScoreOfAttitude = new ScaleOf0To9 ( 0 )
}
Let z = Utilities.Average ( interviewerScoreOfAttitude, interviewerScoreOfReadiness, concernsAboutPursuingTreatment,
desireAndExternalFactorsDrivingTreatment )
Let careLevel_III_1_Score.UnderstandsPsychiatricAndSubstanceAbuseRiskOfRelapseAtLowerLevelOfCare =
( z < 3 and ( x > 2 and x <= 3 ) ) or ( levelOfSupervisionNeededForProtectionFromSelfHarm > 4 and
patientAbleToSafelyAccessNeededResources.Value )
Let careLevel_III_1_Score.RequiresStaffSupportInRecoveryEffortAndTransitionToCommunityLife =
needForStaffSupportToMaintainRecovery = NeedForStaffSupportToMaintainRecovery.NeedsContactDaily
Let careLevel_III_1_Score.HighRiskOfPsychiatricAndSubstanceAbuseWithDangerousConsequencesNeeds24HourCare =
noRelapseRecognitionImminentDangerPsychiatricProblems.Value or
experiencingIntensifiedAddictionSymptomsOrPsychiatric.Value or noRecognitionOfRelapseHarmToSelfNeeds2HourCare.Value
or isStabilizingUnableToStopUseOrPsychiatricProblems.Value or experiencingPsychiatricOrAddictionSymptomsHarm.Value
Let careLevel_III_1_Score.HasModerateRiskOfPsychiatricProblemsAndSubstanceAbuseRelapseNeeds24HourCare =
hasImpairedRecognitionAndModerateRiskOfRelapse.Value
Let careLevel_III_1_Score.IsMet =
careLevel_III_1_Score.HasLimitedSkillsImminentDangerOfRelapseWithDangerousConsequences.Value or
careLevel_III_1_Score.UnderstandsPsychiatricAndSubstanceAbuseRiskOfRelapseAtLowerLevelOfCare.Value or
careLevel_III_1_Score.RequiresStaffSupportInRecoveryEffortAndTransitionToCommunityLife.Value
Let careLevel_III_1_Score.IsDualDiagnosisEnhanced = careLevel_III_1_Score.IsMet.Value and
careLevel_III_1_Score.HasModerateRiskOfPsychiatricProblemsAndSubstanceAbuseRelapseNeeds24HourCare.Value
Let careLevel_III_1_Score.IsMetDimFivePartialHospitalization =
careLevel_III_1_Score.HighRiskOfPsychiatricAndSubstanceAbuseWithDangerousConsequencesNeeds24HourCare.Value
Level of Care: Clinically Managed Medium-Intensity Residential Treatment (III.3)
Level III.3 (Clinically Managed Medium-Intensity Residential Treatment) Summary
The patient has little awareness and needs interventions available only at Level III.3 to prevent continued use, with
imminent dangerous consequences, because of cognitive deficits or comparable dysfunction.
Criterion(a)
NoRelapseRecognitionImminentDangerPsychiatricProblemsAndSubstanceAbuse
The resident does not recognize relapse triggers and has little awareness of the need for continuing care. Because of the
intensity or chronicity of the resident’s addictive disorder or the chronicity of the mental health problem or cognitive
limitations, he or she is in imminent danger of continued substance use or mental health problems, with dangerous
emotional, behavioral or cognitive consequences. The resident thus needs 24-hour monitoring and structure to assist in
the application of recovery and coping skills, as well as active staff interventions to prevent relapse.
Original Equation
D5LIII.3-a = TRUE If [(Sum ASId18 a+d >2) OR ASIp1a>2 or p2=1] & [(mean ASId24 x,y,z >=2.5to<3) or (mean ASI: f6a,f8a,
f8b,&d22f >2.5) or (ASIp13a=4 or ASIp17D or 18D >4))] & ImSev Con=1
Narrative
This criterion is met if:
1)
2)
3)
4)
Patient has been treated for alcohol and/or drug abuse at least twice or
Patient has been treated for psychological or emotional problems in a hospital setting at least twice or
Patient receives a pension for a psychiatric disability and
Patient shows vague awareness of relapse risks, limited personal responsibility for continuing treatment and a
passivity towards reventing future relapse or
5)
Criterion(b)
ExperiencingIntensifiedAddictionSymptomsOrPsychiatricProblemsDespiteAmendedTreatmentPlan
The resident is experiencing an intensification of symptoms of his or her substance dependence disorder (such as
difficulty in postponing immediate gratification and related drug-seeking behavior) or mental disorder (for example,
increasing suicidal thoughts or impulses without a plan), and his or her level of functioning is deteriorating despite
amendment of the treatment plan.
Original Equation
D5LIII.3-b = TRUE If [ASId21a >0&<10] & [(ASId22f=4) or (Any two of: ASId22 g,h,i, or k >2)] & ImSevCon=1
Narrative
This criterion is met if:
Criterion(c)
RequiresRelapsePreventionDeliveredAtSlowerPaceIn24HourCare
The resident’s cognitive impairment has limited his or her ability to identify and cope with relapse triggers and high-risk
situations. He or she requires relapse prevention activities that are delivered at a slower pace, more concretely and
more repetitively, in a setting that provides 24-hour structure and support to prevent imminent dangerous
consequences.
Original Equation
D5LIII.3-c = TRUE If [(ASIp 17,18,18b,18c,19b, or19f >4) or ASIp19k=1] & ASIp19g>4 & ImSevCon=1
Narrative
This criterion is met if:
Criterion(d)
ActiveParticipantLowerLevelCareContinuedUseOrPsychiatricProblemsNeeds24HourCare
Despite recent, active participation in treatment at a less intensive level of care, the resident continues to use alcohol or
other drugs or to deteriorate psychiatrically, with imminent serious consequences, and is at high risk of continued
substance use or mental deterioration without close 24-hour monitoring and structured treatment.
Original Equation
D5LIII.3-d = TRUE If [ASId21a >0&<10] & ASId22i>2 & ImSevCon=1
Narrative
This criterion is met if:
Criterion(dde)
HasPsychiatricSymptomsModerateRiskOrPsychiaProblemsSubstanceUseNeeds24HourCare
Dual Diagnosis Enhanced Programs The resident’s status in Dimension 5 is characterized by psychiatric symptoms
that pose a moderate risk of relapse to a substance dependence or mental disorder. Such a resident demonstrates
limited ability to apply relapse prevention skills, as well as poor skills in coping with mental disorders and/or avoiding or
limiting relapse, with imminent serious consequences. For example, the resident continues to engage in behaviors that
pose a risk of relapse (such as non-compliance with the medication regimen or spending time in places where drugs are
being sold or used) because he or she has cognitive deficits that prevent understanding of the relationship between
those behaviors and relapse to substance-dependence or mental disorders. The presence of these relapse issues
requires the types of services and 24-hour structure of a Level III.3 Dual Diagnosis Enhanced program. Case
management and collaboration across levels of care may be needed to manage anti-craving, psychotropic or opioid
maintenance medications. For example, because of significant cognitive deficits, the resident may have difficulty in
managing the activities of daily living without 24-hour interventions and thus require preparation for placement in a
group home in order to support his or her continued recovery from a substance use or mental health problem. (Such a
group home may involve supervised living for persons with cognitive deficits such as mental retardation or those who
are severely and persistently mentally ill.) Preparation for transfer of the resident to a less intensive level of care, a
different type of service in the community, and/or reentry into the community requires case management and staff
exploration of supportive living environments, separately from their therapeutic work with the resident.
Original Equation
D5LIII.3dde = TRUE If [mean of ASIp (12,12b,13,13a) =2.5to<3] OR ASIp20=5to6
Narrative
This Dual Diagnosis Enhanced criterion is met if:
Level III.3 (Clinically Managed Medium-Intensity Residential Treatment) Placement Criteria
Original Equation
D5LIII.3 = TRUE If D5LIII.3 -a, -b, -c OR -d
D5LIII.3dde = TRUE If D5LIII.3 & D5LIII.3dde
Narrative
The Level III.3 placement criterion is met if:
Dimension 5: Level III.3 (Clinically Managed Medium-Intensity Residential Treatment)
Reference Pseudo Code
Let hasImminentSevereConsequences = assessmentScore.Dimension5RelapsePotentialScores.HasImminentSevereConsequences
Let helpfulnessOfTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let possibleFutureRelapseCause =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
Let strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let freeTimeAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let dealsWithProblemsInFreeTimeThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let numberOfTimesTreatedForAlcoholAbuseLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesTreatedForAlcoholAbuseLifetime
Let numberOfTimesDrugTreatmentLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesDrugTreatmentLifetime
Let timesTreatedForPsychologicalOrEmotionalProblemsInHospital =
assessment.PsychologicalSection.PsychologicalHistory.TimesTreatedForPsychologicalOrEmotionalProblemsInHospital
Let receivesPensionForPsychiatricDisability =
assessment.PsychologicalSection.PsychologicalHistory.ReceivesPensionForPsychiatricDisability
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering
Let currentStrengthOfSubstanceUseDesire =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.CurrentStrengthOfSubstanceUseDesire
Let opioidRelapseLikelyIndicator = assessment.DrugAndAlcoholSection.OtherOpiateUse.OpioidRelapseLikelyIndicator
Let addictionSymptomsIncreasedRecently =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.AddictionSymptomsIncreasedRecently
Let feelLikelyToContinueSubstanceUseOrRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.FeelLikelyToContinueSubstanceUseOrRelapse
Let highestCareLevelFailedFromInPast90Days =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.HighestCareLevelFailedFromInPast90Days
Let appearanceOfFluctuatingOrientationInLast24Hours =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfFluctuatingOrientationInLast24Hours
Let appearanceOfSpeechImpairmentBadPosture =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfSpeechImpairmentBadPosture
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let likelihoodOfRecurrenceOfPsychiatricDecompensation =
assessment.PsychologicalSection.InterviewerRating.LikelihoodOfRecurrenceOfPsychiatricDecompensation
Let evidenceOfChronicOrganicMentalDisability =
assessment.PsychologicalSection.InterviewerRating.EvidenceOfChronicOrganicMentalDisability
Let levelOfSupervisionNeededForProtectionFromSelfHarm =
assessment.PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let hasPsychiatricSymptomsHighRiskOfAlcoholDrugMentalDisorderRelapse =
assessmentScore.Dimension5RelapsePotentialScores.CareLevel_II_5_PartialHospitalizationScore.
HasPsychiatricSymptomsHighRiskOfAlcoholDrugMentalDisorderRelapse
Let relapseAverage = Utilities.Average ( helpfulnessOfTreatment, possibleFutureRelapseCause, strategyToPreventRelapse )
Let recoveryRelatedAverage = Utilities.Average ( livingArrangementAffectOnRecovery, freeTimeAffectOnRecovery,
dealsWithProblemsInFreeTimeThatRiskRelapse, strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers )
Let careLevel_III_3_Score.NoRelapseRecognitionImminentDangerPsychiatricProblemsAndSubstanceAbuse =
( ( numberOfTimesTreatedForAlcoholAbuseLifetime + numberOfTimesDrugTreatmentLifetime ) > 2 or
timesTreatedForPsychologicalOrEmotionalProblemsInHospital > 2 or
( receivesPensionForPsychiatricDisability not false ) ) and ( ( relapseAverage >= 2.5 and relapseAverage < 3 ) or
recoveryRelatedAverage > 2.5 or howEmotionalProblemsImpactRecoveryEfforts =
EmotionalProblemsImpactRecoveryEffortsScale.LikelyToThreatenRecovery or appearanceOfParanoiaOrImpairedThinking > 4
or appearanceOfTroubleConcentratingOrRemembering > 4 ) and hasImminentSevereConsequences.Value
Let array = new[]
{
currentStrengthOfSubstanceUseDesire.Value,
opioidRelapseLikelyIndicator.Value,
addictionSymptomsIncreasedRecently.Value,
feelLikelyToContinueSubstanceUseOrRelapse.Value
}
Let symptomsCount = array.Count ( v => v > 2 )
Let careLevel_III_3_Score.ExperiencingIntensifiedAddictionSymptomsOrPsychiatricProblemsDespiteAmendedTreatmentPlan =
( highestCareLevelFailedFromInPast90Days > CareLevel.None and highestCareLevelFailedFromInPast90Days <
CareLevel.Level_III_3 ) and ( strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers = LikertScale.Extremely or
symptomsCount > 1 ) and hasImminentSevereConsequences.Value
Let careLevel_III_3_Score.RequiresRelapsePreventionDeliveredAtSlowerPaceIn24HourCare =
( appearanceOfParanoiaOrImpairedThinking > 4 or appearanceOfTroubleConcentratingOrRemembering > 4 or
appearanceOfFluctuatingOrientationInLast24Hours > 4 or appearanceOfSpeechImpairmentBadPosture > 4 or
limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers > 4 or
likelihoodOfRecurrenceOfPsychiatricDecompensation > 4 or evidenceOfChronicOrganicMentalDisability =
YesNoNotSure.NotSure ) and levelOfSupervisionNeededForProtectionFromSelfHarm > 4 and
hasImminentSevereConsequences.Value
Let careLevel_III_3_Score.ActiveParticipantLowerLevelCareContinuedUseOrPsychiatricProblemsNeeds24HourCare =
( highestCareLevelFailedFromInPast90Days > CareLevel.None and
highestCareLevelFailedFromInPast90Days < CareLevel.Level_III_3 ) and
addictionSymptomsIncreasedRecently > IncreaseInAddictionSymptoms.MoreRiskTakingBehaviorsButNotUse and
hasImminentSevereConsequences.Value
Let careLevel_III_3_Score.HasPsychiatricSymptomsModerateRiskOrPsychiatricProblemsSubstanceUseNeeds24HourCare =
hasPsychiatricSymptomsHighRiskOfAlcoholDrugMentalDisorderRelapse
Let careLevel_III_3_Score.IsMet =
careLevel_III_3_Score.NoRelapseRecognitionImminentDangerPsychiatricProblemsAndSubstanceAbuse.Value or
careLevel_III_3_Score.ExperiencingIntensifiedAddictionSymptomsOrPsychiatricProblemsDespiteAmendedTreatmentPlan.Value
or careLevel_III_3_Score.RequiresRelapsePreventionDeliveredAtSlowerPaceIn24HourCare.Value or
careLevel_III_3_Score.ActiveParticipantLowerLevelCareContinuedUseOrPsychiatricProblemsNeeds24HourCare.Value
Let careLevel_III_3_Score.IsDualDiagnosisEnhanced = careLevel_III_3_Score.IsMet.Value and
careLevel_III_3_Score. HasPsychiatricSymptomsModerateRiskOrPsychiatricProblemsSubstanceUseNeeds24HourCare.Value
Level of Care: Clinically Managed High-Intensity Residential Treatement (III.5)
Level III.5 (Clinically Managed High-Intensity Residential Treatment) Summary
The patient has no recognition of the skills needed to prevent continued use, with imminently dangerous consequences.
Criterion(a)
NoRecognitionOfRelapseHarmToSelfNeeds24HourCare
The resident does not recognize relapse triggers and is not committed to continuing care. His or her continued
substance use poses an imminent danger of harm to self or others in the absence of 24-hour monitoring and structured
support.
Original Equation
D5LIII.5-a = TRUE If (mean ASId24 x,y,z >=3) or (mean ASIf 6a,9a,9b >=3)
Narrative
This criterion is met if:
Criterion(b)
NoRecognitionOfRelapseHarmToSelfNeeds24HourCare
The resident’s psychiatric condition is stabilizing. However, despite his or her best efforts, the resident is unable to
control his or her use of alcohol or other drugs and/or antisocial behaviors, with attendant probability of harm to self or
others. The resident has little ability to interrupt the relapse process or to use peer supports when at risk for relapse to
his or her substance dependence or mental disorder. His or her continued substance use poses an imminent danger of
harm to self or others in the absence of 24-hour monitoring and structured support.
Original Equation
D5LIII.5-b = TRUE If [(ASId22k=4) or (ASId22: g,h,i,or k >2)] & ImSevCon=1
Narrative
This criterion is met if:
Criterion(c)
ExperiencingPsychiatricOrAddictionSymptomsHarmToSelfNeeds24HourCare
The resident is experiencing psychiatric or addiction symptoms such as drug craving, difficulty in postponing immediate
gratification and other drug-seeking behaviors. This situation poses an imminent danger of harm to self or others in the
absence of close 24-hour monitoring and structured support.
Original Equation
D5LIII.5-c = TRUE If ASI f6a & ASId22k=4 & ImSevCon=1
Narrative
This criterion is met if:
Criterion(d)
CrisisSituationWithImminentDangerOfRelapseAndCon sequences
The resident is in imminent danger of relapse, with dangerous emotional, behavioral or cognitive consequences,
because of a crisis situation.
Original Equation
D5LIII.5-d = TRUE If [(ASId22k=4) or (ASId22: g,h,i,or k >2) or or ASId25:a or d >7] & [ASI: e20,f20,f21,or l26 =4] &
ImSevCon=1
Narrative
This criterion is met if:
Criterion(e)
ExperiencingPsychiatricOrAddictionSymptomsHarmToSelfNeeds24HourCare
Despite recent, active participation in treatment at a less intensive level of care, the resident continues to use alcohol or
other drugs or to deteriorate psychiatrically, with imminent serious consequences, and is at high risk of continued
substance use or mental deterioration in the absence of close 24-hour monitoring and structured treatment.
Original Equation
D5LIII.5-e = TRUE If [ASId21a >0&<11] & [ASId22i=4 or ASIp20>3] & ImSevCon=1
Narrative
This criterion is met if:
Criterion(dde)
PsychiatricSymptomsModerateToHighRiskOfRelapseOrMentalDisorderNeeds24HourCare
Despite recent, active participation in treatment at a less intensive level of care, the resident continues to use alcohol or
other drugs or to deteriorate psychiatrically, with imminent serious consequences, and is at high risk of continued
substance use or mental deterioration in the absence of close 24-hour monitoring and structured treatment.
Original Equation
D5LIII.5dde = TRUE If [mean of ASIp (12,12b,13,13a) =2.5to<3.5] OR ASIp20=5to7
Narrative
This criterion is met if:
Level III.5 (Clinically Managed High-Intensity Residential Treatment) Placement Criteria
Original Equation
D5LIII.5 = TRUE If D5LIII.5 -a, -b, -c, -d OR -e
D5LIII.5dde = TRUE If D5LIII.5 & D5LIII.5dde
Narrative
The Level III.5 placement criterion is met if:
Dimension 5: Level III.5 (Clinically Managed High-Intensity Residential Treatment)
Reference Pseudo Code
Let helpfulnessOfTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let possibleFutureRelapseCause =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
Let strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let dimension2SeverityNumber = assessmentScore.Dimension2BiomedicalScores.SeverityNumber
Let dimension3SeverityNumber = assessmentScore.Dimension3EmotionalBehavioralScores.SeverityNumber
Let detoxificationRequiredMoreThanHourlyMonitoring =
assessment.CompletionSection.DetoxificationRequiredMoreThanHourlyMonitoring
Let feelLikelyToContinueSubstanceUseOrRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.FeelLikelyToContinueSubstanceUseOrRelapse
Let hasImminentSevereConsequences = assessmentScore.Dimension5RelapsePotentialScores.HasImminentSevereConsequences
Let currentStrengthOfSubstanceUseDesire =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.CurrentStrengthOfSubstanceUseDesire
Let opioidRelapseLikelyIndicator = assessment.DrugAndAlcoholSection.OtherOpiateUse.OpioidRelapseLikelyIndicator
Let addictionSymptomsIncreasedRecently =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.AddictionSymptomsIncreasedRecently
Let livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let interviewerScoreOfAlcoholTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAlcoholTreatmentNeed
Let interviewerScoreOfDrugTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfDrugTreatmentNeed
Let concernAboutEmploymentProblemsInPast30Days =
assessment.EmploymentAndSupportSection.ConcernAboutEmploymentProblemsInPast30Days
Let troubledByFamilyProblemsInPast30Days =
assessment.FamilyAndSocialHistorySection.TroubledByFamilyProblemsInPast30Days
Let troubledBySocialProblemsInPast30Days =
assessment.FamilyAndSocialHistorySection.TroubledBySocialProblemsInPast30Days
Let severityOfCurrentLegalProblems = assessment.LegalSection.SeverityOfCurrentLegalProblems
Let highestCareLevelFailedFromInPast90Days =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.HighestCareLevelFailedFromInPast90Days
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let howTroubledByPsychologicalEmotionalProblemsLast30Days =
assessment.PsychologicalSection.PsychologicalHistory.HowTroubledByPsychologicalEmotionalProblemsLast30Days
Let howDifficultProblemsForWorkHomeAndSocialInteraction =
assessment.PsychologicalSection.PsychologicalHistory.HowDifficultProblemsForWorkHomeAndSocialInteraction
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let avg = Utilities.Average ( helpfulnessOfTreatment, possibleFutureRelapseCause, strategyToPreventRelapse )
Let careLevel_III_5_Score.NoRecognitionOfRelapseHarmToSelfNeeds2HourCare = ( avg >= 3 ) and
( dimension2SeverityNumber > 5 or dimension3SeverityNumber > 6 or
detoxificationRequiredMoreThanHourlyMonitoring.Value )
Let careLevel_III_5_Score.IsStabilizingUnableToStopUseOrPsychiatricProblemsNeeds24HourCare =
( currentStrengthOfSubstanceUseDesire > LikertScale.Moderately or opioidRelapseLikelyIndicator >
LikertScale.Moderately or addictionSymptomsIncreasedRecently >
IncreaseInAddictionSymptoms.MoreRiskTakingBehaviorsButNotUse or
feelLikelyToContinueSubstanceUseOrRelapse > SubstanceUseOrRelapseLikelihood.FeelsAtRiskWithinAWeek ) and
hasImminentSevereConsequences.Value
Let careLevel_III_5_Score.ExperiencingPsychiatricOrAddictionSymptomsHarmToSelfNeeds24HourCare =
livingArrangementAffectOnRecovery = LivingArrangementAffectOnRecovery.WillOftenExposeToSubstanceUse and
feelLikelyToContinueSubstanceUseOrRelapse = SubstanceUseOrRelapseLikelihood.AtRiskToday and
hasImminentSevereConsequences.Value
Let careLevel_III_5_Score.CrisisSituationWithImminentDangerOfRelapseAndConsequences =
( currentStrengthOfSubstanceUseDesire > LikertScale.Moderately or opioidRelapseLikelyIndicator >
LikertScale.Moderately or addictionSymptomsIncreasedRecently >
IncreaseInAddictionSymptoms.MoreRiskTakingBehaviorsButNotUse or
feelLikelyToContinueSubstanceUseOrRelapse > SubstanceUseOrRelapseLikelihood.FeelsAtRiskWithinAWeek or
interviewerScoreOfAlcoholTreatmentNeed > 7 or interviewerScoreOfDrugTreatmentNeed > 7 ) and
( concernAboutEmploymentProblemsInPast30Days = LikertScale.Extremely or
troubledByFamilyProblemsInPast30Days = LikertScale.Extremely or
troubledBySocialProblemsInPast30Days = LikertScale.Extremely or
severityOfCurrentLegalProblems = LikertScale.Extremely ) and hasImminentSevereConsequences.Value
Let careLevel_III_5_Score.ActiveParticipantLowerLevelCareContinuedUseOrPsychiatricProblemsInAbsenceOf24HourCare =
( highestCareLevelFailedFromInPast90Days > CareLevel.None and
highestCareLevelFailedFromInPast90Days < CareLevel.Level_III_5 ) and ( addictionSymptomsIncreasedRecently =
IncreaseInAddictionSymptoms.IncreasedUseOrMoreAcuteRouteOfAdministrationThanBefore or
patientNeedForPsychiatricPsychologicalTreatmentRating > 3 ) and hasImminentSevereConsequences.Value
Let avg = Utilities.Average ( howTroubledByPsychologicalEmotionalProblemsLast30Days,
howDifficultProblemsForWorkHomeAndSocialInteraction, howImportantPsychologicalEmotionalCounseling,
howEmotionalProblemsImpactRecoveryEfforts
Let careLevel_III_5_Score.PsychiatricSymptomsModerateToHighRiskOfRelapseOrMentalDisorderNeeds24HourCare =
( avg >= 2.5 and avg < 3.5 ) or ( patientNeedForPsychiatricPsychologicalTreatmentRating >= 5 and
patientNeedForPsychiatricPsychologicalTreatmentRating <= 7 )
Let careLevel_III_5_Score.IsMet =
careLevel_III_5_Score.NoRecognitionOfRelapseHarmToSelfNeeds2HourCare.Value or
careLevel_III_5_Score.IsStabilizingUnableToStopUseOrPsychiatricProblemsNeeds24HourCare.Value or
careLevel_III_5_Score.ExperiencingPsychiatricOrAddictionSymptomsHarmToSelfNeeds24HourCare.Value or
careLevel_III_5_Score.CrisisSituationWithImminentDangerOfRelapseAndConsequences.Value or
careLevel_III_5_Score.ActiveParticipantLowerLevelCareContinuedUseOrPsychiatricProblemsInAbsenceOf24HourCare.
Value
Let careLevel_III_5_Score.IsDualDiagnosisEnhanced = careLevel_III_5_Score.IsMet.Value and
careLevel_III_5_Score.PsychiatricSymptomsModerateToHighRiskOfRelapseOrMentalDisorderNeeds24HourCare.Value
Level of Care: Medically Monitored Intensive Inpatient Treatment (III.7)
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Summary
The patient is unable to control use, with imminently dangerous consequences, despite active participation at less
intensive levels of care.
Criterion(a)
ExperiencingAcutePsychiatricOrSubstanceCrisisWithIntensifiedSymptomsNeeds24HourCare
The patient is experiencing an acute psychiatric or substance use crisis, marked by intensification of symptoms of his or
her addictive or mental disorder (such as difficulty postponing immediate gratification, drug-seeking behavior, or
increasing severity of anxiety or depressive symptoms). This situation poses an imminent danger of harm to self or
others in the absence of 24-hour monitoring and structured support.
Original Equation
D5LIII.7-a = TRUE If [(ASId22:e,f,g, or k =4) or ASId25:a or d >7] & ImSevCon=1
Narrative
This criterion is met if:
Criterion(b)
ExperiencingEscalationOfRelapseOrAcuteSymptomsImminentDanger Needs24HourCare
The patient is experiencing an escalation of relapse behaviors and/or reemergence of acute symptoms. This situation
poses an imminent danger of harm to self or others in the absence of the type of 24-hour monitoring and structured
support found in a medically monitored setting.
Original Equation
D5LIII.7-b = TRUE If (ASId25e=1 OR ASIm9a=1) & ImSevCon=1
Narrative
This criterion is met if:
Criterion(c)
TreatmentMethodsRequireIntensiveLevelMedicallyManagedProgram
The modality of treatment or protocols to address relapse (such as aversion therapy and similar behavioral therapy
techniques) require that the patient receive care in a Level III.7 program.
Original Equation
D5LIII.7-c = TRUE If Post10=1
Narrative
This criterion is met if:
Criterion(dde)
PsychiatricSymptomsModerateToHighRiskOfRelapseOrMentalDisordersAllLower LevelsNotFeasible
Dual Diagnosis Enhanced Programs
The patient’s status in Dimension 5 is characterized by psychiatric symptoms
that pose a moderate to high risk of relapse to a substance dependence or mental disorder. Such a patient
demonstrates limited ability to apply relapse prevention skills, as well as poor skills in coping with mental disorders
and/or avoiding or limiting relapse, with imminent serious consequences. The patient’s follow-through in treatment is
poor or inconsistent, and his or her relapse problems are escalating to such a degree that treatment at a lower level of
care is not succeeding or not feasible. For example, the patient continues to evidence self-harm behaviors, such as
superficially cutting himself or herself, or suicidal ideation or impulses with a plan to commit suicide, but agrees to reach
out if seriously suicidal and is assessed as capable of enough internal control to do so. Or the patient’s continuing
substance-induced psychotic symptoms are resolving, but his or her difficulties in controlling substance use and craving
for use are exacerbating his or her psychotic symptoms.
Original Equation
D5LIII.7dde = TRUE If [mean of ASIp (12,12b,13,13a) =2.5to<3.5] OR ASIp20=5to7
Narrative
This criterion is met if:
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Placement Criteria
Original Equation
D5LIII.7 = TRUE If D5LIII.7 -a, -b, OR -c
D5LIII.7dde = TRUE If D5LIII.7 & D5LIII.7dde
Narrative
The Level III.7 placement criterion is met if:
Dimension 5: Level III.7 (Medically Monitored Intensive Inpatient Treatment)
Reference Pseudo Code
Let likelihoodPreviousEnvironmentWillInduceSubstanceUse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
LikelihoodPreviousEnvironmentWillInduceSubstanceUse
Let strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.
StrengthOfSubstanceUseUrgeDueToEnvironmentalTriggers
Let currentStrengthOfSubstanceUseDesire =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.CurrentStrengthOfSubstanceUseDesire
Let feelLikelyToContinueSubstanceUseOrRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.FeelLikelyToContinueSubstanceUseOrRelapse
Let interviewerScoreOfAlcoholTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAlcoholTreatmentNeed
Let interviewerScoreOfDrugTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfDrugTreatmentNeed
Let hasImminentSevereConsequences = assessmentScore.Dimension5RelapsePotentialScores.HasImminentSevereConsequences
Let patientManifestingSeriousRelapseBehaviors =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.PatientManifestingSeriousRelapseBehaviors
Let requiresMedicalMonitoringForReemergenceOfSymptoms =
assessment.MedicalSection.RequiresMedicalMonitoringForReemergenceOfSymptoms
Let requiresTreatmentModeOnlyAvailableInCareLevel_III_7 =
assessment.CompletionSection.RequiresTreatmentModeOnlyAvailableInCareLevel_III_7
Let psychiatricSymptomsModerateToHighRiskOfRelapseOrMentalDisorderNeeds24HourCare =
assessmentScore.Dimension5RelapsePotentialScores.
CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore.
PsychiatricSymptomsModerateToHighRiskOfRelapseOrMentalDisorderNeeds24HourCare
Let careLevel_III_7_Score.ExperiencingAcutePsychiatricOrSubstanceCrisisWithIntensifiedSymptomsNeeds24HourCare =
( likelihoodPreviousEnvironmentWillInduceSubstanceUse = LikertScale.Extremely or
strengthOfSubstanceUseUrgeDueToEnvironmentalTriggers = LikertScale.Extremely or
currentStrengthOfSubstanceUseDesire = LikertScale.Extremely or
feelLikelyToContinueSubstanceUseOrRelapse = SubstanceUseOrRelapseLikelihood.AtRiskToday or
interviewerScoreOfAlcoholTreatmentNeed > 7 or interviewerScoreOfDrugTreatmentNeed > 7 )
and hasImminentSevereConsequences.Value
Let careLevel_III_7_Score.ExperiencingEscalationOfRelapseOrAcuteSymptomsImminentDangerNeeds24HourCare =
( patientManifestingSeriousRelapseBehaviors.Value or requiresMedicalMonitoringForReemergenceOfSymptoms.Value )
and hasImminentSevereConsequences.Value
Let careLevel_III_7_Score.TreatmentMethodsRequireIntensiveLevelMedicallyManagedProgram =
requiresTreatmentModeOnlyAvailableInCareLevel_III_7.Value
Let careLevel_III_7_Score.
PsychiatricSymptomsModerateToHighRiskOfRelapseOrMentalDisordersAllLowerLevelsNotFeasible =
psychiatricSymptomsModerateToHighRiskOfRelapseOrMentalDisorderNeeds24HourCare.Value
Let careLevel_III_7_Score.IsMet = careLevel_III_7_Score.
ExperiencingAcutePsychiatricOrSubstanceCrisisWithIntensifiedSymptomsNeeds24HourCare.Value or
careLevel_III_7_Score.ExperiencingEscalationOfRelapseOrAcuteSymptomsImminentDangerNeeds24HourCare.Value or
careLevel_III_7_Score.TreatmentMethodsRequireIntensiveLevelMedicallyManagedProgram.Value
Let careLevel_III_7_Score.IsDualDiagnosisEnhanced = careLevel_III_7_Score.IsMet.Value and careLevel_III_7_Score.
PsychiatricSymptomsModerateToHighRiskOfRelapseOrMentalDisordersAllLowerLevelsNotFeasible.Value
Level of Care: Medically Managed Intensive Inpatient Treatment (IV)
Summary
Problems in this dimension do not qualify the patient for Level IV services.
Criterion
None
Criteria
None
Dimension 6: Recovery/Living Environment
Level of Care: Early Intervention (0.5)
Level 0.5 (Early Intervention) Summary
The patient’s social support system or significant others increase the risk of personal conflict about alcohol or drug use.
Level 0.5 (Early Intervention)
Criterion(a)
HasSupportSystemThatPreventsThemFromMeetingObligations
The individual’s social support system is composed primarily of persons whose substance use patterns prevent them
from meeting social, work, school or family obligations.
Original Equation
D6L0.5-a OB_D6L05_a := (ASIf8a > 2)
Narrative
This criterion is met if:
1) The individual’s alcohol and drug use in free time activities will permit recovery if sufficiently motivated.
Criterion(b)
HasFamilyMembersCurrentlyAbusingAlcoholOrDrugs
The individual’s family member(s) currently is/are abusing alcohol or other drugs (or has/have done so in the past),
thereby heightening the individual’s risk for a substance-related disorder.
Original Equation
D6L0.5-b OB_D6L05_b := (ASIf6a > 2)
Narrative
This criterion is met if:
1) The patient’s living arrangements will permit recovery if sufficiently motivated.
Criterion(c)
HasSignificantOtherWithDrugOrAlcoholValuesConflict
The individual’s significant other(s) expresses values concerning alcohol or other drug use that create serious conflict for
the individual.
Original Equation
D6L0.5-c OB_D6L05_c := (ASIf9a > 2)
Narrative
This criterion is met if:
1) The patient’s alcohol and drug use among friends will permit recovery if sufficiently motivated.
Criterion(d)
HasSignificantOtherWhoCondonesOrEncouragesAlcoholOrDrugUse
The individual’s significant other(s) condones or encourages inappropriate use of alcohol or other drugs.
Original Equation
D6L0.5-d
OB_D6L05_d := (ASIf19h = 4)
Narrative
This criterion is met if:
1) The patient’s closest contact(s) seriously conflicts with and is not amenable to family treatment.
Level 0.5 (Early Intervention) Placement Criterion
Original Equation
D6L0.5 OB_D6L05 := ((ASIf6a > 2) or (ASIf8a > 2) or (ASIf8b > 2) or (ASIf9a > 2) or (ASIf19h = 4)) and (not
AnyDxExceptNico)
Narrative
Placement criteria are met if either of the following is met and no diagnosis of and substance use (except nicotine):
1) The patient’s living arrangements will permit recovery if sufficient motivated.
2) The patient’s alcohol and drug use in free time activities will permit recovery if sufficient motivated.
3) The patient has minimal ideas for increasing and/or maintaining safety to deal with any problems in the free time
that put him/her at risk for relapse.
4) The patient’s alcohol and drug use among friends will permit recovery if sufficient motivated.
5) The patient’s closest contact(s) seriously conflicts with and is not amenable to family treatment.
Dimension 6: Level 0.5 Early Intervention
Reference Pseudo Code
Let
Let
Let
Let
Let
Let
freeTimeAffectOnRecovery = FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
livingArrangementAffectOnRecovery = FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
friendsAffectOnRecovery = FamilyAndSocialHistorySection.FriendsAffectOnRecovery
closestContactsHelpTreatment = FamilyAndSocialHistorySection.ClosestContactsNeedsAndWillingnessToHelpTreatment
dealsWithProblemsInFreeTime = FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
anyAddictionDiagnosisExceptNicotine = assessmentScore.DiagnosisResults.AnyAddictionDiagnosisExceptNicotine
Let HasSupportSystemThatPreventsThemFromMeetingObligations =
freeTimeAffectOnRecovery > FreeTimeAffectOnRecovery.WillPermitRecoveryIfSufficientlyMotivated
Let HasFamilyMembersCurrentlyAbusingAlcoholOrDrugs =
livingArrangementAffectOnRecovery > LivingArrangementAffectOnRecovery.WillPermitRecoveryIfSufficientlyMotivated
Let HasSignificantOtherWithDrugOrAlcoholValuesConflict =
friendsAffectOnRecovery > FriendsAffectOnRecovery.WillPermitRecovery
Let HasSignificantOtherWhoCondonesOrEncouragesAlcoholOrDrugUse =
closestContactsHelpTreatment = NeedsAndWillingnessToHelpTreatment.SeriousConflictsAndNotAmenableToFamilyTreatment
Let IsMet =
(livingArrangementAffectOnRecovery > LivingArrangementAffectOnRecovery.WillPermitRecoveryIfSufficientlyMotivated
or freeTimeAffectOnRecovery > FreeTimeAffectOnRecovery.WillPermitRecoveryIfSufficientlyMotivated or
dealsWithProblemsInFreeTimeThatRiskRelapse > StrategiesToDealWithProblemsInFreeTimeThatRiskRelapse.
MinimalIdeasForIncreasingAndorMaintainingSafety or friendsAffectOnRecovery >
FriendsAffectOnRecovery.WillPermitRecovery or closestContactsNeedsAndWillingnessToHelpTreatment =
NeedsAndWillingnessToHelpTreatment.SeriousConflictsAndNotAmenableToFamilyTreatment) and Not
(anyAddictionDiagnosisExceptNicotine)
Level of Care: Outpatient Treatment (I)
Level I (Outpatient Treatment) Summary
The patient’s recovery environment is supportive and/or the patient has skills to cope.
Level I (Outpatient Treatment)
Criterion(a)
PsychosocialEnvironmentSupportiveOutpatientTreatmentFeasible
The patient’s psychosocial environment is sufficiently supportive that outpatient treatment is feasible (for example,
significant others are in agreement with the recovery effort there is a supportive work environment or legal coercion
adequate transportation to the program is available and support meeting locations and non-alcohol/drug-centered work
are near the home environment and accessible.
Original Equation
D6LI-a = TRUE If mean ASI: [d22k,f6a,f8a,f8b,f9a,f9b,f19h,l1x] <=2 & Post9≠2 & ASIf19l=1 & ASIm6j=0
Narrative
This criterion is met if:
1) The patient feels like moderately will reuse substance, or has family or social problems with moderate risk relapse
2) Level of Care I (Outpatient Treatment) is unavailable to the patient, either due to lack of service, lack of funding, or
distance to a facility
3) The patient has no mobility problem that may affect treatment attendance
Criterion(b)
SocialSupportNotAdequatePatientMotivatedToObtainSupportive
The patient does not have an adequate primary or social support system, but he or she has demonstrated motivation
and willingness to obtain such a support system.
Original Equation
D6LI-b = TRUE If [(mean ASI: f6a,8a,9a,19h >2) & (mean ASI: d24w,d24z,f9b <=2)]
Narrative
This criterion is met if:
1)
2)
3)
4)
The patient feels like moderately will reuse substance, or has family or social problems with moderate risk relapse
The patient is open to treatment
The patient is open to, or has relapse prevention strategies
Patient has a supportive and healthy social network
Criterion(c)
SupportiveButRequireProfessionalInterventionsForRecovery
The patient’s family, guardian or significant others are supportive but require professional interventions to improve the
patient’s chance of treatment success and recovery. Such interventions may involve assistance in limit setting,
communication skills, a reduction in rescuing behaviors, and the like.
Original Equation
D6LI-c = TRUE If mean ASIf: [6a,19h] <=2
Narrative
This criterion is met if:
1) Patient has a supportive and healthy social network and will have no access to substances
2) Contacts within social network (family, guardian or significant others) will get involved in patient treatment and
recovery efforts
Criterion(dde-a)
SocialSupportNotAdequateAndMildImpairmentInAbilityToObtainOne
Dual Diagnosis Enhanced Programs
The patient does not have an adequate primary or social support system and has mild impairment in his or her ability to
obtain a support system. For example, mood, cognition and impulse control fluctuate and distract the patient from
focusing on treatment tasks.
Original Equation
D6LIdde-a = TRUE If [mean ASI: f6a,8a,9a,19h >2] & [ASIp12b=2 or P13a=2to3]
Narrative
Dual Diagnosis Enhanced criterion (a) is met if:
1) Contacts within social network (family, guardian or significant others) may not be available or may even hinder
recovery efforts and
2) The patient’s emotional problems and usage make is moderately difficult for him/her to work, take care of home, or
get along with others or
3) The patient’s emotional problems and usage may distract from recovery efforts or even hinder recovery
participation
Criterion(dde-b)
SocialSupportRequiresActiveFamilyTherapyForSuccessAndRecovery
The family, guardian or significant others require active family therapy or systems interventions to improve the patient’s
chances of treatment success and recovery. These may include family enmeshment issues, significant guilt or anxiety, or
passivity or disengaged aloofness or neglect
Original Equation
D6LIdde-b = TRUE If [ASIf19h=2]
Narrative
Dual Diagnosis Enhanced criterion (b) is met if:
1) Contacts within social network (family, guardian or significant others) would need couples or family counseling or
therapy to participate in the patient’s recovery efforts
Criterion(dde-c)
SocialSupportRequiresActiveFamilyTherapyForSuccessAndRecovery
The patient’s status in Dimension 6 is characterized by all of the following: (1) the patient has a severe and persistent
mental disorder or emotional, behavioral or cognitive problem, and (2) the patient does not have an adequate family or
social support system, and (3) the patient is chronically impaired, but not in imminent danger, and has limited ability to
establish a supportive recovery environment. However, he or she does have access to intensive outreach and case
management services that can provide structure and allow him or her to work toward stabilizing both the substancerelated and mental disorders.
Original Equation
D6LIdde-c = TRUE If [Dim3Px=1 or ASIp19j>0] & [ASIp20=3to5 or ASIp13=2to3] & [(mean of ASIf: 6a,8a,8b,9a,9b & f19h>2)
or p13a>1] & ImSevCon=0 & ASIp20e=2
Narrative
Dual Diagnosis Enhanced criterion (c) is met if:
1) The patient shows signs and symptoms of withdrawal and emotional/behavioral/cognitive problems or
2) The patient has any of the following active psychiatric diagnoses:
a) Anxiety disorder
b) Panic Disorder
c) Agoraphobia
d) Post-Traumatic Stress Disorder
e) Social Phobia
f) Obsessive-Compulsive Disorder
g) Eating disorder
h) Depressive disorder
i) Mania/Bi-polar
j) Schizophrenia/Psychotic/Thought disorder
k) Borderline/Paranoid/Antisocial/or Other Personality disorder and
3) The interviewer believes the patient’s psychological and psychiatric treatment requires close outpatient follow-up,
and that without treatment, there is considerable problems & risk, especially if patient uses substances and
4) Contacts within social network (family, guardian or significant others) may not be available or may even hinder
recovery efforts and
5) The patient can access services such as assertive community treatment and intensive case mgmt
Level I (Outpatient Treatment) Placement Criteria
Original Equation:
D6LI = TRUE If D6LI -a, -b, OR –c
D6LIdde = TRUE If D6LI & D6LIdde (-a or -b or -c)
Level I Placement criteria is met if:
1) The patient’s psychosocial environment is sufficiently supportive that outpatient treatment is feasible or
2) The patient is motivated but lacks an adequate primary or social support system or
3) Contacts within social network (family, guardian or significant others) are willing to assist recovery efforts but
require professional intervention
Level I Placement criteria for Dual Diagnosis Enhanced is met if:
1) Contacts within social network (family, guardian or significant others)) are not adequate and
2) The patient needs active social support for success with recovery efforts or
3) The patient is chronically impaired with no adequate support, but has access to treatment services
Dimension 6: Level I Outpatient Treatment
Reference Pseudo Code
Let avg = Utilities.Average( feelLikelyToContinueSubstanceUseOrRelapse,lvingArrangementAffectOnRecovery,
freeTimeAffectOnRecovery, dealsWithProblemsInFreeTimeThatRiskRelapse, friendsAffectOnRecovery,
dealsWithProblemsFromFriendsThatRiskRelapse, closestContactsNeedsAndWillingnessToHelpTreatment,
desireAndExternalFactorsDrivingTreatment )
Let careLevel_I_Score.PsychosocialEnvironmentSupportiveOutpatientTreatmentFeasible =
avg <= 2 and (isAbleToLocateAndGetToCommunityResourcesSafely not false) and
mobilityProblemsMayAffectTreatmentAttendance = YesNoNotSure.No
Let x = Utilities.Average( livingArrangementAffectOnRecovery,
freeTimeAffectOnRecovery, friendsAffectOnRecovery, closestContactsNeedsAndWillingnessToHelpTreatment )
Let y = Utilities.Average( concernsAboutPursuingTreatment,
strategyToPreventRelapse, dealsWithProblemsFromFriendsThatRiskRelapse )
Let careLevel_I_Score. SocialSupportNotAdequatePatientMotivatedToObtainSupportive = x > 2 and y <= 2
Let avgSupport = Utilities.Average( livingArrangementAffectOnRecovery,
closestContactsNeedsAndWillingnessToHelpTreatment )
Let careLevel_I_Score.SupportiveButRequireProfessionalInterventionsForRecovery = avgSupport <= 2
Let avgSocialSupport = Utilities.Average( livingArrangementAffectOnRecovery,
freeTimeAffectOnRecovery, friendsAffectOnRecovery, closestContactsNeedsAndWillingnessToHelpTreatment
Let careLevel_I_Score.SocialSupportNotAdequateAndMildImpairmentInAbilityToObtainOne = avgSocialSupport > 2 and
(howDifficultProblemsForWorkHomeAndSocialInteraction =
ProblemsForWorkHomeAndSocialInteractionScale.Moderately or
IsBtw(howEmotionalProblemsImpactRecoveryEfforts,
EmotionalProblemsImpactRecoveryEffortsScale.SomewhatDistractingFromRecovery,
EmotionalProblemsImpactRecoveryEffortsScale.WillHinderTreatmentRecoveryParticipation))
Let careLevel_I_Score.SocialSupportRequiresActiveFamilyTherapyForSuccessAndRecovery =
closestContactsNeedsAndWillingnessToHelpTreatment =
NeedsAndWillingnessToHelpTreatment.NeedsCouplesOrFamilyCounselingOrTherapyAndWillParticipate
Let avgChronicallyImpaired = Utilities.Average( livingArrangementAffectOnRecovery,
freeTimeAffectOnRecovery, dealsWithProblemsInFreeTimeThatRiskRelapse,
friendsAffectOnRecovery, dealsWithProblemsFromFriendsThatRiskRelapse,
closestContactsNeedsAndWillingnessToHelpTreatment )
Let careLevel_I_Score.IsChronicallyImpairedNoAdequateSupportButAccessToRecoveryEnvironment =
((withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) and
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max(p => p.Value) > PsychiatricDiagnosis.None) and
(IsBtw(patientNeedForPsychiatricPsychologicalTreatmentRating, 3, 5) or
IsBtw(howImportantPsychologicalEmotionalCounseling,
PsychologicalEmotionalCounselingImportanceScale.ModeratelyImportant,
PsychologicalEmotionalCounselingImportanceScale.ConsiderablyImportant)) and
(avgChronicallyImpaired > 2 or howEmotionalProblemsImpactRecoveryEfforts >
EmotionalProblemsImpactRecoveryEffortsScale.ProblemsWontInterfere) and
(hasImminentSevereConsequences not false) and intensiveCaseManagementAccessibleToPatient = YesNoNotSure.Yes
Let careLevel_I_Score.IsMet =
careLevel_I_Score.PsychosocialEnvironmentSupportiveOutpatientTreatmentFeasible.Value or
careLevel_I_Score.SocialSupportNotAdequatePatientMotivatedToObtainSupportive.Value or
careLevel_I_Score.SupportiveButRequireProfessionalInterventionsForRecovery.Value
Let careLevel_I_Score.IsDualDiagnosisEnhanced = careLevel_I_Score.IsMet.Value and
(careLevel_I_Score.SocialSupportNotAdequateAndMildImpairmentInAbilityToObtainOne.Value or
careLevel_I_Score.SocialSupportRequiresActiveFamilyTherapyForSuccessAndRecovery.Value or
careLevel_I_Score.IsChronicallyImpairedNoAdequateSupportButAccessToRecoveryEnvironment.Value)
Level of Care: Opiate Maintenance Therapy
Level Opiate Maintenance Therapy Summary
The patient’s recovery environment is supportive and/or the patient has skills to cope.
Level Opiate Maintenance Therapy Criterion
Criterion(a)
HasSupportivePsychosocialEnvironmentToRenderOpioidManintenanceFeasible
The patient’s psychosocial environment is sufficiently supportive that outpatient treatment is feasible (for example,
significant others are in agreement with the recovery effort there is a supportive work environment or legal coercion
adequate transportation to the program is available and support meeting locations and non-alcohol/drug-centered work
are near the home environment and accessible).
Original Equation
D6LM-a = TRUE If mean of ASI: [d22k,f6a,f8a,f8b,f9a,f9b,f19h]<=2 & Post9≠2 & ASIm6j=0
Narrative
Criterion (a) is met if:
1) The patient feels like moderately will reuse substance, or has family or social problems with moderate risk relapse.
2) Level of Care I (Outpatient Treatment) is unavailable to the patient, either due to lack of service, lack of funding, or
distance to a facility.
3) The patient has no mobility problem that may affect treatment attendance.
Criterion(b)
SupportiveButRequireProfessionalInterventionsForTreatmentSuccess
The patient’s family members or significant others are supportive, but require professional intervention to improve the
patient’s likelihood of treatment success (such as assistance with limit-setting, communication skills, avoiding rescuing
behaviors, education about methadone treatment and HIV risk avoidance, and the like).
Original Equation
D6LM-b = TRUE If ASIf: 6a<3 & 19h<3
Narrative
Criterion (b) is met if:
1) The patient’s living arrangement discourages or hinders treatment.
2) The patient’s needs and wellness to help treatment is not clear if will help or no one available.
Criterion(c)
NoPositiveSocialSupportPatientMotivatedToObtainSupportSystem
The patient does not have a positive social support system to assist with immediate recovery efforts, but he or she has
demonstrated motivation to obtain such a support system or to pursue (with assistance) an appropriate alternative
living environment.
Original Equation
D6LM-c = TRUE If [(mean ASI: f6a,8a,9a,19h >2) & (mean ASI: d24w,d24z <2) & ASIf9b<3]
Narrative
Criterion (c) is met if:
1) The patient feels like more than moderately will reuse substance, or has family or social problems with more than
moderate risk relapse.
2) The patient is passive or has some hesitations about pursuing treatment or has some ideas and occasional effort
about relapse prevention.
3) The patient is passive about developing protective relationships strategies to deal with problems from friends that
put the patient at risk for relapse.
Criterion(d)
HasExperiencedTraumaInRecoveryEnviro nmentManageableAsOutpatient
The patient has experienced traumatic events in his or her recovery environment (such as physical, emotional, sexual or
domestic abuse) or has manifested the effects of emotional, behavioral or cognitive problems in the environment (such
as criminal activity), but these are manageable on an outpatient basis.
Original Equation
D6LM-d = TRUE If [Any of ASIf19 a,b or c =1to2 & ASIf 19f=0 & 19j=0] or [(Sum of ASIl:
2,3,4,5,6,7,8,9,10,11,12,13,14a,b,c,15 >1) & (All of ASIp 19,19a,19b,19c,19d <3)]
Narrative
Criterion (d) is met if:
1) The patient has been convicted of a crime.
2) The patient has emotional abuse, physical abuse, sexual abuse or family neglect or abuse in past 30 days between
slight and moderate severity.
3) The patient demonstrates mild (less than 3 out of 8) harm risk to self or others.
Level Opiate Maintenance Therapy Placement Criteria
Original Equation
D6LM = TRUE If D6LM -a, -b, -c OR –d
Narrative
Placement criteria are met if either of the following is met:
1) The patient’s psychosocial environment is sufficiently supportive that outpatient treatment is feasible.
2) The patient’s family members or significant others are supportive, but require professional intervention to improve
the patient’s likelihood of treatment success.
3) The patient demonstrates motivation to obtain support system or to pursue an appropriate alternative living
environment.
4) The patient’s traumatic events in recovery environment are manageable on an outpatient basis.
Dimension 6: Level Opiate Maintenance Therapy
Reference Pseudo Code
Let likelyOnRelapse =
DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.FeelLikelyToContinueSubstanceUseOrRelapse
Let livingArrangementAffect = FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let freeTimeAffect = FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let dealsWithProblemsInFreeTime = FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let friendsAffect = FamilyAndSocialHistorySection.FriendsAffectOnRecovery
Let dealsWithProblemsFromFriends = FamilyAndSocialHistorySection.DealsWithProblemsFromFriendsThatRiskRelapse
Let mobilityProblems = MedicalSection.MobilityProblemsMayAffectTreatmentAttendance
Let closestContactsHelp = FamilyAndSocialHistorySection.ClosestContactsNeedsAndWillingnessToHelpTreatment
Let concerns = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
Let strategyToPreventRelapse = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let emotionalAbuseInPast30Days = FamilyAndSocialHistorySection.EmotionalAbuseInPast30Days
Let physicalAbuseInPast30Days = FamilyAndSocialHistorySection.PhysicalAbuseInPast30Days
Let sexualAbuseInPast30Days = FamilyAndSocialHistorySection.SexualAbuseInPast30Days
Let familyNeglectLevel = FamilyAndSocialHistorySection.FamilyNeglectOrAbuseWillWorsenWithoutGreaterThanCareLevel_II
Let riskPatientHarmedByOther = FamilyAndSocialHistorySection.RiskPatientHarmedByOther
Let wasVisitPromptedByCriminalJusticeSystem = LegalSection.WasVisitPromptedByCriminalJusticeSystem
Let isOnProbationOrParole = LegalSection.IsOnProbationOrParole
Let numberOfTimesArrestedForShopliftingVandalism = LegalSection.NumberOfTimesArrestedForShopliftingVandalism
Let numberOfTimesArrestedForParoleProbationViolation = LegalSection.NumberOfTimesArrestedForParoleProbationViolation
Let numberOfTimesArrestedForDrugCharges = LegalSection.NumberOfTimesArrestedForDrugCharges
Let numberOfTimesArrestedForForgery = LegalSection.NumberOfTimesArrestedForForgery
Let numberOfTimesArrestedForWeaponsOffense = LegalSection.NumberOfTimesArrestedForWeaponsOffense
Let numberOfTimesArrestedForBurglaryLarceny = LegalSection.NumberOfTimesArrestedForBurglaryLarceny
Let numberOfTimesArrestedForRobbery = LegalSection.NumberOfTimesArrestedForRobbery
Let numberOfTimesArrestedForAssault = LegalSection.NumberOfTimesArrestedForAssault
Let numberOfTimesArrestedForArson = LegalSection.NumberOfTimesArrestedForArson
Let numberOfTimesArrestedForRape = LegalSection.NumberOfTimesArrestedForRape
Let numberOfTimesArrestedForHomicide = LegalSection.NumberOfTimesArrestedForHomicide
Let numberOfTimesArrestedForProstitution = LegalSection.NumberOfTimesArrestedForProstitution
Let numberOfTimesArrestedForContemptOfCourt = LegalSection.NumberOfTimesArrestedForContemptOfCourt
Let numberOfTimesArrestedForOtherArrest = LegalSection.NumberOfTimesArrestedForOtherArrest
Let numberOfTimesConvicted = LegalSection.NumberOfTimesConvicted
Let hasSuicidalThoughts = PsychologicalSection.InterviewerRating.HasSuicidalThoughts
Let demonstratingDangerToSelfOrOthers = PsychologicalSection.InterviewerRating.DemonstratingDangerToSelfOrOthers
Let limitedInAbility =
PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers
Let indicatingRiskOfHarmToOthers = PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToOthers
Let indicatingRiskOfHarmToSelf =
PsychologicalSection.InterviewerRating.IndicatingRiskOfHarmToSelfOrVictimizationByOthers
Let anyOpioidAddictionDiagnosis = assessmentScore.DiagnosisResults.AnyOpioidAddictionDiagnosis
Let avgRelapse = Average(likelyOnRelapse, livingArrangementAffect, freeTimeAffect, dealsWithProblemsInFreeTime,
friendsAffect, dealsWithProblemsFromFriends, closestContactsHelp)
Let HasSupportivePsychosocialEnvironmentToRenderOpioidManintenanceFeasible =
avgRelapse <= 2 and mobilityProblems = YesNoNotSure.No
Let SupportiveButRequireProfessionalInterventionsForTreatmentSuccess =
livingArrangement < LivingArrangementAffectOnRecovery.WillDiscourageOrHinderTreatment and
closestContactsNeedsAndWillingnessToHelpTreatment <
NeedsAndWillingnessToHelpTreatment.NotClearIfWillHelpOrNoOneAvailable
Let avgAffect = Average( livingArrangementAffect, freeTimeAffect, friendsAffect, closestContactsHelp )
Let avgPositiveSupport = Average( concernsAboutPursuingTreatment, strategyToPreventRelapse )
Let NoPositiveSocialSupportPatientMotivatedToObtainSupportSystem =
avgAffect > 2 and avgPositiveSupport < 2 and dealsWithProblemsFromFriendsThatRiskRelapse <
StrategiesToDealWithProblemsFromFriendsThatRiskRelapse.PassiveAboutDevelopingProtectiveRelationships
Let numberOfPriorArrests = CountOf(numberOfTimesArrestedForShopliftingVandalism,
numberOfTimesArrestedForParoleProbationViolation,
numberOfTimesArrestedForDrugCharges,
numberOfTimesArrestedForForgery,
numberOfTimesArrestedForWeaponsOffense,
numberOfTimesArrestedForBurglaryLarceny,
numberOfTimesArrestedForRobbery,
numberOfTimesArrestedForAssault,
numberOfTimesArrestedForArson,
numberOfTimesArrestedForRape,
numberOfTimesArrestedForHomicide,
numberOfTimesArrestedForProstitution,
numberOfTimesArrestedForContemptOfCourt,
numberOfTimesArrestedForOtherArrest)
Let hasBeenConvictedOfACrime = numberOfPriorArrests > 1
Let HasExperiencedTraumaInRecoveryEnvironmentManageableAsOutpatient =
((IsBtw(emotionalAbuseInPast30Days, LikertScale.Slightly, LikertScale.Moderately) or
IsBtw(physicalAbuseInPast30Days, LikertScale.Slightly, LikertScale.Moderately) or
IsBtw(sexualAbuseInPast30Days, LikertScale.Slightly, LikertScale.Moderately)) and (familyNeglectLevel
LikertScale.NotAtAll and riskPatientHarmedByOther = LikertScale.NotAtAll))
or
(hasBeenConvictedOfACrime and
riskPatientHarmedByOther = LikertScale.NotAtAll and
hasSuicidalThoughts < 3 and
demonstratingDangerToSelfOrOthers < 3 and
limitedInAbility < 3 and
indicatingRiskOfHarmToOthers < 3 and indicatingRiskOfHarmToSelfOrVictimizationByOthers < 3)
careLevel_OMT_Score.IsMet = (HasSupportivePsychosocialEnvironmentToRenderOpioidManintenanceFeasible or
SupportiveButRequireProfessionalInterventionsForTreatmentSuccess or
NoPositiveSocialSupportPatientMotivatedToObtainSupportSystem or
HasExperiencedTraumaInRecoveryEnvironmentManageableAsOutpatient) and anyOpioidAddictionDiagnosis
=
Level of Care: Intensive Outpatient (II.1)
Level II.1 (Intensive Outpatient) Summary
The patient’s recovery environment is not supportive but, with structure and support, the patient can cope.
Level II.1 (Intensive Outpatient) Criteria
Criterion(a)
CurrentSchoolWorkLivingWillRenderRecoveryUnlikely
The patient continued exposure to the patient’s current school, work or living environment will render recovery unlikely.
The patient lacks the resources or skills necessary to maintain an adequate level of functioning without the services of a
Level II.1 program.
Original Equation
D6LII.1-a = TRUE If [mean of ASI: e7a,d22k,f6a,f8a >2 & <=3] & [mean of ASI: d24w,d24x,d24y,d24z,f8b >1&<=2]
Narrative
Criterion (a) is met if:
1) The patient’s current school, work or living environment will render recovery unlikely.
2) The patient requires Level II.1 service to maintain an adequate level of functioning or prevent relapse.
Criterion(b)
InsufficientOrInappropriateSocialContactsJeopardizeRecovery
The patient lacks social contacts, or has inappropriate social contacts that jeopardize recovery, or has few friends or
peers who do not use alcohol or other drugs. He or she also lacks the resources or skills necessary to maintain an
adequate level of functioning without Level II.1 services.
Original Equation
D6LII.1-b = TRUE If [f7=3 or f9=0 or f9a>2] & [f9b=2to3 or f19h=2to3]
Narrative
Criterion (b) is met if:
1) The patient has no close friends, does not spend free time with friends, or has friends discourage treatment and
recovery.
2) The patient has some plans to use recovery support from friends, and has closest contacts can help the recovery if
they get involved in the treatment.
Criterion(dde)
HasInsufficientResourcesSupportiveOfGoodMentalFunctioning
Dual Diagnosis Enhanced Programs : The patient’s status in Dimension 6 is characterized by a living, working, social
and/or community environment that is not supportive of good mental functioning. The patient has insufficient
resources and skills to deal with this situation. For example, the patient is unable to cope with continuing stresses
caused by hostile and alcoholic family members, and he or she evidences increasing depression and anxiety. The
support and intermittent structure of a Level II.1 Dual Diagnosis Enhanced program provide sufficient stability to prevent
further deterioration.
Original Equation
D6LII.1dde = TRUE If [Any of ASIp 14,15a,16 or 20 =2to4] & ASIp19g=5to6
Narrative
Dual Diagnosis Enhanced criterion is met if:
1) The patient experiencing withdrawal/emotional/behavioral symptoms, including: mild to moderate anxiety,
depression, or agitation.
2) The patient requires considerably high (5 or 6 out of 8) level of supervision/structure, coping skills for safety and
self-care to keep the patient remain safe.
Level II.1 (Intensive Outpatient) Placement Criteria
Original Equation
D6LII.1 = TRUE If -a OR –b
Narrative
Placement criteria are met if a or b:
1) Patient requires higher level of care than Level I (Outpatient) due to previous treatment failures.
2) The patient’s recovery environment is not supportive but, with structure and support, the patient can cope.
Dual Diagnosis Criteria
Original Equation
D6LII.1dde = TRUE If D6LII.1 & D6LII.1dde
Narrative
The dual diagnosis criteria are met if both of the following are met:
1) RequiresMoreThanLevelOPTherapySinceOtherCareLevelFailed is met
2) HasInsufficientResourcesSupportiveOfGoodMentalFunctioning is met
Dimension 6: Level II.1 Intensive Outpatient
Reference Pseudo Code
Let workOrSchoolAffect = EmploymentAndSupportSection.WorkOrSchoolAffectOnRecovery
Let likelyOnRelapse =
DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.FeelLikelyToContinueSubstanceUseOrRelapse
Let livingArrangementAffect = FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let freeTimeAffect = FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let concerns = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
Let helpfulnessOfTreatment = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let possibleFutureRelapseCause = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
Let strategyToPreventRelapse = DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let dealsWithProblemsInFreeTime = FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let spendsFreeTimeWith = FamilyAndSocialHistorySection.SpendsFreeTimeWith
Let numberOfCloseFriends = FamilyAndSocialHistorySection.NumberOfCloseFriends
Let friendsAffectOnRecovery = FamilyAndSocialHistorySection.FriendsAffectOnRecovery
Let dealsWithProblemsFromFriends = FamilyAndSocialHistorySection.DealsWithProblemsFromFriendsThatRiskRelapse
Let closestContactsHelp = FamilyAndSocialHistorySection.ClosestContactsNeedsAndWillingnessToHelpTreatment
Let depressionWithdrawal = PsychologicalSection.InterviewerRating.AppearanceOfDepressionWithdrawal
Let agitation = PsychologicalSection.InterviewerRating.AppearanceofAgitation
Let anxietyNervousness = PsychologicalSection.InterviewerRating.AppearanceOfAnxietyNervousness
Let patientNeedForTreatment =
PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let protectionFromSelfHarm = PsychologicalSection.InterviewerRating.LevelOfSupervisionNeededForProtectionFromSelfHarm
Let avgAffectOnRecovery = Average( workOrSchoolAffect, likelyOnRelapse, livingArrangementAffect, freeTimeAffect )
Let avgCauseOnRelapse = Average( concerns, helpfulnessOfTreatment, possibleFutureRelapseCause,
strategyToPreventRelapse, dealsWithProblemsInFreeTime )
Let CurrentSchoolWorkLivingWillRenderRecoveryUnlikely =
(avgAffectOnRecovery > 2 and avgAffactOnRecovery <= 3) and
(avgCauseOnRelapse > 1 and avgCauseOnRelapse <= 2)
Let InsufficientOrInappropriateSocialContactsJeopardizeRecovery =
(spendsFreeTimeWith = Companionship.Alone or
numberOfCloseFriends = 0 or
friendsAffectOnRecovery > FriendsAffectOnRecovery.WillPermitRecovery)
and
(IsBtw(dealsWithProblemsFromFriends,
StrategiesToDealWithProblemsFromFriendsThatRiskRelapse.SomePlansToUseRecoverySupports,
StrategiesToDealWithProblemsFromFriendsThatRiskRelapse.PassiveAboutDevelopingProtectiveRelationships) or
IsBtw(closestContactsHelp,
NeedsAndWillingnessToHelpTreatment.NeedsCouplesOrFamilyCounselingOrTherapyAndWillParticipate,
NeedsAndWillingnessToHelpTreatment.NotClearIfWillHelpOrNoOneAvailable))
Let HasInsufficientResourcesSupportiveOfGoodMentalFunctioning =
(IsBtw(depressionWithdrawal, 2, 4 ) or
IsBtw(agitation, 2, 4) or
IsBtw(anxietyNervousness, 2, 4) or
IsBtw(patientNeedForTreatment, 2, 4))
and IsBtw(protectionFromSelfHarm, 5, 6)
Let IsMet = CurrentSchoolWorkLivingWillRenderRecoveryUnlikely or
InsufficientOrInappropriateSocialContactsJeopardizeRecovery
Let IsDualDiagnosisEnhanced = IsMet and HasInsufficientResourcesSupportinvOfGoodMentalFUnctioning
Level of Care: Partial Hospitalization (II.5)
Level II.5 (Partial Hospitalization) Summary
The patient’s recovery environment is not supportive but, with structure and support and relief from the home
environment, the patient can cope.
Level II.5 (Partial Hospitalization) Criteria
Criterion(a)
ContinuedExposureToCurrentSchoolWorkLivin gWillRenderRecoverUnlikely
Continued exposure to the patient’s current school, work or living environment will render recovery unlikely. The
patient lacks the resources or skills necessary to maintain an adequate level of functioning without the services of a
Level II.5 program.
Original Equation
D6LII.5-a = TRUE If [mean of ASI: e7a,d22k,f6a,f8a >2 & <=3] & [mean of ASI: d24w,d24x,d24y,d24z,f8b >2&<=3]
Narrative
Criterion (a) is met if:
1)
2)
3)
4)
5)
6)
7)
School, work has the potential to hinder recovery
Home life has the potential to hinder recovery
Risk of relapse within a few days and
Reticent or resistant to treatment
More reliant on a program than on self-empowerment
No relapse prevention strategies or vague/apathetic in developing strategies
No plans for preventing relapse when faced with free time
Criterion(b)
AreNotSupportiveOfRecoveryGoalsPassivelyOpposedToTreatment
Family members and/or significant other(s) who live with the patient are not supportive of his or her recovery goals, or
are passively opposed to his or her treatment. The patient requires the intermittent structure of Level II.5 treatment
services and relief from the home environment in order to remain focused on recovery, but may live at home because
there is no active opposition to, or sabotaging of, his or her recovery efforts.
Original Equation
D6LII.5-b = TRUE If mean ASIf: 6a,8a,19h >2, <=3
Narrative
Criterion (b) is met if:
1) Living arrangement have the potential to hinder recovery
2) Misuse of free time has the potential to hinder recovery
3) Lack of support network or lack of participation of support network to assist in treatment
Criterion(dde)
HasInsufficientResourcesSupportiveOfGoodMentalFunctioning
Dual Diagnosis Enhanced Programs The patient’s status in Dimension 6 is characterized by a living, working, social
and/or community environment that is not supportive of good mental functioning. The patient has such limited
resources and skills to deal with this situation that treatment is not succeeding or not feasible. For example, the patient
is unable to cope with continuing stresses caused by homelessness, unemployment and isolation, and evidences
increasing depression and hopelessness. The support and intermittent structure of a Level II.5 Dual Diagnosis Enhanced
program provide sufficient stability to prevent further deterioration.
Original Equation
D6LII.5dde = TRUE If [Any of ASIp 14,15a,16 or 20 =5to7] & ASIp19g=5to6
Dual Diagnosis Enhanced criterion is met if:
1)
2)
3)
4)
Considerable or extreme depression/withdrawal.
Considerable or extreme Agitation
Considerable or extreme anxiousness/nervousness
Interviewer believes patient shows considerable or extreme need for psychiatric/psychological treatment
Level II.5 (Partial Hospitalization) Placement Criteria)
D6LII.5 = TRUE If D6LII.5-a OR –b
Level II.5 Placement criteria is met if:
1) The continued exposure to current work/school/living environments will render recovery unlikely or
2) Support network is either passively or completely opposed to patient seeking treatment.
Dimension 6: Level II.5 Partial Hospitalization
Reference Pseudo Code
Let workOrSchoolAffectOnRecovery = assessment.EmploymentAndSupportSection.WorkOrSchoolAffectOnRecovery
Let feelLikelyTContinueSubstanceUseOrRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.FeelLikelyToContinueSubstanceUseOrRelapse
Let livingArrangementAffectRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let freeTimeAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let concernsAboutPursuingTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
Let helpfulnessOfTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let possibleFutureRelapseCause =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapse
Let strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let dealsWithProblemsInFreeTimeThatRiskRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.DealsWithProblemsInFreeTimeThatRiskRelapse
Let closestContactNeedsAndWillingnessToHelpTreatment =
assessment.FamilyAndSocialHistorySection.ClosestContactNeedsAndWillingnessToHelpTreatment
Let appearanceOfDepressionWithdrawal =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfDepressionWithdrawal
Let appearanceOfAgitation = assessment.PsychologicalSection.InterviewerRating.AppearanceOfAgitation
Let appearanceOfAnxietyNervousness =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfAnxietyNervousness
Let patientNeedForPsychiatricPsychologicalTreatmentRating = assessment.PsychologicalSection.InterviewerRating.
PatientNeedForPsychiatricPsychologicalTreatmentRating
Let levelOfSupervisionNeededForProtectionFromSelfHarm = assessment.PsychologicalSection.InterviewerRating.
LevelOfSupervisionNeededForProtectionFromSelfHarm
Let x = Utilities.Average ( WorkOrSchoolAffectOnRecovery, feelLikelyTContinueSubstanceUseOrRelapse,
livingArrangementAffectRecovery, freeTimeAffectOnRecovery )
Let y = Utilities.Average (concernsAboutPursuingTreatment, helpfulnessOfTreatment, possibleFutureRelapseCause,
strategyToPreventRelapse, dealsWithProblemsInFreeTimeThatRiskRelapse )
Let ContinuedExposureToCurrentSchoolWorkLivingWillRenderRecoveryUnlikely = (x > 2 and x <= 3) and (y > 2 and y <= 3)
Let Avg = Utilities.Average (livingArrangementAffectRecovery, freeTimeAffectOnRecovery,
closestContactNeedsAndWillingnessToHelpTreatment )
Let AreNotSupportiveOfRecoveryGoalsPassivelyOpposedToTreatment = (avg > 2 and avg <= 3)
Let HasSufficientResourcesSupportiveOfGoodMentalFunctioning = (appearanceOfDepressionWithdrawal value between 5, 7) or
(appearanceOfAgitation value between 5, 7) or (appearanceOfAnxietyNervousness value between 5, 7) or
(patientNeedForPsychiatricPsychologicalTreatmentRating value between 5, 7) and
(levelOfSupervisionNeededForProtectionFromSelfHarm value between 5, 6)
Let scoreIsMet = ContinuedExposureToCurrentSchoolWorkLivingWillRenderRecoveryUnlikely.Value or
AreNotSupportiveOfRecoveryGoalsPassivelyOpposedToTreatment.Value
Let dde.IsMet = scoreIsMet.Value and HasSufficientResourcesSupportiveOfGoodMentalFunctioning.Value
Level of Care: Clinically Managed Low-Intensity Residential Services (III.1)
Level III.1 (Clinically Managed Low-Intensity Residential Services) Summary
The patient’s environment is dangerous, but recovery is achievable if Level III.1 24-hour structure is available.
Level III.1 (Intensive Outpatient) Criteria
Criterion(a)
LivingInModeratelyHighRiskEnvironmentImpactToRecovery
The resident has been living in an environment that is characterized by a moderately high risk of initiation or repetition
of physical, sexual or emotional abuse, or substance use so endemic that the resident is assessed as being unable to
achieve or maintain recovery at a less intensive level of care.
Original Equation
D6LIII.1a = TRUE If [(any of ASIf: 19a,b,c >1) & ASIf19j>1] or [ASIf6a=4]
Narrative
Criterion (a) is met if:
1)
2)
3)
4)
5)
Patient has experienced moderate emotional abuse within the past 30 days
Patient has experienced moderate physical abuse within the past 30 days
Patient has experienced moderate sexual abuse within the past 30 days
Patient faces a moderate risk of being hurt or victimized by another
Living arrangements will often expose patient to substance suppliers or users
Criterion(bc)
InsufficientOrInappropriateSocialContactsOrSocialIsolationImpactsRecovery
The resident lacks social contacts or has inappropriate social contacts that jeopardize his or her recovery, or the
resident’s social network is characterized by significant social isolation and withdrawal. The resident’s social network
includes few friends who are not regular users of alcohol or other drugs, leading recovery goals to be assessed as
unachievable outside of a 24-hour supportive setting.
Original Equation
D6LIII.1bc = TRUE If [any of ASIf: f7,f9,f19g=0 & f9b=4] or [mean of ASIf 6a,9a,9b,19h =>3]
Narrative
Criterion (bc) is met if:
1) Patient's free time is mostly spent alone
2) Patient has no close friends
a) Mother is the only person whom the patient has had contact with during the past 4 months and
b) Mother is most important person to the patient
a)
b)
c)
d)
Patient is reclusive or drawn to high-risk social contacts
Patient’s living arrangements and friends will discourage or hinder treatment / recovery
Patient is passive about developing protective relationships
Patient is not clear if this person (or these persons) will assist in treatment / recovery or if the person (or
persons) will be available to assist in treatment / recovery
Criterion(d)
ContinuedExposureToCurrentSchoolWorkLivingNeeds24HourSupport
Continued exposure to the resident’s school, work or living environment makes recovery unlikely, and the resident has
insufficient resources and skills to maintain an adequate level of functioning outside of a 24-hour supportive
environment.
Original Equation
D6LIII.1d = TRUE If [mean of ASI: e7a,d22k,f6a,f8a >2 & <=3] & [mean of ASI:d24w,d24x,d24y,d24z,f8b>3]
Narrative
Criteria (d) is met if:
1)
2)
3)
4)
5)
6)
7)
8)
9)
Patient's work (or school) has the potential to hinder treatment /recovery
Patient feels at risk of relapsing within days
Living arrangement has the potential to hinder treatment / recovery.
Patient's free time activities have the potential to hinder treatment/ recovery
Patient rejects treatment plan with many contingencies
Patient holds significant other, family, or program as responsible for success
Patient is convinced relapse will not occur in the future
Patient is highly ambivalent or rejects any need of outside assistance in preventing relapse
Patient has a preference for high-risk hobbies that could result in a relapse
Criterion(e)
DangerOfVictimizationByAnotherRequires24HourSupervision
The resident is in danger of victimization by another and thus requires 24-hour supervision.
Original Equation
D6LIII.1-e = TRUE If ASIf19j>2]
Narrative
Criteria (e) is met if:
1) Patient faces considerable risk of being hurt of victimized by another
Criterion(f)
AbleToCopeLimitedPeriodsTimeOutside24HourStructure
The resident is able to cope, for limited periods of time, outside the 24-hour structure of a Level III.1 program in order to
pursue clinical, vocational, educational and community activities.
Original Equation
D6LIII.1-f = TRUE If ASIf19l=1 & ASIe7a<3
Narrative
Criteria (f) is met if:
1) Patient is unable to locate and get to community resources in a safe manner
2) Patient's schedule require adjustments in order for treatment and recovery to be successful
Criterion(dde)
HasSevereMentalIllnessNeedsStructureOfLevel31DualDiagnosisEnhanced
Dual Diagnosis Enhanced Programs The resident’s status in Dimension 6 is characterized by severe and persistent
mental illness. He or she may be too ill to benefit from skills training to learn to cope with problems in the recovery
environment. Such a resident requires planning for assertive community treatment, intensive case management or
other community outreach and support services. The resident’s living, working, social and/or community environment is
not supportive of good mental health functioning. He or she has insufficient resources and skills to deal with this
situation. For example, the resident may be unable to cope with the continuing stress of homelessness, or hostile or
alcoholic family members, and thus exhibits increasing anxiety and depression. Such a resident needs the support and
structure of a Level III.1 Dual Diagnosis Enhanced program to achieve stabilization and prevent further deterioration.
Original Equation
D6LIII.1dde = TRUE If [Dim3Px=1 or ASIp19j>0] & [ASIp20=3to7 or ASIp13=2to4] & [(mean of ASIf: 6a,8a,8b,9a,9b & f19h>2)
or p13a>1]
Narrative
Criteria(dde) is met if:
1) Patient shows withdrawal symptoms and emotional behavioral problems and/or cognitive condition and
complication
2) Patient seems to have anxiety disorder, panic disorder, agoraphobia, post-traumatic stress disorder, social phobia,
obsessive-compulsive disorder, eating disorder, depressive disorder, mania/ bipolar disorder,
schizophrenia/psychotic/thought disorder, borderline/paranoid/antisocial /or other personality disorder
3) Patient has moderate psychiatric/psychological problems that require close outpatient follow-up, patient also has
considerable problems and risk, particularly if patient uses substances. Patient needs acute hospitalization
4) Need for counseling for these psychological problems are moderate, patient's psychiatric needs will require
specialized psychiatric care
5) Living arrangements have the potential to discourage or hinder treatment/ recovery. Patient's free time activities
have the potential to discourage or hinder treatment/recovery. Patient rejects any need to develop a safe
recreation. Patient's friends have the potential to discourage or hinder treatment/ recovery. Patient is passive about
developing protective relationships with people who can help with recovery. Patient is not clear if this person (or
these persons) will assist in treatment / recovery or if the person (or persons) will be available to assist in treatment
/ recovery
6) Patient's emotional problems are somewhat distracting from recovery
Level III.1 (Clinically Managed Low-Intensity Residential Services) Placement Criteria
Original Equation
D6LIII.1 = TRUE If (Any of: D6LIII.1 -a, -b, -c, -d, OR -e) & -f
D6LIII.1dde = TRUE If D6LIII.1 & D6LIII.1dde
Placement criteria(IsMet) is met if:
1) Patient is living in moderately high risk environment that jeopardizes his or her recovery
2) Patient lacks social contacts or has inappropriate social contacts that jeopardize his or her recovery
3) Patient's continued exposure to school, work or living environment makes recovery unlikely, and the patient has
insufficient resources and skills to maintain an adequate level of functioning outside of a 24-hour supportive
environment
4) The patient is in danger of victimization by another and thus requires 24-hour supervision
5) The patient is able to cope, for limited periods of time, outside the 24-hour structure of a Level III.1 program in order
to pursue clinical, vocational, and educational and community activities.
Criteria (Dual Diagnosis Enhanced) is met if:
1) The patient status in Dimension 6 is characterized by severe and persistent mental illness. He or she may be too ill to
benefit from skills training to learn to cope with problems in the recovery environment
Dimension 6: Level III_1 Clinically Managed Low Intensity Treatment
Reference Pseudo Code
Let emotionalAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.EmotionalAbuseInPast30Days
Let physicalAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.PhysicalAbuseInPast30Days
Let sexualAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.SexualAbuseInPast30Days
Let riskPatientHarmedByOther = assessment.FamilyAndSocialHistorySection.RiskPatientHarmedByOther
Let livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
Let friendsAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FriendsAffectOnRecovery
Let dealsWithProblemsFromFriendsThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsFromFriendsThatRiskRelapse
Let closestContactsNeedsAndWillingnessToHelpTreatment =
assessment.FamilyAndSocialHistorySection.ClosestContactsNeedsAndWillingnessToHelpTreatment
Let spendsFreeTimeWith = assessment.FamilyAndSocialHistorySection.SpendsFreeTimeWith
Let numberOfCloseFriends = assessment.FamilyAndSocialHistorySection.NumberOfCloseFriends
Let closestPersonalContactInPast4Months = assessment.FamilyAndSocialHistorySection.ClosestPersonalContactInPast4Months
Let workOrSchoolAffectOnRecovery = assessment.EmploymentAndSupportSection.WorkOrSchoolAffectOnRecovery
Let feelLikelyToContinueSubstanceUseOrRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.FeelLikelyToContinueSubstanceUseOrRelapse
Let freeTimeAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let concernsAboutPursuingTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.ConcernsAboutPursuingTreatment
Let helpfulnessOfTreatment =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.HelpfulnessOfTreatment
Let possibleFutureRelapseCause =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.PossibleFutureRelapseCause
Let strategyToPreventRelapse =
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.StrategyToPreventRelapse
Let dealsWithProblemsInFreeTimeThatRiskRelapse =
assessment.FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
Let isAbleToLocateAndGetToCommunityResourcesSafely =
assessment.FamilyAndSocialHistorySection.IsAbleToLocateAndGetToCommunityResourcesSafely
Let patientNeedForPsychiatricPsychologicalTreatmentRating =
assessment.PsychologicalSection.InterviewerRating.PatientNeedForPsychiatricPsychologicalTreatmentRating
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling
Let howEmotionalProblemsImpactRecoveryEfforts =
assessment.PsychologicalSection.PsychologicalHistory.HowEmotionalProblemsImpactRecoveryEfforts
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse =
assessment.PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
---------------------------------------------------------------------------LikertScale emotionalAbuseInPast30Days
LikertScale physicalAbuseInPast30Days
LikertScale sexualAbuseInPast30Days
LikertScale riskPatientHarmedByOther
LivingArrangementAffectOnRecovery livingArrangementAffectOnRecovery
FriendsAffectOnRecovery friendsAffectOnRecovery
StrategiesToDealWithProblemsFromFriendsThatRiskRelapse dealsWithProblemsFromFriendsThatRiskRelapse
NeedsAndWillingnessToHelpTreatment closestContactsNeedsAndWillingnessToHelpTreatment
Companionship spendsFreeTimeWith
uint? numberOfCloseFriends
ContactPerson closestPersonalContactInPast4Months
WorkOrSchoolAffectOnRecovery workOrSchoolAffectOnRecovery
SubstanceUseOrRelapseLikelihood feelLikelyToContinueSubstanceUseOrRelapse
FreeTimeAffectOnRecovery freeTimeAffectOnRecovery
ConcernsAboutPursuingTreatment concernsAboutPursuingTreatment
HelpfulnessOfTreatment helpfulnessOfTreatment
RelapseCause possibleFutureRelapseCause
RelapsePreventionStrategies strategyToPreventRelapse
StrategiesToDealWithProblemsInFreeTimeThatRiskRelapse dealsWithProblemsInFreeTimeThatRiskRelapse
bool? isAbleToLocateAndGetToCommunityResourcesSafely
ScaleOf0To8 patientNeedForPsychiatricPsychologicalTreatmentRating
PsychologicalEmotionalCounselingImportanceScale howImportantPsychologicalEmotionalCounseling
EmotionalProblemsImpactRecoveryEffortsScale howEmotionalProblemsImpactRecoveryEfforts
IEnumerable<PsychiatricDiagnosis> activePsychiatricDiagnosesOtherThanSubstanceAbuse
bool? withdrawalSymptomsAndEmotionalBehavioralProblems
Let careLevel_III_1_Score.LivingInModeratelyHighRiskEnvironmentImpactToRecovery =
((emotionalAbuseInPast30Days > LikertScale.Slightly or
physicalAbuseInPast30Days > LikertScale.Slightly or
sexualAbuseInPast30Days > LikertScale.Slightly) and
riskPatientHarmedByOther > LikertScale.Slightly) or
livingArrangementAffectOnRecovery = LivingArrangementAffectOnRecovery.WillOftenExposeToSubstanceUse
Let z = Utilities.Average(livingArrangementAffectOnRecovery,friendsAffectOnRecovery,
dealsWithProblemsFromFriendsThatRiskRelapse,closestContactsNeedsAndWillingnessToHelpTreatment)
Let careLevel_III_1_Score.InsufficientOrInappropriateSocialContactsOrSocialIsolationImpactsRecovery =
((spendsFreeTimeWith = Companionship.Alone or numberOfCloseFriends = 0 or closestPersonalContactInPast4Months =
ContactPerson.Mother) and dealsWithProblemsFromFriendsThatRiskRelapse =
StrategiesToDealWithProblemsFromFriendsThatRiskRelapse.ReclusiveOrDrawnToHighRiskSocialContacts) or (z >= 3)
Let x = Utilities.Average(workOrSchoolAffectOnRecovery,feelLikelyToContinueSubstanceUseOrRelapse,
livingArrangementAffectOnRecovery, freeTimeAffectOnRecovery)
Let y = Utilities.Average(concernsAboutPursuingTreatment,helpfulnessOfTreatment,possibleFutureRelapseCause,
strategyToPreventRelapse, dealsWithProblemsInFreeTimeThatRiskRelapse)
Let careLevel_III_1_Score.ContinuedExposureToCurrentSchoolWorkLivingNeeds24HourSupport =
(x > 2 and x <= 3) and (y > 3)
Let careLevel_III_1_Score.DangerOfVictimizationByAnotherRequires24HourSupervision =
riskPatientHarmedByOther > LikertScale.Moderately
Let careLevel_III_1_Score.AbleToCopeLimitedPeriodsTimeOutside24HourStructure =
!(isAbleToLocateAndGetToCommunityResourcesSafely ?? true) and
workOrSchoolAffectOnRecovery < WorkOrSchoolAffectOnRecovery.WillDiscourageOrHinderRecovery
Let avg = Utilities.Average(livingArrangementAffectOnRecovery, freeTimeAffectOnRecovery,
dealsWithProblemsInFreeTimeThatRiskRelapse, friendsAffectOnRecovery, dealsWithProblemsFromFriendsThatRiskRelapse,
closestContactsNeedsAndWillingnessToHelpTreatment)
Let activeDxMax = activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max(a => a.Value)
Let careLevel_III_1_Score.HasSevereMentalIllnessNeedsStructureOfLevel31DualDiagnosisEnhanced =
((withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) and activeDxMax > PsychiatricDiagnosis.None)
And (IsBtw(patientNeedForPsychiatricPsychologicalTreatmentRating, 3, 8) or
IsBtw(howImportantPsychologicalEmotionalCounseling,
PsychologicalEmotionalCounselingImportanceScale.ModeratelyImportant,
PsychologicalEmotionalCounselingImportanceScale.ExtremelyImportant)) and
(avg > 2 or howEmotionalProblemsImpactRecoveryEfforts >
EmotionalProblemsImpactRecoveryEffortsScale.ProblemsWontInterfere)
Let careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.IsMet =
(careLevel_III_1_Score.LivingInModeratelyHighRiskEnvironmentImpactToRecovery or
careLevel_III_1_Score.InsufficientOrInappropriateSocialContactsOrSocialIsolationImpactsRecovery or
careLevel_III_1_Score.ContinuedExposureToCurrentSchoolWorkLivingNeeds24HourSupport or
careLevel_III_1_Score.DangerOfVictimizationByAnotherRequires24HourSupervision) and
careLevel_III_1_Score.AbleToCopeLimitedPeriodsTimeOutside24HourStructure
Let careLevel_III_1_Score.IsDualDiagnosisEnhanced =
careLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore.IsMet and
HasSevereMentalIllnessNeedsStructureOfLevel31DualDiagnosisEnhanced
Level of Care: Clinically Managed Medium-Intensity Residential Services (III.3)
Level III.3 (Clinically Managed Medium-Intensity Residential Services) Summary
The patient’s environment is dangerous and he or she needs 24-hour structure to learn to cope.
Level III.3 (Clinically Managed Medium-Intensity Residential Services) Criteria
Criterion(a)
LivingEnvironmentModerateHighRiskUnableToMaintainRecovery
The resident has been living in an environment that is characterized by a moderately high risk of initiation or repetition
of physical, sexual or emotional abuse, or substance use so endemic that the resident is assessed as being unable to
achieve or maintain recovery at a less intensive level of care.
Original Equation
D6LIII.3-a = TRUE If [(any of ASIf: 19a,b,c >1) & ASIf19j >1]
or
[ASIf6a=4]
Narrative
Criterion (a) is met if:
1) Patient has experienced any of the following in the past 30 days:
a) Physical abuse
b) Psychological abuse
c) Sexual abuse and
2) There is a risk that the patient could be hurt or victimized by another or
3) Patient will be exposed to substance suppliers and/or users
Criteria(b and e)
CognitiveImpairmentRequires24HourSupervisionToPreventVictimization
(b)The resident is in significant danger of victimization and thus requires 24-hour supervision. For example, the resident
has sustained a traumatic brain injury, as a result of which he or she is vulnerable to victimization when using
psychoactive substances.
(e) Because of cognitive limitations, the resident is in danger of victimization by another and thus requires 24-hour
supervision.
Original Equation
D6LIII.3-b & -e = TRUE If [(any of ASIf: 19a,b,c >1) & ASIf19j>1] or [ASIf6a=4] & [ASIp 18>4 or 19k=2 or or 20a=2]
Narrative
Criteria (b) and (e) are met if:
1) Patient has experienced any of the following in the past 30 days:
a) Physical abuse
b) Psychological abuse
c) Sexual abuse and
2) There is a risk that the patient could be hurt or victimized by another or
3) Patient will be exposed to substance suppliers and/or users and
4) Patient is experiencing trouble comprehending, concentrating and remembering to the point of symptoms
suggesting risk of impairment or evidence or report of impairment or
5) Patient shows evidence of a chronic organic, mental disability such as: Alcohol Amnestic Disorder or Alzheimers or
6) Interviewer believes the patient's current behavior is inconsistent with reliable self-care, safety, or ability to
participate in treatment
Criteria(c and d)
SocialNetworkOrLivingWithAlcoholDrugUserI mpactsRecovery
The resident’s social network includes regular users of alcohol or other drugs, such that recovery goals are assessed as
unachievable at a less intensive level of care.
Original Equation
D6LIII.3-c & -d = TRUE If mean of ASIf 6a,9a,9b,19h =>3
Narrative
Criteria (c ) and (d) are met if:
1)
2)
3)
4)
The patient’s current living arrangement will hinder or discourage recovery efforts
The patient’s social network will hinder or discourage recovery efforts
The patient will be passive to the negative influence of social network, or drawn to high-risk contacts.
The patient may lack support from social network, or have no friends/acquaintances who are available or willing to
help patient in recovery efforts.
Criterion(f)
IsUnableToCopeOutside24HourStructureProgram
The resident is unable to cope, for even limited periods of time, outside the 24-hour structure of a Level III.3 program.
He or she needs staff monitoring to assure his or her safety and well-being.
Original Equation
D6LIII.3-f = TRUE If ASIf19l=0 or p19j>6 or p20b=2 or Post2=0 or Post3=4
Narrative
Criterion (f) is met if:
1) The patient is unable to locate/travel to available community resources or
2) The patient has any of the following active psychiatric diagnoses:
a) Eating disorder
b) Depressive disorder
c) Mania/Bi-polar
d) Schizophrenia/Psychotic/Thought disorder
e) Borderline/Paranoid/Antisocial/or Other Personality disorder or
3) Interviewer believes the patient is exhibiting behaviors so severe as to require continuous limit-setting interventions
or
4) Interviewer believes the patient is exhibiting symptoms that cannot be managed at home w/supervision or
5) Interviewer believes it will take >24 hours for the patient to respond to detox care, such that monitoring at home
will be sufficient without professional monitoring
Criterion(dde)
HasInsufficientResourcesSupportiveOfGoodMentalFunctioning
Dual Diagnosis Enhanced Programs The resident’s status in Dimension 6 is characterized by severe and persistent
mental illness. He or she may be too ill to benefit from skills training to learn to cope with problems in the recovery
environment. Such a resident requires planning for assertive community treatment, intensive case management or
other community outreach and support services.
Original Equation
D6LIII.3-dde = TRUE If [Dim3Px=1 or ASIp19j>0] & [ASIp20=3to7 or ASIp13=2to4] & [(mean of ASIf: 6a,8a,8b,9a,9b &
f19h>2) or p13a>1]
Dual Diagnosis Enhanced criterion is met if:
1) Patient is exhibiting withdrawal symptoms and emotional/behavioral/cognitive problems or
2) The patient has any of the following active psychiatric diagnoses:
a) Anxiety disorder
b) Panic Disorder
c) Agoraphobia
d) Post-Traumatic Stress Disorder
e) Social Phobia
f) Obsessive-Compulsive Disorder
g) Eating disorder
h) Depressive disorder
i) Mania/Bi-polar
j) Schizophrenia/Psychotic/Thought disorder
k) Borderline/Paranoid/Antisocial/or Other Personality disorder and
3) Interviewer believes the patient is at risk and in need of psychiatric/psychological treatment or
4) Patient believes that at a minimum he/she requires counseling for psychological problems and
5) The patient’s current living arrangement will hinder or discourage recovery efforts
6) The patient’s social network will hinder or discourage recovery efforts
7) The patient will be passive to the negative influence of social network, or drawn to high-risk contacts.
8) The patient may lack support from social network, or have no friends/acquaintances who are available or willing to
help patient in recovery efforts or
9) Patient believes that his/her emotional problems will hinder or discourage recovery efforts
Dimension 6: Level III.3 Clinically Managed Medium-Intensity Residential Services
Reference Pseudo Code
Let
Let
Let
Let
Let
Let
emotionalAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.EmotionalAbuseInPast30Days
physicalAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.PhysicalAbuseInPast30Days
sexualAbuseInPast30Days = assessment.FamilyAndSocialHistorySection.SexualAbuseInPast30Days
riskPatientHarmedByOther = assessment.FamilyAndSocialHistorySection.RiskPatientHarmedByOther
livingArrangementAffectOnRecovery = assessment.FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
appearanceOfTroubleConcentratingOrRemembering = assessment.PsychologicalSection.InterviewerRating.
AppearanceOfTroubleConcentratingOrRemembering
Let evidenceOfChronicOrganicMentalDisability = assessment.PsychologicalSection.InterviewerRating.
EvidenceOfChronicOrganicMentalDisability
Let currentBehaviorInconsistentWithSelfCare = assessment.PsychologicalSection.InterviewerRating.
CurrentBehaviorInconsistentWithSelfCare
Let friendsAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FriendsAffectOnRecovery
Let dealsWithProblemsFromFriendsThatRiskRelapse = assessment.FamilyAndSocialHistorySection.
DealsWithProblemsFromFriendsThatRiskRelapse
Let closestContactsNeedsAndWillingnessToHelpTreatment = assessment.FamilyAndSocialHistorySection.
ClosestContactsNeedsAndWillingnessToHelpTreatment
Let isAbleToLocateAndGetToCommunityResourcesSafely = assessment.FamilyAndSocialHistorySection.
IsAbleToLocateAndGetToCommunityResourcesSafely
Let activePsychiatricDiagnosesOtherThanSubstanceAbuse = assessment.PsychologicalSection.
ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
Let currentProblemBehaviorsRequireContinuousInterventions = assessment.PsychologicalSection.
CurrentProblemBehaviorsRequireContinuousInterventions
Let symptomsStabilizedDuringTreatmentDay = assessment.CompletionSection.SymptomsStabilizedDuringTreatmentDay
Let timingOfPositiveResponseToDetoxificationCare = assessment.CompletionSection.
TimingOfPositiveResponseToDetoxificationCare
Let freeTimeAffectOnRecovery = assessment.FamilyAndSocialHistorySection.FreeTimeAffectOnRecovery
Let dealsWithProblemsInFreeTimeThatRiskRelapse = assessment.FamilyAndSocialHistorySection.
DealsWithProblemsInFreeTimeThatRiskRelapse
Let patientNeedForPsychiatricPsychologicalTreatmentRating = assessment.PsychologicalSection.
PatientNeedForPsychiatricPsychologicalTreatmentRating
Let howImportantPsychologicalEmotionalCounseling = assessment.PsychologicalSection.
HowImportantPsychologicalEmotionalCounseling
Let howEmotionalProblemsImpactRecoveryEfforts = assessment.PsychologicalSection.
HowEmotionalProblemsImpactRecoveryEfforts
Let detoxificationRequiredMoreThanHourlyMonitoring = assessment.COmpletionSection.
DetoxificationRequiredMoreThanHourlyMonitoring
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems
Let dimension2SeverityNumber = assessmentScore.Dimension2BiomedicalScores.SeverityNumber
Let livingModeratelyHighRiskEnvironmentImpactToRecovery =
assessmentScore.Dimension6LivingEnvironmentScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScor
e.LivingModeratelyHighRiskEnvironmentImpactRecovery
Let LivingEnvironmentModerateHighRiskUnableToMaintainRecovery = (( emotionalAbuseInPast30Days > LikertScale.Slightly or
physicalAbusePast30Days > LikertScale.Slightly or sexualAbuseInPast30Days > LikertScale.Slightly and
riskPatientHarmedByOther > LikertScale.Slightly )) or livingArrangementAffectOnRecovery =
livingArrangementAffectOnRecovery not = LivingArrangementAffectOnRecovery.WillOftenExposeToSubstance
Let CognitiveImpairmentRequires24HourSupervisionToPreventVictimization =
livingModeratelyHighRiskEnvironmentImpactToRecovery.Value and (appearanceOfTroubleConcentratingOrRemembering > 4
or evidenceOfChronicOrganicMentalDIsability not = YesNoNotSure.Yes or currentBehaviorInconsistentWithSelfCare not
= YesNoNotSure.Yes)
Let z = Utilities.Average (livingArrangementAffectOnRecovery, friendsAffectOnRecovery,
dealsWithProblemsFromFriendsThatRiskRelapse, closestContactsNeedsAndWillingnessToHelpTreatment)
Let SocialNetworkOrLivingWithAlcoholDrugUserImpactsRecovery = z >= 3
Let IsUnableToCopeOutside24HourStructureProgram = not isAbleToLocateAndGetToCommunityResourcesSafely or
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Contains(PsychiatricDiagnosis.ManiaOrBipolarDisorder) or
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Contains(PsychiatricDiagnosis.
SchizophreniaPsychoticOrThoughtDisorder) or currentProblemBehaviorsRequireContinuousInterventions = YesNoNotSure.Yes
or symptomsStabilizedDuringTreatmentDay = null or timingOfPositiveResponseToDetoxification =
DetoxificationCareResponseTiming.MoreThan24Hours
Let x = Utilities.Average (livingArrangementAffectOnRecovery, freeTimeAffectOnRecovery,
dealsWithProblemsInFreeTimeThatRiskRelapse, friendsAffectOnRecovery, dealsWIthProblemsFromFriendsThatRiskRelapse,
closestContactNeedsAndWillingnessToHelpTreatment)
Let HasSeverePersistentMentalIllnessNeedsStructureOfLevel33DualDiagnosisEnhanced =
((withdrawalSymptomsAndEmotionalBehavioralProblems not false) and activePsychiatricDiagnosesOtherThanSubstanceAbuse.Max
(p => p.Value) > PsychiatricDiagnosis.None) and (patientNeedForPsychiatric between range of 3,8) or
(howImportantPsychologicalEmotionalCOunseling between range of
PsychologicalEmotionalCOunselingImportantScale.ModeratelyImportant,
PsychologicalEmotionalCOunselingImportanceScale.ExtremelyImportant)) and (x > 2 or
howEmotionalProblemsImpactRecoveryEfforts > EmotionalProblemsImpactRecoveryEffortsScale.ProblemsWontInterfere)
Let careLevel_III_3_Score.IsMet =
(careLevel_III_3_Score.LivingEnvironmentModerateHighRiskUnableToMaintainRecovery.Value or
careLevel_III_3_Score.CognitiveImpairmentRequires24HourSupervisionToPreventVictimization.Value or
careLevel_III_3_Score.SocialNetworkOrLivingWithAlcoholDrugUserImpactsRecovery.Value or careLevel_III_3_Score.
IsUnableToCopeOutside24HourStructureProgram.Value) and (dimension2SeverityNumber > 5 or dimension3SeverityNumber >
5 or (detoxificationRequiredMoreThanHourlyMonitoring not false))
Let careLevel_III_3_Score.IsDualDiagnosisEnhanced = careLevel_III_3_Score.IsMet.Value and careLevel_III_3_Score.
HasPersistentMentalIllnessNeedsStructureOfLevel33DualDiagnosisEnhanced.Value
Level of Care: Clinically Managed High-Intensity Residential Services (III.5)
Level III.5 (Clinically Managed High-Intensity Residential Treatment) Summary
The patient’s environment is dangerous and he or she lacks skills to cope outside of a highly structured 24-hour setting.
Level III.5 (Clinically Managed High-Intensity Residential Treatment) Criteria
Criterion(a)
LivingEnvironmentModerateHighRiskAbuseNoRecoveryAtLowerLevelCare
The resident has been living in an environment that is characterized by a moderately high risk of initiation or repetition
of physical, sexual or emotional abuse, or substance use so endemic that the resident is assessed as being unable to
achieve or maintain recovery at a less intensive level of care.
Original Equation
D6LIII.1-a, 3-a, & 5-a = TRUE If [(any of ASIf: 19a,b,c >1) & ASIf19j>1] or [ASIf6a=4]
Criterion (a) is met if:
1) Patient has experienced any of the following in the past 30 days:
a) Physical abuse
b) Psychological abuse
c) Sexual abuse and
2) There is a risk that the patient could be hurt or victimized by another or
3) Patient will be exposed to substance suppliers and/or users
Criterion(b, c, d)
SocialNetworkAlcoholDrugUsersUnachievableRecoveryAtLewerLevelOfCare
(b) The resident’s social network includes regular users of alcohol or other drugs, such that recovery goals are assessed
as unachievable at a less intensive level of care.
OR (c) The resident’s social network is characterized by significant social isolation or withdrawal, such that recovery
goals are assessed as unachievable at a less intensive level of care.
OR (d) The resident’s social network involves living with an individual who is a regular user, abuser or dealer of alcohol
or other drugs, or the resident’s living environment is so highly invested in alcohol or other drug use that his or her
recovery goals are assessed as unachievable.
Original Equation
D6LIII.5-b, -c, & -d = TRUE If [any of ASIf: f7,f9,f19g=0 & f9b=4] or [mean of ASIf 6a,9a,9b,19h =>3]
Criterion (b, c, d) is met if:
1) The patient spends free time alone, or has no close friend, or the only closest personal contact in past four months
is his/her mother and
2) the patient’s strategy to deal with problem from friends is reclusive or drawn to high risk social contacts.
3) The patient’s living arrangements on recovery discourages or hinders treatment.
4) The patient’s friends effect on recovery discourages or hinders treatment.
5) The patient’s strategy to deal with problem from friends is passive about developing protective relationships.
6) And patient closest contacts are not clear if will help the treatment or no one available.
Criterion(e)
UnableToCopeOutside24HourCareNeedsStaffMonitoring
(e) The resident is unable to cope, for even limited periods of time, outside of 24-hour care. He or she needs staff
monitoring to learn to cope with Dimension 6 problems before being transferred safely to a less intensive setting.
Original Equation
D6LIII.5-e = TRUE If ASIf19l=0 or p19j>6 or p20b=2 or Post2=0 or Post3=4
Criterion (e) is met if has any the following:
1) The patient has diagnosed with mania or bipolar disorder, or schizophrenia psychotic or thought disorder other than
substance abuse.
2) The patient’s current problem behavior required continues intervention.
3) The patient symptoms are not stabilized during the treatment day.
4) The patient’s responding (or likely to respond) timing to detoxification care is more than 24 hours.
Criterion(f)
LivingEnvironmentHasCriminalBehaviorAndOtherAntiSocialValues
(f) The resident’s living environment is characterized by criminal behavior, victimization, and other antisocial norms and
values.
Original Equation
D6LIII.5-f = TRUE If [Any of ASIf 6a,8b,9a,or 9b=4] & [(Sum of ASIl3thru14a,b,c >1) or ASIl22=1 or ASIl25>5]
Criterion (f) is met if has any the following:
1) The patient has been convicted of crime, or is currently awaiting charge trail sentence, or has more than 5 days
committed crimes for profit in past 30 days and
2) Met any of the following
a) The patient’s living arrangements often exposes to substance use.
b) The patient’s friends effect on recovery often exposes him/her to substance use.
c) The patient’s strategy to deal with problem from friends is reclusive or drawn to high risk social contacts.
d) The patient’s strategy to deal with problem in free time preference is for high risk hobbies.
Criterion(dde)
HasSeverePersistentMentalIllnessNeedsStructureOfLevel35DualDiagnosisEnhanced
Dual Diagnosis Enhanced Programs The resident’s status in Dimension 6 is characterized by severe and persistent
mental illness. He or she may be too ill to benefit from skills training to learn to cope with problems in the recovery
environment. Such a resident requires planning for assertive community treatment, intensive case management or
other community outreach and support services. Such a resident’s living, working, social and/or community
environment is not supportive of good mental health functioning. He or she has insufficient resources and skills to deal
with this situation. For example, the resident may be unable to cope with the continuing stress of peer pressure to be
involved in criminal behavior, or threats by former criminal associates, or hostile or alcoholic family members, and thus
exhibits increasing anxiety and depression. Such a resident needs the support and structure of a Level III.5 Dual
Diagnosis Enhanced program to achieve stabilization and prevent further deterioration.
Original Equation
D6LIII.5-dde = TRUE If [Dim3Px=1 or ASIp19j>0] & [ASIp20=3to7 or ASIp13=2to4] & [(mean of ASIf: 6a,8a,8b,9a,9b &
f19h>2) or p13a>1]
Dual Diagnosis Enhanced criterion is met if:
1) Patient is exhibiting withdrawal symptoms and emotional/behavioral/cognitive problems or
2) The patient has any of the following active psychiatric diagnoses:
a) Anxiety disorder
b) Panic Disorder
c) Agoraphobia
d) Post-Traumatic Stress Disorder
e) Social Phobia
f) Obsessive-Compulsive Disorder
g) Eating disorder
h) Depressive disorder
i) Mania/Bi-polar
j) Schizophrenia/Psychotic/Thought disorder
k) Borderline/Paranoid/Antisocial/or Other Personality disorder and
3) Interviewer believes the patient is at risk and in need of psychiatric/psychological treatment or
4) Patient believes that at a minimum he/she requires counseling for psychological problems and
5) The patient’s current living arrangement will hinder or discourage recovery efforts
6) The patient’s social network will hinder or discourage recovery efforts
7) The patient will be passive to the negative influence of social network, or drawn to high-risk contacts.
8) The patient may lack support from social network, or have no friends/acquaintances who are available or willing to
help patient in recovery efforts or
9) Patient believes that his/her emotional problems will hinder or discourage recovery efforts
Level III.5 (Clinically Managed High-Intensity Residential Treatment) Placement Criteria
Original Equation
D6LIII.5 = TRUE If D6LIII.5 -a, -b, -c, -d, -e, OR –f
Narrative
Placement criteria are met if a, b, c, d, e or f and any the following is met:
1) Dimension 2 severity is greater than 6.
2) Dimension 3 severity is greater than 6.
3) The patient’s detoxification is required more than hourly monitoring.
Note
Terms disagree between original equation and current implementation.
Dual Diagnosis Criteria
Original Equation
D6LIII.5dde = TRUE If D6LIII.5 & D6LIII.5dde
Narrative
The dual diagnosis criteria are met if both of the following are met:
1) Care Level III.5 placement criteria is met.
2) HasSeverePersistentMentalIllnessNeedsStructureOfLevel35DualDiagnosisEnhanced is met.
Dimension 6: Level III.5 Clinically Managed High-Intensity Residential Treatment
Reference Pseudo Code
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
emotionalAbuseInPast30Days = FamilyAndSocialHistorySection.EmotionalAbuseInPast30Days
physicalAbuseInPast30Days = FamilyAndSocialHistorySection.PhysicalAbuseInPast30Days
sexualAbuseInPast30Days = FamilyAndSocialHistorySection.SexualAbuseInPast30Days
riskPatientHarmedByOther = FamilyAndSocialHistorySection.RiskPatientHarmedByOther
livingArrangement = FamilyAndSocialHistorySection.LivingArrangementAffectOnRecovery
friendsAffectOnRecovery = FamilyAndSocialHistorySection.FriendsAffectOnRecovery
dealsWithProblemsFromFriends = FamilyAndSocialHistorySection.DealsWithProblemsFromFriendsThatRiskRelapse
closestContactsHelp = FamilyAndSocialHistorySection.ClosestContactsNeedsAndWillingnessToHelpTreatment
spendsFreeTimeWith = FamilyAndSocialHistorySection.SpendsFreeTimeWith
numberOfCloseFriends = FamilyAndSocialHistorySection.NumberOfCloseFriends
closestPersonalContactInPast4Months = FamilyAndSocialHistorySection.ClosestPersonalContactInPast4Months
activePsychiatricDiagnoses =
PsychologicalSection.InterviewerRating.ActivePsychiatricDiagnosesOtherThanSubstanceAbuse
requireContinuousInterventions =
PsychologicalSection.InterviewerRating.CurrentProblemBehaviorsRequireContinuousInterventions
symptomsStabalizedDuringTreatmentDay = CompletionSection.SymptomsStabalizedDuringTreatmentDay
timingOfPositiveResponse = CompletionSection.TimingOfPositiveResponseToDetoxificationCare
dealsWithProblemsInFreeTimeThatRiskRelapse =
FamilyAndSocialHistorySection.DealsWithProblemsInFreeTimeThatRiskRelapse
numberOfTimesArrestedForShopliftingVandalism = LegalSection.NumberOfTimesArrestedForShopliftingVandalism
numberOfTimesArrestedForParoleProbationViolation = LegalSection.NumberOfTimesArrestedForParoleProbationViolation
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
Let
numberOfTimesArrestedForDrugCharges = LegalSection.NumberOfTimesArrestedForDrugCharges
numberOfTimesArrestedForForgery = LegalSection.NumberOfTimesArrestedForForgery
numberOfTimesArrestedForWeaponsOffense = LegalSection.NumberOfTimesArrestedForWeaponsOffense
numberOfTimesArrestedForBurglaryLarceny = LegalSection.NumberOfTimesArrestedForBurglaryLarceny
numberOfTimesArrestedForRobbery = LegalSection.NumberOfTimesArrestedForRobbery
numberOfTimesArrestedForAssault = LegalSection.NumberOfTimesArrestedForAssault
numberOfTimesArrestedForArson = LegalSection.NumberOfTimesArrestedForArson
numberOfTimesArrestedForRape = LegalSection.NumberOfTimesArrestedForRape
numberOfTimesArrestedForHomicide = LegalSection.NumberOfTimesArrestedForHomicide
numberOfTimesArrestedForProstitution = LegalSection.NumberOfTimesArrestedForProstitution
numberOfTimesArrestedForContemptOfCourt = LegalSection.NumberOfTimesArrestedForContemptOfCourt
numberOfTimesArrestedForOtherArrest = LegalSection.NumberOfTimesArrestedForOtherArrest
isCurrentlyAwaitingChargesTrialSentence = LegalSection.IsCurrentlyAwaitingChargesTrialSentence
numberOfDaysCommitingCrimesForProfitInPast30Days = LegalSection.NumberOfDaysCommitingCrimesForProfitInPast30Days
detoxificationRequiredMoreThanHourlyMonitoring = CompletionSection.DetoxificationRequiredMoreThanHourlyMonitoring
dimension2SeverityNumber = assessmentScore.Dimension2BiomedicalScores.SeverityNumber
dimension3SeverityNumber = assessmentScore.Dimension3EmotionalBehavioralScores.SeverityNumber
anxietyAttackMoreThanOnceInLast24Hours =
PsychologicalSection.PsychologicalHistory.AnxietyAttackMoreThanOnceInLast24Hours
significantPeriodFidgetingInLast24Hours =
PsychologicalSection.PsychologicalHistory.SignificantPeriodFidgetingInLast24Hours
significantPeriodNegativeThoughtsInLast24Hours =
PsychologicalSection.PsychologicalHistory.SignificantPeriodNegativeThoughtsInLast24Hours
significantPeriodExcessiveBehaviorInLast24Hours =
PsychologicalSection.PsychologicalHistory.SignificantPeriodExcessiveBehaviorInLast24Hours
significantPeriodParanoiaInLast24Hours =
PsychologicalSection.PsychologicalHistory.SignificantPeriodParanoiaInLast24Hours
significantPeriodFlashbacksInLast24Hours =
PsychologicalSection.PsychologicalHistory.SignificantPeriodFlashbacksInLast24Hours
significantPeriodCurbingViolentBehaviorInLast24Hours =
PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorInLast24Hours
significantPeriodViolentUrgesInLast24Hours =
PsychologicalSection.PsychologicalHistory.SignificantPeriodViolentUrgesInLast24Hours
significantPeriodSuicidalThoughtsInLast24Hours =
PsychologicalSection.PsychologicalHistory.SignificantPeriodSuicidalThoughtsInLast24Hours
significantPeriodThoughtsOfSelfInjuryInLast24Hours =
PsychologicalSection.PsychologicalHistory.SignificantPeriodThoughtsOfSelfInjuryInLast24Hours
significantPeriodAttemptedSuicideInLast24Hours =
PsychologicalSection.PsychologicalHistory.SignificantPeriodAttemptedSuicideInLast24Hours
needsStructureOfLevel31DualDiagnosisEnhanced =
assessmentScore.Dimension6LivingEnvironmentScores.CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmen
tScore.HasSevereMentalIllnessNeedsStructureOfLevel31DualDiagnosisEnhanced
Let LivingEnvironmentModerateHighRiskAbuseNoRecoveryAtLowerLevelCare =
((emotionalAbuseInPast30Days > LikertScale.Slightly or
physicalAbuseInPast30Days > LikertScale.Slightly or
sexualAbuseInPast30Days > LikertScale.Slightly) and
riskPatientHarmedByOther > LikertScale.Slightly)
or
livingArrangement = LivingArrangementAffectOnRecovery.WillOftenExposeToSubstanceUse
Let avgRecoveryAffect = Average( livingArrangement, friendsAffectOnRecovery, dealsWithProblemsFromFriends,
closestContactsHelp )
Let SocialNetworkOrLivingWithAlcoholDrugUserPreventsRecoveryAtLowerLevelOfCare =
((spendsFreeTimeWith = Companionship.Alone or numberOfCloseFriends = 0 or
closestPersonalContactInPast4Months = ContactPerson.Mother) and
dealsWithProblemsFromFriends =
StrategiesToDealWithProblemsFromFriendsThatRiskRelapse.ReclusiveOrDrawnToHighRiskSocialContacts)
or
avgRecoveryAffect >= 3
Let UnableToCopeOutside24HourCareNeedsStaffMonitoring =
activePsychiatricDiagnoses.Contains(PsychiatricDiagnosis.ManiaOrBipolarDisorder) or
activePsychiatricDiagnoses.Contains(PsychiatricDiagnosis.SchizophreniaPsychoticOrThoughtDisorder) or
requireContinuousInterventions = YesNoNotSure.Yes or
not symptomsStabalizedDuringTreatmentDay or
timingOfPositiveResponse = DetoxificationCareResponseTiming.MoreThan24Hours
Let hasBeenConvictedOfCrime = CountOf( numberOfTimesArrestedForShopliftingVandalism,
numberOfTimesArrestedForParoleProbationViolation,
numberOfTimesArrestedForDrugCharges,
numberOfTimesArrestedForForgery,
numberOfTimesArrestedForWeaponsOffense,
numberOfTimesArrestedForBurglaryLarceny,
numberOfTimesArrestedForRobbery,
numberOfTimesArrestedForAssault,
numberOfTimesArrestedForArson,
numberOfTimesArrestedForRape,
numberOfTimesArrestedForHomicide,
numberOfTimesArrestedForProstitution,
numberOfTimesArrestedForContemptOfCourt,
numberOfTimesArrestedForOtherArrest )
Let LivingEnvironmentHasCriminalBehaviorAndOtherAntiSocialValues =
(livingArrangement = LivingArrangementAffectOnRecovery.WillOftenExposeToSubstanceUse or
dealsWithProblemsInFreeTimeThatRiskRelapse =
StrategiesToDealWithProblemsInFreeTimeThatRiskRelapse.PreferenceIsForHighRiskHobbies or
friendsAffectOnRecovery = FriendsAffectOnRecovery.WillOftenExposePatientToSubstanceUse or
dealsWithProblemsFromFriends =
StrategiesToDealWithProblemsFromFriendsThatRiskRelapse.ReclusiveOrDrawnToHighRiskSocialContacts)
and
(hasBeenConvictedOfCrime or isCurrentlyAwaitingChargesTrialSentence = true or
numberOfDaysCommitingCrimesForProfitInPast30Days > 5)
Let moreImmedPsychD6 = AnyValueGreaterThan2(anxietyAttackMoreThanOnceInLast24Hours,
significantPeriodFidgetingInLast24Hours,
significantPeriodNegativeThoughtsInLast24Hours,
significantPeriodExcessiveBehaviorInLast24Hours,
significantPeriodParanoiaInLast24Hours,
significantPeriodFlashbacksInLast24Hours,
significantPeriodCurbingViolentBehaviorInLast24Hours,
significantPeriodViolentUrgesInLast24Hours,
significantPeriodSuicidalThoughtsInLast24Hours,
significantPeriodThoughtsOfSelfInjuryInLast24Hours,
significantPeriodAttemptedSuicideInLast24Hours)
Let HasSeverePersistentMentalIllnessNeedsStructureOfLevel35DualDiagnosisEnhanced =
needsStructureOfLevel31DualDiagnosisEnhanced.Value and moreImmedPsychD6
Let IsMet =
(careLevel_III_5_Score.LivingEnvironmentModerateHighRiskAbuseNoRecoveryAtLowerLevelCare.Value or
careLevel_III_5_Score.SocialNetworkOrLivingWithAlcoholDrugUserPreventsRecoveryAtLowerLevelOfCare.Value or
careLevel_III_5_Score.UnableToCopeOutside24HourCareNeedsStaffMonitoring.Value or
careLevel_III_5_Score.LivingEnvironmentHasCriminalBehaviorAndOtherAntiSocialValues.Value)
and
(dimension2SeverityNumber > 6 or dimension3SeverityNumber > 6 or detoxificationRequiredMoreThanHourlyMonitoring
Let IsDualDiagnosisEnhanced = IsMet and HasSeverePersistentMentalIllnessNeedsStructureOfLevel35DualDiagnosisEnhanced.
Level of Care: Medically Monitored Intensive Inpatient Treatment (III.7)
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Summary
The patient’s environment is dangerous and he or she lacks skills to cope outside of a highly structured 24-hour setting.
Level III.7 (Medically Monitored Intensive Inpatient Treatment) Criteria
Criterion(a)
RequiresContinuousMedicalMonitoringAddressPsychSubstance
The patient requires continuous medical monitoring while addressing his or her substance use and/or psychiatric
problems, because his or her current living situation is characterized by a high risk of initiation or repetition of physical,
sexual or emotional abuse, or substance use so endemic that the patient is assessed as being unable to achieve or
maintain recovery at a less intensive level of care. For example, because of mania (which is treated with moodstabilizing medications), the patient is believes he or she is able to control the people in his or her environment who
pose the risk.
Original Equation
D6LIII.7-a = TRUE If [{(any of ASIf: 19a,b,c >1) & ASIf19j>1} or {ASIf6a=4}] & Post4=1
Narrative
Criterion (a) is met if:
1) Patient has experienced any of the following in the past 30 days (moderately to extremely):
a) Physical abuse
b) Psychological abuse
c) Sexual abuse and
2) There is a risk that the patient could be hurt or victimized by another or
3) Patient will often be exposed to substance use, which will hinder recovery efforts and
4) The patient’s condition (intoxication, withdrawal, medical, psychiatric) or detoxification procedure (e.g., rapid opiate
detox) requires monitoring or intervention more frequently than hourly.
Criterion(b)
AreNotSupportiveOfRecoveryGoalsActivelySabotagingTreatment
Family members or significant others living with the patient are not supportive of his or her recovery goals and are
actively sabotaging treatment. This situation requires structured treatment services and relief from the home
environment in order for the patient to focus on recovery.
Original Equation
D6LIII.7-b = TRUE If mean of ASIf 6a,9a,9b,19h =>3
Narrative
Criterion (b) is met if:
1)
2)
3)
4)
The patient’s current living arrangement will hinder or discourage recovery efforts
The patient’s social network will hinder or discourage recovery efforts
The patient will be passive to the negative influence of social network, or drawn to high-risk contacts.
The patient may lack support from social network, or have no friends/acquaintances who are available or willing to
help patient in recovery efforts.
Criterion(c)
UnableToCopeOutside24HourCareNeedsStaffMonitoring
The patient is unable to cope, for even limited periods of time, outside of 24-hour care. The patient needs staff
monitoring to learn to cope with Dimension 6 problems before he or she can be transferred safely to a less intensive
setting.
Original Equation
D6LIII.7-c = TRUE If ASIf19l=0 or p19j>6 or p20b=2 or Post2=0 or Post3=4
Narrative
Criterion (a) is met if:
1) The patient is unable to locate/travel to available community resources or
2) The patient has any of the following active psychiatric diagnoses:
a) Eating disorder
b) Depressive disorder
c) Mania/Bi-polar
d) Schizophrenia/Psychotic/Thought disorder
e) Borderline/Paranoid/Antisocial/or Other Personality disorder or
3) Interviewer believes the patient is exhibiting behaviors so severe as to require continuous limit-setting interventions
or
4) Interviewer believes the patient is exhibiting symptoms that cannot be managed at home w/supervision or
5) Interviewer believes it will take >24 hours for the patient to respond to detox care, such that monitoring at home
will be sufficient without professional monitoring
Criterion(dde)
HasSeverePersistentMentalIllnessNeedsStructureOfLevel37DualDiagnosisENhanced
Dual Diagnosis Enhanced Programs The resident’s status in Dimension 6 is characterized by severe and persistent
mental illness. He or she may be too ill to benefit from skills training to learn to cope with problems in the recovery
environment. Such a resident requires planning for assertive community treatment, intensive case management or
other community outreach and support services.
Original Equation
D6LIII.7dde = TRUE If [Dim3Px=1 or ASIp19j>0] & [ASIp20=3to7 or ASIp13=2to4] & [(mean of ASIf: 6a,8a,8b,9a,9b & f19h>2)
or p13a>1]
Narrative
Dual Diagnosis Enhanced criterion is met if:
1) Patient is exhibiting withdrawal symptoms and emotional/behavioral/cognitive problems or
2) The patient has any of the following active psychiatric diagnoses:
a) Anxiety disorder
b) Panic Disorder
c) Agoraphobia
d) Post-Traumatic Stress Disorder
e) Social Phobia
f) Obsessive-Compulsive Disorder
g) Eating disorder
h) Depressive disorder
i) Mania/Bi-polar
j) Schizophrenia/Psychotic/Thought disorder
k) Borderline/Paranoid/Antisocial/or Other Personality disorder and
3) Interviewer believes the patient is at risk and in need of psychiatric/psychological treatment or
4) Patient believes that at a minimum he/she requires counseling for psychological problems and
5) The patient’s current living arrangement will hinder or discourage recovery efforts
6) The patient’s social network will hinder or discourage recovery efforts
7) The patient will be passive to the negative influence of social network, or drawn to high-risk contacts.
8) The patient may lack support from social network, or have no friends/acquaintances who are available or willing to
help patient in recovery efforts or
9) Patient believes that his/her emotional problems will hinder or discourage recovery efforts
Dimension 6: Level III.7 Medically Monitored Inpatient Treatment
Reference Pseudo Code
Let currentProblemBehaviorsRequireContinuousInterventions =
assessment.PsychologicalSection.InterviewerRating.CurrentProblemBehaviorsRequireContinuousInterventions
Let timingOfPositiveResponseToDetoxificationCare =
assessment.COmpletionSection.TimingOfPositiveResponseToDetoxificationCare
Let anxietyAttackMoreThanOnceInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.
AnxietyAttackMoreThanOnceInLast24Hours
Let significantPeriodFidgetingInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.
SignificantPeriodFidgetingInLast24Hours
Let significantPeriodNegativeThoughtsInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.
SignificantPeriodNegativeThoughtsInLast24Hours
Let significantPeriodExcessiveBehaviorInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.
SignificantPeriodExcessiveBehaviorInLast24Hours
Let significantPeriodParanoiaInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.
SignificantPeriodParanoiaInLast24Hours
Let significantPeriodFlashbacksInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.
SignificantPeriodFlashbacksInLast24Hours
Let significantPeriodCurbingViolentBehaviorInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.
SignificantPeriodCurbingViolentBehaviorInLast24Hours
Let significantPeriodViolentUrgesInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.
SignificantPeriodViolentUrgesInLast24Hours
Let significantPeriodSuicidalThoughtsInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.
SignificantPeriodSuicidalThoughtsInLast24Hours
Let significantPeriodThoughtsOfSelfInjuryInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.
SignificantPeriodThoughtsOfSelfInjuryInLast24Hours
Let significantPeriodAttemptedSuicideInLast24Hours = assessment.PsychologicalSection.PsychologicalHistory.
SignificantPeriodAttemptedSuicideInLast24Hours
Let dimension2SeverityNumber = assessmentScore.Dimension2BiomedicalScores.SeverityNumber
Let dimension3SeverityNumber = assessmentScore.Dimension3EmotionalBehavioralScores.SeverityNumber
Let socialNetworkOrLivingWithAlcoholDrugUserImpactsRecovery =
assessmentScore.Dimension6LivingEnvironmentScores.CareLevel_III_3_CLinicallyManagedMediumIntensity
ResidentialTreatmentScore.socialNetworkOrLivingWithAlcoholDrugUserImpactsRecovery
Let hasSevereMentalIllnessNeedsStructureOfLevel31DualDiagnosisEnhanced =
assessmentScore.Dimension6LivingEnvironmentScores.CareLevel_III_1_CLinicallyManagedLowIntensityResidential
TreatmentScore.HasSevereMentalIllnessNeedsStructureOfLevel31DualDiagnosisEnhanced
Let careLevel_III_7_Score.RequiresContinuousMedicalMonitoringAddressPsychSubstance =
(((emotionalAbuseInPast30Days > LikertScale.Slightly or physicalAbuseInPast30Days > LikertScale.Slightly or
sexualAbuseInPast30Days > LikertScale.Slightly) and riskPatientHarmedByOther > LikertScale.Slightly) or
livingArrangementAffectOnRecovery = LivingArrangementAffectOnRecovery.WillOftenExposeToSubstanceUse and
(detoxificationRequiredMoreThanHourlyMonitoring not false)
Let careLevel_III_7_Score.AreNotSupportiveOfRecoveryGoalsActivelySabotagingTreatment =
(socialNetworkOrLivingWithAlcoholDrugUserImpactsRecovery not false)
Let Let careLevel_III_7_Score.UnableToCopeOutside24HourCareNeedsStaffMonitoring =
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Contains(PsychiatricDiagnosis.ManiaOrBipolarDisorder) or
activePsychiatricDiagnosesOtherThanSubstanceAbuse.Contains(PsychiatricDiagnosis.Schizophrenia
PsychoticOrThoughtDisorder) or currentProblemBehaviorsRequireContinuousInterventions = YesNoNotSure.Yes or
timingOfPositiveResponseToDetoxificationCare = DetoxificationCareResponseTiming.MoreThan24Hours
Let moreImmedPsychD6 = MoreImmedPsychD6(3, anxietyAttackMoreThanOnceInLast24Hours,
significantPeriodFidgetingInLast24Hours, significantPeriodNegativeThoughtsInLast24Hours,
significantPeriodExcessiveBehaviorInLast24Hours, significantPeriodParanoiaInLast24Hours,
significantPeriodFlashbacksInLast24Hours, significantPeriodCurbingViolentBehaviorInLast24Hours,
significantPeriodViolentUrgesInLast24Hours, significantPeriodSuicidalThoughtsInLast24Hours,
significantPeriodThoughtsOfSelfInjuryInLast24Hours, significantPeriodAttemptedSuicideInLast24Hours)
Let careLevel_III_7_Score.HasSeverePersistentMentalIllnessNeedsStructureOfLevel37DualDiagnosisEnhanced =
(hasSevereMentalIllnessNeedsStructureOfLevel31DualDiagnosisEnhanced not false) and moreImmedPsychD6
Let careLevel_III_7_Score.IsMet =
(careLevel_III_7_Score.RequiresContinuousMedicalMonitoringAddressPsychSubstance.Value or
careLevel_III_7_Score.AreNotSupportiveOfRecoveryGoalsActivelySabotagingTreatment.Value or
careLevel_III_7_Score.UnableToCopeOutside24HourCareNeedsStaffMonitoring.Value) and (dimension2SeverityNumber > 6 or
dimension3SeverityNumber > 6 or (detoxificationRequiredMoreThanHourlyMOnitoring not false))
Let careLevel_III_7_Score.IsDualDiagnosisEnhanced = careLevel_III_7_Score.IsMet.Value and careLevel_III_7_Score.
HasSeverePersistentMentalIllnessNeedsStructureOfLevel37DualDiagnosisEnhanced.Value
Diagnosis
LEVEL of Care: Detoxification – Outpatient ( I-D)
Level I-D (Detoxification - Outpatient Treatment) Summary
The patient requires 24-hour medical monitoring but not intensive treatment.
Level -D (Detoxification - Outpatient Treatment) Criteria
Criterion- (a)
EITHER (a) The patient who is appropriately placed in a Level I-D detoxification program meets the diagnostic criteria for
Substance-Induced Disorder of the current Diagnostic and Statistical Manual of Mental Disorders of the American
Psychiatric Association or other standardized and widely accepted criteria, as well as the dimensional criteria for
admission.
Original Equation
DxLIDa = TRUE If [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a =2)] OR [(any of ASId01R thru -d13bR <=1wk) & (CIWA
OR CINA Total>4 OR CUAD##/02 OR ##/03=1)] OR [DSM-IV-SA or SD=1]
Narrative
Criterion is met if:
Criterion- (b)
IsLikelyDiagnosed
OR (b) In patients whose presenting alcohol or other drug history is inadequate to substantiate such a diagnosis,
information provided by collateral parties (such as family members or legal guardian) indicates a high probability of such
a diagnosis, subject to confirmation by further evaluation.
Original Equation
DxLIDb = TRUE If [(any of ASId01R thru -d13bR <=1wk) & (ASId27a=1) & (#CUAD-IV items 01-19 >=2)]
Narrative
Criterion is met if:
Dimension 1: Level I-D Detoxification Outpatient Treatment
Pseudo Code
Let
Let
Let
Let
hasEverUsedAlcohol = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed.HasEverUsedAlcohol;
lastUsedAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.LastUsed;
alcoholUsedToIntoxication = assessment.DrugAndAlcoholSection.AlcoholUse.AlcoholUsedToIntoxication;
lastUsedToIntoxification = assessment.DrugAndAlcoholSection.AlcoholUse.LastUsedToIntoxification;
LEVEL of Care: Detoxification –Intensive Outpatient (II-D)
Level II-D (Detoxification – Intensive Outpatient) Summary
Level II-D (Detoxification – Intensive Outpatient) Criteria
Criterion- (a)
???
EITHER (a) The patient who is appropriately placed in a Level II-D detoxification program meets the diagnostic criteria
for Substance-Induced Disorder of the current Diagnostic and Statistical Manual of Mental Disorders of the American
Psychiatric Association or other standardized and widely accepted criteria, as well as the dimensional criteria for
admission.
Original Equation
DxLIIDa = TRUE If [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a =2)] OR [(any of ASId01R thru -d13bR <=1wk) & (CIWA OR CINA Total>4 OR CUAD##/02 OR
##/03=1)] OR [DSM-IV-SA or SD =1]
Narrative
Criterion is met if:
Criterion- (b
???
OR (b) In patients whose presenting alcohol or other drug history is inadequate to substantiate such a diagnosis,
information provided by collateral parties (such as family members or legal guardian) indicates a high probability of such
a diagnosis, subject to confirmation by further evaluation.
Original Equation
DxLIIDb = TRUE If [(any of ASId01R thru -d13bR <=1wk) & (ASId27a=1) & (#CUAD-IV items ##/01-19 >=2)]
Narrative
Criterion is met if:
Dimension 1: Level II-D Detoxification Intensive Outpatient
Pseudo Code
Let experiencedNauseaOrVomitedRecentlyCiwa =
assessment.DrugAndAlcoholSection.CiwaScale.ExperiencedNauseaOrVomitedRecently;
Let observedTremorCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTremor;
Let observedSweatingCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedSweating;
Let observedNervousness = assessment.DrugAndAlcoholSection.CiwaScale.ObservedNervousness;
Let interviewerObservationOfPatientAgitationLevel =
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel;
Let observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances;
Let auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
Let visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
Let headAcheOrFullnessSeverity = assessment.DrugAndAlcoholSection.CiwaScale.HeadAcheOrFullnessSeverity;
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
Let experiencedNauseaOrVomitedRecently = assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
Let observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
Let observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
Let observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
Let observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
Let observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
Let observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
Let observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
Let hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
Let feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
Let hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
Let heartRate = assessment.MedicalSection.HeartRate;
Let experiencesWithdrawalSicknessAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessHeroin = assessment.DrugAndAlcoholSection.HeroinUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessCocaine = assessment.DrugAndAlcoholSection.CocaineUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessCannabis = assessment.DrugAndAlcoholSection.CannabisUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessHallucinogen =
Let experiencesWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.ExperiencesWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessHeroin =
assessment.DrugAndAlcoholSection.HeroinUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessCocaine =
assessment.DrugAndAlcoholSection.CocaineUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessCannabis =
assessment.DrugAndAlcoholSection.CannabisUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.UseSubstanceToPreventWithdrawalSickness;
Let minimumDaysSinceLastUsedDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MinimumDaysSinceLastUsedDrugExceptNicotine;
Let daysSinceLastUsedNicotine = assessmentScore.DiagnosisResults.CommonScores.DaysSinceLastUsedNicotine;
Let signsOfIntoxicationExist = assessment.MedicalSection.SignsOfIntoxicationExist;
Let majorityOfInformationFromCollateralSource =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.MajorityOfInformationFromCollateralSource;
Let maxCuadScaleSumForOneDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MaxCuadScaleSumForOneDrugExceptNicotine;
Let anyAddictionDiagnosis = assessmentScore.DiagnosisResults.AnyAddictionDiagnosis;
Let ciwaCinaAndWithdrawalSicknessIndicator =
CalculateCiwaCinaAndWithdrawalSicknessIndicator ( experiencedNauseaOrVomitedRecentlyCiwa,
observedTremorCiwa, observedSweatingCiwa, observedNervousness,
interviewerObservationOfPatientAgitationLevel, observedTactileDisturbances, auditoryDisturbanceLevel,
visualDisturbanceLevel, headAcheOrFullnessSeverity,
interviewerObservationOfPatientSenseOfAwareness, experiencedNauseaOrVomitedRecently, observedGooseFlesh,
observedSweating, observedRestlessness, observedTremor,
observedLacrimination, observedNasalCongestion, observedYawning, hasAbdominalPain, feelsHotOrCold,
hasMuscleAches, heartRate, experiencesWithdrawalSicknessAlcohol, experiencesWithdrawalSicknessHeroin,
experiencesWithdrawalSicknessMethadone, experiencesWithdrawalSicknessOtherOpiate,
experiencesWithdrawalSicknessBarbiturate, experiencesWithdrawalSicknessOtherSedative,
experiencesWithdrawalSicknessCocaine, experiencesWithdrawalSicknessStimulant,
experiencesWithdrawalSicknessCannabis, experiencesWithdrawalSicknessHallucinogen,
experiencesWithdrawalSicknessSolventAndInhalant, experiencesWithdrawalSicknessOtherSubstance,
useSubstanceToPreventWithdrawalSicknessAlcohol, useSubstanceToPreventWithdrawalSicknessHeroin,
useSubstanceToPreventWithdrawalSicknessMethadone, useSubstanceToPreventWithdrawalSicknessOtherOpiate,
useSubstanceToPreventWithdrawalSicknessBarbiturate, useSubstanceToPreventWithdrawalSicknessOtherSedative,
useSubstanceToPreventWithdrawalSicknessCocaine, useSubstanceToPreventWithdrawalSicknessStimulant,
useSubstanceToPreventWithdrawalSicknessCannabis, useSubstanceToPreventWithdrawalSicknessHallucinogen,
useSubstanceToPreventWithdrawalSicknessSolventAndInhalant,
useSubstanceToPreventWithdrawalSicknessOtherSubstance );
return CalculateCareLevel_II_DetoxificationScore ( ciwaCinaAndWithdrawalSicknessIndicator,
minimumDaysSinceLastUsedDrugExceptNicotine, daysSinceLastUsedNicotine, signsOfIntoxicationExist,
majorityOfInformationFromCollateralSource, maxCuadScaleSumForOneDrugExceptNicotine,
anyAddictionDiagnosis );
LEVEL of Care: Detoxification – Clinically Managed Low-Intensity Residential Services
(III.2-D)
Level III.2-D (Clinically Managed Low-Intensity Residential Services) Summary
Level III.2-D (Clinically Managed Low-Intensity Residential Services) Criteria
Sole Criterion
???
The patient who is appropriately placed in a Level III.2-D detoxification program meets the diagnostic criteria for
Substance-Induced Disorder of the current Diagnostic and Statistical Manual of Mental Disorders of the American
Psychiatric Association or other standardized and widely accepted criteria, as well as the dimensional criteria for
admission.
Original Equation
DxLIII.2D, DxLIII.7D & DxLIVD = TRUE If [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a=2)] OR [(any of ASId01R thru d13bR <=1wk) & (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)] OR [DSM-IV-SA or SD=1]
Narrative
Criterion is met if:
LEVEL of Care: Detoxification – Medically Monitored Inpatient Treatment (III.7-D)
Level III.7-D (Medically Monitored Inpatient Treatment) Summary
Level III.7-D (Medically Monitored Inpatient Treatment) Criteria
Sole Criterion
???
The patient who is appropriately placed in a Level III.7-D detoxification program meets the diagnostic criteria for
Substance-Induced Disorder of the current Diagnostic and Statistical Manual of Mental Disorders of the American
Psychiatric Association or other standardized and widely accepted criteria, as well as the dimensional criteria for
admission.
Original Equation
DxLIII.2D, DxLIII.7D & DxLIVD = TRUE If [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a=2)] OR [(any of ASId01R thru d13bR <=1wk) & (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)] OR [DSM-IV-SA or SD=1]
Narrative
Criterion is met if:
LEVEL of Care: Detoxification – Medically Managed Inpatient Treatment (IV-D)
Level IV-D (Medically Managed Inpatient Treatment) Summary
Level IV-D (Medically Managed Inpatient Treatment) Criteria
Sole Criterion
???
The patient who is appropriately placed in a Level IV-D detoxification program meets the diagnostic criteria for
Substance-Induced Disorder of the current Diagnostic and Statistical Manual of Mental Disorders of the American
Psychiatric Association or other standardized and widely accepted criteria, as well as the dimensional criteria for
admission.
Original Equation
DxLIII.2D, DxLIII.7D & DxLIVD = TRUE If [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a=2)] OR [(any of ASId01R thru d13bR <=1wk) & (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)] OR [DSM-IV-SA or SD=1]
Narrative
Criterion is met if:
LEVEL of Care: Early Intervention (0.5)
Level 0.5 (Early Intervention) Summary
Level 0.5 (Early Intervention) Criteria
Sole Criterion
The individual who is an appropriate candidate for Level 0.5 services evidences problems and risk factors that appear to
be related to substance use but do not meet the diagnostic criteria for Substance-Related Disorder as defined in the
current Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association or other
standardized and widely accepted criteria.
Original Equation
DxL0.5 = TRUE If [DxLI ¹ TRUE] & [#CUAD-IV items ##/02-19 >=1]
Narrative
Criterion is met if:
Dimension 1: Level 0.5 Detoxification Outpatient Treatment
Pseudo Code
public CareLevel_0_5_EarlyInterventionScore CalculateCareLevel_0_5_EarlyInterventionScore ( Assessment assessment,
AssessmentScore assessmentScore )
Let diagnosisxResultsCareLevel_I_OutpatientScoreIsMet =
assessmentScore.DiagnosisResults.CareLevel_I_OutpatientScore.IsMet;
Let maxCuadScaleSumForOneDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MaxCuadScaleSumForOneDrugExceptNicotine;
Let nicotineCuadScaleSum = assessmentScore.DiagnosisResults.CommonScores.NicotineCuadScaleSum;
Let anyAddictionDiagnosisExceptNicotine = assessmentScore.DiagnosisResults.AnyAddictionDiagnosisExceptNicotine;
return CalculateCareLevel_0_5_EarlyInterventionScore (diagnosisxResultsCareLevel_I_OutpatientScoreIsMet,
maxCuadScaleSumForOneDrugExceptNicotine, nicotineCuadScaleSum, anyAddictionDiagnosisExceptNicotine );
LEVEL of Care: Outpatient Treatement (I – OP/DDC/DDE)
Either Criterion: DxLI-a OR -b
EITHER a) The patient who is appropriately placed in a Level I program is assessed as meeting the diagnostic criteria for a
Substance-Related Disorder (including Substance Use Disorder or Substance-Induced Disorder), as defined in the current
Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association or other
standardized and widely accepted criteria, as well as the dimensional criteria for admission
OR b) If the patient’s presenting alcohol or drug use history is inadequate to substantiate such a diagnosis, the
probability of such a diagnosis may be determined from information submitted by collateral parties (such as family
members, legal guardians and significant others).
Decision Rules
 DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)]
AND [(any of
ASId01R thru -d13bR <=24 hrs) & (ASIm6a =2)]
OR [(any of ASId01R thru d13bR <=1wk) &
. (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1]
 DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 & (ASIp19i>0)]
 DxLI through…DxLIV = TRUE If Sub-rules -a OR -b (respectively)
Dual Diagnosis Capable Programs
EITHER a) At Level I, some patients have co-occurring mental disorders that meet the stability criteria for a Dual
Diagnosis Capable program
OR b) Other patients have difficulties in mood, behavior or cognition as the result of other psychiatric or substanceinduced disorders, or the patient’s emotional, behavioral or cognitive symptoms are troublesome but not sufficient to
meet the criteria for a diagnosed mental disorder.
Decision Rules
DxLIddc through…DxLIVddc = TRUE If [Dim3Px=1 or P19i>0]
AND [respective level (DxLI through…DxLIV) = TRUE]
Dual Diagnosis Enhanced Programs
EITHER a) In contrast to the foregoing criteria, the patient who is identified as in need of Level I Dual Diagnosis Enhanced
program services is assessed as meeting the diagnostic criteria for a Mental Disorder as well as a Substance Use
Disorder, as defined in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American
Psychiatric Association or other standardized and widely accepted criteria, as well as the dimensional criteria for
admission
OR b) If the patient’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Decision Rules
 DxLIdde through…DxLIVdde = TRUE If [Dim3Px=1 & ASI-P19i>0 & <9] AND [respective level (DxLI through…DxLIV)
= TRUE]
Dimension 1: Level I Outpatient Treatment
Pseudo Code
public CareLevel_I_OutpatientScore CalculateCareLevel_I_OutpatientScore ( Assessment assessment, AssessmentScore
assessmentScore )
{
Let experiencedNauseaOrVomitedRecentlyCiwa =
assessment.DrugAndAlcoholSection.CiwaScale.ExperiencedNauseaOrVomitedRecently;
Let observedTremorCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTremor;
Let observedSweatingCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedSweating;
Let observedNervousness = assessment.DrugAndAlcoholSection.CiwaScale.ObservedNervousness;
Let interviewerObservationOfPatientAgitationLevel =
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel;
Let observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances;
Let auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
Let visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
Let headAcheOrFullnessSeverity = assessment.DrugAndAlcoholSection.CiwaScale.HeadAcheOrFullnessSeverity;
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
Let experiencedNauseaOrVomitedRecently =
assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
Let observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
Let observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
Let observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
Let observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
Let observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
Let observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
Let observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
Let hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
Let feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
Let hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
Let heartRate = assessment.MedicalSection.HeartRate;
Let experiencesWithdrawalSicknessAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessHeroin =
assessment.DrugAndAlcoholSection.HeroinUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessCocaine =
assessment.DrugAndAlcoholSection.CocaineUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessCannabis =
assessment.DrugAndAlcoholSection.CannabisUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.ExperiencesWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessHeroin =
assessment.DrugAndAlcoholSection.HeroinUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessCocaine =
assessment.DrugAndAlcoholSection.CocaineUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessCannabis =
assessment.DrugAndAlcoholSection.CannabisUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.UseSubstanceToPreventWithdrawalSickness;
Let minimumDaysSinceLastUsedDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MinimumDaysSinceLastUsedDrugExceptNicotine;
Let daysSinceLastUsedNicotine = assessmentScore.DiagnosisResults.CommonScores.DaysSinceLastUsedNicotine;
Let signsOfIntoxicationExist = assessment.MedicalSection.SignsOfIntoxicationExist;
Let majorityOfInformationFromCollateralSource =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.MajorityOfInformationFromCollateralSource;
Let maxCuadScaleSumForOneDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MaxCuadScaleSumForOneDrugExceptNicotine;
Let nicotineCuadScaleSum = assessmentScore.DiagnosisResults.CommonScores.NicotineCuadScaleSum;
Let anyAddictionDiagnosis = assessmentScore.DiagnosisResults.AnyAddictionDiagnosis;
Let anyAddictionDiagnosisExceptNicotine =
assessmentScore.DiagnosisResults.AnyAddictionDiagnosisExceptNicotine;
Let numberOfTimesTreatedForAlcoholAbuseLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesTreatedForAlcoholAbuseLifetime;
Let numberOfTimesDrugTreatmentLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesDrugTreatmentLifetime;
Let interviewerScoreOfAlcoholTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAlcoholTreatmentNeed;
Let interviewerScoreOfDrugTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfDrugTreatmentNeed;
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
Let nicotineTobaccoIsDependentWithPhysiologicalDependency =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.NicotineTobaccoScore.IsDependen
tWithPhysiologicalDependency;
Let ciwaCinaAndWithdrawalSicknessIndicator =
CalculateCiwaCinaAndWithdrawalSicknessIndicator ( experiencedNauseaOrVomitedRecentlyCiwa,
observedTremorCiwa, observedSweatingCiwa,
observedNervousness,
interviewerObservationOfPatientAgitationLevel,
observedTactileDisturbances,
auditoryDisturbanceLevel,
visualDisturbanceLevel, headAcheOrFullnessSeverity,
interviewerObservationOfPatientSenseOfAwareness,
experiencedNauseaOrVomitedRecently,
observedGooseFlesh,
observedSweating, observedRestlessness,
observedTremor,
observedLacrimination, observedNasalCongestion,
observedYawning, hasAbdominalPain, feelsHotOrCold,
hasMuscleAches, heartRate,
experiencesWithdrawalSicknessAlcohol,
experiencesWithdrawalSicknessHeroin,
experiencesWithdrawalSicknessMethadone,
experiencesWithdrawalSicknessOtherOpiate,
experiencesWithdrawalSicknessBarbiturate,
experiencesWithdrawalSicknessOtherSedative,
experiencesWithdrawalSicknessCocaine,
experiencesWithdrawalSicknessStimulant,
experiencesWithdrawalSicknessCannabis,
experiencesWithdrawalSicknessHallucinogen,
experiencesWithdrawalSicknessSolventAndInhalant,
experiencesWithdrawalSicknessOtherSubstance,
useSubstanceToPreventWithdrawalSicknessAlcohol,
useSubstanceToPreventWithdrawalSicknessHeroin,
useSubstanceToPreventWithdrawalSicknessMethadone,
useSubstanceToPreventWithdrawalSicknessOtherOpiate,
useSubstanceToPreventWithdrawalSicknessBarbiturate,
useSubstanceToPreventWithdrawalSicknessOtherSedative,
useSubstanceToPreventWithdrawalSicknessCocaine,
useSubstanceToPreventWithdrawalSicknessStimulant,
useSubstanceToPreventWithdrawalSicknessCannabis,
useSubstanceToPreventWithdrawalSicknessHallucinogen,
useSubstanceToPreventWithdrawalSicknessSolventAndInhalant,
useSubstanceToPreventWithdrawalSicknessOtherSubstance
);
return CalculateCareLevel_I_OutpatientScore ( ciwaCinaAndWithdrawalSicknessIndicator,
minimumDaysSinceLastUsedDrugExceptNicotine,
daysSinceLastUsedNicotine,
signsOfIntoxicationExist,
majorityOfInformationFromCollateralSource,
maxCuadScaleSumForOneDrugExceptNicotine,
nicotineCuadScaleSum,
anyAddictionDiagnosis,
anyAddictionDiagnosisExceptNicotine,
numberOfTimesTreatedForAlcoholAbuseLifetime,
numberOfTimesDrugTreatmentLifetime,
interviewerScoreOfAlcoholTreatmentNeed,
interviewerScoreOfDrugTreatmentNeed,
doesPatientCarryPsychiatricDiagnosis,
withdrawalSymptomsAndEmotionalBehavioralProblems,
nicotineTobaccoIsDependentWithPhysiologicalDependency );
Level of Care: Opiate Management Therapy (OMT)
Sole Criterion: DxLM-a OR -b
EITHER (a) The patient who is appropriately placed in opioid maintenance therapy is assessed as meeting the diagnostic
criteria for Opioid Dependence Disorder, as defined in the current Diagnostic and Statistical Manual of Mental Disorders
(DSM) or other standardized and widely accepted criteria, aside from those exceptions listed in the Federal Register of
the U.S. Department of Health and Human Services, Food and Drug Administration, 21 CFR Part 291.
OR (b) If the patient’s drug use history is inadequate to substantiate such a diagnosis, the probability of such a diagnosis
may be determined from information submitted by other health care professionals and programs and collateral parties
(such as family members, legal guardian or significant others).Individuals who are admitted to treatment with
methadone or LAAM must demonstrate specific objective and subjective signs of opiate dependence, as defined in FDA
21 CFR Part 291.
Decision Rules

DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)] AND [(any of ASId01R thru -d13bR <=24 hrs) &
(ASIm6a =2)] OR [(any of ASId01R thru -d13bR <=1wk) & . (CIWA OR CINA Total>4 OR CUAD##/02 OR
##/03=1)] OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1]


DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 & (ASIp19i>0)]
DxLI through…DxLIV = TRUE If Sub-rules -a OR -b (respectively)
Dimension 1: Level I Outpatient Treatment
Pseudo Code
public CareLevelOpioidMaintenanceTherapyScore CalculateCareLevelOpioidMaintenanceTherapyScore ( Assessment assessment,
AssessmentScore assessmentScore )
{
Let experiencedNauseaOrVomitedRecentlyCiwa =
assessment.DrugAndAlcoholSection.CiwaScale.ExperiencedNauseaOrVomitedRecently;
Let observedTremorCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTremor;
Let observedSweatingCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedSweating;
Let observedNervousness = assessment.DrugAndAlcoholSection.CiwaScale.ObservedNervousness;
Let interviewerObservationOfPatientAgitationLevel =
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel;
Let observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances;
Let auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
Let visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
Let headAcheOrFullnessSeverity = assessment.DrugAndAlcoholSection.CiwaScale.HeadAcheOrFullnessSeverity;
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
Let experiencedNauseaOrVomitedRecently =
assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
Let observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
Let observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
Let observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
Let observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
Let observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
Let observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
Let observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
Let hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
Let feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
Let hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
Let heartRate = assessment.MedicalSection.HeartRate;
Let experiencesWithdrawalSicknessAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessHeroin =
assessment.DrugAndAlcoholSection.HeroinUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessCocaine =
assessment.DrugAndAlcoholSection.CocaineUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessCannabis =
assessment.DrugAndAlcoholSection.CannabisUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.ExperiencesWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessHeroin =
assessment.DrugAndAlcoholSection.HeroinUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessCocaine =
assessment.DrugAndAlcoholSection.CocaineUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessCannabis =
assessment.DrugAndAlcoholSection.CannabisUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.UseSubstanceToPreventWithdrawalSickness;
Let minimumDaysSinceLastUsedDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MinimumDaysSinceLastUsedDrugExceptNicotine;
Let signsOfIntoxicationExist = assessment.MedicalSection.SignsOfIntoxicationExist;
Let majorityOfInformationFromCollateralSource =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.MajorityOfInformationFromCollateralSource;
Let maxCuadScaleSumForOneDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MaxCuadScaleSumForOneDrugExceptNicotine;
Let anyAddictionDiagnosisExceptNicotine =
assessmentScore.DiagnosisResults.AnyAddictionDiagnosisExceptNicotine;
Let numberOfTimesTreatedForAlcoholAbuseLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesTreatedForAlcoholAbuseLifetime;
Let numberOfTimesDrugTreatmentLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesDrugTreatmentLifetime;
Let interviewerScoreOfAlcoholTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAlcoholTreatmentNeed;
Let interviewerScoreOfDrugTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfDrugTreatmentNeed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis;
Let ciwaCinaAndWithdrawalSicknessIndicator =
CalculateCiwaCinaAndWithdrawalSicknessIndicator ( experiencedNauseaOrVomitedRecentlyCiwa,
observedTremorCiwa, observedSweatingCiwa,
observedNervousness,
interviewerObservationOfPatientAgitationLevel,
observedTactileDisturbances,
auditoryDisturbanceLevel,
visualDisturbanceLevel, headAcheOrFullnessSeverity,
interviewerObservationOfPatientSenseOfAwareness,
experiencedNauseaOrVomitedRecently,
observedGooseFlesh,
observedSweating, observedRestlessness,
observedTremor,
observedLacrimination, observedNasalCongestion,
observedYawning, hasAbdominalPain, feelsHotOrCold,
hasMuscleAches, heartRate,
experiencesWithdrawalSicknessAlcohol,
experiencesWithdrawalSicknessHeroin,
experiencesWithdrawalSicknessMethadone,
experiencesWithdrawalSicknessOtherOpiate,
experiencesWithdrawalSicknessBarbiturate,
experiencesWithdrawalSicknessOtherSedative,
experiencesWithdrawalSicknessCocaine,
experiencesWithdrawalSicknessStimulant,
experiencesWithdrawalSicknessCannabis,
experiencesWithdrawalSicknessHallucinogen,
experiencesWithdrawalSicknessSolventAndInhalant,
experiencesWithdrawalSicknessOtherSubstance,
useSubstanceToPreventWithdrawalSicknessAlcohol,
useSubstanceToPreventWithdrawalSicknessHeroin,
useSubstanceToPreventWithdrawalSicknessMethadone,
useSubstanceToPreventWithdrawalSicknessOtherOpiate,
useSubstanceToPreventWithdrawalSicknessBarbiturate,
useSubstanceToPreventWithdrawalSicknessOtherSedative,
useSubstanceToPreventWithdrawalSicknessCocaine,
useSubstanceToPreventWithdrawalSicknessStimulant,
useSubstanceToPreventWithdrawalSicknessCannabis,
useSubstanceToPreventWithdrawalSicknessHallucinogen,
useSubstanceToPreventWithdrawalSicknessSolventAndInhalant,
useSubstanceToPreventWithdrawalSicknessOtherSubstance
);
return CalculateCareLevelOpioidMaintenanceTherapyScore ( ciwaCinaAndWithdrawalSicknessIndicator,
minimumDaysSinceLastUsedDrugExceptNicotine,
signsOfIntoxicationExist,
majorityOfInformationFromCollateralSource,
maxCuadScaleSumForOneDrugExceptNicotine,
anyAddictionDiagnosisExceptNicotine,
numberOfTimesTreatedForAlcoholAbuseLifetime,
numberOfTimesDrugTreatmentLifetime,
interviewerScoreOfAlcoholTreatmentNeed,
interviewerScoreOfDrugTreatmentNeed,
withdrawalSymptomsAndEmotionalBehavioralProblems,
doesPatientCarryPsychiatricDiagnosis );
LEVEL of care II.1- Intensive Outpatient Treatment (II.1/DDC/DDE)
Level II.1 (Intensive Outpatient Treatment) Summary
Either Criterion: DxLII.1-a OR -b
Level II.1 (Intensive Outpatient Treatment) Criteria
Criterion- (a)
EITHER a) The patient who is appropriately placed in a Level II.1 program is assessed as meeting the diagnostic criteria
for a Substance-Related Disorder (including Substance Use Disorder or Substance-Induced Disorder), as defined in the
current Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association or other
standardized and widely accepted criteria, as well as the dimensional criteria for admission.
Original Equation
DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)] AND [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a
=2)] OR [(any of ASId01R thru -d13bR <=1wk) & (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1]
Narrative
Criterion is met if:
Criterion- (b)
IsLikelyDiagnosed
OR b) If the patient’s presenting alcohol or drug use history is inadequate to substantiate such a diagnosis, the
probability of such a diagnosis may be determined from information submitted by collateral parties (such as family
members, legal guardians and significant others).
Original Equation
DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 & (ASIp19i>0)]
DxLI through…DxLIV = TRUE If Sub-rules -a OR -b (respectively)
Narrative
Criterion is met if:
IsDualDiagnosisCapable
NOTE: EITHER: a) Residents in Level II.1 Dual Diagnosis Capable programs may have co-occurring Mental Disorders that
meet the stability criteria for placement in a Dual Diagnosis Capable program
OR b) difficulties with mood, behavior or cognition related to a substance use or mental disorder or emotional,
behavioral or cognitive symptoms that are troublesome but do not meet the DSM criteria for a mental disorder.
Decision Rules
Original Equation:
DxLIddc through…DxLIVddc = TRUE If [Dim3Px=1 or P19i>0]
AND [respective level (DxLI through…DxLIV) = TRUE]
Narrative
Criterion is met if:
IsDualDiagnosisEnhanced
EITHER a) The patient in need of Level II.1 Dual Diagnosis Enhanced program services is assessed as meeting the
diagnostic criteria for a Mental Disorder as well as a Substance-Related Disorder, as defined in the current Diagnostic
and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association or other standardized and
widely accepted criteria, as well as the dimensional criteria for admission
OR b) If the patient’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Decision Rules
Original Equation:
DxLIdde through…DxLIVdde = TRUE If [Dim3Px=1 & ASI-P19i>0 & <9] AND [respective level (DxLI through…DxLIV) = TRUE]
Narrative
Criterion is met if:
Dimension 1: Level II.1 Intensive Outpatient Treatment
Pseudo Code
public CareLevel_II_1_IntensiveOutpatientScore CalculateCareLevel_II_1_IntensiveOutpatientScore ( Assessment
assessment, AssessmentScore assessmentScore )
{
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed =
assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_II_1_IntensiveOutpatientScore (
omtIsDiagnosed,
omtIsLikelyDiagnosed,
withdrawalSymptomsAndEmotionalBehavioralProblems );
LEVEL II.5- Partial Hospitalization (II.5/DDC/DDE)
Either Criterion: DxLII.5-a OR -b
IsLikelyDiagnosed
EITHER a) The patient who is appropriately placed in a Level II.5 program is assessed as meeting the diagnostic criteria
for a Substance-Related Disorder (including Substance Use Disorder or Substance-Induced Disorder), as defined in the
current Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association or other
standardized and widely accepted criteria, as well as the dimensional criteria for admission.
OR b) If the patient’s presenting alcohol or drug use history is inadequate to substantiate such a diagnosis, the
probability of such a diagnosis may be determined from information submitted by collateral parties (such as family
members, legal guardians and significant others).
Original Equations
DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)]
AND [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a
=2)]
OR [(any of ASId01R thru -d13bR <=1wk) &
(CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1]
DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 & (ASIp19i>0)]
DxLI through…DxLIV = TRUE If Sub-rules -a OR -b (respectively)
IsDualDiagnosisCapable
NOTE: EITHER: a) Residents in Level II.5 Dual Diagnosis Capable programs may have co-occurring Mental Disorders that
meet the stability criteria for placement in a Dual Diagnosis Capable program
OR b) difficulties with mood, behavior or cognition related to a substance use or mental disorder or emotional,
behavioral or cognitive symptoms that are troublesome but do not meet the DSM criteria for a mental disorder.
Original Equation
DxLIddc through…DxLIVddc = TRUE If [Dim3Px=1 or P19i>0]
AND [respective level (DxLI through…DxLIV) = TRUE]
IsDualDiagnosisEnhanced
EITHER a) The patient in need of Level II.5 Dual Diagnosis Enhanced program services is assessed as meeting the
diagnostic criteria for a Mental Disorder as well as a Substance-Related Disorder, as defined in the current Diagnostic
and Statistical Manual of Mental Disorders (DSM)of the American Psychiatric Association or other standardized and
widely accepted criteria, as well as the dimensional criteria for admission
OR b) If the patient’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Original Equation
DxLIdde through…DxLIVdde = TRUE If [Dim3Px=1 & ASI-P19i>0 & <9] AND [respective level (DxLI through…DxLIV) = TRUE
Dimension 1: Level II.5 Partial Hospitalization
Pseudo Code
public CareLevel_II_5_PartialHospitalizationScore CalculateCareLevel_II_5_PartialHospitalizationScore ( Assessment
assessment, AssessmentScore assessmentScore )
{
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed =
assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_II_5_PartialHospitalizationScore(
omtIsDiagnosed,
omtIsLikelyDiagnosed,
withdrawalSymptomsAndEmotionalBehavioralProblems);
LEVEL III.1 – Clinically Managed Low Intensity Residential Services (III.1/DDC/DDE)
Meets criterion:DxLIII.1
IsLikelyDiagnosed
EITHER a) The resident who is appropriately placed in a Level III.1 program meets the diagnostic criteria for a Substance
Dependence Disorder, as defined in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) of the
American Psychiatric Association or other standardized and widely accepted criteria, as well as the dimensional criteria
for admission
OR b) If the resident’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Original Equations
DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)] AND [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a
=2)] OR [(any of ASId01R thru -d13bR <=1wk) & .
(CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)] OR [(ASId18a or d18d >0 OR #CUAD-IV items ##/02-19 >=2)]
OR [(DSM-IV-SA OR -SD) =1]
DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 & (ASIp19i>0)]
DxLI through…DxLIV = TRUE If Sub-rules -a OR -b (respectively)
IsDualDiagnosisCapable
NOTE: EITHER: a) Residents in Level III.1 Dual Diagnosis Capable programs may have co-occurring Mental Disorders that
meet the stability criteria for placement in a Dual Diagnosis Capable program
OR b) difficulties with mood, behavior or cognition related to a substance use or mental disorder or emotional,
behavioral or cognitive symptoms that are troublesome but do not meet the DSM criteria for a mental disorder.
Original Equation:
DxLIddc through…DxLIVddc = TRUE If [Dim3Px=1 or P19i>0]
AND [respective level (DxLI through…DxLIV) = TRUE]
IsDualDiagnosisEnhanced
EITHER a) The resident who is appropriately admitted to a Level III.1 Dual Diagnosis Enhanced program meets the
diagnostic criteria for a Mental Disorder as well as a Substance Dependence Disorder, as defined in the current
Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association or other
standardized and widely accepted criteria, as well as the dimensional criteria for admission
OR b) If the resident’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Original Equation:
DxLIdde through…DxLIVdde = TRUE If [Dim3Px=1 & ASI-P19i>0 & <9] AND [respective level (DxLI through…DxLIV) = TRUE]
Dimension 1: Level III.1 Managed Low-Intensity Residential Treatment Services
Pseudo Code
public CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore
CalculateCareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore ( Assessment assessment,
AssessmentScore assessmentScore )
{
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed =
assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore(
omtIsDiagnosed,
omtIsLikelyDiagnosed,
withdrawalSymptomsAndEmotionalBehavioralProblems);
LEVEL III.3 – Clinically Managed Medium Intensity Residential Treatment
(III.3/DDC/DDE)
Meets criterion: DxLIII.3 All Programs
IsLikelyDiagnosed
EITHER a) The resident who is appropriately placed in a Level III.3 program meets the diagnostic criteria for a Substance
Dependence Disorder, as defined in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) of the
American Psychiatric Association or other standardized and widely accepted criteria, as well as the dimensional criteria
for admission
OR b) If the resident’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Original Equations:
DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)] AND [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a
=2)] OR [(any of ASId01R thru -d13bR <=1wk) & (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)] OR [(DSM-IV-SA OR -SD) =1]
DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 & (ASIp19i>0)]
DxLI through…DxLIV = TRUE If Sub-rules -a OR -b (respectively)
IsDualDiagnosisCapable
NOTE: EITHER: a) Residents in Level III.3 Dual Diagnosis Capable programs may have co-occurring Mental Disorders that
meet the stability criteria for placement in a Dual Diagnosis Capable program
OR b) difficulties with mood, behavior or cognition related to a substance use or mental disorder or emotional,
behavioral or cognitive symptoms that are troublesome but do not meet the DSM criteria for a mental disorder.
Original Equation:
DxLIddc through…DxLIVddc = TRUE If [Dim3Px=1 or P19i>0] AND [respective level (DxLI through…DxLIV) = TRUE]
IsDualDiagnosisEnhanced
EITHER a) The resident who is appropriately admitted to a Level III.3 Dual Diagnosis Enhanced program meets the
diagnostic criteria for a Mental Disorder as well as a Substance Dependence Disorder, as defined in the current
Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association or other
standardized and widely accepted criteria, as well as the dimensional criteria for admission
OR b) If the resident’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Original Equation:
= DxLIII.3dde
Dimension Diagnosis: Level III.3 Managed Medium-Intensity Residential Treatment Services
Pseudo Code
public CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore
CalculateCareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore ( Assessment assessment,
AssessmentScore assessmentScore )
{
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed =
assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore(
omtIsDiagnosed,
omtIsLikelyDiagnosed,
withdrawalSymptomsAndEmotionalBehavioralProblems);
LEVEL III.5 – Clinically Managed High Intensity Residential Treatment (III.5/DDC/DDE)
Meets criterion: DxLIII.5
IsLikelyDiagnosed
EITHER a) The resident who is appropriately placed in a Level III.5 program meets the diagnostic criteria for a Substance
Dependence Disorder, as defined in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) of the
American Psychiatric Association or other standardized and widely accepted criteria, as well as the dimensional criteria
for admission
OR b) If the resident’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Original Equations:
DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)] AND [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a
=2)]
OR [(any of ASId01R thru -d13bR <=1wk) &
(CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)] OR [(DSM-IV-SA OR -SD) =1]
DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 & (ASIp19i>0)]
DxLI through…DxLIV = TRUE If Sub-rules -a OR -b (respectively)
IsDualDiagnosisCapable
NOTE: EITHER: a) Residents in Level III.5 Dual Diagnosis Capable programs may have co-occurring Mental Disorders that
meet the stability criteria for placement in a Dual Diagnosis Capable program
OR b) difficulties with mood, behavior or cognition related to a substance use or mental disorder or emotional,
behavioral or cognitive symptoms that are troublesome but do not meet the DSM criteria for a mental disorder.
Original Equation:
DxLIddc through…DxLIVddc = TRUE If [Dim3Px=1 or P19i>0] AND [respective level (DxLI through…DxLIV) = TRUE]
IsDualDiagnosisEnhanced
EITHER a) The resident who is appropriately admitted to a Level III.5 Dual Diagnosis Enhanced program meets the
diagnostic criteria for a Mental Disorder as well as a Substance Dependence Disorder, as defined in the current
Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association or other
standardized and widely accepted criteria, as well as the dimensional criteria for admission
OR b) If the resident’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Original Equation:
DxLIdde through…DxLIVdde = TRUE If [Dim3Px=1 & ASI-P19i>0 & <9] AND [respective level (DxLI through…DxLIV) = TRUE]
Dimension Diagnosis: Level III.5 Managed High-Intensity Residential Treatment Services
Pseudo Code
public CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore
CalculateCareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore ( Assessment assessment,
AssessmentScore assessmentScore )
{
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed =
assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore(
omtIsDiagnosed,
omtIsLikelyDiagnosed,
withdrawalSymptomsAndEmotionalBehavioralProblems);
LEVEL III.7 – Medically Monitored Intensive Inpatient Treatment (III.7/DDC/DDE)
Meets criterion:DxLIII.7
IsLikelyDiagnosed
EITHER a) The resident who is appropriately placed in a Level III.7 program meets the diagnostic criteria for a Substance
Dependence Disorder, as defined in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) of the
American Psychiatric Association or other standardized and widely accepted criteria, as well as the dimensional criteria
for admission
OR b) If the resident’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Original Equations:
DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)] AND [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a
=2)] OR [(any of ASId01R thru -d13bR <=1wk) & (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)] OR [(DSM-IV-SA OR -SD) =1]
DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 & (ASIp19i>0)]
DxLI through…DxLIV = TRUE If Sub-rules -a OR -b (respectively)
IsDualDiagnosisCapable
NOTE: EITHER: a) Residents in Level III.7 Dual Diagnosis Capable programs may have co-occurring Mental Disorders that
meet the stability criteria for placement in a Dual Diagnosis Capable program
OR b) difficulties with mood, behavior or cognition related to a substance use or mental disorder or emotional,
behavioral or cognitive symptoms that are troublesome but do not meet the DSM criteria for a mental disorder.
Original Equation:
DxLIddc through…DxLIVddc = TRUE If [Dim3Px=1 or P19i>0] AND [respective level (DxLI through…DxLIV) = TRUE]
EITHER a) The resident who is appropriately admitted to a Level III.7 Dual Diagnosis Enhanced program meets the
diagnostic criteria for a Mental Disorder as well as a Substance Dependence Disorder, as defined in the current
Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association or other
standardized and widely accepted criteria, as well as the dimensional criteria for admission
OR b) If the resident’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Original Equation:
= DxLIII.7dde
Dimension Diagnosis: Level III.7 Medically Monitored Inoatient Treatment
Pseudo Code
public CareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore
CalculateCareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore ( Assessment assessment, AssessmentScore
assessmentScore )
{
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed =
assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore(
omtIsDiagnosed,
omtIsLikelyDiagnosed,
withdrawalSymptomsAndEmotionalBehavioralProblems);
LEVEL IV – Medically Managed Intensive Inpatient Treatment (IV/DDC/DDE)
Either Criterion: DxLIV-a OR -b
IsLikelyDiagnosed
The patient who is appropriately placed in a Level IV program is assessed as:
EITHER (a) meeting the diagnostic criteria for a Substance-Related Disorder (including Substance-Use Disorder or
Substance-Induced Disorder), as defined in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) of
the American Psychiatric Association or other standardized and widely accepted criteria, as well as the dimensional
criteria for admission.
OR (b) If the patient’s presenting alcohol or drug use history is inadequate to substantiate such a diagnosis, the
probability of such a diagnosis may be determined from information submitted by collateral parties (such as family
members, legal guardian and significant others).
Original Equations:
DxLIa through…DxLIVa = TRUE... If [Dim3Px=0 & (ASIp19i=0 or 9)] AND [(any of ASId01R thru -d13bR <=24 hrs) & (ASIm6a
=2)] OR [(any of ASId01R thru -d13bR <=1wk) & (CIWA OR CINA Total>4 OR CUAD##/02 OR ##/03=1)]
OR [(ASId18a or -d18d >0 OR #CUAD-IV items ##/02-19 >=2)] OR [(DSM-IV-SA OR -SD) =1]
DxLIb through…DxLIVb = TRUE If [(ASId27a)=1 & (#CUAD-IV items ##/02-19)>=2] AND [Dim3Px=0 & (ASIp19i>0)]
DxLI through…DxLIV = TRUE If Sub-rules -a OR -b (respectively)
IsDualDiagnosisCapable
Some patients have co-occurring mental disorders that meet stability criteria for admission to a Dual Diagnosis Capable
program. Other patients may have difficulties with mood, behavior or cognition as the result of other psychiatric or
substance-induced disorders, or the patient’s emotional, behavioral or cognitive symptoms may be troublesome but not
sufficient to meet the criteria for a diagnosed mental disorder.
Original Equation:
DxLIddc through…DxLIVddc = TRUE If [Dim3Px=1 or P19i>0]
AND [respective level (DxLI through…DxLIV) = TRUE]
IsDualDiagnosisEnhanced
In contrast to the foregoing criteria, the patient who is appropriately placed in a Level IV Dual Diagnosis Enhanced
program is assessed as:
EITHER (a) meeting the diagnostic criteria for a Mental Disorder as well as a Substance-Related Disorder, as defined in
the current Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association or other
standardized and widely accepted criteria, as well as the dimensional criteria for admission.
OR (b) If the patient’s presenting history is inadequate to substantiate such a diagnosis, the probability of such a
diagnosis may be determined from information submitted by collateral parties (such as family members, legal guardians
and significant others).
Original Equation:
DxLIdde through…DxLIVdde = TRUE If [Dim3Px=1 & ASI-P19i>0 & <9] AND [respective level (DxLI through…DxLIV) = TRUE]
Dimension Diagnosis: Level IV Medically Managed Intensive Inpatient Treatment
Pseudo Code
public CareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore
CalculateCareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore ( Assessment assessment, AssessmentScore
assessmentScore )
{
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed =
assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore(
omtIsDiagnosed,
omtIsLikelyDiagnosed, withdrawalSymptomsAndEmotionalBehavioralProblems);
Dimension Diagnosis: Common Scores
using System.Collections.Generic;
using System.Linq;
using Asam.Ppc.Domain.Scoring.ReportModule.AddictionSeverityIndexCompositeScores;
namespace Asam.Ppc.Domain.Scoring.ScoringModule.Diagnosis
{
public class CommonScores
{
internal double MinimumDaysSinceLastUsedDrugExceptNicotine { get; set; }
internal double DaysSinceLastUsedNicotine { get; set; }
/// (NumberOfCUADsPositive).
internal virtual int NumberOfCuadScaleSumGreaterThanOneExceptNicotine { get; set; }
/// (MaxCUADOneDrug).
internal int MaxCuadScaleSumForOneDrugExceptNicotine { get; set; }
/// (CUAD13a).
internal int NicotineCuadScaleSum { get; set; }
internal IList<AsiScore> AddictionSeverityIndexCompositeScores { get; set; }
public virtual WhichSubstenceEverUsed WhichSubstenceEverUsed { get; internal set; }
/// (OB_Dim3Px).
public bool? WithdrawalSymptomsAndEmotionalBehavioralProblems { get; internal set; }
public int CiwaScore { get; internal set; }
public int CinaScore { get; internal set; }
Dimension Diagnosis: Diagnosis Results
using Asam.Ppc.Domain.AssessmentModule;
namespace Asam.Ppc.Domain.Scoring.ScoringModule.Diagnosis
{
/// DiagnosisScores class.
public class DiagnosisResults
{
#region Constructors and Destructors
/// Initializes a new instance of the <see cref="DiagnosisResults"/> class.
protected internal DiagnosisResults()
{
DiagnosticStatisticalManualOfMentalDisorders_IV_Scores = new
DiagnosticStatisticalManualOfMentalDisorders_IV_Scores();
}
#endregion
#region Public Properties
/// Gets a value indicating whether [any addiction diagnosis except nicotine]. (AnyDxExceptNico)
/// AnyDxExceptNico := OB_DSMSA01 or OB_DSMSA03 or OB_DSMSA04 or OB_DSMSA05 or OB_DSMSA06 or OB_DSMSA07 or
///
OB_DSMSA08 or OB_DSMSA09 or OB_DSMSA10 or OB_DSMSA11 or OB_DSMSA12 or OB_DSMSA13 or
///
OB_DSMSA13b or OB_DSMSD01 or OB_DSMSD03 or OB_DSMSD04 or OB_DSMSD05 or OB_DSMSD06 or
///
OB_DSMSD07 or OB_DSMSD08 or OB_DSMSD09 or OB_DSMSD10 or OB_DSMSD11 or OB_DSMSD12 or
///
OB_DSMSD13 or OB_DSMSD13b;
public bool AnyAddictionDiagnosisExceptNicotine
{
get
{
Let dsmScores = DiagnosticStatisticalManualOfMentalDisorders_IV_Scores;
return dsmScores.AlcoholAnyUseScore.IsAbused Or dsmScores.AlcoholAnyUseScore.IsDependent
Or dsmScores.BarbituratesScore.IsAbused Or dsmScores.BarbituratesScore.IsDependent
Or dsmScores.CannabisScore.IsAbused Or dsmScores.CannabisScore.IsDependent
Or dsmScores.CocaineScore.IsAbused Or dsmScores.CocaineScore.IsDependent
Or dsmScores.HallucinogensScore.IsAbused Or dsmScores.HallucinogensScore.IsDependent
Or dsmScores.HeroinScore.IsAbused Or dsmScores.HeroinScore.IsDependent
Or dsmScores.MethadoneScore.IsAbused Or dsmScores.MethadoneScore.IsDependent
Or dsmScores.MultiplePerDayScore.IsAbused Or dsmScores.MultiplePerDayScore.IsDependent
Or dsmScores.OtherScore.IsAbused Or dsmScores.OtherScore.IsDependent
Or dsmScores.OtherOpiatesAnalgesicsScore.IsAbused Or dsmScores.OtherOpiatesAnalgesicsScore.IsDependent
Or dsmScores.OtherSedativesHypnoticsScore.IsAbused Or dsmScores.OtherSedativesHypnoticsScore.IsDependent
Or dsmScores.SolventInhalantsScore.IsAbused Or dsmScores.SolventInhalantsScore.IsDependent
Or dsmScores.StimulantsScore.IsAbused Or dsmScores.StimulantsScore.IsDependent;
}
}
/// Gets a value indicating whether [any addiction diagnosis]. (AnyDxMade)
/// AnyDxMade := AnyDxExceptNico or OB_DSMSA13a or OB_DSMSD13a;
public bool AnyAddictionDiagnosis
{
get
{
Let dsmScores = DiagnosticStatisticalManualOfMentalDisorders_IV_Scores;
return AnyAddictionDiagnosisExceptNicotine Or dsmScores.NicotineTobaccoScore.IsAbused ||
dsmScores.NicotineTobaccoScore.IsDependent;
}
}
/// Gets a value indicating whether [any opioid addiction diagnosis]. (AnyOpioidDx)
/// AnyOpioidDx := OB_DSMSD03 or OB_DSMSD04 or OB_DSMSD05;
/// </remarks>
public bool AnyOpioidAddictionDiagnosis
{
get
{
Let dsmScores = DiagnosticStatisticalManualOfMentalDisorders_IV_Scores;
return dsmScores.HeroinScore.IsDependent ||
dsmScores.MethadoneScore.IsDependent ||
dsmScores.OtherOpiatesAnalgesicsScore.IsDependent;
}
}
/// Gets a value indicating whether [no non sedative diagnosis]. (NoNonSedDx)
/// <value><c>true</c> if [no non sedative diagnosis]; otherwise, <c>false</c>.</value>
/// NoNonSedDx := (not OB_DSMSD01 ) And (not OB_DSMSD03 ) And (not OB_DSMSD04 ) And
///
(not OB_DSMSD05 ) And (not OB_DSMSD08 ) And (not OB_DSMSD09 ) And
///
(not OB_DSMSD10 ) And (not OB_DSMSD11 ) And (not OB_DSMSD12 );
public bool NoNonSedativeDiagnosis
{
get
{
Let dsmScores = DiagnosticStatisticalManualOfMentalDisorders_IV_Scores;
return !dsmScores.AlcoholAnyUseScore.IsDependent And
!dsmScores.HeroinScore.IsDependent And
!dsmScores.MethadoneScore.IsDependent And
!dsmScores.OtherOpiatesAnalgesicsScore.IsDependent And
!dsmScores.CocaineScore.IsDependent And
!dsmScores.StimulantsScore.IsDependent And
!dsmScores.CannabisScore.IsDependent And
!dsmScores.HallucinogensScore.IsDependent And
!dsmScores.SolventInhalantsScore.IsDependent;
}
}
/// (OB_AnyPhysiolDep).
/// OB_AnyPhysiolDep := OB_DSMSD01wP or OB_DSMSD03wP or OB_DSMSD04wP or OB_DSMSD05wP or
///
OB_DSMSD06wP or OB_DSMSD07wP or OB_DSMSD08wP or OB_DSMSD09wP or
///
OB_DSMSD10wP or OB_DSMSD11wP or OB_DSMSD12wP or OB_DSMSD13wP or
///
OB_DSMSD13bwP;
public bool AnyPhysiologicalDependency
{
get
{
Let dsmScores = DiagnosticStatisticalManualOfMentalDisorders_IV_Scores;
return dsmScores.AlcoholAnyUseScore.IsDependentWithPhysiologicalDependency ||
dsmScores.HeroinScore.IsDependentWithPhysiologicalDependency ||
dsmScores.MethadoneScore.IsDependentWithPhysiologicalDependency ||
dsmScores.OtherOpiatesAnalgesicsScore.IsDependentWithPhysiologicalDependency ||
dsmScores.BarbituratesScore.IsDependentWithPhysiologicalDependency ||
dsmScores.OtherSedativesHypnoticsScore.IsDependentWithPhysiologicalDependency ||
dsmScores.CocaineScore.IsDependentWithPhysiologicalDependency ||
dsmScores.StimulantsScore.IsDependentWithPhysiologicalDependency ||
dsmScores.CannabisScore.IsDependentWithPhysiologicalDependency ||
dsmScores.HallucinogensScore.IsDependentWithPhysiologicalDependency ||
dsmScores.SolventInhalantsScore.IsDependentWithPhysiologicalDependency ||
dsmScores.MultiplePerDayScore.IsDependentWithPhysiologicalDependency ||
dsmScores.OtherScore.IsDependentWithPhysiologicalDependency;
}
}
public virtual CommonScores CommonScores { get; internal set; }
/// Gets the diagnostic statistical manual of mental disorders_ I v_ scores.
public DiagnosticStatisticalManualOfMentalDisorders_IV_Scores
DiagnosticStatisticalManualOfMentalDisorders_IV_Scores { get; private set; }
/// Gets the care level_ i_ detoxification.
public CareLevel_I_DetoxificationScore CareLevel_I_DetoxificationScore { get; private set; }
/// Gets the care level_ I i_ detoxification.
public CareLevel_II_DetoxificationScore CareLevel_II_DetoxificationScore { get; private set; }
/// Gets the care level_ II i_2_ detoxification.
public CareLevel_III_2_DetoxificationScore CareLevel_III_2_DetoxificationScore { get; private set; }
/// Gets the care level_ II i_7_ detoxification.
public CareLevel_III_7_DetoxificationScore CareLevel_III_7_DetoxificationScore { get; private set; }
/// Gets the care level_ I v_ detoxification.
public CareLevel_IV_DetoxificationScore CareLevel_IV_DetoxificationScore { get; private set; }
/// Gets the care level_0_5.
public CareLevel_0_5_EarlyInterventionScore CareLevel_0_5_EarlyInterventionScore { get; private set; }
/// Gets the care level_ i_ outpatient.
public CareLevel_I_OutpatientScore CareLevel_I_OutpatientScore { get; private set; }
/// Gets the care level opioid maintenance therapy.
public CareLevelOpioidMaintenanceTherapyScore CareLevelOpioidMaintenanceTherapyScore { get; private set; }
/// Gets the care level_ I i_1_ intensive outpatient.
public CareLevel_II_1_IntensiveOutpatientScore CareLevel_II_1_IntensiveOutpatientScore { get; private set; }
/// Gets the care level_ I i_5_ partial hospitalization.
public CareLevel_II_5_PartialHospitalizationScore CareLevel_II_5_PartialHospitalization{ get; private set; }
/// Gets the care level_ II i_1_ clinically managed low intensity residential treatment.
public CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore
CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore { get; private set; }
/// Gets the care level_ II i_3_ clinically managed medium intensity residential treatment.
public CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore
CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore { get; private set; }
/// Gets the care level_ II i_5_ clinically managed high intensity residential treatment.
public CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore
CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore { get; private set; }
/// Gets the care level_ II i_7_ medically monitored intensive inpatient treatment.
public CareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore
CareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore { get; private set; }
/// Gets the care level IV medically managed intensive inpatient services.
public CareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore
CareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore { get; private set; }
#endregion
public void CalculateScores(Assessment assessment, AssessmentScore assessmentScore, IDiagnosisScoringStrategy
diagnosisScoringStrategy)
{
CommonScores = diagnosisScoringStrategy.CalculateCommonScoresStage1(assessment, assessmentScore);
CommonScores = diagnosisScoringStrategy.CalculateCommonScoresStage2(assessment, assessmentScore);
DiagnosticStatisticalManualOfMentalDisorders_IV_Scores =
diagnosisScoringStrategy.CalculateDiagnosticStatisticalManualOfMentalDisorders_IV_Scores(assessment, assessmentScore);
CareLevel_I_DetoxificationScore = diagnosisScoringStrategy.CalculateCareLevel_I_DetoxificationScore(assessment,
assessmentScore);
CareLevel_II_DetoxificationScore = diagnosisScoringStrategy.CalculateCareLevel_II_DetoxificationScore(assessment,
assessmentScore);
CareLevel_III_2_DetoxificationScore = diagnosisScoringStrategy.CalculateCareLevel_III_2_DetoxificationScore(assessment,
assessmentScore);
CareLevel_III_7_DetoxificationScore = diagnosisScoringStrategy.CalculateCareLevel_III_7_DetoxificationScore(assessment,
assessmentScore);
CareLevel_IV_DetoxificationScore = diagnosisScoringStrategy.CalculateCareLevel_IV_DetoxificationScore(assessment,
assessmentScore);
CareLevel_I_OutpatientScore = diagnosisScoringStrategy.CalculateCareLevel_I_OutpatientScore(assessment,
assessmentScore);
// Note: Move CareLevel I up since CareLevel_05 depends on CareLevel I.
CareLevel_0_5_EarlyInterventionScore =
diagnosisScoringStrategy.CalculateCareLevel_0_5_EarlyInterventionScore(assessment, assessmentScore);
CareLevelOpioidMaintenanceTherapyScore =
diagnosisScoringStrategy.CalculateCareLevelOpioidMaintenanceTherapyScore(assessment, assessmentScore);
CareLevel_II_1_IntensiveOutpatientScore =
diagnosisScoringStrategy.CalculateCareLevel_II_1_IntensiveOutpatientScore(assessment, assessmentScore);
CareLevel_II_5_PartialHospitalizationScore =
diagnosisScoringStrategy.CalculateCareLevel_II_5_PartialHospitalizationScore(assessment, assessmentScore);
CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore =
diagnosisScoringStrategy.CalculateCareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore
(assessment, assessmentScore);
CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore =
diagnosisScoringStrategy.CalculateCareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore
(assessment, assessmentScore);
CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore =
diagnosisScoringStrategy.CalculateCareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore
(assessment, assessmentScore);
CareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore =
diagnosisScoringStrategy.CalculateCareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore(assessment,
assessmentScore);
CareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore =
diagnosisScoringStrategy.CalculateCareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore(assessment,
assessmentScore);
}
}
Dimension Diagnosis: Scoring Strategy
using
using
using
using
using
using
using
using
using
using
using
using
System;
System.Linq;
System.Collections.Generic;
Asam.Ppc.Domain.AssessmentModule;
Asam.Ppc.Domain.AssessmentModule.DrugAndAlcohol;
Asam.Ppc.Domain.AssessmentModule.DrugAndAlcohol.Lookups;
Asam.Ppc.Domain.AssessmentModule.Medical;
Asam.Ppc.Domain.AssessmentModule.Psychological;
Asam.Ppc.Domain.Common.Lookups;
Asam.Ppc.Domain.Common.ValueObjects;
Asam.Ppc.Domain.Scoring.ReportModule.AddictionSeverityIndexCompositeScores;
Asam.Ppc.Primitives;
namespace Asam.Ppc.Domain.Scoring.ScoringModule.Diagnosis
{
public class DiagnosisScoringStrategy : IDiagnosisScoringStrategy
{
private readonly ISubstanceScoreCalculator substanceScoreCalculator;
public DiagnosisScoringStrategy (ISubstanceScoreCalculator substanceScoreCalculator )
{
this.substanceScoreCalculator = substanceScoreCalculator;
}
#region Public Properties
// Separate common score calculation for mocking in unit tests.
public CommonScores CalculateCommonScoresStage1(Assessment assessment, AssessmentScore assessmentScore)
{
Let commonScores = new CommonScores();
commonScores.AddictionSeverityIndexCompositeScores =
CalculateAddictionSeverityIndexCompositeScores(assessment, assessmentScore);
commonScores.WhichSubstenceEverUsed =
Utilities.CalculateWhichSubstanceEverUsed(assessment.DrugAndAlcoholSection.UsedSubstances.SubstanceHasEverUsed);
commonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems =
CalculateWithdrawalSymptomsAndEmotionalBehavioralProblems(assessment, assessmentScore);
Let ciwaScale = assessment.DrugAndAlcoholSection.CiwaScale;
commonScores.CiwaScore = Utilities.CalculateCiwa (
ciwaScale.ExperiencedNauseaOrVomitedRecently,
ciwaScale.ObservedTremor,
ciwaScale.ObservedSweating,
ciwaScale.ObservedNervousness,
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel,
ciwaScale.ObservedTactileDisturbances,
assessment.MedicalSection.AuditoryDisturbanceLevel,
assessment.MedicalSection.VisualDisturbanceLevel,
ciwaScale.HeadAcheOrFullnessSeverity,
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness);
Let cinaScale = assessment.DrugAndAlcoholSection.CinaScale;
commonScores.CinaScore = Utilities.CalculateCina (
cinaScale.ExperiencedNauseaOrVomitedRecently,
cinaScale.ObservedGooseFlesh,
cinaScale.ObservedSweating,
cinaScale.ObservedRestlessness,
cinaScale.ObservedTremor,
cinaScale.ObservedLacrimination,
cinaScale.ObservedNasalCongestion,
cinaScale.ObservedYawning,
cinaScale.HasAbdominalPain,
cinaScale.FeelsHotOrCold,
cinaScale.HasMuscleAches,
assessment.MedicalSection.HeartRate );
return commonScores;
}
public CommonScores CalculateCommonScoresStage2(Assessment assessment, AssessmentScore assessmentScore)
{
Let commonScores = assessmentScore.DiagnosisResults.CommonScores;
// function UsedInLastDays(const nDays: integer): Boolean;
// begin
//
Result := ( (ASId01E = 1) and (ASId01R <= nDays) ) or ( (ASId02E = 1) and (ASId02R <= nDays) ) or
//
( (ASId03E = 1) and (ASId03R <= nDays) ) or ( (ASId04E = 1) and (ASId04R <= nDays) ) or
//
( (ASId05E = 1) and (ASId05R <= nDays) ) or ( (ASId06E = 1) and (ASId06R <= nDays) ) or
//
( (ASId07E = 1) and (ASId07R <= nDays) ) or ( (ASId08E = 1) and (ASId08R <= nDays) ) or
//
( (ASId09E = 1) and (ASId09R <= nDays) ) or ( (ASId10E = 1) and (ASId10R <= nDays) ) or
//
( (ASId11E = 1) and (ASId11R <= nDays) ) or ( (ASId12E = 1) and (ASId12R <= nDays) ) or
//
( (ASId13E = 1) and (ASId13R <= nDays) ) or ( (ASId13bE = 1) and (ASId13bR <= nDays) );
// Exclude Nicotine
// end;
Let whichSubstenceEverUsed = commonScores.WhichSubstenceEverUsed;
commonScores.MinimumDaysSinceLastUsedDrugExceptNicotine =
substanceScoreCalculator.CalculateMinimumDaysSinceLastUsedDrugExceptNicotine (
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedAlcohol,
assessment.DrugAndAlcoholSection.AlcoholUse.LastUsed ),
new SubstanceUseHistory ( assessment.DrugAndAlcoholSection.AlcoholUse.AlcoholUsedToIntoxication,
assessment.DrugAndAlcoholSection.AlcoholUse.LastUsedToIntoxification ),
// alcohol to intoxication
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedHeroin,
assessment.DrugAndAlcoholSection.HeroinUse.LastUsed ),
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedMethadone,
assessment.DrugAndAlcoholSection.MethadoneUse.LastUsed ),
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedOtherOpiate,
assessment.DrugAndAlcoholSection.OtherOpiateUse.LastUsed ),
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedBarbiturates,
assessment.DrugAndAlcoholSection.BarbiturateUse.LastUsed ),
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedOtherSedatives,
assessment.DrugAndAlcoholSection.OtherSedativeUse.LastUsed ),
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedCocaine,
assessment.DrugAndAlcoholSection.CocaineUse.LastUsed ),
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedStimulate,
assessment.DrugAndAlcoholSection.StimulantUse.LastUsed ),
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedCannabis,
assessment.DrugAndAlcoholSection.CannabisUse.LastUsed ),
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedHallucinogens,
assessment.DrugAndAlcoholSection.HallucinogenUse.LastUsed ),
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedSolventInhalants,
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.LastUsed ),
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedMultipleSubstancesPerDay,
assessment.DrugAndAlcoholSection.MultipleSubstanceUsePerDay.LastUsed ),
new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedOtherSubstance,
assessment.DrugAndAlcoholSection.OtherSubstanceUse.LastUsed ) );
Let nicotineHx = new SubstanceUseHistory ( whichSubstenceEverUsed.HasEverUsedNicotine,
assessment.DrugAndAlcoholSection.NicotineUse.LastUsed );
commonScores.DaysSinceLastUsedNicotine = (nicotineHx.HasEverUsed ?? false)
? double.MaxValue
: nicotineHx.UseFrequency;
// CUAD = Chemical Use, Abuse and Dependence Scale
// CUAD03NotDetox := CUAD03_04 + CUAD03_05 + CUAD03_06 + CUAD03_07 +
//
CUAD03_08 + CUAD03_09 + CUAD03_10 + CUAD03_11 + CUAD03_12 + CUAD03_13 +
//
CUAD03_14 + CUAD03_15 + CUAD03_16 + CUAD03_17 + CUAD03_18 + CUAD03_19;
// CUAD03 := CUAD03_01 + CUAD03_02 + CUAD03_03 + CUAD03NotDetox;
// if CUAD03 > 1 then
//
Inc(NumberOfCUADsPositive);
// MaxCUADOneDrug := iMax(MaxCUADOneDrug, CUAD03);
// //MaxCUADNoDetoxOneDrug := iMax(MaxCUADOneDrug, CUAD03NotDetox);
// Note: No need to calculate CUAD03NotDetox anymore since it is only used as a part of CUADSum.
Let cuadScaleScoresExceptNicotine = new ISubstanceUse[]
{
assessment.DrugAndAlcoholSection.AlcoholUse,
assessment.DrugAndAlcoholSection.HeroinUse,
assessment.DrugAndAlcoholSection.MethadoneUse,
assessment.DrugAndAlcoholSection.OtherOpiateUse,
assessment.DrugAndAlcoholSection.BarbiturateUse,
assessment.DrugAndAlcoholSection.OtherSedativeUse,
assessment.DrugAndAlcoholSection.CocaineUse,
assessment.DrugAndAlcoholSection.StimulantUse,
assessment.DrugAndAlcoholSection.CannabisUse,
assessment.DrugAndAlcoholSection.HallucinogenUse,
assessment.DrugAndAlcoholSection.SolventAndInhalantUse,
assessment.DrugAndAlcoholSection.OtherSubstanceUse
};
commonScores.MaxCuadScaleSumForOneDrugExceptNicotine =
substanceScoreCalculator.CalculateMaxCuadScaleSumForOneDrugExceptNicotine
(cuadScaleScoresExceptNicotine );
commonScores.NumberOfCuadScaleSumGreaterThanOneExceptNicotine =
substanceScoreCalculator.CalculateNumberOfCuadScaleSumGreaterThanOneExceptNicotine(cuadScaleScoresExceptNicotine);
commonScores.NicotineCuadScaleSum =
substanceScoreCalculator.CalculateChemicalUseAbuseAndDependenceScaleScoreSum (
assessment.DrugAndAlcoholSection.NicotineUse );
return commonScores;
}
public DiagnosticStatisticalManualOfMentalDisorders_IV_Scores
CalculateDiagnosticStatisticalManualOfMentalDisorders_IV_Scores ( Assessment assessment, AssessmentScore
assessmentScore )
{
Let dsmScore = new DiagnosticStatisticalManualOfMentalDisorders_IV_Scores ( );
Let whichSubstenceEverUsed = assessmentScore.DiagnosisResults.CommonScores.WhichSubstenceEverUsed;
Let alcoholUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedAlcohol,
assessment.DrugAndAlcoholSection.AlcoholUse );
alcoholUseScore.HasImminentWithdrawalPotential =
substanceScoreCalculator.CalculateImminentWithdrawalPotential(
whichSubstenceEverUsed.HasEverUsedAlcohol,
assessment.DrugAndAlcoholSection.AlcoholUse,
assessment.DrugAndAlcoholSection.AlcoholUse.AlcoholUsedToIntoxication,
assessment.DrugAndAlcoholSection.AlcoholUse.LastUsedToIntoxification,
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfDaysIntoxicatedInPast30Days);
dsmScore.AlcoholAnyUseScore = alcoholUseScore;
Let heroinUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedHeroin,
assessment.DrugAndAlcoholSection.HeroinUse );
dsmScore.HeroinScore = heroinUseScore;
Let methadoneUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedMethadone,
assessment.DrugAndAlcoholSection.MethadoneUse );
dsmScore.MethadoneScore = methadoneUseScore;
Let otherOpiateUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedOtherOpiate,
assessment.DrugAndAlcoholSection.OtherOpiateUse );
dsmScore.OtherOpiatesAnalgesicsScore = otherOpiateUseScore;
Let barbituratesUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedBarbiturates,
assessment.DrugAndAlcoholSection.BarbiturateUse );
dsmScore.BarbituratesScore = barbituratesUseScore;
Let otherSedativesUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedOtherSedatives,
assessment.DrugAndAlcoholSection.OtherSedativeUse );
dsmScore.OtherSedativesHypnoticsScore = otherSedativesUseScore;
Let cocaineUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedCocaine,
assessment.DrugAndAlcoholSection.CocaineUse );
dsmScore.CocaineScore = cocaineUseScore;
Let stimulantsUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedStimulate,
assessment.DrugAndAlcoholSection.StimulantUse );
dsmScore.StimulantsScore = stimulantsUseScore;
Let cannabisUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedCannabis,
assessment.DrugAndAlcoholSection.CannabisUse );
dsmScore.CannabisScore = cannabisUseScore;
Let hallucinogensUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedHallucinogens,
assessment.DrugAndAlcoholSection.HallucinogenUse );
dsmScore.HallucinogensScore = hallucinogensUseScore;
Let solventInhalantsUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedSolventInhalants,
assessment.DrugAndAlcoholSection.SolventAndInhalantUse );
dsmScore.SolventInhalantsScore = solventInhalantsUseScore;
// Multiple per day
Let multipleSubstanceUseScore = substanceScoreCalculator.CalculateSubstanceScore (
whichSubstenceEverUsed.HasEverUsedMultipleSubstancesPerDay,
assessment.DrugAndAlcoholSection.MultipleSubstanceUsePerDay.LastUsed,
assessmentScore.DiagnosisResults.CommonScores.NumberOfCuadScaleSumGreaterThanOneExceptNicotine,
assessment.DrugAndAlcoholSection.AdditionalAddictionAndTreatmentItems.WhichSubstanceIsMajorProblem,
assessment.DrugAndAlcoholSection.AlcoholUse,
assessment.DrugAndAlcoholSection.HeroinUse,
assessment.DrugAndAlcoholSection.MethadoneUse,
assessment.DrugAndAlcoholSection.OtherOpiateUse,
assessment.DrugAndAlcoholSection.BarbiturateUse,
assessment.DrugAndAlcoholSection.OtherSedativeUse,
assessment.DrugAndAlcoholSection.CocaineUse,
assessment.DrugAndAlcoholSection.StimulantUse,
assessment.DrugAndAlcoholSection.CannabisUse,
assessment.DrugAndAlcoholSection.HallucinogenUse,
assessment.DrugAndAlcoholSection.SolventAndInhalantUse,
assessment.DrugAndAlcoholSection.OtherSubstanceUse );
dsmScore.MultiplePerDayScore = multipleSubstanceUseScore;
Let nicotineUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedNicotine,
assessment.DrugAndAlcoholSection.NicotineUse );
dsmScore.NicotineTobaccoScore = nicotineUseScore;
Let otherSubstanceUseScore =
substanceScoreCalculator.CalculateSubstanceScore ( whichSubstenceEverUsed.HasEverUsedOtherSubstance,
assessment.DrugAndAlcoholSection.OtherSubstanceUse );
dsmScore.OtherScore = otherSubstanceUseScore;
return dsmScore;
}
public CareLevel_I_DetoxificationScore CalculateCareLevel_I_DetoxificationScore ( Assessment assessment,
AssessmentScore assessmentScore )
{
Let experiencedNauseaOrVomitedRecentlyCiwa =
assessment.DrugAndAlcoholSection.CiwaScale.ExperiencedNauseaOrVomitedRecently;
Let observedTremorCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTremor;
Let observedSweatingCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedSweating;
Let observedNervousness = assessment.DrugAndAlcoholSection.CiwaScale.ObservedNervousness;
Let interviewerObservationOfPatientAgitationLevel =
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel;
Let observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances;
Let auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
Let visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
Let headAcheOrFullnessSeverity = assessment.DrugAndAlcoholSection.CiwaScale.HeadAcheOrFullnessSeverity;
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
Let experiencedNauseaOrVomitedRecently = assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
Let observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
Let observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
Let observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
Let observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
Let observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
Let observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
Let observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
Let hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
Let feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
Let hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
Let heartRate = assessment.MedicalSection.HeartRate;
Let experiencesWithdrawalSicknessAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessHeroin = assessment.DrugAndAlcoholSection.HeroinUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessCocaine = assessment.DrugAndAlcoholSection.CocaineUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessCannabis = assessment.DrugAndAlcoholSection.CannabisUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.ExperiencesWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessHeroin =
assessment.DrugAndAlcoholSection.HeroinUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessCocaine =
assessment.DrugAndAlcoholSection.CocaineUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessCannabis =
assessment.DrugAndAlcoholSection.CannabisUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.UseSubstanceToPreventWithdrawalSickness;
Let minimumDaysSinceLastUsedDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MinimumDaysSinceLastUsedDrugExceptNicotine;
Let daysSinceLastUsedNicotine = assessmentScore.DiagnosisResults.CommonScores.DaysSinceLastUsedNicotine;
Let signsOfIntoxicationExist = assessment.MedicalSection.SignsOfIntoxicationExist;
Let majorityOfInformationFromCollateralSource =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.MajorityOfInformationFromCollateralSource;
Let maxCuadScaleSumForOneDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MaxCuadScaleSumForOneDrugExceptNicotine;
Let nicotineCuadScaleSum = assessmentScore.DiagnosisResults.CommonScores.NicotineCuadScaleSum;
Let anyAddictionDiagnosis = assessmentScore.DiagnosisResults.AnyAddictionDiagnosis;
Let ciwaCinaAndWithdrawalSicknessIndicator =
CalculateCiwaCinaAndWithdrawalSicknessIndicator ( experiencedNauseaOrVomitedRecentlyCiwa,
observedTremorCiwa, observedSweatingCiwa,
observedNervousness, interviewerObservationOfPatientAgitationLevel,
observedTactileDisturbances, auditoryDisturbanceLevel, visualDisturbanceLevel, headAcheOrFullnessSeverity,
interviewerObservationOfPatientSenseOfAwareness, experiencedNauseaOrVomitedRecently, observedGooseFlesh,
observedSweating, observedRestlessness, observedTremor,
observedLacrimination, observedNasalCongestion, observedYawning, hasAbdominalPain, feelsHotOrCold,
hasMuscleAches, heartRate, experiencesWithdrawalSicknessAlcohol,experiencesWithdrawalSicknessHeroin,
experiencesWithdrawalSicknessMethadone, experiencesWithdrawalSicknessOtherOpiate,
experiencesWithdrawalSicknessBarbiturate, experiencesWithdrawalSicknessOtherSedative,
experiencesWithdrawalSicknessCocaine, experiencesWithdrawalSicknessStimulant,
experiencesWithdrawalSicknessCannabis, experiencesWithdrawalSicknessHallucinogen,
experiencesWithdrawalSicknessSolventAndInhalant, experiencesWithdrawalSicknessOtherSubstance,
useSubstanceToPreventWithdrawalSicknessAlcohol, useSubstanceToPreventWithdrawalSicknessHeroin,
useSubstanceToPreventWithdrawalSicknessMethadone, useSubstanceToPreventWithdrawalSicknessOtherOpiate,
useSubstanceToPreventWithdrawalSicknessBarbiturate, useSubstanceToPreventWithdrawalSicknessOtherSedative,
useSubstanceToPreventWithdrawalSicknessCocaine, useSubstanceToPreventWithdrawalSicknessStimulant,
useSubstanceToPreventWithdrawalSicknessCannabis, useSubstanceToPreventWithdrawalSicknessHallucinogen,
useSubstanceToPreventWithdrawalSicknessSolventAndInhalant,useSubstanceToPreventWithdrawalSicknessOtherSubstance );
return CalculateCareLevel_I_DetoxificationScore ( ciwaCinaAndWithdrawalSicknessIndicator,
minimumDaysSinceLastUsedDrugExceptNicotine,daysSinceLastUsedNicotine,signsOfIntoxicationExist,
majorityOfInformationFromCollateralSource,maxCuadScaleSumForOneDrugExceptNicotine, nicotineCuadScaleSum,
anyAddictionDiagnosis );
public CareLevel_II_DetoxificationScore CalculateCareLevel_II_DetoxificationScore ( Assessment assessment,
AssessmentScore assessmentScore )
Let experiencedNauseaOrVomitedRecentlyCiwa =
assessment.DrugAndAlcoholSection.CiwaScale.ExperiencedNauseaOrVomitedRecently;
Let observedTremorCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTremor;
Let observedSweatingCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedSweating;
Let observedNervousness = assessment.DrugAndAlcoholSection.CiwaScale.ObservedNervousness;
Let interviewerObservationOfPatientAgitationLevel =
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel;
Let observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances;
Let auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
Let visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
Let headAcheOrFullnessSeverity = assessment.DrugAndAlcoholSection.CiwaScale.HeadAcheOrFullnessSeverity;
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
Let experiencedNauseaOrVomitedRecently = assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
Let observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
Let observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
Let observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
Let observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
Let observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
Let observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
Let observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
Let hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
Let feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
Let hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
Let heartRate = assessment.MedicalSection.HeartRate;
Let experiencesWithdrawalSicknessAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessHeroin = assessment.DrugAndAlcoholSection.HeroinUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessCocaine = assessment.DrugAndAlcoholSection.CocaineUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessCannabis = assessment.DrugAndAlcoholSection.CannabisUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.ExperiencesWithdrawalSickness;
Let experiencesWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.ExperiencesWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessHeroin =
assessment.DrugAndAlcoholSection.HeroinUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessCocaine =
assessment.DrugAndAlcoholSection.CocaineUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessCannabis =
assessment.DrugAndAlcoholSection.CannabisUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.UseSubstanceToPreventWithdrawalSickness;
Let useSubstanceToPreventWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.UseSubstanceToPreventWithdrawalSickness;
Let minimumDaysSinceLastUsedDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MinimumDaysSinceLastUsedDrugExceptNicotine;
Let daysSinceLastUsedNicotine = assessmentScore.DiagnosisResults.CommonScores.DaysSinceLastUsedNicotine;
Let signsOfIntoxicationExist = assessment.MedicalSection.SignsOfIntoxicationExist;
Let majorityOfInformationFromCollateralSource =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.MajorityOfInformationFromCollateralSource;
Let maxCuadScaleSumForOneDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MaxCuadScaleSumForOneDrugExceptNicotine;
Let anyAddictionDiagnosis = assessmentScore.DiagnosisResults.AnyAddictionDiagnosis;
Let ciwaCinaAndWithdrawalSicknessIndicator =
CalculateCiwaCinaAndWithdrawalSicknessIndicator ( experiencedNauseaOrVomitedRecentlyCiwa,
observedTremorCiwa, observedSweatingCiwa, observedNervousness,
interviewerObservationOfPatientAgitationLevel, observedTactileDisturbances, auditoryDisturbanceLevel,
visualDisturbanceLevel, headAcheOrFullnessSeverity, interviewerObservationOfPatientSenseOfAwareness,
experiencedNauseaOrVomitedRecently, observedGooseFlesh, observedSweating, observedRestlessness, observedTremor,
observedLacrimination, observedNasalCongestion, observedYawning, hasAbdominalPain, feelsHotOrCold,
hasMuscleAches, heartRate, experiencesWithdrawalSicknessAlcohol,experiencesWithdrawalSicknessHeroin,
experiencesWithdrawalSicknessMethadone, experiencesWithdrawalSicknessOtherOpiate,
experiencesWithdrawalSicknessBarbiturate, experiencesWithdrawalSicknessOtherSedative,
experiencesWithdrawalSicknessCocaine, experiencesWithdrawalSicknessStimulant,
experiencesWithdrawalSicknessCannabis, experiencesWithdrawalSicknessHallucinogen,
experiencesWithdrawalSicknessSolventAndInhalant, experiencesWithdrawalSicknessOtherSubstance,
useSubstanceToPreventWithdrawalSicknessAlcohol, useSubstanceToPreventWithdrawalSicknessHeroin,
useSubstanceToPreventWithdrawalSicknessMethadone, useSubstanceToPreventWithdrawalSicknessOtherOpiate,
useSubstanceToPreventWithdrawalSicknessBarbiturate, useSubstanceToPreventWithdrawalSicknessOtherSedative,
useSubstanceToPreventWithdrawalSicknessCocaine, useSubstanceToPreventWithdrawalSicknessStimulant,
useSubstanceToPreventWithdrawalSicknessCannabis, useSubstanceToPreventWithdrawalSicknessHallucinogen,
useSubstanceToPreventWithdrawalSicknessSolventAndInhalant,useSubstanceToPreventWithdrawalSicknessOtherSubstance );
return CalculateCareLevel_II_DetoxificationScore ( ciwaCinaAndWithdrawalSicknessIndicator,
minimumDaysSinceLastUsedDrugExceptNicotine, daysSinceLastUsedNicotine, signsOfIntoxicationExist,
majorityOfInformationFromCollateralSource,maxCuadScaleSumForOneDrugExceptNicotine,anyAddictionDiagnosis );
public CareLevel_III_2_DetoxificationScore CalculateCareLevel_III_2_DetoxificationScore ( Assessment assessment,
AssessmentScore assessmentScore )
Let careLevel_II_DetoxificationIsDiagnosed =
assessmentScore.DiagnosisResults.CareLevel_II_DetoxificationScore.IsDiagnosed;
return CalculateCareLevel_III_2_DetoxificationScore ( careLevel_II_DetoxificationIsDiagnosed );
public CareLevel_III_7_DetoxificationScore CalculateCareLevel_III_7_DetoxificationScore ( Assessment assessment,
AssessmentScore assessmentScore )
Let careLevel_II_DetoxificationIsDiagnosed =
assessmentScore.DiagnosisResults.CareLevel_II_DetoxificationScore.IsDiagnosed;
return CalculateCareLevel_III_7_DetoxificationScore(careLevel_II_DetoxificationIsDiagnosed);
public CareLevel_IV_DetoxificationScore CalculateCareLevel_IV_DetoxificationScore ( Assessment assessment,
AssessmentScore assessmentScore )
Let careLevel_II_DetoxificationIsDiagnosed =
assessmentScore.DiagnosisResults.CareLevel_II_DetoxificationScore.IsDiagnosed;
return CalculateCareLevel_IV_DetoxificationScore(careLevel_II_DetoxificationIsDiagnosed);
public CareLevel_0_5_EarlyInterventionScore CalculateCareLevel_0_5_EarlyInterventionScore ( Assessment
assessment, AssessmentScore assessmentScore )
Let diagnosisxResultsCareLevel_I_OutpatientScoreIsMet =
assessmentScore.DiagnosisResults.CareLevel_I_OutpatientScore.IsMet;
Let maxCuadScaleSumForOneDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MaxCuadScaleSumForOneDrugExceptNicotine;
Let nicotineCuadScaleSum = assessmentScore.DiagnosisResults.CommonScores.NicotineCuadScaleSum;
Let anyAddictionDiagnosisExceptNicotine = assessmentScore.DiagnosisResults.AnyAddictionDiagnosisExceptNicotine;
return CalculateCareLevel_0_5_EarlyInterventionScore (diagnosisxResultsCareLevel_I_OutpatientScoreIsMet,
maxCuadScaleSumForOneDrugExceptNicotine,nicotineCuadScaleSum,anyAddictionDiagnosisExceptNicotine );
public CareLevel_I_OutpatientScore CalculateCareLevel_I_OutpatientScore ( Assessment assessment, AssessmentScore
assessmentScore )
Let experiencedNauseaOrVomitedRecentlyCiwa =
assessment.DrugAndAlcoholSection.CiwaScale.ExperiencedNauseaOrVomitedRecently;
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observedTremorCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTremor;
observedSweatingCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedSweating;
observedNervousness = assessment.DrugAndAlcoholSection.CiwaScale.ObservedNervousness;
interviewerObservationOfPatientAgitationLevel =
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel;
observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances;
auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
headAcheOrFullnessSeverity = assessment.DrugAndAlcoholSection.CiwaScale.HeadAcheOrFullnessSeverity;
interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
experiencedNauseaOrVomitedRecently = assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
heartRate = assessment.MedicalSection.HeartRate;
experiencesWithdrawalSicknessAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessHeroin = assessment.DrugAndAlcoholSection.HeroinUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessCocaine = assessment.DrugAndAlcoholSection.CocaineUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessCannabis = assessment.DrugAndAlcoholSection.CannabisUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.ExperiencesWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessHeroin =
assessment.DrugAndAlcoholSection.HeroinUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessCocaine =
assessment.DrugAndAlcoholSection.CocaineUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessCannabis =
assessment.DrugAndAlcoholSection.CannabisUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.UseSubstanceToPreventWithdrawalSickness;
Let minimumDaysSinceLastUsedDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MinimumDaysSinceLastUsedDrugExceptNicotine;
Let daysSinceLastUsedNicotine = assessmentScore.DiagnosisResults.CommonScores.DaysSinceLastUsedNicotine;
Let signsOfIntoxicationExist = assessment.MedicalSection.SignsOfIntoxicationExist;
Let majorityOfInformationFromCollateralSource =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.MajorityOfInformationFromCollateralSource;
Let maxCuadScaleSumForOneDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MaxCuadScaleSumForOneDrugExceptNicotine;
Let nicotineCuadScaleSum = assessmentScore.DiagnosisResults.CommonScores.NicotineCuadScaleSum;
Let anyAddictionDiagnosis = assessmentScore.DiagnosisResults.AnyAddictionDiagnosis;
Let anyAddictionDiagnosisExceptNicotine = assessmentScore.DiagnosisResults.AnyAddictionDiagnosisExceptNicotine;
Let numberOfTimesTreatedForAlcoholAbuseLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesTreatedForAlcoholAbuseLifetime;
Let numberOfTimesDrugTreatmentLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesDrugTreatmentLifetime;
Let interviewerScoreOfAlcoholTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAlcoholTreatmentNeed;
Let interviewerScoreOfDrugTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfDrugTreatmentNeed;
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
Let nicotineTobaccoIsDependentWithPhysiologicalDependency =
assessmentScore.DiagnosisResults.DiagnosticStatisticalManualOfMentalDisorders_IV_Scores.NicotineTobaccoScore.
IsDependentWithPhysiologicalDependency;
Let ciwaCinaAndWithdrawalSicknessIndicator =
CalculateCiwaCinaAndWithdrawalSicknessIndicator ( experiencedNauseaOrVomitedRecentlyCiwa,
observedTremorCiwa, observedSweatingCiwa, observedNervousness, interviewerObservationOfPatientAgitationLevel,
observedTactileDisturbances, auditoryDisturbanceLevel, visualDisturbanceLevel, headAcheOrFullnessSeverity,
interviewerObservationOfPatientSenseOfAwareness,experiencedNauseaOrVomitedRecently, observedGooseFlesh,
observedSweating, observedRestlessness, observedTremor, observedLacrimination, observedNasalCongestion,
observedYawning, hasAbdominalPain, feelsHotOrCold, hasMuscleAches, heartRate,
experiencesWithdrawalSicknessAlcohol, experiencesWithdrawalSicknessHeroin,experiencesWithdrawalSicknessMethadone,
experiencesWithdrawalSicknessOtherOpiate, experiencesWithdrawalSicknessBarbiturate,
experiencesWithdrawalSicknessOtherSedative, experiencesWithdrawalSicknessCocaine,
experiencesWithdrawalSicknessStimulant, experiencesWithdrawalSicknessCannabis,
experiencesWithdrawalSicknessHallucinogen, experiencesWithdrawalSicknessSolventAndInhalant,
experiencesWithdrawalSicknessOtherSubstance, useSubstanceToPreventWithdrawalSicknessAlcohol,
useSubstanceToPreventWithdrawalSicknessHeroin, useSubstanceToPreventWithdrawalSicknessMethadone,
useSubstanceToPreventWithdrawalSicknessOtherOpiate, useSubstanceToPreventWithdrawalSicknessBarbiturate,
useSubstanceToPreventWithdrawalSicknessOtherSedative, useSubstanceToPreventWithdrawalSicknessCocaine,
useSubstanceToPreventWithdrawalSicknessStimulant, useSubstanceToPreventWithdrawalSicknessCannabis,
useSubstanceToPreventWithdrawalSicknessHallucinogen, useSubstanceToPreventWithdrawalSicknessSolventAndInhalant,
useSubstanceToPreventWithdrawalSicknessOtherSubstance );
return CalculateCareLevel_I_OutpatientScore ( ciwaCinaAndWithdrawalSicknessIndicator,
minimumDaysSinceLastUsedDrugExceptNicotine, daysSinceLastUsedNicotine, signsOfIntoxicationExist,
majorityOfInformationFromCollateralSource, maxCuadScaleSumForOneDrugExceptNicotine,
nicotineCuadScaleSum, anyAddictionDiagnosis, anyAddictionDiagnosisExceptNicotine,
numberOfTimesTreatedForAlcoholAbuseLifetime, numberOfTimesDrugTreatmentLifetime,
interviewerScoreOfAlcoholTreatmentNeed, interviewerScoreOfDrugTreatmentNeed,
doesPatientCarryPsychiatricDiagnosis, withdrawalSymptomsAndEmotionalBehavioralProblems,
nicotineTobaccoIsDependentWithPhysiologicalDependency );
public CareLevelOpioidMaintenanceTherapyScore CalculateCareLevelOpioidMaintenanceTherapyScore ( Assessment assessment,
AssessmentScore assessmentScore )
Let experiencedNauseaOrVomitedRecentlyCiwa =
assessment.DrugAndAlcoholSection.CiwaScale.ExperiencedNauseaOrVomitedRecently;
Let observedTremorCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTremor;
Let observedSweatingCiwa = assessment.DrugAndAlcoholSection.CiwaScale.ObservedSweating;
Let observedNervousness = assessment.DrugAndAlcoholSection.CiwaScale.ObservedNervousness;
Let interviewerObservationOfPatientAgitationLevel =
assessment.MedicalSection.InterviewerObservationOfPatientAgitationLevel;
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observedTactileDisturbances = assessment.DrugAndAlcoholSection.CiwaScale.ObservedTactileDisturbances;
auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
headAcheOrFullnessSeverity = assessment.DrugAndAlcoholSection.CiwaScale.HeadAcheOrFullnessSeverity;
interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
experiencedNauseaOrVomitedRecently = assessment.DrugAndAlcoholSection.CinaScale.ExperiencedNauseaOrVomitedRecently;
observedGooseFlesh = assessment.DrugAndAlcoholSection.CinaScale.ObservedGooseFlesh;
observedSweating = assessment.DrugAndAlcoholSection.CinaScale.ObservedSweating;
observedRestlessness = assessment.DrugAndAlcoholSection.CinaScale.ObservedRestlessness;
observedTremor = assessment.DrugAndAlcoholSection.CinaScale.ObservedTremor;
observedLacrimination = assessment.DrugAndAlcoholSection.CinaScale.ObservedLacrimination;
observedNasalCongestion = assessment.DrugAndAlcoholSection.CinaScale.ObservedNasalCongestion;
observedYawning = assessment.DrugAndAlcoholSection.CinaScale.ObservedYawning;
hasAbdominalPain = assessment.DrugAndAlcoholSection.CinaScale.HasAbdominalPain;
feelsHotOrCold = assessment.DrugAndAlcoholSection.CinaScale.FeelsHotOrCold;
hasMuscleAches = assessment.DrugAndAlcoholSection.CinaScale.HasMuscleAches;
heartRate = assessment.MedicalSection.HeartRate;
experiencesWithdrawalSicknessAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessHeroin = assessment.DrugAndAlcoholSection.HeroinUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessCocaine = assessment.DrugAndAlcoholSection.CocaineUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessCannabis = assessment.DrugAndAlcoholSection.CannabisUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.ExperiencesWithdrawalSickness;
experiencesWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.ExperiencesWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessHeroin =
assessment.DrugAndAlcoholSection.HeroinUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessMethadone =
assessment.DrugAndAlcoholSection.MethadoneUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessCocaine =
assessment.DrugAndAlcoholSection.CocaineUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessStimulant =
assessment.DrugAndAlcoholSection.StimulantUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessCannabis =
assessment.DrugAndAlcoholSection.CannabisUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessSolventAndInhalant =
assessment.DrugAndAlcoholSection.SolventAndInhalantUse.UseSubstanceToPreventWithdrawalSickness;
useSubstanceToPreventWithdrawalSicknessOtherSubstance =
assessment.DrugAndAlcoholSection.OtherSubstanceUse.UseSubstanceToPreventWithdrawalSickness;
minimumDaysSinceLastUsedDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MinimumDaysSinceLastUsedDrugExceptNicotine;
signsOfIntoxicationExist = assessment.MedicalSection.SignsOfIntoxicationExist;
Let majorityOfInformationFromCollateralSource =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.MajorityOfInformationFromCollateralSource;
Let maxCuadScaleSumForOneDrugExceptNicotine =
assessmentScore.DiagnosisResults.CommonScores.MaxCuadScaleSumForOneDrugExceptNicotine;
Let anyAddictionDiagnosisExceptNicotine = assessmentScore.DiagnosisResults.AnyAddictionDiagnosisExceptNicotine;
Let numberOfTimesTreatedForAlcoholAbuseLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesTreatedForAlcoholAbuseLifetime;
Let numberOfTimesDrugTreatmentLifetime =
assessment.DrugAndAlcoholSection.AddictionTreatmentHistory.NumberOfTimesDrugTreatmentLifetime;
Let interviewerScoreOfAlcoholTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfAlcoholTreatmentNeed;
Let interviewerScoreOfDrugTreatmentNeed =
assessment.DrugAndAlcoholSection.AlcoholAndDrugInterviewerRating.InterviewerScoreOfDrugTreatmentNeed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
Let doesPatientCarryPsychiatricDiagnosis =
assessment.PsychologicalSection.InterviewerRating.DoesPatientCarryPsychiatricDiagnosis;
Let ciwaCinaAndWithdrawalSicknessIndicator =
CalculateCiwaCinaAndWithdrawalSicknessIndicator ( experiencedNauseaOrVomitedRecentlyCiwa,
observedTremorCiwa, observedSweatingCiwa, observedNervousness, interviewerObservationOfPatientAgitationLevel,
observedTactileDisturbances, auditoryDisturbanceLevel, visualDisturbanceLevel, headAcheOrFullnessSeverity,
interviewerObservationOfPatientSenseOfAwareness, experiencedNauseaOrVomitedRecently, observedGooseFlesh,
observedSweating, observedRestlessness, observedTremor, observedLacrimination, observedNasalCongestion,
observedYawning, hasAbdominalPain, feelsHotOrCold, hasMuscleAches, heartRate,
experiencesWithdrawalSicknessAlcohol, experiencesWithdrawalSicknessHeroin, experiencesWithdrawalSicknessMethadone,
experiencesWithdrawalSicknessOtherOpiate, experiencesWithdrawalSicknessBarbiturate,
experiencesWithdrawalSicknessOtherSedative, experiencesWithdrawalSicknessCocaine,
experiencesWithdrawalSicknessStimulant, experiencesWithdrawalSicknessCannabis,
experiencesWithdrawalSicknessHallucinogen, experiencesWithdrawalSicknessSolventAndInhalant,
experiencesWithdrawalSicknessOtherSubstance, useSubstanceToPreventWithdrawalSicknessAlcohol,
useSubstanceToPreventWithdrawalSicknessHeroin, useSubstanceToPreventWithdrawalSicknessMethadone,
useSubstanceToPreventWithdrawalSicknessOtherOpiate, useSubstanceToPreventWithdrawalSicknessBarbiturate,
useSubstanceToPreventWithdrawalSicknessOtherSedative, useSubstanceToPreventWithdrawalSicknessCocaine,
useSubstanceToPreventWithdrawalSicknessStimulant, useSubstanceToPreventWithdrawalSicknessCannabis,
useSubstanceToPreventWithdrawalSicknessHallucinogen,useSubstanceToPreventWithdrawalSicknessSolventAndInhalant,
useSubstanceToPreventWithdrawalSicknessOtherSubstance );
return CalculateCareLevelOpioidMaintenanceTherapyScore ( ciwaCinaAndWithdrawalSicknessIndicator,
minimumDaysSinceLastUsedDrugExceptNicotine, signsOfIntoxicationExist, majorityOfInformationFromCollateralSource,
maxCuadScaleSumForOneDrugExceptNicotine, anyAddictionDiagnosisExceptNicotine,
numberOfTimesTreatedForAlcoholAbuseLifetime,numberOfTimesDrugTreatmentLifetime,
interviewerScoreOfAlcoholTreatmentNeed, interviewerScoreOfDrugTreatmentNeed,
withdrawalSymptomsAndEmotionalBehavioralProblems, doesPatientCarryPsychiatricDiagnosis );
public CareLevel_II_1_IntensiveOutpatientScore CalculateCareLevel_II_1_IntensiveOutpatientScore ( Assessment
assessment, AssessmentScore assessmentScore )
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_II_1_IntensiveOutpatientScore (omtIsDiagnosed,omtIsLikelyDiagnosed,
withdrawalSymptomsAndEmotionalBehavioralProblems );
public CareLevel_II_5_PartialHospitalizationScore CalculateCareLevel_II_5_PartialHospitalizationScore ( Assessment
assessment, AssessmentScore assessmentScore )
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_II_5_PartialHospitalizationScore(omtIsDiagnosed,omtIsLikelyDiagnosed,
withdrawalSymptomsAndEmotionalBehavioralProblems);
public CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore
CalculateCareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore ( Assessment assessment,
AssessmentScore assessmentScore )
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore( omtIsDiagnosed,
omtIsLikelyDiagnosed, withdrawalSymptomsAndEmotionalBehavioralProblems);
public CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore
CalculateCareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore ( Assessment assessment,
AssessmentScore assessmentScore )
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore(
omtIsDiagnosed,omtIsLikelyDiagnosed,withdrawalSymptomsAndEmotionalBehavioralProblems);
public CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore
CalculateCareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore ( Assessment assessment,
AssessmentScore assessmentScore )
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore(
omtIsDiagnosed,omtIsLikelyDiagnosed,withdrawalSymptomsAndEmotionalBehavioralProblems);
public CareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore
CalculateCareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore ( Assessment assessment,
AssessmentScore assessmentScore )
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore(omtIsDiagnosed,
omtIsLikelyDiagnosed,withdrawalSymptomsAndEmotionalBehavioralProblems);
public CareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore
CalculateCareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore ( Assessment assessment, AssessmentScore
assessmentScore )
Let omtIsDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsDiagnosed;
Let omtIsLikelyDiagnosed = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsLikelyDiagnosed;
Let withdrawalSymptomsAndEmotionalBehavioralProblems =
assessmentScore.DiagnosisResults.CommonScores.WithdrawalSymptomsAndEmotionalBehavioralProblems;
return CalculateCareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore(omtIsDiagnosed,
omtIsLikelyDiagnosed, withdrawalSymptomsAndEmotionalBehavioralProblems);
public IList<AsiScore> CalculateAddictionSeverityIndexCompositeScores(Assessment assessment, AssessmentScore
assessmentScore)
Let numberOfDaysWithMedicalProblemsInPast30Days =
assessment.MedicalSection.NumberOfDaysWithMedicalProblemsInPast30Days;
Let levelOfConcernInPast30DaysAboutMedicalProblems =
assessment.MedicalSection.LevelOfConcernInPast30DaysAboutMedicalProblems;
Let importanceOfTreatmentForMedicalProblems = assessment.MedicalSection.ImportanceOfTreatmentForMedicalProblems;
Let hasValidDriversLicense = assessment.EmploymentAndSupportSection.HasValidDriversLicense;
Let hasAutomobileAvailableForUse = assessment.EmploymentAndSupportSection.HasAutomobileAvailableForUse;
Let numberOfDaysWorkingInPast30Days = assessment.EmploymentAndSupportSection.NumberOfDaysWorkingInPast30Days;
Let amountOfMoneyInPast30DaysFromEmployment =
assessment.EmploymentAndSupportSection.AmountOfMoneyInPast30DaysFromEmployment;
Let numberOfDaysIntoxicatedInPast30DaysAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfDaysIntoxicatedInPast30Days;
Let amountOfMoneySpentInLast30DaysAlcohol = assessment.DrugAndAlcoholSection.AlcoholUse.AmountOfMoneySpentInLast30Days;
Let troubledInLast30DaysBySubstanceProblemsAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.TroubledInLast30DaysBySubstanceProblems;
Let importanceOfTreatmentForSubstanceProblemsAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.ImportanceOfTreatmentForSubstanceProblems;
Let numberOfDaysWithSubstanceProblemsInLast30DaysAlcohol =
assessment.DrugAndAlcoholSection.AlcoholUse.NumberOfDaysWithSubstanceProblemsInLast30Days;
Let numberOfDaysUsedInPast30DaysHeroin = assessment.DrugAndAlcoholSection.HeroinUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysMethadone = assessment.DrugAndAlcoholSection.MethadoneUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysOtherOpiate =
assessment.DrugAndAlcoholSection.OtherOpiateUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysBarbiturate =
assessment.DrugAndAlcoholSection.BarbiturateUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysOtherSedative =
assessment.DrugAndAlcoholSection.OtherSedativeUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysCocaine = assessment.DrugAndAlcoholSection.CocaineUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysStimulant = assessment.DrugAndAlcoholSection.StimulantUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysCannabis = assessment.DrugAndAlcoholSection.CannabisUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30DaysHallucinogen =
assessment.DrugAndAlcoholSection.HallucinogenUse.NumberOfDaysUsedInPast30Days;
Let numberOfDaysUsedInPast30Days =
assessment.DrugAndAlcoholSection.MultipleSubstanceUsePerDay.NumberOfDaysUsedInPast30Days;
Let numberOfDaysExperiencedSubstanceProblemsInPast30Days =
assessment.DrugAndAlcoholSection.DrugConsequences.NumberOfDaysExperiencedSubstanceProblemsInPast30Days;
Let troubledInLast30DaysBySubstanceProblems =
assessment.DrugAndAlcoholSection.DrugConsequences.TroubledInLast30DaysBySubstanceProblems;
Let importanceOfTreatmentForSubstanceProblem =
assessment.DrugAndAlcoholSection.DrugConsequences.ImportanceOfTreatmentForSubstanceProblem;
Let isCurrentlyAwaitingChargesTrialSentence = assessment.LegalSection.IsCurrentlyAwaitingChargesTrialSentence;
Let numberOfDaysCommitingCrimesForProfitInPast30Days =
assessment.LegalSection.NumberOfDaysCommitingCrimesForProfitInPast30Days;
Let severityOfCurrentLegalProblems = assessment.LegalSection.SeverityOfCurrentLegalProblems;
Let amountOfMoneyInPast30DaysFromIllegalMeans =
assessment.EmploymentAndSupportSection.AmountOfMoneyInPast30DaysFromIllegalMeans;
Let hadProblemsInPastMonthWithMother = assessment.FamilyAndSocialHistorySection.HadProblemsInPastMonthWithMother;
Let hadProblemsInPastMonthWithFather = assessment.FamilyAndSocialHistorySection.HadProblemsInPastMonthWithFather;
Let hadProblemsInPastMonthWithSibling = assessment.FamilyAndSocialHistorySection.HadProblemsInPastMonthWithSibling;
Let hadProblemsInPastMonthWithSexPartner =
assessment.FamilyAndSocialHistorySection.HadProblemsInPastMonthWithSexPartner;
Let hadProblemsInPastMonthWithChildren = assessment.FamilyAndSocialHistorySection.HadProblemsInPastMonthWithChildren;
Let hadProblemsInPastMonthWithOtherFamily =
assessment.FamilyAndSocialHistorySection.HadProblemsInPastMonthWithOtherFamily;
Let hadProblemsInPastMonthWithCloseFriends =
assessment.FamilyAndSocialHistorySection.HadProblemsInPastMonthWithCloseFriends;
Let hadProblemsInPastMonthWithNeighbors = assessment.FamilyAndSocialHistorySection.HadProblemsInPastMonthWithNeighbors;
Let hadProblemsInPastMonthWithCoworkers = assessment.FamilyAndSocialHistorySection.HadProblemsInPastMonthWithCoworkers;
Let satisfiedWithThisSituation = assessment.FamilyAndSocialHistorySection.SatisfiedWithThisSituation;
Let seriousConflictsWithFamilyInPast30Days =
assessment.FamilyAndSocialHistorySection.SeriousConflictsWithFamilyInPast30Days;
Let troubledByFamilyProblemsInPast30Days =
assessment.FamilyAndSocialHistorySection.TroubledByFamilyProblemsInPast30Days;
Let importanceOfTreatmentForFamilyMembers =
assessment.FamilyAndSocialHistorySection.ImportanceOfTreatmentForFamilyMembers;
Let howTroubledByPsychologicalEmotionalProblemsLast30Days =
assessment.PsychologicalSection.PsychologicalHistory.HowTroubledByPsychologicalEmotionalProblemsLast30Days;
Let significantPeriodOfSeriousDepressionInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodOfSeriousDepressionInLastMonth;
Let anxietyTensionWorryInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.AnxietyTensionWorryInLastMonth;
Let significantPeriodHallucinationsInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodHallucinationsInLastMonth;
Let significantPeriodImpairedThoughtInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodImpairedThoughtInLastMonth;
Let significantPeriodCurbingViolentBehaviorInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodCurbingViolentBehaviorInLastMonth;
Let significantPeriodSuicidalThoughtsInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSuicidalThoughtsInLastMonth;
Let significantPeriodAttemptedSuicideInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodAttemptedSuicideInLastMonth;
Let medicatedForPsychologicalEmotionalProblemInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.MedicatedForPsychologicalEmotionalProblemInLastMonth;
Let numberOfDaysExperiencedPsychologicalEmotionalProblemsInLast30Days =
assessment.PsychologicalSection.PsychologicalHistory.NumberOfDaysExperiencedPsychologicalEmotional
ProblemsInLast30Days;
Let howImportantPsychologicalEmotionalCounseling =
assessment.PsychologicalSection.PsychologicalHistory.HowImportantPsychologicalEmotionalCounseling;
return CalculateAddictionSeverityIndexCompositeScores (
numberOfDaysWithMedicalProblemsInPast30Days, levelOfConcernInPast30DaysAboutMedicalProblems,
importanceOfTreatmentForMedicalProblems,hasValidDriversLicense,hasAutomobileAvailableForUse,
numberOfDaysWorkingInPast30Days,amountOfMoneyInPast30DaysFromEmployment,numberOfDaysUsedInPast30DaysAlcohol,
numberOfDaysIntoxicatedInPast30DaysAlcohol, amountOfMoneySpentInLast30DaysAlcohol,
troubledInLast30DaysBySubstanceProblemsAlcohol, importanceOfTreatmentForSubstanceProblemsAlcohol,
numberOfDaysWithSubstanceProblemsInLast30DaysAlcohol,numberOfDaysUsedInPast30DaysHeroin,
numberOfDaysUsedInPast30DaysMethadone, numberOfDaysUsedInPast30DaysOtherOpiate,
numberOfDaysUsedInPast30DaysBarbiturate,numberOfDaysUsedInPast30DaysOtherSedative,
numberOfDaysUsedInPast30DaysCocaine, numberOfDaysUsedInPast30DaysStimulant,
numberOfDaysUsedInPast30DaysCannabis,numberOfDaysUsedInPast30DaysHallucinogen,numberOfDaysUsedInPast30Days,
numberOfDaysExperiencedSubstanceProblemsInPast30Days,troubledInLast30DaysBySubstanceProblems,
importanceOfTreatmentForSubstanceProblem,isCurrentlyAwaitingChargesTrialSentence,
numberOfDaysCommitingCrimesForProfitInPast30Days, severityOfCurrentLegalProblems,
importanceOfCounselingForCurrentLegalProblems, amountOfMoneyInPast30DaysFromIllegalMeans,
hadProblemsInPastMonthWithMother,
hadProblemsInPastMonthWithFather,
hadProblemsInPastMonthWithSibling,
hadProblemsInPastMonthWithSexPartner,
hadProblemsInPastMonthWithChildren,
hadProblemsInPastMonthWithOtherFamily,
hadProblemsInPastMonthWithCloseFriends,
hadProblemsInPastMonthWithNeighbors,
hadProblemsInPastMonthWithCoworkers,
satisfiedWithThisSituation,
seriousConflictsWithFamilyInPast30Days,
troubledByFamilyProblemsInPast30Days,
importanceOfTreatmentForFamilyMembers,
howTroubledByPsychologicalEmotionalProblemsLast30Days,
significantPeriodOfSeriousDepressionInLastMonth,
anxietyTensionWorryInLastMonth,
significantPeriodHallucinationsInLastMonth,
significantPeriodImpairedThoughtInLastMonth,
significantPeriodCurbingViolentBehaviorInLastMonth,
significantPeriodSuicidalThoughtsInLastMonth,
significantPeriodAttemptedSuicideInLastMonth,
medicatedForPsychologicalEmotionalProblemInLastMonth,
numberOfDaysExperiencedPsychologicalEmotionalProblemsInLast30Days,
howImportantPsychologicalEmotionalCounseling );
public bool? CalculateWithdrawalSymptomsAndEmotionalBehavioralProblems(Assessment assessment, AssessmentScore
assessmentScore)
Let significantPeriodNegativeThoughtsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodNegativeThoughtsInLast24Hours;
Let significantPeriodExcessiveBehaviorInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodExcessiveBehaviorInLast24Hours;
Let significantPeriodParanoiaInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodParanoiaInLast24Hours;
Let significantPeriodUntruePerceptionInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodUntruePerceptionInLast24Hours;
Let significantPeriodHallucinationsInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodHallucinationsInLast24Hours;
Let significantPeriodFlashbacksInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodFlashbacksInLast24Hours;
Let significantPeriodImpairedThoughtInLast24Hours =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodImpairedThoughtInLast24Hours;
Let significantPeriodSuicidalThoughtsInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodSuicidalThoughtsInLastMonth;
Let significantPeriodAttemptedSuicideInLastMonth =
assessment.PsychologicalSection.PsychologicalHistory.SignificantPeriodAttemptedSuicideInLastMonth;
Let interviewerObservationOfPatientSenseOfAwareness =
assessment.MedicalSection.InterviewerObservationOfPatientSenseOfAwareness;
Let signsOfToxicPsychosisExist = assessment.MedicalSection.SignsOfToxicPsychosisExist;
Let appearanceOfParanoiaOrImpairedThinking =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfParanoiaOrImpairedThinking;
Let appearanceOfTroubleConcentratingOrRemembering =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfTroubleConcentratingOrRemembering;
Let appearanceOfLethargy = assessment.PsychologicalSection.InterviewerRating.AppearanceOfLethargy;
Let appearanceOfFluctuatingOrientationInLast24Hours =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfFluctuatingOrientationInLast24Hours;
Let appearanceOfSpeechImpairmentBadPosture =
assessment.PsychologicalSection.InterviewerRating.AppearanceOfSpeechImpairmentBadPosture;
Let hasSuicidalThoughts = assessment.PsychologicalSection.InterviewerRating.HasSuicidalThoughts;
Let demonstratingDangerToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.DemonstratingDangerToSelfOrOthers;
Let limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers =
assessment.PsychologicalSection.InterviewerRating.LimitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers;
Let auditoryDisturbanceLevel = assessment.MedicalSection.AuditoryDisturbanceLevel;
Let visualDisturbanceLevel = assessment.MedicalSection.VisualDisturbanceLevel;
Let commonScores = assessmentScore.Dimension3EmotionalBehavioralScores.CommonScores;
return CalculateWithdrawalSymptomsAndEmotionalBehavioralProblems(
significantPeriodNegativeThoughtsInLast24Hours, significantPeriodExcessiveBehaviorInLast24Hours,
significantPeriodParanoiaInLast24Hours, significantPeriodUntruePerceptionInLast24Hours,
significantPeriodHallucinationsInLast24Hours, significantPeriodFlashbacksInLast24Hours,
significantPeriodImpairedThoughtInLast24Hours, significantPeriodSuicidalThoughtsInLastMonth,
significantPeriodAttemptedSuicideInLastMonth, appearanceOfParanoiaOrImpairedThinking,
appearanceOfTroubleConcentratingOrRemembering, appearanceOfLethargy,
appearanceOfFluctuatingOrientationInLast24Hours, appearanceOfSpeechImpairmentBadPosture,
hasSuicidalThoughts, demonstratingDangerToSelfOrOthers,
limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers,interviewerObservationOfPatientSenseOfAwareness,
signsOfToxicPsychosisExist,auditoryDisturbanceLevel, visualDisturbanceLevel,
commonScores.HasImmediateMajorDepressionDisorder,commonScores.HasImmediateOtherDepressionDisorder,
commonScores.HasPanicSyndrome, commonScores.HasOtherAnxietySyndrome, commonScores.HistoryOfHarmRiskToSelfOthers,
commonScores.CurrentHarmRiskToSelfOthers);
// David Gastfriends Original PseudoCode:
// Dim3Px = TRUE If [any of ASIp: 4vD,4wD,4xD,4yD,5D,5aD,6D >2] or [ASIp8M or p9M >1] or [MDDI, ODDI, PS or OAS =1]
or CIWA10>2 or ASIm6b>0 or [Any of ASIp: 17,18,18a,18b,18c,19,19a,19b >2] or [CIWA7 or 8 >3]
// Current Delphi Code:
//
OB_Dim3Px := ( (ASIp4vD > 2) or (ASIp4wD > 2) or (ASIp4xD > 2) or (ASIp4yD > 2) or (ASIp5D > 2) or
(ASIp5aD > 2) or (ASIp6D > 2) ) or
// ( (ASIp8M > 1) or (ASIp9M > 1) ) or
// (OB_MDDI or OB_ODDI or OB_PS or OB_OAS) or
// (CIWA10 > 2) or (ASIm6b > 0) or
// ( OI_HxRisk > 0 ) or ( OI_CurRisk > 0 ) or
// ( (ASIp17 > 2) or (ASIp18 > 2) or (ASIp18a > 2) or (ASIp18b > 2) or (ASIp18c > 2) or (ASIp19 > 2) or
//
(ASIp19a > 2) or (ASIp19b > 2) or (CIWA7 > 3) or (CIWA8 > 3) );
Let significantDisorderSymptomsList = new[]
{ significantPeriodNegativeThoughtsInLast24Hours, significantPeriodExcessiveBehaviorInLast24Hours,
significantPeriodParanoiaInLast24Hours, significantPeriodUntruePerceptionInLast24Hours,
significantPeriodHallucinationsInLast24Hours, significantPeriodFlashbacksInLast24Hours,
significantPeriodImpairedThoughtInLast24Hours,};
Let significantDisorderSymptomsInLastMonthList = new[]
significantPeriodSuicidalThoughtsInLastMonth,
significantPeriodAttemptedSuicideInLastMonth, };
{
Let appearanceList = new[]
{
appearanceOfParanoiaOrImpairedThinking, appearanceOfTroubleConcentratingOrRemembering,
appearanceOfLethargy, appearanceOfFluctuatingOrientationInLast24Hours,
appearanceOfSpeechImpairmentBadPosture,hasSuicidalThoughts, demonstratingDangerToSelfOrOthers,
limitedInAbilityToContractForSafetyIfRiskOfHarmToSelfOrOthers, };
return significantDisorderSymptomsList.Any(s => s > LikertScale.Moderately)
Or significantDisorderSymptomsInLastMonthList.Any(s => s > LikertScale.Slightly)
Or (hasImmediateMajorDepressionDisorder ?? false)
Or (hasImmediateOtherDepressionDisorder ?? false)
Or (hasPanicSyndrome ?? false)
Or (hasOtherAnxietySyndrome ?? false)
Or interviewerObservationOfPatientSenseOfAwareness > SenseOfAwareness.DisorientedForDateByNoMoreThan2CalendarDays
Or signsOfToxicPsychosisExist > YesNoNotSure.No
Or (historyOfHarmRiskToSelfOthers > 0)
Or (currentHarmRiskToSelfOthers > 0)
Or appearanceList.Any(s => s > 2)
Or auditoryDisturbanceLevel > AuditoryDisturbanceLevel.ModerateHarshnessOrAbilityToFrighten
Or visualDisturbanceLevel > VisualDisturbanceLevel.ModerateSensitivity;
}
// Calculate D0 := ( CIWA > 4 ) or (CINA > 4) or (CUADITEM02 > 0) or (CUADITEM03 > 0);
internal static bool CalculateCiwaCinaAndWithdrawalSicknessIndicator (
ExperiencedNauseaOrVomitedRecently experiencedNauseaOrVomitedRecentlyCiwa,
TremorObservation observedTremorCiwa,SweatingObservation observedSweatingCiwa,
NervousnessObservation observedNervousness, ScaleOf0To7 interviewerObservationOfPatientAgitationLevel,
TactileDisturbancesObservation observedTactileDisturbances,
AuditoryDisturbanceLevel auditoryDisturbanceLevel,
VisualDisturbanceLevel visualDisturbanceLevel,
HeadAcheOrFullnessSeverity headAcheOrFullnessSeverity,
SenseOfAwareness interviewerObservationOfPatientSenseOfAwareness,
ScaleOf0To9 experiencedNauseaOrVomitedRecently,
GooseFleshObservation observedGooseFlesh,
SweatingObservation observedSweating,
RestlessnessObservation observedRestlessness,
TremorObservation observedTremor,
LacriminationObservation observedLacrimination,
NasalCongestionObservation observedNasalCongestion,
YawningObservation observedYawning,
AbdominalPainStatus hasAbdominalPain,
BodyTemperatureStatus feelsHotOrCold, MuscleAcheStatus hasMuscleAches, HeartRate heartRate,
bool? experiencesWithdrawalSicknessAlcohol, bool? experiencesWithdrawalSicknessHeroin,
bool? experiencesWithdrawalSicknessMethadone,
bool? experiencesWithdrawalSicknessOtherOpiate,
bool? experiencesWithdrawalSicknessBarbiturate,
bool? experiencesWithdrawalSicknessOtherSedative,
bool? experiencesWithdrawalSicknessCocaine,
bool? experiencesWithdrawalSicknessStimulant,
bool? experiencesWithdrawalSicknessCannabis,
bool? experiencesWithdrawalSicknessHallucinogen,
bool? experiencesWithdrawalSicknessSolventAndInhalant,
bool? experiencesWithdrawalSicknessOtherSubstance,
bool? useSubstanceToPreventWithdrawalSicknessAlcohol,
bool? useSubstanceToPreventWithdrawalSicknessHeroin,
bool? useSubstanceToPreventWithdrawalSicknessMethadone,
bool? useSubstanceToPreventWithdrawalSicknessOtherOpiate,
bool? useSubstanceToPreventWithdrawalSicknessBarbiturate,
bool? useSubstanceToPreventWithdrawalSicknessOtherSedative,
bool? useSubstanceToPreventWithdrawalSicknessCocaine,
bool? useSubstanceToPreventWithdrawalSicknessStimulant,
bool? useSubstanceToPreventWithdrawalSicknessCannabis,
bool? useSubstanceToPreventWithdrawalSicknessHallucinogen,
bool? useSubstanceToPreventWithdrawalSicknessSolventAndInhalant,
bool? useSubstanceToPreventWithdrawalSicknessOtherSubstance )
{
Let ciwa = Utilities.CalculateCiwa ( experiencedNauseaOrVomitedRecentlyCiwa,
observedTremorCiwa, observedSweatingCiwa, observedNervousness, interviewerObservationOfPatientAgitationLevel,
observedTactileDisturbances, auditoryDisturbanceLevel, visualDisturbanceLevel,
headAcheOrFullnessSeverity, interviewerObservationOfPatientSenseOfAwareness );
Let cina = Utilities.CalculateCina ( experiencedNauseaOrVomitedRecently,observedGooseFlesh,
observedSweating, observedRestlessness, observedTremor, observedLacrimination, observedNasalCongestion,
observedYawning, hasAbdominalPain, feelsHotOrCold,hasMuscleAches, heartRate );
// CUADITEM02 := CUAD01_02 + CUAD03_02 + CUAD04_02 + CUAD05_02 + CUAD06_02 + CUAD07_02 +
//
CUAD08_02 + CUAD09_02 + CUAD10_02 + CUAD11_02 + CUAD12_02 + CUAD13_02 + CUAD13b_02;
Let experiencesWithdrawalSicknessList = new List<bool?> // CUAD13_02
{experiencesWithdrawalSicknessAlcohol, // CUAD01_02
experiencesWithdrawalSicknessHeroin, // CUAD03_02
experiencesWithdrawalSicknessMethadone, // CUAD04_02
experiencesWithdrawalSicknessOtherOpiate, // CUAD05_02
experiencesWithdrawalSicknessBarbiturate, // CUAD06_02
experiencesWithdrawalSicknessOtherSedative, // CUAD07_02
experiencesWithdrawalSicknessCocaine, // CUAD08_02
experiencesWithdrawalSicknessStimulant, // CUAD09_02
experiencesWithdrawalSicknessCannabis, // CUAD10_02
experiencesWithdrawalSicknessHallucinogen, // CUAD11_02
experiencesWithdrawalSicknessSolventAndInhalant, // CUAD12_02
experiencesWithdrawalSicknessOtherSubstance, // CUAD13b_02 }
Let sumOfExperiencesWithdrawalSickness = experiencesWithdrawalSicknessList.Count ( u => u.HasValue And
Let useSubstanceToPreventWithdrawalSicknessList = new List<bool?> //CUAD13_03
{useSubstanceToPreventWithdrawalSicknessAlcohol, // CUAD01_03
useSubstanceToPreventWithdrawalSicknessHeroin, // CUAD03_03
useSubstanceToPreventWithdrawalSicknessMethadone, // CUAD04_03
useSubstanceToPreventWithdrawalSicknessOtherOpiate, // CUAD05_03
useSubstanceToPreventWithdrawalSicknessBarbiturate, // CUAD06_03
useSubstanceToPreventWithdrawalSicknessOtherSedative, // CUAD07_03
useSubstanceToPreventWithdrawalSicknessCocaine, // CUAD08_03
useSubstanceToPreventWithdrawalSicknessStimulant, // CUAD09_03
useSubstanceToPreventWithdrawalSicknessCannabis, // CUAD10_03
useSubstanceToPreventWithdrawalSicknessHallucinogen, // CUAD11_03
useSubstanceToPreventWithdrawalSicknessSolventAndInhalant, // CUAD12_03
useSubstanceToPreventWithdrawalSicknessOtherSubstance, // CUAD13b_03
};
u.Value );
// CUADITEM03 := CUAD01_03 + CUAD03_03 + CUAD04_03 + CUAD05_03 + CUAD06_03 + CUAD07_03 +
//
CUAD08_03 + CUAD09_03 + CUAD10_03 + CUAD11_03 + CUAD12_03 + CUAD13_03 + CUAD13b_03;
// Note: No need to include Multiple Per Day CUAD13_03.
Let sumOfUseSubstanceToPreventWithdrawalSickness =
useSubstanceToPreventWithdrawalSicknessList.Count ( u => u.HasValue And
u.Value );
Let combinedindicator = ciwa > 4 Or cina > 4 Or sumOfExperiencesWithdrawalSickness > 0 Or
sumOfUseSubstanceToPreventWithdrawalSickness > 0; return combinedindicator; }
internal IList<AsiScore> CalculateAddictionSeverityIndexCompositeScores(
uint? numberOfDaysWithMedicalProblemsInPast30Days,
// ASIm6
LikertScale levelOfConcernInPast30DaysAboutMedicalProblems,
// ASIm7
LikertScale importanceOfTreatmentForMedicalProblems,
// ASIm8
bool? hasValidDriversLicense,
// ASIe4
bool? hasAutomobileAvailableForUse,
// ASIe5
uint? numberOfDaysWorkingInPast30Days,
// ASIe11
Money amountOfMoneyInPast30DaysFromEmployment,
// ASIe12
uint? numberOfDaysUsedInPast30DaysAlcohol,
// ASId01F
uint? numberOfDaysIntoxicatedInPast30DaysAlcohol,
// ASId02F
Money amountOfMoneySpentInLast30DaysAlcohol,
// ASId22a
LikertScale troubledInLast30DaysBySubstanceProblemsAlcohol,
// ASId23a
LikertScale importanceOfTreatmentForSubstanceProblemsAlcohol,
// ASId24a
uint? numberOfDaysWithSubstanceProblemsInLast30DaysAlcohol,
// ASId20a
uint? numberOfDaysUsedInPast30DaysHeroin,
// ASId03F
uint? numberOfDaysUsedInPast30DaysMethadone,
// ASId04F
uint? numberOfDaysUsedInPast30DaysOtherOpiate,
// ASId05F
uint? numberOfDaysUsedInPast30DaysBarbiturate,
// ASId06F
uint? numberOfDaysUsedInPast30DaysOtherSedative,
// ASId07F
uint? numberOfDaysUsedInPast30DaysCocaine,
// ASId08F
uint? numberOfDaysUsedInPast30DaysStimulant,
// ASId09F
uint? numberOfDaysUsedInPast30DaysCannabis,
// ASId10F
uint? numberOfDaysUsedInPast30DaysHallucinogen,
// ASId11F
uint? numberOfDaysUsedInPast30Days,
// ASId13F
uint? numberOfDaysExperiencedSubstanceProblemsInPast30Days,
// ASId22d
LikertScale troubledInLast30DaysBySubstanceProblems,
// ASId23d
LikertScale importanceOfTreatmentForSubstanceProblem,
// ASId24d
bool? isCurrentlyAwaitingChargesTrialSentence,
// ASIl22
uint? numberOfDaysCommitingCrimesForProfitInPast30Days,
// ASIl25
LikertScale severityOfCurrentLegalProblems,
// ASIl26
LikertScale importanceOfCounselingForCurrentLegalProblems,
// ASIl27
Money amountOfMoneyInPast30DaysFromIllegalMeans,
// ASIe17
YesNoNotApplicable hadProblemsInPastMonthWithMother,
// ASIf11_MONTH
YesNoNotApplicable hadProblemsInPastMonthWithFather,
// ASIf12_MONTH
YesNoNotApplicable hadProblemsInPastMonthWithSibling,
// ASIf13_MONTH
YesNoNotApplicable hadProblemsInPastMonthWithSexPartner,
// ASIf14_MONTH
YesNoNotApplicable hadProblemsInPastMonthWithChildren,
// ASIf15_MONTH
YesNoNotApplicable hadProblemsInPastMonthWithOtherFamily,
// ASIf16_MONTH
YesNoNotApplicable hadProblemsInPastMonthWithCloseFriends,
// ASIf17_MONTH
YesNoNotApplicable hadProblemsInPastMonthWithNeighbors,
// ASIf18_MONTH
YesNoNotApplicable hadProblemsInPastMonthWithCoworkers,
// ASIf19_MONTH
YesNoIndifferent satisfiedWithThisSituation,
// ASIf3
uint? seriousConflictsWithFamilyInPast30Days,
// ASIf10b
LikertScale troubledByFamilyProblemsInPast30Days,
// ASIf20
LikertScale importanceOfTreatmentForFamilyMembers,
// ASIf22
LikertScale howTroubledByPsychologicalEmotionalProblemsLast30Days,
// ASIp12
LikertScale significantPeriodOfSeriousDepressionInLastMonth,
// ASIp3M
LikertScale anxietyTensionWorryInLastMonth,
// ASIp4M
LikertScale significantPeriodHallucinationsInLastMonth,
// ASIp5M
LikertScale significantPeriodImpairedThoughtInLastMonth,
// ASIp6M
LikertScale significantPeriodCurbingViolentBehaviorInLastMonth,
// ASIp7M
LikertScale significantPeriodSuicidalThoughtsInLastMonth,
// ASIp8M
LikertScale significantPeriodAttemptedSuicideInLastMonth,
// ASIp9M
bool? medicatedForPsychologicalEmotionalProblemInLastMonth,
// ASIp10M
uint? numberOfDaysExperiencedPsychologicalEmotionalProblemsInLast30Days,
// ASIp11
PsychologicalEmotionalCounselingImportanceScale howImportantPsychologicalEmotionalCounseling
)
// ASIp13
{
Let asiScores = new List<AsiScore> ( );
//
//
//
//
// *** ASI Composite
// Added 1 Dec 2003,
// Medical Status is
ASI_Med_Composite :=
Scales Scoring ***
phe
A/90 + B/12 + C/12
RoundTo(((ASIm6/90) + (ASIm7+ ASIm8)/12), -3);
Let medicalScore =
Math.Round(((double)numberOfDaysWithMedicalProblemsInPast30Days) / 90D +
((double)levelOfConcernInPast30DaysAboutMedicalProblems + importanceOfTreatmentForMedicalProblems) / 12D, 3);
asiScores.Add(new AsiScore { AsiAspect = AsiAspect.Medical, Score = medicalScore });
//
//
//
//
//
//
//
// Employment Status is 1.00 - (A/4 + B/4 + C/120 + Log D/36)
ASI_Emp_Composite := 1.00 - ((ASIe4/4) + (ASIe5/4) + (ASIe11/120));
if (ASIe12 > 0) then
ASI_Emp_Composite := ASI_Emp_Composite - Log10(ASIe12)/36;
if (ASI_Emp_Composite = 1) then //SER added to compensate for interviewer skipping the Employment assessment
ASI_Emp_Composite := 0;
ASI_Emp_Composite := RoundTo(ASI_Emp_Composite, -3);
Let employmentScore = 1.00 - (Convert.ToDouble(hasValidDriversLicense) / 4D +
Convert.ToDouble(hasAutomobileAvailableForUse) / 4D + (double)numberOfDaysWorkingInPast30Days / 120D);
if (amountOfMoneyInPast30DaysFromEmployment > 0)
{employmentScore = employmentScore - Math.Log10(Convert.ToDouble(amountOfMoneyInPast30DaysFromEmployment))
/ 36D; }
if (employmentScore == 1D) { employmentScore = 0; }
employmentScore = Math.Round(employmentScore, 3);
asiScores.Add(new AsiScore { AsiAspect = AsiAspect.Employment, Score = employmentScore });
//
//
//
//
//
//
// Alcohol Use is A/180 + B/180 + C/180 + D/24 + E/24 + Log F/44
ASI_Alc_Composite := ASId01F/180 + ASId02F/180 + ASId22a/180 + ASId23a/24 + ASId24a/24;
if (ASId20a > 0) then
ASI_Alc_Composite := ASI_Alc_Composite + Log10(ASId20a)/44;
ASI_Alc_Composite := RoundTo(ASI_Alc_Composite, -3);
TODO: Delphi code is wrong. It mixed C with F.
Let alcoholScore = Convert.ToDouble(numberOfDaysUsedInPast30DaysAlcohol) / 180 + // A
Convert.ToDouble ( numberOfDaysIntoxicatedInPast30DaysAlcohol )/180 + // B
Convert.ToDouble ( numberOfDaysWithSubstanceProblemsInLast30DaysAlcohol )/180 + // C
Convert.ToDouble ( troubledInLast30DaysBySubstanceProblemsAlcohol )/24 + // D
Convert.ToDouble ( importanceOfTreatmentForSubstanceProblemsAlcohol )/24; // E
if ( amountOfMoneySpentInLast30DaysAlcohol > 0) // F
{ alcoholScore = alcoholScore + Math.Log10(Convert.ToDouble(amountOfMoneySpentInLast30DaysAlcohol)) / 44; }
alcoholScore = Math.Round(alcoholScore, 3);
asiScores.Add(new AsiScore { AsiAspect = AsiAspect.Alcohol, Score = alcoholScore });
// // Drug Use is A/390 + B/390 + C/390 + D/390 + E/390 + F/390 + G/390 + H/390 + I/390 + J/390 + K/390 + L/52 +
Log M/44
// ASI_Drug_Composite := ((ASId03F + ASId04F + ASId05F + ASId06F + ASId07F + ASId08F + ASId09F +
//
ASId10F + ASId11F + ASId13F + ASId22d)/390) + (ASId23d/52) + (ASId24d/52);
// ASI_Drug_Composite := RoundTo(ASI_Drug_Composite, -3);
// TODO: Terms disagree: Log M/44 in pseudo code but (ASId24d/52) in Delphi code. Pseudo code is not correct.
Let drugScore = ( ( (double) numberOfDaysUsedInPast30DaysHeroin +
(double) numberOfDaysUsedInPast30DaysMethadone +
(double) numberOfDaysUsedInPast30DaysOtherOpiate +
(double) numberOfDaysUsedInPast30DaysBarbiturate +
(double) numberOfDaysUsedInPast30DaysOtherSedative +
(double) numberOfDaysUsedInPast30DaysCocaine +
(double) numberOfDaysUsedInPast30DaysStimulant +
(double) numberOfDaysUsedInPast30DaysCannabis +
(double) numberOfDaysUsedInPast30DaysHallucinogen +
(double) numberOfDaysUsedInPast30Days +
(double) numberOfDaysExperiencedSubstanceProblemsInPast30Days )/390D ) +
( troubledInLast30DaysBySubstanceProblems/52D ) +
( importanceOfTreatmentForSubstanceProblem/52D );
drugScore = Math.Round(drugScore, 3);
asiScores.Add(new AsiScore { AsiAspect = AsiAspect.Drug, Score = drugScore });
//
//
//
//
//
// Legal status is A/5 + B/150 + C/20 + D/20 + Log E/46
ASI_Leg_Composite := (ASIl22/5) + (ASIl25/150) + (ASIl26 + ASIl27)/20;
if (ASIe17 > 0) then
ASI_Leg_Composite := ASI_Leg_Composite + Log10(ASIe17)/46;
ASI_Leg_Composite := RoundTo(ASI_Leg_Composite, -3);
Let legalScore = ( Convert.ToDouble ( isCurrentlyAwaitingChargesTrialSentence )/5 ) +
(double) numberOfDaysCommitingCrimesForProfitInPast30Days/150 +
( (double) severityOfCurrentLegalProblems + (double) importanceOfCounselingForCurrentLegalProblems )/20;
if (amountOfMoneyInPast30DaysFromIllegalMeans > 0)
{legalScore = legalScore + Math.Log10(Convert.ToDouble(amountOfMoneyInPast30DaysFromIllegalMeans) / 46);}
legalScore = Math.Round(legalScore, 3);
asiScores.Add(new AsiScore { AsiAspect = AsiAspect.Legal, Score = legalScore });
// // Family/Social status is A/10 + B/150 + C/20 + D/20 + Ratio/5
// x := 0.0;
// i := 0;
Let problemList = new[]
{hadProblemsInPastMonthWithMother,
hadProblemsInPastMonthWithFather,
hadProblemsInPastMonthWithSibling,
hadProblemsInPastMonthWithSexPartner,
hadProblemsInPastMonthWithChildren,
hadProblemsInPastMonthWithOtherFamily,
hadProblemsInPastMonthWithCloseFriends,
hadProblemsInPastMonthWithNeighbors,
hadProblemsInPastMonthWithCoworkers };
Let count = problemList.Count ( v => v < 2 );
Let disturbValue = problemList.Where ( v => v < 2 ).Sum ( v => v );
if (count != 0) {disturbValue = disturbValue/count;}
// invert the values according to the Family Composite instructions switch (satisfiedWithThisSituation)
{case 0: count = 2; break;
case 1: count = 1; break;
default: count = 0; break;}
Let
familyScore = (double) count/10 + (double) seriousConflictsWithFamilyInPast30Days/150 +
( (double) troubledByFamilyProblemsInPast30Days + (double) importanceOfTreatmentForFamilyMembers )/20 +
(double) disturbValue/5;
familyScore = Math.Round(familyScore, 3);
asiScores.Add(new AsiScore { AsiAspect = AsiAspect.FamilyAndSocial, Score = familyScore });
//
//
//
//
//
//
//
//
//
//
//
//
//
//
//
//
// Psychiatric status is A/11 + B/11 + C/11 + D/11 + E/11 + F/11 + G/11 + H/11 + I/330 + J/44 + K/44
ASI_Psych_Composite := (ScoreIsModerate(ASIp3M) + ScoreIsModerate(ASIp4M) + ScoreIsModerate(ASIp5M) +
ScoreIsModerate(ASIp6M) + ScoreIsModerate(ASIp7M) + ScoreIsModerate(ASIp8M) +
ScoreIsModerate(ASIp9M) + ScoreIsModerate(ASIp10M))/11 +
ASIp11/330 + (ASIp12 + ASIp13)/44;
ASI_Psych_Composite := RoundTo(ASI_Psych_Composite, -3);
CheckForDrugEffectOnPsych; // TODO: This reset assessment variables has not implemented.
function ScoreIsModerate(nVal: integer): integer;
begin
// Return a 1 if value is 2 or greater (Moderate Symptoms)
if (nVal >= 2) then
Result := 1
else
Result := 0;
end;
TODO: ScoreIsModerate(ASIp10M) in Delphi code is wrong. It should be ASIp10M/11.
Let symptomList = new[]
{significantPeriodOfSeriousDepressionInLastMonth,
anxietyTensionWorryInLastMonth,
significantPeriodHallucinationsInLastMonth,
significantPeriodImpairedThoughtInLastMonth,
significantPeriodCurbingViolentBehaviorInLastMonth,
significantPeriodSuicidalThoughtsInLastMonth,
significantPeriodAttemptedSuicideInLastMonth };
Let symptomCount = symptomList.Count ( v => v >= 2 );
Let psychiatricScore = (double) symptomCount/11 +
(double) numberOfDaysExperiencedPsychologicalEmotionalProblemsInLast30Days/330 +
( (double) howTroubledByPsychologicalEmotionalProblemsLast30Days +
(double) howImportantPsychologicalEmotionalCounseling )/44;
psychiatricScore = Math.Round(psychiatricScore, 3);
asiScores.Add(new AsiScore { AsiAspect = AsiAspect.Psychiatric, Score = psychiatricScore });
return asiScores; }
internal CareLevel_I_DetoxificationScore CalculateCareLevel_I_DetoxificationScore (
bool ciwaCinaAndWithdrawalSicknessIndicator, // D0
double minimumDaysSinceLastUsedDrugExceptNicotine, // UseToday?
double daysSinceLastUsedNicotine,
YesNoNotSure signsOfIntoxicationExist, // ASIm6a
bool? majorityOfInformationFromCollateralSource, // ASId27a
int maxCuadScaleSumForOneDrugExceptNicotine, // MaxCUADOneDrug
int nicotineCuadScaleSum, // CUAD13a
bool anyAddictionDiagnosis ) // AnyDxMade
{Let careLevel_I_DetoxScore = new CareLevel_I_DetoxificationScore();
// Current Delphi Code
// D0 := ( CIWA > 4 ) or (CINA > 4) or (CUADITEM02 > 0) or (CUADITEM03 > 0);
//
CUADITEM02 := CUAD01_02 + CUAD03_02 + CUAD04_02 + CUAD05_02 + CUAD06_02 + CUAD07_02 +
//
CUAD08_02 + CUAD09_02 + CUAD10_02 + CUAD11_02 + CUAD12_02 + CUAD13_02 + CUAD13b_02;
//
//
CUADITEM03 := CUAD01_03 + CUAD03_03 + CUAD04_03 + CUAD05_03 + CUAD06_03 + CUAD07_03 +
//
CUAD08_03 + CUAD09_03 + CUAD10_03 + CUAD11_03 + CUAD12_03 + CUAD13_03 + CUAD13b_03;
// OB_DxLIDa := ( (UseToday or NicoToday) and (ASIm6a = 2) ) or
//
( (UseThisWeek or NicoThisWeek) and D0 ) or AnyDxMade;
careLevel_I_DetoxScore.IsDiagnosed = ( ( minimumDaysSinceLastUsedDrugExceptNicotine <= 1 ||
daysSinceLastUsedNicotine <= 1 ) And signsOfIntoxicationExist == 2 ) ||
( ( minimumDaysSinceLastUsedDrugExceptNicotine <= 7 Or daysSinceLastUsedNicotine <= 7 ) And
ciwaCinaAndWithdrawalSicknessIndicator ) Or anyAddictionDiagnosis;
// Current Delphi Code
// OB_DxLIDb := (UseThisWeek or NicoThisWeek) and
//
(ASId27a = 1) and
//
((MaxCUADOneDrug >= 2) or (CUAD13a >= 2));
careLevel_I_DetoxScore.IsLikelyDiagnosed =
(minimumDaysSinceLastUsedDrugExceptNicotine <= 7 Or daysSinceLastUsedNicotine <= 7) And
(majorityOfInformationFromCollateralSource ?? false) And
(maxCuadScaleSumForOneDrugExceptNicotine >= 2 Or nicotineCuadScaleSum >= 2);
return careLevel_I_DetoxScore;
internal CareLevel_II_DetoxificationScore CalculateCareLevel_II_DetoxificationScore(
bool ciwaCinaAndWithdrawalSicknessIndicator,
double minimumDaysSinceLastUsedDrugExceptNicotine,
// UseToday?
double daysSinceLastUsedNicotine,
YesNoNotSure signsOfIntoxicationExist,
// ASIm6a
bool? majorityOfInformationFromCollateralSource,
// ASId27a
int maxCuadScaleSumForOneDrugExceptNicotine,
// MaxCUADOneDrug
bool anyAddictionDiagnosis ) // AnyDxMade
Let careLeve_II_DetoxScore = new CareLevel_II_DetoxificationScore ( );
// Current Delphi Code
// // This: "CUAD##/02 OR ##/03=1" means: Any CUAD question 02 or 03 = 1. Thus the "> 0" for D0 above.
// D0 := ( CIWA > 4 ) or (CINA > 4) or (CUADITEM02 > 0) or (CUADITEM03 > 0);
// OB_DxLIIDa := ( UseToday and (ASIm6a = 2) ) or ( UseThisWeek and D0 ) or AnyDxMade;
careLeve_II_DetoxScore.IsDiagnosed = ( minimumDaysSinceLastUsedDrugExceptNicotine <= 1 And
signsOfIntoxicationExist == 2 ) Or ( minimumDaysSinceLastUsedDrugExceptNicotine <= 7 And
ciwaCinaAndWithdrawalSicknessIndicator ) Or anyAddictionDiagnosis;
// Current Delphi Code
// OB_DxLIIDb := UseThisWeek and (ASId27a = 1) and (MaxCUADOneDrug >= 2);
careLeve_II_DetoxScore.IsLikelyDiagnosed =
minimumDaysSinceLastUsedDrugExceptNicotine <= 7 And
( majorityOfInformationFromCollateralSource ?? false ) And
( maxCuadScaleSumForOneDrugExceptNicotine >= 2 );
return careLeve_II_DetoxScore;
internal CareLevel_III_2_DetoxificationScore CalculateCareLevel_III_2_DetoxificationScore(
bool careLevel_II_DetoxificationIsDiagnosed )
Let careLevel_III_2_DetoxScore = new CareLevel_III_2_DetoxificationScore ( );
// Current Delphi Code
// OB_DxLIII2D := OB_DxLIIDa;
careLevel_III_2_DetoxScore.IsDiagnosed = careLevel_II_DetoxificationIsDiagnosed;
return careLevel_III_2_DetoxScore;
internal CareLevel_III_7_DetoxificationScore CalculateCareLevel_III_7_DetoxificationScore
(bool careLevel_II_DetoxificationIsDiagnosed )
{
Let careLevel_III_7_DetoxScore = new CareLevel_III_7_DetoxificationScore();
// Current Delphi Code
// OB_DxLIII7D := OB_DxLIIDa;
careLevel_III_7_DetoxScore.IsDiagnosed = careLevel_II_DetoxificationIsDiagnosed;
return careLevel_III_7_DetoxScore; }
internal CareLevel_IV_DetoxificationScore CalculateCareLevel_IV_DetoxificationScore
(bool careLevel_II_DetoxificationIsDiagnosed )
Let careLevel_IV_DetoxScore = new CareLevel_IV_DetoxificationScore();
// Current Delphi Code
// OB_DxLIVD
:= OB_DxLIIDa;
careLevel_IV_DetoxScore.IsDiagnosed = careLevel_II_DetoxificationIsDiagnosed;
return careLevel_IV_DetoxScore;
internal CareLevel_0_5_EarlyInterventionScore CalculateCareLevel_0_5_EarlyInterventionScore
(bool? diagnosisxResultsCareLevel_I_OutpatientScoreIsMet,
// OB_DxLI
int maxCuadScaleSumForOneDrugExceptNicotine,
// MaxCUADNoDetoxOneDrug
int nicotineCuadScaleSum,
// CUAD13a
bool anyAddictionDiagnosisExceptNicotine ) // AnyDxExceptNico
Let careLevel_0_5_score = new CareLevel_0_5_EarlyInterventionScore ( );
// Current Delphi Code
//
OB_DxL05 := (( not OB_DxLI ) and
//
( (MaxCUADNoDetoxOneDrug >= 1) or (CUAD13a >= 1) )) and (not AnyDxExceptNico);
// CUAD13bNotDetox := CUAD13b_04 + CUAD13b_05 + CUAD13b_06 + CUAD13b_07 +
//
CUAD13b_08 + CUAD13b_09 + CUAD13b_10 + CUAD13b_11 + CUAD13b_12 + CUAD13b_13 +
//
CUAD13b_14 + CUAD13b_15 + CUAD13b_16 + CUAD13b_17 + CUAD13b_18 + CUAD13b_19;
// CUAD13b := CUAD13b_01 + CUAD13b_02 + CUAD13b_03 + CUAD13bNotDetox;
// if CUAD13b > 1 then
//
Inc(NumberOfCUADsPositive);
// MaxCUADOneDrug := iMax(MaxCUADOneDrug, CUAD13b);
// MaxCUADNoDetoxOneDrug := iMax(MaxCUADOneDrug, CUAD13bNotDetox);
// TODO: Terms disagree.
careLevel_0_5_score.IsMet =
(!diagnosisxResultsCareLevel_I_OutpatientScoreIsMet.Value And (maxCuadScaleSumForOneDrugExceptNicotine >= 1
Or nicotineCuadScaleSum >= 1)) And !anyAddictionDiagnosisExceptNicotine;
return careLevel_0_5_score;
internal CareLevel_I_OutpatientScore CalculateCareLevel_I_OutpatientScore(
bool ciwaCinaAndWithdrawalSicknessIndicator, // D0
double minimumDaysSinceLastUsedDrugExceptNicotine,
// UseToday?
double daysSinceLastUsedNicotine,
YesNoNotSure signsOfIntoxicationExist,
// ASIm6a
bool? majorityOfInformationFromCollateralSource,
// ASId27a
int maxCuadScaleSumForOneDrugExceptNicotine,
// MaxCUADOneDrug
int nicotineCuadScaleSum,
// CUAD13a
bool anyAddictionDiagnosis, // AnyDxMade
bool anyAddictionDiagnosisExceptNicotine, // AnyDxExceptNico
uint? numberOfTimesTreatedForAlcoholAbuseLifetime,
// ASId18a
uint? numberOfTimesDrugTreatmentLifetime,
// ASId18d
ScaleOf0To9 interviewerScoreOfAlcoholTreatmentNeed,
// ASId25a
ScaleOf0To9 interviewerScoreOfDrugTreatmentNeed,
// ASId25d
PatientCarriesPsychiatricDiagnosis doesPatientCarryPsychiatricDiagnosis,
// ASIp19i
bool? withdrawalSymptomsAndEmotionalBehavioralProblems,
// OB_Dim3Px
bool nicotineTobaccoIsDependentWithPhysiologicalDependency) // OB_DSMSD13awP
Let careLevel_I_Score = new CareLevel_I_OutpatientScore ( );
// Current Delphi Code
//
// Make more permissive for Level I
//
OB_DxLIa := (UseToday and (ASIm6a = 2)) or
//
(UseThisWeek and D0) or
//
(((ASId18a > 1) or (ASId18d > 1)) and AnyDxMade and UseThisMonth and ((ASId25a + ASId25d)>0)) or
//
((MaxCUADNoDetoxOneDrug >= 2) and UseThisMonth)or
//
(NicoToday and OB_DSMSD13awP);
// if OB_DxLIa and (not AnyDxExceptNico) and (not OB_DSMSD13awP) then
//
OB_DxLIa := False;
// D0 := ( CIWA > 4 ) or (CINA > 4) or (CUADITEM02 > 0) or (CUADITEM03 > 0);
// TODO: Terms disagree. "CUAD##/02 OR ##/03=1" interpreted as (CUADITEM02 > 0) or (CUADITEM03 > 0) in Delphi code.
careLevel_I_Score.IsDiagnosed =
( minimumDaysSinceLastUsedDrugExceptNicotine <= 1 And signsOfIntoxicationExist == 2 ) Or
( minimumDaysSinceLastUsedDrugExceptNicotine <= 7 And ciwaCinaAndWithdrawalSicknessIndicator ) Or
( ( numberOfTimesTreatedForAlcoholAbuseLifetime > 1 Or numberOfTimesDrugTreatmentLifetime > 1 ) And
anyAddictionDiagnosis And
minimumDaysSinceLastUsedDrugExceptNicotine <= 30 And
( interviewerScoreOfAlcoholTreatmentNeed + interviewerScoreOfDrugTreatmentNeed ) > 0 ) Or
( maxCuadScaleSumForOneDrugExceptNicotine >= 2 And minimumDaysSinceLastUsedDrugExceptNicotine <= 30 )
( daysSinceLastUsedNicotine <= 1 And nicotineTobaccoIsDependentWithPhysiologicalDependency );
Or
// TODO: MaxCUADNoDetoxOneDrug and MaxCUADOneDrug, any difference?
// MaxCUADNoDetoxOneDrug := iMax(MaxCUADOneDrug, CUAD13bNotDetox); this assignment cannot change anything.
if (careLevel_I_Score.IsDiagnosed And !anyAddictionDiagnosisExceptNicotine And
!nicotineTobaccoIsDependentWithPhysiologicalDependency)
{ careLevel_I_Score.IsDiagnosed = false; }
// Current Delphi Code
// OB_DxLIb := (ASId27a = 1) and
//
((MaxCUADNoDetoxOneDrug >= 2) or (CUAD13a >= 2)) and
//
(not OB_Dim3Px) and
//
IsBtw(ASIp19i, 1, 8);
// TODO: (ASIp19i>0) was interpreted as IsBtw(ASIp19i, 1, 8) in Delphi code. One special case ASIp19i = 9 (unknown)
satisfied Pseudo code but not Delphi logic.
careLevel_I_Score.IsLikelyDiagnosed =
( majorityOfInformationFromCollateralSource ?? false ) And
( maxCuadScaleSumForOneDrugExceptNicotine >= 2 Or nicotineCuadScaleSum >= 2 ) And
( !withdrawalSymptomsAndEmotionalBehavioralProblems.Value ) And
( doesPatientCarryPsychiatricDiagnosis >= 1 And doesPatientCarryPsychiatricDiagnosis <= 8 );
// Current Delphi Code
// OB_DxLI
:= OB_DxLIa or OB_DxLIb;
careLevel_I_Score.IsMet = careLevel_I_Score.IsDiagnosed Or careLevel_I_Score.IsLikelyDiagnosed;
//
//
//
//
Current Delphi Code
D0 := OB_Dim3Px; // or IsBtw(ASIp19i, 1, 8);
OB_DxLIddc
:= D0 and OB_DxLI;
TODO: P19i>0 was removed in Delphi code.
(see below)
careLevel_I_Score.IsDualDiagnosisCapable = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_I_Score.IsMet.Value;
//
//
//
//
//
Current Delphi Code
// phe - 20051201 - Remove criteria for having diagnosis from this equation
D0 := OB_Dim3Px; // and (ASIp19i > 0);
OB_DxLIdde
:= D0 and OB_DxLI;
TODO: ASI-P19i>0 & <9 was removed in Delphi code.
careLevel_I_Score.IsDualDiagnosisEnhanced = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_I_Score.IsMet.Value;
return careLevel_I_Score;
internal CareLevelOpioidMaintenanceTherapyScore CalculateCareLevelOpioidMaintenanceTherapyScore (
bool ciwaCinaAndWithdrawalSicknessIndicator,
ouble minimumDaysSinceLastUsedDrugExceptNicotine, // UseToday?
YesNoNotSure signsOfIntoxicationExist, // ASIm6a
bool? majorityOfInformationFromCollateralSource, // ASId27a
int maxCuadScaleSumForOneDrugExceptNicotine, // MaxCUADOneDrug
bool anyAddictionDiagnosisExceptNicotine, // AnyDxExceptNico
uint? numberOfTimesTreatedForAlcoholAbuseLifetime, // ASId18a
uint? numberOfTimesDrugTreatmentLifetime, // ASId18d
ScaleOf0To9 interviewerScoreOfAlcoholTreatmentNeed, // ASId25a
ScaleOf0To9 interviewerScoreOfDrugTreatmentNeed, // ASId25d
bool? withdrawalSymptomsAndEmotionalBehavioralProblems, // OB_Dim3Px
PatientCarriesPsychiatricDiagnosis doesPatientCarryPsychiatricDiagnosis ) // ASIp19i
Let careLevel_OMT_Score = new CareLevelOpioidMaintenanceTherapyScore ( );
// Current Delphi Code
//
// These values reworked with David G. 2 May 2005. No longer corresponds with Excel Diagnosis/A25
//
// N.B. - UseToday does or does not include Nico.
//
OB_DxLMa := (UseToday and (ASIm6a = 2)) or
//
(UseThisWeek and D0) or
//
(((ASId18a > 1) or (ASId18d > 1)) and AnyDxExceptNico and UseThisMonth and ((ASId25a + ASId25d)>0)) or
//
((MaxCUADNoDetoxOneDrug >= 2) and UseThisMonth);
// D0 := ( CIWA > 4 ) or (CINA > 4) or (CUADITEM02 > 0) or (CUADITEM03 > 0);
careLevel_OMT_Score.IsDiagnosed =
( minimumDaysSinceLastUsedDrugExceptNicotine <= 1 And signsOfIntoxicationExist == 2 ) Or
( minimumDaysSinceLastUsedDrugExceptNicotine <= 7 And ciwaCinaAndWithdrawalSicknessIndicator ) Or
( ( numberOfTimesTreatedForAlcoholAbuseLifetime > 1 Or numberOfTimesDrugTreatmentLifetime > 1 ) And
anyAddictionDiagnosisExceptNicotine And minimumDaysSinceLastUsedDrugExceptNicotine <= 30 And
( interviewerScoreOfAlcoholTreatmentNeed + interviewerScoreOfDrugTreatmentNeed ) > 0 ) Or
( maxCuadScaleSumForOneDrugExceptNicotine >= 2 And minimumDaysSinceLastUsedDrugExceptNicotine <= 30 );
// Current Delphi Code
// OB_DxLMb
:= (ASId27a = 1) and
//
(MaxCUADNoDetoxOneDrug >= 2) and
//
(not OB_Dim3Px) and
//
IsBtw(ASIp19i, 1, 8);
careLevel_OMT_Score.IsLikelyDiagnosed = ( majorityOfInformationFromCollateralSource ?? false ) And
( maxCuadScaleSumForOneDrugExceptNicotine >= 2 ) And
!withdrawalSymptomsAndEmotionalBehavioralProblems.Value And
( doesPatientCarryPsychiatricDiagnosis >= 1 And doesPatientCarryPsychiatricDiagnosis <= 8 );
// Current Delphi Code
// OB_DxLM
:= OB_DxLMa or OB_DxLMb;
careLevel_OMT_Score.IsMet = careLevel_OMT_Score.IsDiagnosed Or careLevel_OMT_Score.IsLikelyDiagnosed;
// Current Delphi Code
// D0 := OB_Dim3Px; // or IsBtw(ASIp19i, 1, 8);
// OB_DxLMddc
:= D0 and OB_DxLM;
(see below)
careLevel_OMT_Score.IsDualDiagnosisCapable = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_OMT_Score.IsMet.Value;
// Current Delphi Code
// // phe - 20051201 - Remove criteria for having diagnosis from this equation
//
D0 := OB_Dim3Px; // and (ASIp19i > 0);
// OB_DxLMdde
:= D0 and OB_DxLM;
careLevel_OMT_Score.IsDualDiagnosisEnhanced = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_OMT_Score.IsMet.Value;
return careLevel_OMT_Score;
Let careLevel_II_1_Score = new CareLevel_II_1_IntensiveOutpatientScore ( );
// Current Delphi Code
// OB_DxLII1a := OB_DxLMa;
careLevel_II_1_Score.IsDiagnosed = omtIsDiagnosed;
// Current Delphi Code
// OB_DxLII1b := OB_DxLMb;
careLevel_II_1_Score.IsLikelyDiagnosed = omtIsLikelyDiagnosed;
// Current Delphi Code
// OB_DxLII1
:= OB_DxLII1a or OB_DxLII1b;
careLevel_II_1_Score.IsMet = careLevel_II_1_Score.IsDiagnosed Or careLevel_II_1_Score.IsLikelyDiagnosed;
// Current Delphi Code
// D0 := OB_Dim3Px; // or IsBtw(ASIp19i, 1, 8);
// OB_DxLII1ddc := D0 and OB_DxLII1;
(see below)
careLevel_II_1_Score.IsDualDiagnosisCapable = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_II_1_Score.IsMet.Value;
// Current Delphi Code
// // phe - 20051201 - Remove criteria for having diagnosis from this equation
//
D0 := OB_Dim3Px; // and (ASIp19i > 0);
// OB_DxLII1dde := D0 and OB_DxLII1;
careLevel_II_1_Score.IsDualDiagnosisEnhanced = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_II_1_Score.IsMet.Value;
return careLevel_II_1_Score;
Let careLevel_II_5_Score = new CareLevel_II_5_PartialHospitalizationScore ( );
// Current Delphi Code
// OB_DxLII5a := OB_DxLMa;
careLevel_II_5_Score.IsDiagnosed = omtIsDiagnosed;
// Current Delphi Code
// OB_DxLII5b := OB_DxLMb;
careLevel_II_5_Score.IsLikelyDiagnosed = omtIsLikelyDiagnosed;
// Current Delphi Code
// OB_DxLII5
:= OB_DxLII5a or OB_DxLII5b;
careLevel_II_5_Score.IsMet = careLevel_II_5_Score.IsDiagnosed Or careLevel_II_5_Score.IsLikelyDiagnosed;
// Current Delphi Code
// D0 := OB_Dim3Px; // or IsBtw(ASIp19i, 1, 8);
(see below)
// OB_DxLII5ddc := D0 and OB_DxLII5;
careLevel_II_5_Score.IsDualDiagnosisCapable = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_II_5_Score.IsMet.Value;
// Current Delphi Code
// // phe - 20051201 - Remove criteria for having diagnosis from this equation
//
D0 := OB_Dim3Px; // and (ASIp19i > 0);
// OB_DxLII5dde := D0 and OB_DxLII5;
careLevel_II_5_Score.IsDualDiagnosisEnhanced = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_II_5_Score.IsMet.Value;
return careLevel_II_5_Score;
internal CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore
CalculateCareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore (
bool omtIsDiagnosed,
bool omtIsLikelyDiagnosed,
bool? withdrawalSymptomsAndEmotionalBehavioralProblems )
Let careLevel_III_1_Score = new CareLevel_III_1_ClinicallyManagedLowIntensityResidentialTreatmentScore ( );
// Current Delphi Code
// OB_DxLIII1a := OB_DxLMa;
careLevel_III_1_Score.IsDiagnosed = omtIsDiagnosed;
// Current Delphi Code
// OB_DxLIII1b := OB_DxLMb;
careLevel_III_1_Score.IsLikelyDiagnosed = omtIsLikelyDiagnosed;
// Current Delphi Code
// OB_DxLIII1 := OB_DxLIII1a or OB_DxLIII1b;
careLevel_III_1_Score.IsMet = careLevel_III_1_Score.IsDiagnosed Or careLevel_III_1_Score.IsLikelyDiagnosed;
// Current Delphi Code
// D0 := OB_Dim3Px; // or IsBtw(ASIp19i, 1, 8);
(see below)
// OB_DxLIII1ddc := D0 and OB_DxLIII1;
careLevel_III_1_Score.IsDualDiagnosisCapable = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_III_1_Score.IsMet.Value;
// Current Delphi Code
// // phe - 20051201 - Remove criteria for having diagnosis from this equation
//
D0 := OB_Dim3Px; // and (ASIp19i > 0);
// OB_DxLIII1dde := D0 and OB_DxLIII1;
careLevel_III_1_Score.IsDualDiagnosisEnhanced = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_III_1_Score.IsMet.Value;
return careLevel_III_1_Score;
internal CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore
CalculateCareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore (
bool omtIsDiagnosed,
bool omtIsLikelyDiagnosed,
bool? withdrawalSymptomsAndEmotionalBehavioralProblems )
Let careLevel_III_3_Score = new CareLevel_III_3_ClinicallyManagedMediumIntensityResidentialTreatmentScore (
);
// Current Delphi Code
// OB_DxLIII3a := OB_DxLMa;
careLevel_III_3_Score.IsDiagnosed = omtIsDiagnosed;
// Current Delphi Code
// OB_DxLIII3b := OB_DxLMb;
careLevel_III_3_Score.IsLikelyDiagnosed = omtIsLikelyDiagnosed;
// Current Delphi Code
// OB_DxLIII3 := OB_DxLIII3a or OB_DxLIII3b;
careLevel_III_3_Score.IsMet = careLevel_III_3_Score.IsDiagnosed Or careLevel_III_3_Score.IsLikelyDiagnosed;
// Current Delphi Code
// D0 := OB_Dim3Px; // or IsBtw(ASIp19i, 1, 8);
(see below)
// OB_DxLIII3ddc := D0 and OB_DxLIII3;
careLevel_III_3_Score.IsDualDiagnosisCapable = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_III_3_Score.IsMet.Value;
// Current Delphi Code
// // phe - 20051201 - Remove criteria for having diagnosis from this equation
//
D0 := OB_Dim3Px; // and (ASIp19i > 0);
// OB_DxLIII3dde := D0 and OB_DxLIII3;
careLevel_III_3_Score.IsDualDiagnosisEnhanced = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_III_3_Score.IsMet.Value;
return careLevel_III_3_Score;
internal CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore
CalculateCareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore (
bool omtIsDiagnosed,
bool omtIsLikelyDiagnosed,
bool? withdrawalSymptomsAndEmotionalBehavioralProblems )
Let careLevel_III_5_Score = new CareLevel_III_5_ClinicallyManagedHighIntensityResidentialTreatmentScore (
// Current Delphi Code
// OB_DxLIII5a := OB_DxLMa;
careLevel_III_5_Score.IsDiagnosed = omtIsDiagnosed;
);
// Current Delphi Code
// OB_DxLIII5b := OB_DxLMb;
careLevel_III_5_Score.IsLikelyDiagnosed = omtIsLikelyDiagnosed;
// Current Delphi Code
// OB_DxLIII5 := OB_DxLIII5a or OB_DxLIII5b;
careLevel_III_5_Score.IsMet = careLevel_III_5_Score.IsDiagnosed Or careLevel_III_5_Score.IsLikelyDiagnosed;
//Current Delphi Code
// D0 := OB_Dim3Px; // or IsBtw(ASIp19i, 1, 8);
(see below)
// OB_DxLIII5ddc := D0 and OB_DxLIII5;
careLevel_III_5_Score.IsDualDiagnosisCapable = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_III_5_Score.IsMet.Value;
// Current Delphi Code
// // phe - 20051201 - Remove criteria for having diagnosis from this equation
//
D0 := OB_Dim3Px; // and (ASIp19i > 0);
// OB_DxLIII5dde := D0 and OB_DxLIII5;
careLevel_III_5_Score.IsDualDiagnosisEnhanced = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_III_5_Score.IsMet.Value;
return careLevel_III_5_Score;
internal CareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore
CalculateCareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore (bool omtIsDiagnosed,
bool omtIsLikelyDiagnosed,bool? withdrawalSymptomsAndEmotionalBehavioralProblems )
Let careLevel_III_7_Score = new CareLevel_III_7_MedicallyMonitoredIntensiveInpatientTreatmentScore (
);
// Current Delphi Code
// OB_DxLIII7a := OB_DxLMa;
careLevel_III_7_Score.IsDiagnosed = omtIsDiagnosed;
// Current Delphi Code
// OB_DxLIII7b := OB_DxLMb;
careLevel_III_7_Score.IsLikelyDiagnosed = omtIsLikelyDiagnosed;
// Current Delphi Code
// OB_DxLIII7 := OB_DxLIII7a or OB_DxLIII7b;
careLevel_III_7_Score.IsMet = careLevel_III_7_Score.IsDiagnosed Or careLevel_III_7_Score.IsLikelyDiagnosed;
// Current Delphi Code
// D0 := OB_Dim3Px; // or IsBtw(ASIp19i, 1, 8);
(see below)
// OB_DxLIII7ddc := D0 and OB_DxLIII7;
careLevel_III_7_Score.IsDualDiagnosisCapable = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_III_7_Score.IsMet.Value;
// Current Delphi Code
// // phe - 20051201 - Remove criteria for having diagnosis from this equation
//
D0 := OB_Dim3Px; // and (ASIp19i > 0);
// OB_DxLIII7dde := D0 and OB_DxLIII7;
careLevel_III_7_Score.IsDualDiagnosisEnhanced = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_III_7_Score.IsMet.Value;
return careLevel_III_7_Score;
internal CareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore
CalculateCareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore( bool omtIsDiagnosed,
bool omtIsLikelyDiagnosed, bool? withdrawalSymptomsAndEmotionalBehavioralProblems)
Let careLevel_IV_Score = new CareLevel_IV_MedicallyManagedIntensiveInpatientTreatmentScore (
);
// Current Delphi Code
// OB_DxLIVa := OB_DxLMa;
careLevel_IV_Score.IsDiagnosed = omtIsDiagnosed;
// Current Delphi Code
// OB_DxLIVb := OB_DxLMb;
careLevel_IV_Score.IsLikelyDiagnosed = omtIsLikelyDiagnosed;
// Current Delphi Code
// OB_DxLIV := OB_DxLIVa or OB_DxLIVb;
careLevel_IV_Score.IsMet = careLevel_IV_Score.IsDiagnosed Or careLevel_IV_Score.IsLikelyDiagnosed;
// Current Delphi Code
// D0 := OB_Dim3Px; // or IsBtw(ASIp19i, 1, 8);
(see below)
// OB_DxLIVddc := D0 and OB_DxLIV;
careLevel_IV_Score.IsDualDiagnosisCapable = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_IV_Score.IsMet.Value;
// Current Delphi Code
// // phe - 20051201 - Remove criteria for having diagnosis from this equation
//
D0 := OB_Dim3Px; // and (ASIp19i > 0);
// OB_DxLIVdde := D0 and OB_DxLIV;
careLevel_IV_Score.IsDualDiagnosisEnhanced = (withdrawalSymptomsAndEmotionalBehavioralProblems ?? false) And
careLevel_IV_Score.IsMet.Value;
return careLevel_IV_Score;
Dimension Diagnosis: DiagnosticStatisticalManualOfMentalDisorders_IV_Scores
namespace Asam.Ppc.Domain.Scoring.ScoringModule.Diagnosis
{
/// <summary>
/// DiagnosticStatisticalManualOfMentalDisorders_IV_Scores class.
/// </summary>
public class DiagnosticStatisticalManualOfMentalDisorders_IV_Scores
{
/// <summary>
/// Gets or sets the alcohol any use.
/// </summary>
/// <value>The alcohol any use.</value>
public SubstanceScore AlcoholAnyUseScore { get; internal set; }
/// <summary>
/// Gets or sets the alcohol to intoxication.
/// </summary>
/// <value>The alcohol to intoxication.</value>
//public SubstanceScore AlcoholToIntoxication { get; internal set; }
/// <summary>
/// Gets or sets the heroin.
/// </summary>
/// <value>The heroin.</value>
public SubstanceScore HeroinScore { get; internal set; }
/// <summary>
/// Gets or sets the methadone.
/// </summary>
/// <value>The methadone.</value>
public SubstanceScore MethadoneScore { get; internal set; }
/// <summary>
/// Gets or sets the other opiates analgesics.
/// </summary>
/// <value>The other opiates analgesics.</value>
public SubstanceScore OtherOpiatesAnalgesicsScore { get; internal set; }
/// <summary>
/// Gets or sets the barbiturates.
/// </summary>
/// <value>The barbiturates.</value>
public SubstanceScore BarbituratesScore { get; internal set; }
/// <summary>
/// Gets or sets the other sedatives hypnotics.
/// </summary>
/// <value>The other sedatives hypnotics.</value>
public SubstanceScore OtherSedativesHypnoticsScore { get; internal set; }
/// <summary>
/// Gets or sets the cocaine.
/// </summary>
/// <value>The cocaine.</value>
public SubstanceScore CocaineScore { get; internal set; }
/// <summary>
/// Gets or sets the stimulants.
/// </summary>
/// <value>The stimulants.</value>
public SubstanceScore StimulantsScore { get; internal set; }
/// <summary>
/// Gets or sets the cannabis.
/// </summary>
/// <value>The cannabis.</value>
public SubstanceScore CannabisScore { get; internal set; }
/// <summary>
/// Gets or sets the hallucinogens.
/// </summary>
/// <value>The hallucinogens.</value>
public SubstanceScore HallucinogensScore { get; internal set; }
/// <summary>
/// Gets or sets the solvent inhalants.
/// </summary>
/// <value>The solvent inhalants.</value>
public SubstanceScore SolventInhalantsScore { get; internal set; }
/// <summary>
/// Gets or sets the multiple per day.
/// </summary>
/// <value>The multiple per day.</value>
public SubstanceScore MultiplePerDayScore { get; internal set; }
/// <summary>
/// Gets or sets the nicotine tobacco.
/// </summary>
/// <value>The nicotine tobacco.</value>
public SubstanceScore NicotineTobaccoScore { get; internal set; }
/// <summary>
/// Gets or sets the other.
/// </summary>
/// <value>The other.</value>
public SubstanceScore OtherScore { get; internal set; }
}
Dimension Diagnosis: SubstanceScoreCalculator
using Asam.Ppc.Domain.AssessmentModule.DrugAndAlcohol;
using Asam.Ppc.Domain.AssessmentModule.DrugAndAlcohol.Lookups;
using Asam.Ppc.Primitives;
namespace Asam.Ppc.Domain.Scoring.ScoringModule.Diagnosis
{
public interface ISubstanceScoreCalculator
{
int CalculateMaxCuadScaleSumForOneDrugExceptNicotine(params ISubstanceUse[] substanceUses);
int CalculateNumberOfCuadScaleSumGreaterThanOneExceptNicotine(params ISubstanceUse[] substanceUses);
double CalculateMinimumDaysSinceLastUsedDrugExceptNicotine ( params SubstanceUseHistory[] substanceUseHistories );
int CalculateChemicalUseAbuseAndDependenceScaleScoreSum ( ISubstanceUse substanceUse );
SubstanceScore CalculateSubstanceScore (bool hasEverUsed, ISubstanceUse substanceUse );
SubstanceScore CalculateSubstanceScore ( bool? hasEverUsed, TimeMeasure lastUsed,
int numberOfCuadScaleSumGreaterThanOneExceptNicotine,
ProblemSubstance whichSubstanceIsMajorProblem,
params ISubstanceUse[] substanceUses );
// For Alcohol only
bool CalculateImminentWithdrawalPotential ( bool hasEverUsed,ISubstanceUse substanceUse,
bool? alcoholUsedToIntoxication, TimeMeasure lastUsedToIntoxification,uint? numberOfDaysIntoxicatedInPast30Days );
using Asam.Ppc.Primitives;
namespace Asam.Ppc.Domain.Scoring.ScoringModule.Diagnosis
{
/// <summary>
/// SubstanceScore class.
/// </summary>
public class SubstanceScore
{
/// <summary>
/// Gets or sets the is dependent. (OB_DSMSD**) ** from 01, 02, ..., 13, 13a, 13b
/// </summary>
/// <value>The is dependent.</value>
public bool IsDependent { get; set; }
/// <summary>
/// Gets or sets the is dependent with physiological dependency. (OB_DSMSD**wP)T
/// </summary>
/// <value>The is dependent with physiological dependency.</value>
public bool IsDependentWithPhysiologicalDependency { get; set; }
/// <summary>
/// Gets or sets the is dependent with out physiological dependency. (OB_DSMSD**oP)
/// </summary>
/// <value>The is dependent with out physiological dependency.</value>
public bool IsDependentWithOutPhysiologicalDependency { get; set; }
/// <summary>
/// Gets or sets the is abused. (OB_DSMSA**)
/// </summary>
/// <value>The is abused.</value>
public bool IsAbused { get; set; }
/// <summary>
/// (CUAD**_SD).
/// </summary>
public ScaleOf0To7 DependenceScore { get; set; }
/// <summary>
/// ( CUAD**_SA).
/// </summary>
public uint AbuseScore { get; set; }
/// <summary>
/// (OB_ImminentWD**). // Both 13 (MPD) and 13a Nicotine do not have this.
/// </summary>
public bool HasImminentWithdrawalPotential { get; set; }
/// <summary>
/// Including HasEverUsed and LastUse // Alcohol calculation has extra logic
/// </summary>
public SubstanceUseHistory SubstanceUseHistory { get; set; }
}
}
_-------------------------------using
using
using
using
using
using
System;
System.Collections.Generic;
System.Linq;
Asam.Ppc.Domain.AssessmentModule.DrugAndAlcohol;
Asam.Ppc.Domain.AssessmentModule.DrugAndAlcohol.Lookups;
Asam.Ppc.Primitives;
namespace Asam.Ppc.Domain.Scoring.ScoringModule.Diagnosis
{
public class SubstanceScoreCalculator : ISubstanceScoreCalculator
{
#region Public Methods
public SubstanceScore CalculateSubstanceScore(bool hasEverUsed, ISubstanceUse substanceUse)
{
return CalculateSubstanceScore ( substanceUse.IncreasedDoseRequiredToGetSameEffect,
substanceUse.ExperiencesWithdrawalSickness,
substanceUse.UseSubstanceToPreventWithdrawalSickness,
substanceUse.UnableToStopUsingSubstance,
substanceUse.SubstanceUseReductionAttempted,
substanceUse.UseOfSubstanceTakesUpALotOfTime,
substanceUse.SubstanceUseReductionInSocialActivities,
substanceUse.SubstanceUseReductionInOccupationalActivities,
substanceUse.SubstanceUseReductionInRecreationalActivities,
substanceUse.HasUsedSubstanceKnowingProblemsWorsened,
substanceUse.FrequentlyHighAtWork,
substanceUse.FrequentlyHighAtSchool,
substanceUse.FrequentlyHighAtHome,
substanceUse.FrequentlyHighInDangerousSituations,
substanceUse.SubstanceUseRecurrentProblemsWithLegalSystem,
substanceUse.SubstanceUseRecurrentProblemsWithFamilyFriends,
substanceUse.SubstanceUseRecurrentProblemsWithJob,
hasEverUsed,
substanceUse.LastUsed,
substanceUse.NumberOfDaysUsedInPast30Days );
// For Multiple Per Day use
public SubstanceScore CalculateSubstanceScore(bool? hasEverUsed, TimeMeasure lastUsed,
int numberOfCuadScaleSumGreaterThanOneExceptNicotine, ProblemSubstance whichSubstanceIsMajorProblem,
params ISubstanceUse[] substanceUses)
// CUAD13 Calculations Poly substance dependence is based on answers for any (+) items other CUADs
// CUAD13_01 := iMin(1, (CUAD01_01 + CUAD03_01 + CUAD04_01 + CUAD05_01 + CUAD06_01 + CUAD07_01 +
//
CUAD08_01 + CUAD09_01 + CUAD10_01 + CUAD11_01 + CUAD12_01 + CUAD13b_01)); // Exclude nicotine use
Let increasedDoseRequiredToGetSameEffect = substanceUses.Any(u => (u.IncreasedDoseRequiredToGetSameEffect ?? false));
Let experiencesWithdrawalSickness = substanceUses.Any(u => (u.ExperiencesWithdrawalSickness ?? false));
Let useSubstanceToPreventWithdrawalSickness = substanceUses.Any(u => (u.UseSubstanceToPreventWithdrawalSickness ??
false));
Let unableToStopUsingSubstance = substanceUses.Any(u => (u.UnableToStopUsingSubstance ?? false));
Let substanceUseReductionAttempted = substanceUses.Any(u => (u.SubstanceUseReductionAttempted ?? false));
Let useOfSubstanceTakesUpALotOfTime = substanceUses.Any(u => (u.UseOfSubstanceTakesUpALotOfTime ?? false));
Let substanceUseReductionInSocialActivities = substanceUses.Any(u => (u.SubstanceUseReductionInSocialActivities ??
false));
Let substanceUseReductionInOccupationalActivities = substanceUses.Any(u =>
(u.SubstanceUseReductionInOccupationalActivities ?? false));
Let substanceUseReductionInRecreationalActivities = substanceUses.Any(u =>
(u.SubstanceUseReductionInRecreationalActivities ?? false));
Let hasUsedSubstanceKnowingProblemsWorsened = substanceUses.Any(u => (u.HasUsedSubstanceKnowingProblemsWorsened ??
false));
Let frequentlyHighAtWork = substanceUses.Any(u => (u.FrequentlyHighAtWork ?? false));
Let frequentlyHighAtSchool = substanceUses.Any(u => (u.FrequentlyHighAtSchool ?? false));
Let frequentlyHighAtHome = substanceUses.Any(u => (u.FrequentlyHighAtHome ?? false));
Let frequentlyHighInDangerousSituations = substanceUses.Any(u => (u.FrequentlyHighInDangerousSituations ?? false));
Let substanceUseRecurrentProblemsWithLegalSystem = substanceUses.Any(u =>
(u.SubstanceUseRecurrentProblemsWithLegalSystem ?? false));
Let substanceUseRecurrentProblemsWithFamilyFriends = substanceUses.Any(u =>
(u.SubstanceUseRecurrentProblemsWithFamilyFriends ?? false));
Let substanceUseRecurrentProblemsWithJob = substanceUses.Any(u => (u.SubstanceUseRecurrentProblemsWithJob ?? false));
if (substanceUses.Count() != 12)
{ throw new ArgumentException("Parameter 'substanceUses' should has exactly all 12 substanceUse object
(no Nicotine) to calculate Multiple Per Day use score.");}
//
//
//
//
//
//
// Polysubstance abuse and dependence. Revised 31 Dec 2002, phe
// Make sure that more than 2 drugs contribute to the problem
// and no drug predominates (ASId14 = 102).
CUAD13_SD := CUAD13_01 + iMin(1, (CUAD13_02 + CUAD13_03)) + CUAD13_04 + CUAD13_05 +
CUAD13_06 + iMin(1, (CUAD13_11 + CUAD13_12 + CUAD13_13)) + CUAD13_19;
OB_DSMSD13 := ((CUAD13_SD > 2) and (NumberOfCUADsPositive > 2)) and (ASId14 = 102);
Let substanceScore = CalculateSubstanceScore(increasedDoseRequiredToGetSameEffect,
experiencesWithdrawalSickness, useSubstanceToPreventWithdrawalSickness,
unableToStopUsingSubstance, substanceUseReductionAttempted,
useOfSubstanceTakesUpALotOfTime,substanceUseReductionInSocialActivities,
substanceUseReductionInOccupationalActivities, substanceUseReductionInRecreationalActivities,
hasUsedSubstanceKnowingProblemsWorsened, frequentlyHighAtWork, frequentlyHighAtSchool,
frequentlyHighAtHome, frequentlyHighInDangerousSituations,substanceUseRecurrentProblemsWithLegalSystem,
substanceUseRecurrentProblemsWithFamilyFriends,
substanceUseRecurrentProblemsWithJob, hasEverUsed, lastUsed, 0);
// OB_DSMSD13 := ((CUAD13_SD > 2) and (NumberOfCUADsPositive > 2)) and (ASId14 = 102);
substanceScore.IsDependent = substanceScore.IsDependent And
numberOfCuadScaleSumGreaterThanOneExceptNicotine > 2 And
whichSubstanceIsMajorProblem == 102;
// OB_DSMSA13 := (CUAD13_SA > 0) and (ASId13R > 0) and (NumberOfCUADsPositive > 2) and (ASId14 = 102);
substanceScore.IsAbused = substanceScore.IsAbused And
numberOfCuadScaleSumGreaterThanOneExceptNicotine > 2 And
whichSubstanceIsMajorProblem == 102;
substanceScore.SubstanceUseHistory = new SubstanceUseHistory ( hasEverUsed, lastUsed );
return substanceScore;}
public int CalculateMaxCuadScaleSumForOneDrugExceptNicotine ( params ISubstanceUse[] substanceUses
Let cuadScaleScoreSumsExceptNicotine = CalculateChemicalUseAbuseAndDependenceScaleScoreSums ( substanceUses );
return cuadScaleScoreSumsExceptNicotine.Max();
Let cuadScaleScoreSumsExceptNicotine = CalculateChemicalUseAbuseAndDependenceScaleScoreSums(substanceUses);
return cuadScaleScoreSumsExceptNicotine.Count ( u => u > 1 );
// function UsedInLastDays(const nDays: integer): Boolean;
//
Result := ( (ASId01E = 1) and (ASId01R <= nDays) ) or ( (ASId02E = 1) and (ASId02R <= nDays) ) or
//
( (ASId03E = 1) and (ASId03R <= nDays) ) or ( (ASId04E = 1) and (ASId04R <= nDays) ) or
//
( (ASId05E = 1) and (ASId05R <= nDays) ) or ( (ASId06E = 1) and (ASId06R <= nDays) ) or
//
( (ASId07E = 1) and (ASId07R <= nDays) ) or ( (ASId08E = 1) and (ASId08R <= nDays) ) or
//
( (ASId09E = 1) and (ASId09R <= nDays) ) or ( (ASId10E = 1) and (ASId10R <= nDays) ) or
//
( (ASId11E = 1) and (ASId11R <= nDays) ) or ( (ASId12E = 1) and (ASId12R <= nDays) ) or
//
( (ASId13E = 1) and (ASId13R <= nDays) ) or ( (ASId13bE = 1) and (ASId13bR <= nDays) );
// Exclude Nicotine
return CalculateMinimumDaysSinceLastUsedDrugExceptNicotineInternal ( substanceUseHistorys );
public int CalculateChemicalUseAbuseAndDependenceScaleScoreSum(ISubstanceUse substanceUse)
// CUAD = Chemical Use, Abuse and Dependence Scale
// CUAD03NotDetox := CUAD03_04 + CUAD03_05 + CUAD03_06 + CUAD03_07 +
//
CUAD03_08 + CUAD03_09 + CUAD03_10 + CUAD03_11 + CUAD03_12 + CUAD03_13 +
//
CUAD03_14 + CUAD03_15 + CUAD03_16 + CUAD03_17 + CUAD03_18 + CUAD03_19;
// CUAD03 := CUAD03_01 + CUAD03_02 + CUAD03_03 + CUAD03NotDetox;
// if CUAD03 > 1 then
//
Inc(NumberOfCUADsPositive);
// MaxCUADOneDrug := iMax(MaxCUADOneDrug, CUAD03);
// //MaxCUADNoDetoxOneDrug := iMax(MaxCUADOneDrug, CUAD03NotDetox);
// Note: No need to calculate CUAD03NotDetox anymore since it is only used as a part of CUADSum.
Let cuadScales = new[]
{
substanceUse.IncreasedDoseRequiredToGetSameEffect,
substanceUse.ExperiencesWithdrawalSickness,
substanceUse.UseSubstanceToPreventWithdrawalSickness,
substanceUse.UnableToStopUsingSubstance,
substanceUse.SubstanceUseReductionAttempted,
substanceUse.UseOfSubstanceTakesUpALotOfTime,
substanceUse.FrequentlyHighAtWork,
substanceUse.FrequentlyHighAtSchool,
substanceUse.FrequentlyHighAtHome,
substanceUse.FrequentlyHighInDangerousSituations,
substanceUse.SubstanceUseReductionInSocialActivities,
substanceUse.SubstanceUseReductionInOccupationalActivities,
substanceUse.SubstanceUseReductionInRecreationalActivities,
substanceUse.SubstanceUseRecurrentProblemsWithFamilyFriends,
substanceUse.SubstanceUseRecurrentProblemsWithHealth,
substanceUse.SubstanceUseRecurrentProblemsWithEmotions,
substanceUse.SubstanceUseRecurrentProblemsWithJob,
substanceUse.SubstanceUseRecurrentProblemsWithLegalSystem,
substanceUse.HasUsedSubstanceKnowingProblemsWorsened
};
return CalculateChemicalUseAbuseAndDependenceScaleScoreSum ( cuadScales );
// For Alcohol only
public bool CalculateImminentWithdrawalPotential ( bool hasEverUsed,
ISubstanceUse substanceUse, bool? alcoholUsedToIntoxication, // ASId02E
TimeMeasure lastUsedToIntoxification, // ASId02R
uint? numberOfDaysIntoxicatedInPast30Days) // ASId02F
return CalculateImminentWithdrawalPotential ( hasEverUsed, substanceUse.LastUsed,
substanceUse.NumberOfDaysUsedInPast30Days, alcoholUsedToIntoxication, // ASId02E
lastUsedToIntoxification, // ASId02R
numberOfDaysIntoxicatedInPast30Days, // ASId02F
substanceUse.IncreasedDoseRequiredToGetSameEffect,// CUAD01_01
substanceUse.ExperiencesWithdrawalSickness, // CUAD01_02
substanceUse.UseSubstanceToPreventWithdrawalSickness // CUAD01_03
);
//
//
//
//
//
//
//
//
//
Substance Dependence w(with) or O(without) Physiol. Dep.
DSM-IV-SD (for each substance 01-13b) = TRUE If SUM of: CUAD##[01+(02or03)+04+05+06+(11or12or13)+19 >2]
IsDependent (DSMSD**) * from 01, 02, ..., 13, 13a, 13b
DSM-IV-SDwP = TRUE If DSM-IV-SD & Any of CUAD##(01,02,or03) =1
IsDependentWithPhysiologicalDependency (DSMSD**wP)
DSM-IV-SDoP = TRUE If DSM-IV-SD & SUM CUAD##(01+02+03) =0
IsDependentWithOutPhysiologicalDependency (DSMSD**oP)
DSM-IV-SA (for each substance 01-13b) = TRUE If SUM ofCUAD##: [(07or08or09)+10+18+(11or14or17)] >0
IsAbused (DSMSA**)
Let substanceScore = new SubstanceScore ( );
Let hasPhysiologicalDependency = HasPhysiologicalDependency ( increasedDoseRequiredToGetSameEffect,
experiencesWithdrawalSickness, useSubstanceToPreventWithdrawalSickness );
Let useFrequency = Utilities.CalculateFrequency ( hasEverUsed, lastUsed );
substanceScore.DependenceScore = CalculateDependenceScore(
increasedDoseRequiredToGetSameEffect,
experiencesWithdrawalSickness,
useSubstanceToPreventWithdrawalSickness,
unableToStopUsingSubstance,
substanceUseReductionAttempted,
useOfSubstanceTakesUpALotOfTime,
substanceUseReductionInSocialActivities,
substanceUseReductionInOccupationalActivities,
substanceUseReductionInRecreationalActivities,
hasUsedSubstanceKnowingProblemsWorsened);
substanceScore.IsDependent = substanceScore.DependenceScore > 2;
//
// DSM-IV-SDwP = TRUE If DSM-IV-SD and Any of CUAD##(01,02,or03) =1
//
OB_DSMSD01wP := OB_DSMSD01 and ( (CUAD01_01 + CUAD01_02 + CUAD01_03) > 0 );
//
OB_DSMSD01oP := OB_DSMSD01 and ( (CUAD01_01 + CUAD01_02 + CUAD01_03) = 0 );
substanceScore.IsDependentWithPhysiologicalDependency = substanceScore.IsDependent And
hasPhysiologicalDependency;
substanceScore.IsDependentWithOutPhysiologicalDependency = substanceScore.IsDependent And
!hasPhysiologicalDependency;
substanceScore.AbuseScore = CalculateAbuseScore ( frequentlyHighAtWork,
frequentlyHighAtSchool, frequentlyHighAtHome, frequentlyHighInDangerousSituations,
substanceUseRecurrentProblemsWithLegalSystem, substanceUseReductionInSocialActivities,
substanceUseRecurrentProblemsWithFamilyFriends, substanceUseRecurrentProblemsWithJob );
substanceScore.IsAbused = substanceScore.AbuseScore > 0 And
useFrequency > 0;
substanceScore.HasImminentWithdrawalPotential =
CalculateImminentWithdrawalPotential ( hasEverUsed, // ASId03E
lastUsed, // ASId03R
numberOfDaysUsedInPast30Days, // ASId03F
increasedDoseRequiredToGetSameEffect, // CUAD03_01
experiencesWithdrawalSickness, // CUAD03_02
useSubstanceToPreventWithdrawalSickness );
substanceScore.SubstanceUseHistory = new SubstanceUseHistory ( hasEverUsed, lastUsed );
return substanceScore;
internal static int CalculateChemicalUseAbuseAndDependenceScaleScoreSum ( params bool?[] cuadScales)
// CUAD = Chemical Use, Abuse and Dependence Scale
// CUAD03NotDetox := CUAD03_04 + CUAD03_05 + CUAD03_06 + CUAD03_07 +
//
CUAD03_08 + CUAD03_09 + CUAD03_10 + CUAD03_11 + CUAD03_12 + CUAD03_13 +
//
CUAD03_14 + CUAD03_15 + CUAD03_16 + CUAD03_17 + CUAD03_18 + CUAD03_19;
// CUAD03 := CUAD03_01 + CUAD03_02 + CUAD03_03 + CUAD03NotDetox;
// if CUAD03 > 1 then
//
Inc(NumberOfCUADsPositive);
// MaxCUADOneDrug := iMax(MaxCUADOneDrug, CUAD03);
// //MaxCUADNoDetoxOneDrug := iMax(MaxCUADOneDrug, CUAD03NotDetox);
// Note: No need to calculate CUAD03NotDetox separately since it is only used as a part of CUADSum.
if (cuadScales.Count() != 19)
{throw new ArgumentException("Parameter 'cuadScales' should has exactly all CUAD 19 scale items
(from CUAD0*_01 to CUAD0*_19).");
}
return cuadScales.Count ( u => u.HasValue And
u.Value );
internal static ISubstanceUse CalculateMultipelPerDayUse(params ISubstanceUse[] substanceUses)
if (substanceUses.Count() != 12)
throw new ArgumentException("Parameter 'substanceUses' should has exactly all 12 substanceUse object
(no Nicotine) to calculate Multiple Per Day use.");
// Calculate Multiple Per Day use from 12 substance use, exclude nicotine use
// Hack: since NicotineUse is a ISubstanceUse, just use it to create a ISubstanceUse instance for calculation only.
Let multiplePerDayUse = new NicotineUse
{IncreasedDoseRequiredToGetSameEffect = substanceUses.Any(u => (u.IncreasedDoseRequiredToGetSameEffect ??
false)),
ExperiencesWithdrawalSickness = substanceUses.Any(u => (u.ExperiencesWithdrawalSickness ?? false)),
UseSubstanceToPreventWithdrawalSickness = substanceUses.Any(u => (u.UseSubstanceToPreventWithdrawalSickness ??
false)),
UnableToStopUsingSubstance = substanceUses.Any(u => (u.UnableToStopUsingSubstance ?? false)),
SubstanceUseReductionAttempted = substanceUses.Any(u => (u.SubstanceUseReductionAttempted ?? false)),
UseOfSubstanceTakesUpALotOfTime = substanceUses.Any(u => (u.UseOfSubstanceTakesUpALotOfTime ?? false)),
FrequentlyHighAtWork = substanceUses.Any(u => (u.FrequentlyHighAtWork ?? false)),
FrequentlyHighAtSchool = substanceUses.Any(u => (u.FrequentlyHighAtSchool ?? false)),
FrequentlyHighAtHome = substanceUses.Any(u => (u.FrequentlyHighAtHome ?? false)),
FrequentlyHighInDangerousSituations = substanceUses.Any(u => (u.FrequentlyHighInDangerousSituations ?? false)),
SubstanceUseReductionInSocialActivities = substanceUses.Any(u => (u.SubstanceUseReductionInSocialActivities ??
false)),
SubstanceUseReductionInOccupationalActivities = substanceUses.Any(u =>
(u.SubstanceUseReductionInOccupationalActivities ?? false)),
SubstanceUseReductionInRecreationalActivities = substanceUses.Any(u => (u.SubstanceUseReductionInRecreationalActivities
?? false)),
SubstanceUseRecurrentProblemsWithFamilyFriends = substanceUses.Any(u =>
(u.SubstanceUseRecurrentProblemsWithFamilyFriends ?? false)),
SubstanceUseRecurrentProblemsWithHealth = substanceUses.Any(u =>
(u.SubstanceUseRecurrentProblemsWithHealth ?? false)),
SubstanceUseRecurrentProblemsWithEmotions = substanceUses.Any(u => (u.SubstanceUseRecurrentProblemsWithEmotions ??
false)),
SubstanceUseRecurrentProblemsWithJob = substanceUses.Any(u => (u.SubstanceUseRecurrentProblemsWithJob ?? false)),
SubstanceUseRecurrentProblemsWithLegalSystem = substanceUses.Any(u => (u.SubstanceUseRecurrentProblemsWithLegalSystem
?? false)),
HasUsedSubstanceKnowingProblemsWorsened = substanceUses.Any(u => (u.HasUsedSubstanceKnowingProblemsWorsened ?? false))
return multiplePerDayUse;
internal IEnumerable<int> CalculateChemicalUseAbuseAndDependenceScaleScoreSums(ISubstanceUse[] substanceUses)
// CUAD Scale = Chemical Use, Abuse and Dependence Scale
// CUAD01, 03, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13****, 13b. // No nicotine
// Calculate Multiple Per Day use from 12 substance use
Let multiplePerDayUse = CalculateMultipelPerDayUse(substanceUses);
Let substanceUseList = new List<ISubstanceUse>();
substanceUseList.AddRange(substanceUses);
substanceUseList.Add(multiplePerDayUse);
Let cuadScaleScores = substanceUseList.Select(CalculateChemicalUseAbuseAndDependenceScaleScoreSum).ToList();
return cuadScaleScores;
internal static double CalculateMinimumDaysSinceLastUsedDrugExceptNicotineInternal (SubstanceUseHistory[]
substanceUseHistorys)
if (substanceUseHistorys.Count() != 14)
{throw new ArgumentException(
"Parameter 'substanceUseHistorys' should has exactly all 14 substance use history data, including Alcohol To
Intoxication and Multiple Per Day use, but not Nicotine.");
if (substanceUseHistorys.Any(u => u.HasEverUsed.HasValue And u.HasEverUsed.Value)) return
substanceUseHistorys.Where(u => u.HasEverUsed.HasValue And u.HasEverUsed.Value).Min
(u => u.UseFrequency);
return Double.MaxValue;
// For Alcohol only
internal bool CalculateImminentWithdrawalPotential(
bool? hasEverUsedAlcohol, // ASId01E
TimeMeasure lastUsedAlcohol, // ASId01R
uint? numberOfDaysUsedInPast30DaysAlcohol, // ASId01F
bool? alcoholUsedToIntoxicationAlcohol, // ASId02E
TimeMeasure lastUsedToIntoxification, // ASId02R
uint? numberOfDaysIntoxicatedInPast30DaysAlcohol, // ASId02F
bool? increasedDoseRequiredToGetSameEffectAlcohol, // CUAD01_01
bool? experiencesWithdrawalSicknessAlcohol, // CUAD01_02
bool? useSubstanceToPreventWithdrawalSicknessAlcohol) // CUAD01_03
// Current Delphi Code
// OB_ImminentWD01 := ( ( ( (ASId01E = 1) and (ASId01R <= 3) ) and (ASId01F >= 15) )
or
// any alcohol
//
( ( (ASId02E = 1) and (ASId02R <= 3) ) and (ASId02F >= 15) ) ) and
//
( (CUAD01_01 > 0) or (CUAD01_02 > 0) or (CUAD01_03 > 0) );
// any CUAD 1-3 is positive.
Let alcoholUseFrequency = Utilities.CalculateFrequency(hasEverUsedAlcohol, lastUsedAlcohol); //ASId01R
Let alcoholUsedToIntoxicationFrequency = Utilities.CalculateFrequency(alcoholUsedToIntoxicationAlcohol,
lastUsedToIntoxification); // ASId02R
if (alcoholUseFrequency > alcoholUsedToIntoxicationFrequency And alcoholUsedToIntoxicationFrequency > 0)
{alcoholUseFrequency = alcoholUsedToIntoxicationFrequency; }
return (((hasEverUsedAlcohol ?? false) And alcoholUseFrequency <= 3 And
numberOfDaysUsedInPast30DaysAlcohol >= 15) Or ((alcoholUsedToIntoxicationAlcohol ?? false) And
alcoholUsedToIntoxicationFrequency <= 3 And
numberOfDaysIntoxicatedInPast30DaysAlcohol >= 15)) And
((increasedDoseRequiredToGetSameEffectAlcohol ?? false) ||
(experiencesWithdrawalSicknessAlcohol ?? false) ||
(useSubstanceToPreventWithdrawalSicknessAlcohol ?? false));
private static ScaleOf0To7 CalculateDependenceScore (bool? increasedDoseRequiredToGetSameEffect,
bool? experiencesWithdrawalSickness,
bool? useSubstanceToPreventWithdrawalSickness,
bool? unableToStopUsingSubstance,
bool? substanceUseReductionAttempted,
bool? useOfSubstanceTakesUpALotOfTime,
bool? substanceUseReductionInSocialActivities,
bool? substanceUseReductionInOccupationalActivities,
bool? substanceUseReductionInRecreationalActivities,
bool? hasUsedSubstanceKnowingProblemsWorsened)
// // DSM-IV-SD (for each substance 01-13b) = TRUE If SUM of: CUAD##[01+(02or03)+04+05+06+(11or12or13)+19 >2]
//
CUAD01_SD := CUAD01_01 + iMin(1, (CUAD01_02 + CUAD01_03)) + CUAD01_04 + CUAD01_05 +
//
CUAD01_06 + iMin(1, (CUAD01_11 + CUAD01_12 + CUAD01_13)) + CUAD01_19;
// OB_DSMSD01 := (CUAD01_SD > 2);
Let cuadScales = new[]
{
( increasedDoseRequiredToGetSameEffect ?? false ),
( experiencesWithdrawalSickness ?? false ) Or ( useSubstanceToPreventWithdrawalSickness ?? false ),
( unableToStopUsingSubstance ?? false ),
( substanceUseReductionAttempted ?? false ),
( useOfSubstanceTakesUpALotOfTime ?? false ),
( substanceUseReductionInSocialActivities ?? false ) ||
( substanceUseReductionInOccupationalActivities ?? false ) ||
( substanceUseReductionInRecreationalActivities ?? false ),
( hasUsedSubstanceKnowingProblemsWorsened ?? false )
};
return new ScaleOf0To7((uint)cuadScales.Count(u => u));
private static bool HasPhysiologicalDependency ( bool? increasedDoseRequiredToGetSameEffect,
bool? experiencesWithdrawalSickness,
bool? useSubstanceToPreventWithdrawalSickness )
// (CUAD01_01 + CUAD01_02 + CUAD01_03)
return ( increasedDoseRequiredToGetSameEffect ?? false ) ||
( experiencesWithdrawalSickness ?? false ) Or ( useSubstanceToPreventWithdrawalSickness ?? false );
private static uint CalculateAbuseScore(bool? frequentlyHighAtWork,
bool? frequentlyHighAtSchool,
bool? frequentlyHighAtHome,
bool? frequentlyHighInDangerousSituations,
bool? substanceUseRecurrentProblemsWithLegalSystem,
bool? substanceUseReductionInSocialActivities,
bool? substanceUseRecurrentProblemsWithFamilyFriends,
bool? substanceUseRecurrentProblemsWithJob)
Let cuadScales = new[]
( frequentlyHighAtWork ?? false ) Or ( frequentlyHighAtSchool ?? false ) ||
( frequentlyHighAtHome ?? false ),
( frequentlyHighInDangerousSituations ?? false ),
( substanceUseRecurrentProblemsWithLegalSystem ?? false ),
( substanceUseReductionInSocialActivities ?? false ) ||
( substanceUseRecurrentProblemsWithFamilyFriends ?? false ) ||
( substanceUseRecurrentProblemsWithJob ?? false )
return (uint) cuadScales.Count ( u => u );
private static bool CalculateImminentWithdrawalPotential ( bool? hasEverUsed, // ASId03E
TimeMeasure lastUsed, // ASId03R
uint? numberOfDaysUsedInPast30Days, // ASId03F
bool? increasedDoseRequiredToGetSameEffect, // CUAD03_01
bool? experiencesWithdrawalSickness, // CUAD03_02
bool? useSubstanceToPreventWithdrawalSickness )
// Current Delphi Code
// OB_ImminentWD03 := ( (ASId03E = 1) and (ASId03R <= 3) ) and (ASId03F >= 15) and
// any recent, consistent heroin use
// ( (CUAD03_01 > 0) or (CUAD03_02 > 0) or (CUAD03_03 > 0) );
// any CUAD 1-3 is positive.
Let useFrequency = Utilities.CalculateFrequency(hasEverUsed, lastUsed);
return (hasEverUsed ?? false) And
useFrequency <= 3 And
numberOfDaysUsedInPast30Days >= 15 And
((increasedDoseRequiredToGetSameEffect ?? false) Or (experiencesWithdrawalSickness ?? false) ||
(useSubstanceToPreventWithdrawalSickness ?? false));
Dimension 3 General Pre-requisites
MDDI (Major Depr. Dis.-Immediate) = TRUE If [ASIp3D or ASIp3aD >1] & [>4 items of (ASIp:
3D,3aD,3bD,3cD,3dD,4rD,4sD,4tD,6D,8D >2 (count ASIp8D if >0)]
MDDI =1
MDDC (Major Depr. Dis.-Current) = TRUE If [ASIp3M or ASIp3aM >1] & [>4 items of (ASIp:
3M,3aM,3bM,3cM,3dM,4rM,4sM,4tM,6M,8M >2 (count ASIp8M if >0)]
MDDC =1
MDDL (Major Depr. Dis.-Lifetime) = TRUE If [ASIp3L or ASIp3aL >1] & [>4 items of (ASIp:
3L,3aL,3bL,3cL,3dL,4rL,4sL,4tL,6L,8L >2 (count ASIp8L if >0)]
MDDL =1
ODDI (Other Depr. Dis.-Immediate) = TRUE If [ASIp3D or ASIp3aD >1] & [2, 3, or 4 items of (ASIp:
3D,3aD,3bD,3cD,3dD,4rD,4sD,4tD,6D,8D >2 (count ASIp8D if >0)]
ODDI =1
ODDC (Other Depr. Dis.-Current) = TRUE If [ASIp3M or ASIp3aM >1] & [2, 3, or 4 items of (ASIp:
3M,3aM,3bM,3cM,3dM,4rM,4sM,4tM,6M,8M >2 (count ASIp8M if >0)]
ODDC =1
ODDL (Other Depr. Dis.-Lifetime) = TRUE If [ASIp3L or ASIp3aL >1] & [2, 3, or 4 items of (ASIp:
3L,3aL,3bL,3cL,3dL,4rL,4sL,4tL,6L,8L >2 (count ASIp8L if >0)]
ODDL=1
PS (Panic Syndrome) = TRUE If [All of ASIp: 4aM,4bM,4cM,4dM >1]
AND [>3 items of ASIp: 4eM thu 4qM >2]
PS = 1
OAS (Other Anx. Synd.) = TRUE If [ASIp4M >1] & [>2 items of ASIp:
4rM,4sM,4tM,4uM,6M,7aM >2]
OAS =1
Dim3Px: "WD Sxs" & "Emot'l/Behav'l/Cogn. Problems"
Dim3Px = TRUE If [any of ASIp: 4vD,4wD,4xD,4yD,5D,5aD,6D >2] or [ASIp8M or p9M >1] or [MDDI,
ODDI, PS or OAS =1] or CIWA10>2 or ASIm6b>0 or [Any of ASIp: 17,18,18a,18b,18c,19,19a,19b >2] or
[CIWA7 or 8 >3]
Dim3Px=1
HxRisk = (Hx of harm risk to self/others) Sum of # of items >0 (regardless of score) of ASI:
p7L,p9L,l10,l11,l12,l13
HxRisk=0thru6
CurRisk = (Risk to self or others) Highest score of ASIp: 19,19a,19c,19d,19f OR ASIf:19d,19f
CurRisk=0thru
8
HxWdPsSxs = TRUE (i.e., Px/Sx is WD-related) If Any of ASIp: (4a,5,6,7,8 or 9)D, M, or L items receive U
code=2
HxWdPsSxs=1
Dimesional Addmission Criteria
Level of Care: Early Intervention (0.5)
Level 0.5 (Early Intervention) Summary
None
Level 0.5 (Early Intervention) Sole Criterion
The individual who is appropriately cared for at Level 0.5 meets one of the specifications in
Dimensions 4, 5 or 6. Any identifiable problems in Dimensions 1, 2 or 3 are stable or are being
addressed through appropriate outpatient medical or mental health services.
Level 0.5 (Early Intervention) Placement Criterion
Original Equation
DacL0.5 =
TRUE If [DxL0.5 & D1LID & D2L0.5 & D3L0.5 & (D4L0.5 or D5L0.5 or D6L0.5)]
Narrative
1)
Dimensional Admission Criteria Care Level 0.5 is met if Detox. Result’s care level 0.5 is met and Dimension 1 severity
number is less than 3 and Dimension 2 care level 0.5 is met and Dimension 3 care level 0.5 is met and (Dimension 4
care level 0.5 is met or Dimension 5 care level 0.5 is met or Dimension 6 care level 0.5 is met)
Dimensional Admission Criteria: Level 0.5 Early Intervention
Reference Pseudo Code
Let dxResultsCareLevel_0_5_ScoreIsMet = assessmentScore.DiagnosisResults.CareLevel_0_5_EarlyInterventionScore.IsMet
Let d1SeverityNumber = assessmentScore.Dimension1WithdrawalScores.SeverityNumber
Let d2CareLevel_0_5_ScoreIsMet = assessmentScore.Dimension2BiomedicalScores.CareLevel_0_5_EarlyInterventionScore.IsMet
Let d3CareLevel_0_5_ScoreIsMet =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_0_5_EarlyInterventionScore.IsMet
Let d4CareLevel_0_5_ScoreIsMet =
assessmentScore.Dimension4ReadinessToChangeScores.CareLevel_0_5_EarlyInterventionScore.IsMet
Let d5CareLevel_0_5_ScoreIsMet =
assessmentScore.Dimension5RelapsePotentialScores.CareLevel_0_5_EarlyInterventionScore.IsMet
Let d6CareLevel_0_5_ScoreIsMet =
assessmentScore.Dimension6LivingEnvironmentScores.CareLevel_0_5_EarlyInterventionScore.IsMet
Bool
Int
Bool
Bool
Bool
Bool
Bool
dxResultsCareLevel_0_5_ScoreIsMet
d1SeverityNumber
d2CareLevel_0_5_ScoreIsMet
d3CareLevel_0_5_ScoreIsMet
d4CareLevel_0_5_ScoreIsMet
d5CareLevel_0_5_ScoreIsMet
d6CareLevel_0_5_ScoreIsMet
Let careLevel_0_5_Score.IsMet = (dxResultsCareLevel_0_5_ScoreIsMet And d1SeverityNumber < 3 And
d2CareLevel_0_5_ScoreIsMet And d3CareLevel_0_5_ScoreIsMet) And (d4CareLevel_0_5_ScoreIsMet Or
d5CareLevel_0_5_ScoreIsMet Or d6CareLevel_0_5_ScoreIsMet)
Level of Care: Outpatient Treatment (I)
Level I (Outpatient Treatment) Summary
None
Level I (Outpatient Treatment) Placement Criteria
Original Equation
DacLI = TRUE If [DxLI & D1LID & D2LI & D3LI & D4LI & D5LI & D6LI]
DacLIdde = TRUE If DacLI & [DxLIdde & D3LIdde & D5LIdde & D6LIdde]
Narrative
Placement criteria(IsMet) is met if:
1) Dimensional Admission Criteria Care Level I is met if Detox. Results care level I is met and Dimension 1 severity
number is less than 4 and Dimension 2 care level I is met and Dimension 3 care level I is met and Dimension 4 care
level I is met and Dimension 5 care level I is met and Dimension 6 care level I is met
Criteria (Dual Diagnosis Enhanced) is met if:
1) Dimensional Admission Criteria Care Level I Dual Diagnosis Enhanced is met if Dimensional Admission Criteria care
level I is met and (Detox. Result's care level I Dual Diagnosis Enhanced is met and Dimension 3 care level I Dual
Diagnosis Enhanced is met and Dimension 5 care level I Dual Diagnosis Enhanced is met and Dimension 6 care level I
Dual Diagnosis Enhanced is met)
Dimensional Admission Criteria: Level I Outpatient Treatment
Reference Pseudo Code
Let dxResultsCareLevel_I_ScoreIsMet = assessmentScore.DiagnosisResults.CareLevel_I_OutpatientScore.IsMet
Let d1SeverityNumber = assessmentScore.Dimension1WithdrawalScores.SeverityNumber
Let d2CareLevel_I_ScoreIsMet = assessmentScore.Dimension2BiomedicalScores.CareLevel_I_OutpatientScore.IsMet
Let d3CareLevel_I_ScoreIsMet = assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_I_OutpatientScore.IsMet
Let d4CareLevel_I_ScoreIsMet =
assessmentScore.Dimension4ReadinessToChangeScores.Dimension4CareLevel_I_OutpatientScore.IsMet
Let d5CareLevel_I_ScoreIsMet = assessmentScore.Dimension5RelapsePotentialScores.CareLevel_I_OutpatientScore.IsMet
Let d6CareLevel_I_ScoreIsMet = assessmentScore.Dimension6LivingEnvironmentScores.CareLevel_I_OutpatientScore.IsMet
Let dacResultsCareLevel_I_ScoreIsMet =
assessmentScore.DimensionalAdmissionCriteriaResults.CareLevel_I_OutpatientScore.IsMet
Let dxResultsCareLevel_I_ScoreIsDualDiagnosisEnhanced =
assessmentScore.DiagnosisResults.CareLevel_I_OutpatientScore.IsDualDiagnosisEnhanced
Let d3CareLevel_I_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_I_OutpatientScore.IsDualDiagnosisEnhanced
Let d5CareLevel_I_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension5RelapsePotentialScores.CareLevel_I_OutpatientScore.IsDualDiagnosisEnhanced
Let d6CareLevel_I_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension6LivingEnvironmentScores.CareLevel_I_OutpatientScore.IsDualDiagnosisEnhanced
Bool
Int
Bool
Bool
Bool
Bool
Bool
Bool
dxResultsCareLevel_I_ScoreIsMet
d1SeverityNumber
d2CareLevel_I_ScoreIsMet
d3CareLevel_I_ScoreIsMet
d4CareLevel_I_ScoreIsMet
d5CareLevel_I_ScoreIsMet
d6CareLevel_I_ScoreIsMet
dacResultsCareLevel_I_ScoreIsMet
Bool
Bool
Bool
Bool
dxResultsCareLevel_I_ScoreIsDualDiagnosisEnhanced
d3CareLevel_I_ScoreIsDualDiagnosisEnhanced
d5CareLevel_I_ScoreIsDualDiagnosisEnhanced
d6CareLevel_I_ScoreIsDualDiagnosisEnhanced
Let careLevel_I_Score.IsMet = dxResultsCareLevel_I_ScoreIsMet And d1SeverityNumber < 4) And d2CareLevel_I_ScoreIsMet
And d3CareLevel_I_ScoreIsMet And d4CareLevel_I_ScoreIsMet And d5CareLevel_I_ScoreIsMet And
d6CareLevel_I_ScoreIsMet
Let careLevel_I_Score.IsDualDiagnosisEnhanced = dacResultsCareLevel_I_ScoreIsMet And
(dxResultsCareLevel_I_ScoreIsDualDiagnosisEnhanced And d3CareLevel_I_ScoreIsDualDiagnosisEnhanced And
d5CareLevel_I_ScoreIsDualDiagnosisEnhanced And d6CareLevel_I_ScoreIsDualDiagnosisEnhanced And)
Level of Care: Opiate Maintenance Therapy (OMT)
Level OMT (Opiate Maintenance Therapy) Summary
None
Level OMT (Opiate Maintenance Therapy) Placement Criterion
Original Equation
DacLM = TRUE If [DxLM & D1LM & D2LM & D3LM & D4LM & D5LM & D6LM]
Narrative
Placement criteria are met if either of the following is met:
1) Dimensional Admission Criteria Care Level OMT is met if Detox. results care level OMT is met and Dimension 1 care
level OMT Dimension 2 care level OMT is met and Dimension 3 care level OMT is met and Dimension 4 care level
OMT is met and Dimension 5 care level OMT is met Dimension 6 care level OMT is met
Dimensional Admission Criteria: Level OMT Opiate Maintenance Therapy
Reference Pseudo Code
Let dxResultsCareLevel_OMT_ScoreIsMet = assessmentScore.DiagnosisResults.CareLevelOpioidMaintenanceTherapyScore.IsMet
Let d1CareLevel_OMT_ScoreIsMet =
assessmentScore.Dimension1WithdrawalScores.CareLevelOpioidMaintenanceTherapyScore.IsMet
Let d2CareLevel_OMT_ScoreIsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevelOpioidMaintenanceTherapyScore.IsMet
Let d3CareLevel_OMT_ScoreIsMet =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevelOpioidMaintenanceTherapyScore.IsMet
Let d4CareLevel_OMT_ScoreIsMet =
assessmentScore.Dimension4ReadinessToChangeScores.CareLevelOpioidMaintenanceTherapyScore.IsMet
Let d5CareLevel_OMT_ScoreIsMet =
assessmentScore.Dimension5RelapsePotentialScores.CareLevelOpioidMaintenanceTherapyScore.IsMet
Let d6CareLevel_OMT_ScoreIsMet =
assessmentScore.Dimension6LivingEnvironmentScores.CareLevelOpioidMaintenanceTherapyScore.IsMet
Bool
Bool
Bool
Bool
Bool
Bool
Bool
dxResultsCareLevel_OMT_ScoreIsMet
d1CareLevel_OMT_ScoreIsMet
d2CareLevel_OMT_ScoreIsMet
d3CareLevel_OMT_ScoreIsMet
d4CareLevel_OMT_ScoreIsMet
d5CareLevel_OMT_ScoreIsMet
d6CareLevel_OMT_ScoreIsMet
Let careLevel_OMT_Score.IsMet = dxResultsCareLevel_OMT_ScoreIsMet And d1CareLevel_OMT_ScoreIsMet An
d2CareLevel_OMT_ScoreIsMet And d3CareLevel_OMT_ScoreIsMet And d4CareLevel_OMT_ScoreIsMet And
d5CareLevel_OMT_ScoreIsMet And d6CareLevel_OMT_ScoreIsMet
Level of Care: Intensive Outpatient (II.1)
Level II.1 (Intensive Outpatient) Summary
None
Level II.1 (Intensive Outpatient) Placement Criteria
Original Equation
DacLII.1 = TRUE If [DxLII.1 & D1LID & D2LII.1 & D3LII.1ato & (D4LII.1 or D5LII.1 or D6LII.1)]
DacLII.1ddc = TRUE If [DxLII.1 & D1LID & D2LII.1 & D3LII.1ddc & (D4LII.1 or D5LII.1 or D6LII.1)]
DacLII.1dde = TRUE If [DxLII.1 & DxLII.1dde & D1LID & D2LII.1 & D3LII.1dde &
({D4LII.1 & D4LII.1dde} or {D5LII.1 & D5LII.1dde} or {D6LII.1 & D6LII.1dde})]
Narrative
Placement criteria(IsMet) is met if:
1) Dimensional Admission Criteria Care Level II.1 is met if Detox. Results care level II.1 is met and Dimension 1 severity
number is less than 5 and Dimension 2 care level II.1 is met and Dimension 3 severity number is less than 4 and
(Dimension 4 care level II.1 is met or Dimension 5 care level II.1 is met or Dimension 6 care level II.1 is met)
Criteria (Dual Diagnosis Capable) is met if:
1) Dimensional Admission Criteria Care Level II.1 Dual Diagnosis Capable is met if Dimensional Admission Criteria care
level II.1 is met and Dimension 3 II.1 Dual Diagnosis Capable is met
Criteria (Dual Diagnosis Enhanced) is met if:
1) Dimensional Admission Criteria Care Level II.1 Dual Diagnosis Enhanced is met if Detox. Results care level II.1 Dual
Diagnosis Enhanced is met Dimension 2 care level II.1 is met and Dimension 3 care level II.1 Dual Diagnosis Enhanced
is met and (Dimension 4 care level II.1 is met or Dimension 4 care level II.1 Dual Diagnosis Enhanced is met or
Dimension 5 care level II.1 is met or Dimension 5 care level II.1 Dual Diagnosis Enhanced is met or Dimension 6 care
level II.1 is met or Dimension 6 care level II.1 Dual Diagnosis Enhanced is met)
Dimensional Admission Criteria: Level II.1 Intensive Outpatient Therapy
Reference Pseudo Code
Let dxResultsCareLevel_II_1_ScoreIsMet = assessmentScore.DiagnosisResults.CareLevel_II_1_IntensiveOutpatientScore.IsMet
Let d1SeverityNumber = assessmentScore.Dimension1WithdrawalScores.SeverityNumber
Let d2CareLevel_II_1_ScoreIsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevel_II_1_IntensiveOutpatientScore.IsMet
Let d3SeverityNumber = assessmentScore.Dimension3EmotionalBehavioralScores.SeverityNumber
Let d4CareLevel_II_1_ScoreIsMet =
assessmentScore.Dimension4ReadinessToChangeScores.CareLevel_II_1_IntensiveOutpatientScore.IsMet
Let d5CareLevel_II_1_ScoreIsMet =
assessmentScore.Dimension5RelapsePotentialScores.CareLevel_II_1_IntensiveOutpatientScore.IsMet
Let d6CareLevel_II_1_ScoreIsMet =
assessmentScore.Dimension6LivingEnvironmentScores.CareLevel_II_1_IntensiveOutpatientScore.IsMet
Let d3CareLevel_II_1_ScoreIsDualDiagnosisCapable =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_II_1_IntensiveOutpatientScore.IsDualDiagnosisCapable
Let d4CareLevel_II_1_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension4ReadinessToChangeScores.CareLevel_II_1_IntensiveOutpatientScore.IsDualDiagnosisEnhanced
Let d5CareLevel_II_1_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension5RelapsePotentialScores.CareLevel_II_1_IntensiveOutpatientScore.IsDualDiagnosisEnhanced
Let d6CareLevel_II_1_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension6LivingEnvironmentScores.CareLevel_II_1_IntensiveOutpatientScore.IsDualDiagnosisEnhanced
Let dxResultsCareLevel_II_1_ScoreIsDualDiagnosisEnhanced =
assessmentScore.DiagnosisResults.CareLevel_II_1_IntensiveOutpatientScore.IsDualDiagnosisEnhanced
Let d3CareLevel_II_1_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_II_1_IntensiveOutpatientScore.IsDualDiagnosisEnhanced
Bool
Int
Bool
Int
Bool
Bool
Bool
Bool
Bool
Bool
Bool
Bool
Bool
dxResultsCareLevel_II_1_ScoreIsMet
d1SeverityNumber
d2CareLevel_II_1_ScoreIsMet
d3SeverityNumber
d4CareLevel_II_1_ScoreIsMet
d5CareLevel_II_1_ScoreIsMet
d6CareLevel_II_1_ScoreIsMet
d3CareLevel_II_1_ScoreIsDualDiagnosisCapable
d4CareLevel_II_1_ScoreIsDualDiagnosisEnhanced
d5CareLevel_II_1_ScoreIsDualDiagnosisEnhanced
d6CareLevel_II_1_ScoreIsDualDiagnosisEnhanced
dxResultsCareLevel_II_1_ScoreIsDualDiagnosisEnhanced
d3CareLevel_II_1_ScoreIsDualDiagnosisEnhance
Let careLevel_II_1_Score.IsMet = (dxResultsCareLevel_II_1_ScoreIsMet And d1SeverityNumber < 5 And
d2CareLevel_II_1_ScoreIsMet And d3SeverityNumber < 4) And (d4CareLevel_II_1_ScoreIsMet And
d5CareLevel_II_1_ScoreIsMet And d6CareLevel_II_1_ScoreIsMet)
Level of Care: Partial Hospitalization (II.5)
Level II.5 (Partial Hospitalization) Summary
None
Level II.5 (Partial Hospitalization) Placement Criteria
Original Equation
DacLII.5 = TRUE If [DxLII.5 & (D1LID OR D1LIID) & D2LII.5 & (D4LII.5 or D5LII.5 or D6LII.5)]
DacLII.5ddc = TRUE If [DxLII.5 & (D1LID OR D1LIID) & D2LII.5 & D3LII.5ddc & (D4LII.5 or D5LII.5 or D6LII.5)]
DacLII.5dde = TRUE If [DxLII.5 & DxLII.5dde & (D1LID OR D1LIID) & D2LII.5 & D3LII.5dde & ({D4LII.5 & D4LII.5dde} or
{D5LII.5 & D5LII.5dde} or {D6LII.5 & D6LII.5dde})]
DacLII.5dde+LIII.1 = TRUE If [DxLII.5 & DxLII.5dde & (D1LID OR D1LIID) & D2LII.5 & (D3LII.5dde+LIII.1) & ({D4LII.5 &
D4LII.5dde} or {D5LII.5 & D5LII.5dde} or {D6LII.5 & D6LII.5dde})]
DacLII.5ddc+LIII.1 = TRUE If [DxLII.5 & (D1LID OR D1LIID) & D2LII.5 & (D3LII.5ddc+LIII.1) & (D4LII.5 or D5LII.5 or
D6LII.5)]
Narrative
Placement criteria(IsMet) is met if:
1) Dimensional Admission Criteria Care Level II.5 is met if Detox. Result's care level II.5 is met and Dimension 1 severity
number is less than 5 and Dimension 2 care level II.5 is met and Dimension 3 severity number is less than 5 and
(Dimension 4 care level II.5 is met or Dimension 5 care level II.5 is met or Dimension 6 care level II.5 is met)
Criteria (Dual Diagnosis Capable) is met if:
1) Dimensional Admission Criteria Care Level II.5 Dual Diagnosis Capable is met if Detox. Result's care level II.5 is met
and Dimension 2 care level II.5 is met Dimension 3 care level II.5 Dual Diagnosis Capable is met and (Dimension 4
care level II.5 is met or Dimension 5 care level II.5 is met or Dimension 6 care level II.5 is met)
Criteria (Dual Diagnosis Enhanced) is met if:
1) Dimensional Admission Criteria Care Level II.5 Dual Diagnosis Enhanced is met if Detox. Result's care level II.5 Dual
Diagnosis Enhanced is met and Dimension 2 care level II.5 is met and Dimension 3 care level II.5 Dual Diagnosis
Enhanced is met and (Dimension 4 care level II.5 Dual Diagnosis Enhanced is met or Dimension 5 care level II.5 Dual
Diagnosis Enhanced is met or Dimension 6 care level II.5 Dual Diagnosis Enhanced is met)
Criteria (Dual Diagnosis Capable and Level III.1) is met if:
1) Dimensional Admission Criteria care level II.5 Dual Diagnosis Capable and Level III.1 is met if Detox. Result's care
level II.5 is met and Dimension 2 care level II.5 is met Dimension 3 care level II.5 Dual Diagnosis Capable level III.1 is
met and (Dimension 4 care level II.5 is met or Dimension 5 care level II.5 is met or Dimension 6 care level II.5 is met)
Criteria (Dual Diagnosis Enhanced and Level III.1) is met if:
1) Dimensional Admission Criteria care level II.5 Dual Diagnosis Enhanced and Level III.1 is met if Detox. Result's care
level II.5 Dual Diagnosis Enhanced is met and Dimension 2 care level II.5 is met and Dimension 3 care level II.5 Dual
Diagnosis Enhanced Level III.1 is met and ((Dimension 4 care level II.5 is met and Dimension 4 care level II.5 Dual
Diagnosis Enhanced is met) or (Dimension 5 care level II.5 is met and Dimension 5 care level II.5 is met) or
(Dimension 6 care level II.5 is met and Dimension 6 care level II.5 Dual Diagnosis Enhanced is met))
Dimensional Admission Criteria: Level II.5 Partial Hospitalization
Reference Pseudo Code
Let dxResultsCareLevel_II_5_ScoreIsMet =
assessmentScore.DiagnosisResults.CareLevel_II_5_PartialHospitalizationScore.IsMet
Let d1SeverityNumber = assessmentScore.Dimension1WithdrawalScores.SeverityNumber
Let d2CareLevel_II_5_ScoreIsMet =
assessmentScore.Dimension2BiomedicalScores.CareLevel_II_5_PartialHospitalizationScore.IsMet
Let d3SeverityNumber = assessmentScore.Dimension3EmotionalBehavioralScores.SeverityNumber
Let d4CareLevel_II_5_ScoreIsMet =
assessmentScore.Dimension4ReadinessToChangeScores.CareLevel_II_5_PartialHospitalizationScore.IsMet
Let d5CareLevel_II_5_ScoreIsMet =
assessmentScore.Dimension5RelapsePotentialScores.CareLevel_II_5_PartialHospitalizationScore.IsMet
Let d6CareLevel_II_5_ScoreIsMet =
assessmentScore.Dimension6LivingEnvironmentScores.CareLevel_II_5_PartialHospitalizationScore.IsMet
Let d3CareLevel_II_5_ScoreIsDualDiagnosisCapable =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisCapable
Let dxResultsCareLevel_II_5_ScoreIsDualDiagnosisEnhanced =
assessmentScore.DiagnosisResults.CareLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisEnhanced
Let d3CareLevel_II_5_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisEnhanced
Let d4CareLevel_II_5_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension4ReadinessToChangeScores.CareLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisEnhanced
Let d5CareLevel_II_5_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension5RelapsePotentialScores.CareLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisEnhanced
Let d6CareLevel_II_5_ScoreIsDualDiagnosisEnhanced =
assessmentScore.Dimension6LivingEnvironmentScores.CareLevel_II_5_PartialHospitalizationScore.IsDualDiagnosisEnhanced
Let d3CareLevel_II_5_ScoreIsDualDiagnosisEnhanced_III_1 =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_II_5_PartialHospitalizationScore.RequiresPartialHospitali
zationOrOutPatientInConjunctionWithLevel3
Let d3CareLevel_II_5_ScoreIsDualDiagnosisCapable_III_1 =
assessmentScore.Dimension3EmotionalBehavioralScores.CareLevel_II_5_PartialHospitalizationScore.HasProblemsRequiringSupp
ortiveEnvironmentWithLevelIII_1Care
Bool
Int
Bool
Int
Bool
Bool
Bool
Bool
Bool
Bool
Bool
Bool
Bool
Bool
Bool
dxResultsCareLevel_II_5_ScoreIsMet
d1SeverityNumber
d2CareLevel_II_5_ScoreIsMet
d3SeverityNumber
d4CareLevel_II_5_ScoreIsMet
d5CareLevel_II_5_ScoreIsMet
d6CareLevel_II_5_ScoreIsMet
d3CareLevel_II_5_ScoreIsDualDiagnosisCapable
dxResultsCareLevel_II_5_ScoreIsDualDiagnosisEnhanced
d3CareLevel_II_5_ScoreIsDualDiagnosisEnhanced
d4CareLevel_II_5_ScoreIsDualDiagnosisEnhanced
d5CareLevel_II_5_ScoreIsDualDiagnosisEnhanced
d6CareLevel_II_5_ScoreIsDualDiagnosisEnhanced
d3CareLevel_II_5_ScoreIsDualDiagnosisEnhanced_III_1
d3CareLevel_II_5_ScoreIsDualDiagnosisCapable_III_1
Let careLevel_II_5_Score.IsMet = (dxResultsCareLevel_II_5_ScoreIsMet And d1SeverityNumber < 5 And
d2CareLevel_II_5_ScoreIsMet And d3SeverityNumber < 5) And (d4CareLevel_II_5_ScoreIsMet Or
d5CareLevel_II_5_ScoreIsMet Or d6CareLevel_II_5_ScoreIsMet)
Let careLevel_II_5_Score.IsDualDiagnosisCapable = (dxResultsCareLevel_II_5_ScoreIsMet And d2CareLevel_II_5_ScoreIsMet
And d3CareLevel_II_5_ScoreIsDualDiagnosisCapable) And (d4CareLevel_II_5_ScoreIsMet Or d5CareLevel_II_5_ScoreIsMet
Or d6CareLevel_II_5_ScoreIsMet)
Let careLevel_II_5_Score.IsDualDiagnosisEnhanced = (dxResultsCareLevel_II_5_ScoreIsDualDiagnosisEnhanced And
d2CareLevel_II_5_ScoreIsMet And d3CareLevel_II_5_ScoreIsDualDiagnosisEnhanced ) And
(d4CareLevel_II_5_ScoreIsDualDiagnosisEnhanced Or d5CareLevel_II_5_ScoreIsDualDiagnosisEnhanced Or
d6CareLevel_II_5_ScoreIsDualDiagnosisEnhanced)
Let careLevel_II_5_Score.IsDualDiagnosisEnhancedAndLevel_III_1 = dxResultsCareLevel_II_5_ScoreIsDualDiagnosisEnhanced
And d2CareLevel_II_5_ScoreIsMet And d3CareLevel_II_5_ScoreIsDualDiagnosisEnhanced_III_1 And
((d4CareLevel_II_5_ScoreIsMet And (d4CareLevel_II_5_ScoreIsDualDiagnosisEnhance) Or
(d5CareLevel_II_5_ScoreIsMet And d5CareLevel_II_5_ScoreIsDualDiagnosisEnhanced) Or
(d6CareLevel_II_5_ScoreIsMet And d6CareLevel_II_5_ScoreIsDualDiagnosisEnhanced))
Let careLevel_II_5_Score.IsDualDiagnosisCapableAndLevel_III_1 = dxResultsCareLevel_II_5_ScoreIsMet And
d2CareLevel_II_5_ScoreIsMet And d3CareLevel_II_5_ScoreIsDualDiagnosisCapable_III_1 And
(d4CareLevel_II_5_ScoreIsMet Or d5CareLevel_II_5_ScoreIsMet Or d6CareLevel_II_5_ScoreIsMet)
Level of Care: Clinically Managed Low-Intensity Residential Services (III.1)
Level III.1 (Clinically Managed Low-Intensity Residential Services) Summary
None
Level II.1 (Intensive Outpatient) Placement Criteria
Original Equation
DacLIII.1 = TRUE If [DxLIII.1 & D1LID & D2LIII.1 & D3LI & D4LIII.1 & D5LIII.1 & D6LIII.1]
DacLIII.1ddc = TRUE If [DxLIII.1 & DxLIII.1ddc & D1LID & D2LIII.1 & D3LIII.1ddc & D4LIII.1 & D5LIII.1 & D6LIII.1]
DacLIII.1dde = TRUE If DacLIII.1 & DxLIII.1dde & [D3LIII.1dde OR D4LIII.1dde OR D5LIII.1dde OR D6LIII.1dde]
DacLIII.1bio = TRUE If [(DacLIII.1 OR DacLIII.1ddc OR DacLIII.1dde) & D2LIII.1bio]
DacLIII.1plusLII.5 = TRUE If [DxLIII.1 & D1LID & D2LIII.1 & D3LI & D4LIII.1 & (D5LIII.1+D5LII.5) & D6LIII.1]
Narrative
Placement criteria(IsMet) is met if:
1) Dimensional Admission Criteria Care Level III.1 is met if Detox. Results care level III.1 is met and Dimension 1 severity
number is less than 5 and Dimension 2 care level III.1 is met Dimension 3 care level I and Dimension 4 care level III.1
is met and Dimension 5 care level III.1 is met and Dimension 6 care level III.1 is met
Criteria (Dual Diagnosis Capable) is met if:
1) Dimensional Admission Criteria Care Level III.1 Dual Diagnosis Capable is met if Detox. Results care level III.1 and
(Dimension 3 care level III.1 Dual Diagnosis Capable is met or Dimension 3 care level III.3 Dual Diagnosis Capable is
met or Dimension 3 care level III.5 Dual Diagnosis Capable is met or Dimension 3 care level III.7 Dual Diagnosis
Capable is met)
Criteria (Dual Diagnosis Enhanced) is met if:
1) Dimensional Admission Criteria Care Level III.1 Dual Diagnosis Enhanced is met if Dimensional Admission Criteria
care level III.1 is met and (Dimension 3 care level III.1 Dual Diagnosis Enhanced is met or Dimension 3 care level III.3
Dual Diagnosis Enhanced is met or Dimension 3 care level III.5 Dual Diagnosis Enhanced is met or Dimension 3 care
level III.7 Dual Diagnosis Enhanced is met)