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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 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 Let Let Let 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; 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 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 Let Let Let 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 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); // 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; 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 Let Let Let Let Let Let Let Let Let Let Let Let Let Let Let Let 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; 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 Let Let Let Let Let Let Let Let Let Let Let Let Let Let 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)