Pennsylvania Client Placement Criteria, Third Edition 3B or 3C. PA Department of Drug and Alcohol Programs

Transcription

1 Pennsylvania Client Placement Criteria, Third Edition 3B or 3C PA Department of Drug and Alcohol Programs

2 DDAP s Mission The Department of Drug and Alcohol s mission is to engage, coordinate and lead the Commonwealth of Pennsylvania s effort to prevent and reduce drug, alcohol and gambling addiction and abuse and to promote recovery, thereby reducing the human and economic impact of the disease. Gary Tennis, First Secretary of DDAP

3 Why use the PCPC? Three best predictors of positive outcomes relate to fidelity to the assessment and placement process: Level of Care Length of Stay Treatment continuum All three are managed by the PCPC

4 Principles of Treatment Individuals with Substance Use Disorder(SUD) require access to a coordinated continuum of services that are clinically appropriate in intensity, duration, and frequency. Foundation of Treatment Principles: Science of SUD treatment, Person-Centered and Community-Based paradigm of recovery. Principles based on the platform of recovery focus on the strengths of the person and his or her connections within a community of recovery supports.

5 Principles of Treatment Principle 1: Treatment is optimal when provided through individualized and coordinated treatment intervention, follow up, and recovery support services that lead to each individual s long term recovery. Principle 2: Beyond cessation of substance use, SUD treatment should also address the individual s needs through the provision of comprehensive services provided within seamlessly linked systems of care.

6 Principles of Treatment Principle 6: Within the continuum of treatment services, treatment placement recommendations need to be based on a comprehensive assessment that includes a review of the severity and biopsychosocial impact of the individual s substance use as well as the individual s clinical, social, and recovery status. Principle 7: Remaining in treatment for an appropriate period of time is critical to positive outcomes. Principle 18: Treatment and recovery systems can and should continually evolve to serve individuals and communities appropriately.

7 PCPC Levels of Care and Types of Service Five Levels of Care Broad Description of Services to meet the client s needs in three areas: Medical Needs Therapeutic Contact (Counseling and Medical) Structure and/or Restrictions Ten types of service organized under the five broad levels of care Nine types of D&A services are licensed in PA Early Intervention is not licensed in PA

8 PCPC Levels of Care *based on service descriptions Types of Service Level.5 Psychoeducational sessions Level I Outpatient 1A Intensive Outpatient 1B Tx Contact/ Staff Ratio Structure* Medical* Setting None Low None Community Low (<5hr/35:1) Medium (5-10 hr./15:1) Low None Community Low None Community Level II Level III Level IV Partial Hospitalization 2A Medium Medium None Community (10+ hr./10:1) Low (<5 Community/ Halfway House 2B High (24 hr.) Low (phys. exam) hr./8:1) Residential Med Monitored Detox 3A High (7:1) High (24 hr.) Medium (exam in 24h) Residential Short Term Residential 3B High (8:1) Long Term Residential 3C High (8:1) Medium (physical High (24 hr.) exam) High (24 hr.) Medium(phys. exam (Longer tx) 48h) Residential Residential Med Managed Detox 4A Very High (5:1) High (24 hr.) Very High (24h Doc) Hospital Med Managed Tx 4B High (7:1) High (24 hr.) High (24h Nurs.) Hospital

9 Tips & Tricks for Placement Question 1: Is the individual s life/health in danger because of the amount of drugs or type of drugs they have taken? (Dimension 1) If YES, see 4A or 3A 4A if they will possibly need emergency care/life is in danger/crash cart & emergency on stand-by 3A if the symptoms aren t extreme If NO, move on (you ve just eliminated 3A & 4A) Question 2: Does the individual s medical or mental condition need frequent care or 24 hour nursing? (Dimension 2 & 3) If YES, placement is 4B If NO, move on (now you have eliminated ALL of LEVEL 4)

10 Tips & Tricks for Placement Question 3: How much structure and contact does the person need? (Dimension 3) A lot? (Level 3) A little? (Level 1) In between? (Level 2) Start reviewing criteria in that level of care look at the Dimensional Scoring Specification Hint: you only need to look at dimensions 3, 4, 5, & 6 Question 4: Are you sure? To check, look at the criteria in the services that are the next most intensive and the next least intensive The Next Step: Anything special about this individual?

11 Initial Placement Determination Level of Care Type of Service Special Considerations Provider What type of help (medical, structure, contact) does the client need? Medication-Assisted Treatment Co-Occurring SUD and Mental Health Women/Women with Children Which Provider meets the needs? Which Type of Service is designed to meet those needs? Criminal Justice Cultural/Ethnic (TOS Placement) Sexual Orientation/ Gender Identity Co-Occurring SUD and Gambling Disorder

12 Level of Care Overview 3B Professionally directed Individuals in acute distress Moderate impairment of social, occupational, of school functioning Rehabilitation is goal 3C Professionally directed Individuals in chronic distress Severe impairment of social, occupational, or school functioning Habilitation is the goal

13 Level of Care Overview 3B (Dimension 3) Must meet one of dimensional specifications e.g. : Emotional/behavioral symptoms sufficiently interfering with recovery Moderate risk of dangerous behavior Self-destructive behaviors related to intoxication Impairment requires 24-hour setting 3C (Dimension 3) Must meet two of dimensional specifications e.g. : Disordered living skills Disordered social adaptiveness Disordered self adaptiveness Disordered psychological status

14 Special Populations/Considerations A vital component of the decision-making process in placement concerns the determination of the need for specialized services. Issues which must be considered prior to placement include (but are not limited to): Medication-Assisted Treatment Co-Occurring Substance Use and Mental Health Disorders Women & Women with Children Criminal Justice Culture and Ethnicity Sexual Orientation and Gender Identity Co-Occurring Substance Use and Gambling Disorder

15 Special Populations/Considerations Medication-Assisted Treatment MAT is the use of medication, in combination with counseling and behavioral therapies, to provide an integrated, person-centered approach to the treatment of SUD. Ensure coordination of care and medication reconciliation to prevent medical errors and duplication of services. Co-Occurring Substance Use and Mental health Disorders Where possible, treatment should be integrated or coordinated between SUD and MH providers. Since each illness affects the course and severity of the other, both disorders are considered primary. The Four-Quadrant Model provides a basis for placing individuals based on their specific needs.

16 High severity Four-Quadrant Model (Ries, 1993) More severe SUD Less severe MH Type: Co-Occurring Capable More severe SUD More severe MH Type: Co-Occurring Integrated Low severity Less severe SUD Less severe MH Type: Co-Occurring Capable Less severe SUD More severe MH Type: Co-Occurring Capable High severity

17 Special Populations/Considerations Women & Women With Children Medical, psychiatric, trauma and violence, childcare, and legal considerations must be understood to assure access and continued treatment. Criminal Justice Since offenders are expected to be abstinent from the use of substances while incarcerated, the evaluation should examine substance use patterns in the 6 months prior to incarceration for the purpose of assessment. Criminality and addiction often coexist, but each can be distinct and function independently of the other. Treatment behind the walls followed by a communitybased continuum of care leads to the best outcomes.

18 Special Populations/Considerations Cultural & Ethnic Considerations The strengths of a culture can be used to reinforce prevention and treatment programs. Certain behaviors have different meanings depending on the cultural context; failure to recognize the appropriate cultural context could result in misinformation or incorrect placement. Sexual Orientation Not all individuals may feel safe revealing their nonheterosexual identity. Some individuals, especially those who have experienced negative consequences related to their sexual orientation, might have better results in a program with targeted services.

19 Special Populations/Considerations Co-Occurring Substance Use and Gambling Disorder Assessing for a co-occurring gambling disorder should be part of the process for every individual. Because each individual s case is extremely variable, treatment needs to be person-centered and highly individualized. Where possible, treatment should be integrated or coordinated between SUD and gambling providers. Many individuals are in denial of their gambling disorder, instead identifying it as money problem.