ASAM Pre-Workshop Needs Assessment Information

Dear Colleague, ASAM Pre-Workshop Needs Assessment Information In preparation for the upcoming workshop on the ASAM Criteria 3rd. Edition, please complete the pre-training tasks listed below. 1.) Pre-Training User Survey, click link or cut and paste it into your browser. https://www.surveymonkey.com/r/asamusersurvey 2.) Pre- Training Needs Assessment / Learning Measure Using the information provided in the case study (attached) please provide the following, and use the recommended format to do so (attached). 1. Provide a Risk Rating for the clients status in each of ASAM's Six Dimensions. 2. Provide a Clinical Justification for each rating. 3. Make a Level of Care Recommendation (LOC), a.k.a., Patient Placement Decision. 4. Provide a clinical justification for it. It is recommended that you type your responses in a word document, using the format attached to the case study, and then copy and paste your responses into the corresponding question and answer boxes provided online via Survey Monkey at the following URL: https://www.surveymonkey.com/r/asamtn The Needs Assessment is just that, a Needs Assessment, SO PLEASE DO NOT WORRY about getting it right, this is a Pre Workshop Needs Assessment / Learning Measure. This initial work product is what we (you) will specifically be working with during the onsite workshop. Please bring a copy of your work product to the workshop. While this requires a little bit of time before attending the workshop, participants have unanimously commented have valuable it was to complete the pre workshop needs assessment / learning measure and be able to review their own work during the course of the workshop. Thank You For Your Time and Your Continued Commitment to Learning and Improving Your Practice and the Delivery of Services to Those in Need! Thomas H. Coyne, Ed.D., LCSW-R

Thomas H. Coyne, Ed.D., LCSW INSTRUCTIONS: Based on the assessment information documented in the Bio-Psycho- Social, choose a risk rating for each of ASAM's dimensions, and write a clinical justification for each rating. Dimension I: Acute Intoxication and Withdrawal Status Dimension Risk Rating: None Slight Moderate Considerable Severe (write your clinical justification for the above rating) Dimension II: Biomedical Conditions and Complications Dimension Risk Rating: None Slight Moderate Considerable Severe (write your clinical justification for the above rating) Not For Distribution TCoyne2016 www.asamtrainingonline.com TCoyne@ASITraining.com 3

Thomas H. Coyne, Ed.D., LCSW Dimension III: Emotional, Behavioral or Cognitive Conditions & Complications Dimension Risk Rating: None Slight Moderate Considerable Severe (write your clinical justification for the above rating) Dimension IV: Readiness to Change Dimension Risk Rating: None Slight Moderate Considerable Severe (write your clinical justification for the above rating) Dimension V: Relapse, Continued Use, Continued Problem Potential Dimension Risk Rating: None Slight Moderate Considerable Severe (write your clinical justification for the above rating) Not For Distribution TCoyne2016 www.asamtrainingonline.com TCoyne@ASITraining.com 4

Thomas H. Coyne, Ed.D., LCSW Dimension VI: Recovery / Living Environment Dimension Risk Rating: None Slight Moderate Considerable Severe Patient Placement Decision & Clinical Justification INSTRUCTIONS: Based on your risk ratings and clinical justifications for each of ASAM's dimensions, select the Level of Care (LOC) in which you would recommend this client be referred to. Dimension I. II III IV. V. VI. Risk Rating ASAM Dimensions: TCoyne2016 1) Acute Intoxication and Withdrawal Potential 2) Biomedical Conditions and Complications 3) Emotional, Behavioral or Cognitive Conditions and Complications 4) Readiness to Change 5) Relapse, Continued Use, Continued Problem Potential 6) Recovery / Living Environment Based on your risk ratings and clinical justifications for each of ASAM's dimensions, select the Level of Care (LOC) in which you would recommend this client be referred to. Level of Care Recommended: 0.5 Early Intervention 1.0 Standard Outpatient 2.1 Intensive Outpatient 2.5 Partial Hospitalization 3.1 Clinically Managed (low intensity) Residential Treatment 3.3 Clinically Managed (medium intensity) Residential Treatment 3.5 Clinically Managed (high intensity) Residential Treatment 3.7 Medically Monitored Intensive Inpatient (1-28 Day Inpatient Program) Not For Distribution 4.0 Medically Managed Intensive Inpatient (Inpatient Medical Detoxification) www.asamtrainingonline.com TCoyne@ASITraining.com 5

Thomas H. Coyne, Ed.D., LCSW Clinical Justification for the Level of Care Recommended: (Please provide a clinical justification for the Level of Care you recommended) Thank You! Not For Distribution TCoyne2016 www.asamtrainingonline.com TCoyne@ASITraining.com 6

Julie Christie 21 Ocean Avenue Atlantic City, NJ. 10101 Date of Birth: 04/30/1981 Date of Interview: 05/31/2016 Interviewer Name: Johnny Walker Time Interview Began: 03:00 pm Time Interview Ended: 04:20 pm Type of Interview: Assessment Introduction The following is a clinical summary based on an in-person interview with Julie Christie, at 3:00pm in the afternoon. The summary is based on the client's self report regarding lifetime and recent Medical, Employment, Alcohol, Drug, Legal, Family/Social and Psychiatric involvement and/or problems. Ms. Christie appeared for the interview on time, and without any family or friends accompanying her. She has been referred (Mandated) for the assessment by her probation officer. General Information Section Julie is a 35 year old, White (Not Hispanic or Latino) female. She states her religious preference is Catholic. Julie reports she really doesn't go to church anymore, maybe Christmas and Easter if she can, however, states she does believe in God. She has no other formal religious and/or spiritual belief system at this time. For the past 3 months Julie has been living with two of her girlfriends. Prior to this she was living with some other friends for approximately 6 months, and before that with other friends for about a year and a half. Neither Julie or her family owns the residence. She and her girlfriends are renting the home. Julie reports spending 10 of the past 30 days in a Medically Monitored Intensive Inpatient Treatment Program (i.e., 1-28 Day Co-Occurring Disorder Program), where she received treatment for depression and suicidal ideation (Admitted 05/01/2016, Discharged 05/11/2016). She was released approximately 3 weeks (20 days) ago. Medical Section Medical History: Julie has been hospitalized for medical problems 2 times in her life. The first in 2000, she had her appendix removed, and again in 2005 due to a car accident. At that time she sustained a neck and back injury which she was prescribed dilaudid for pain, for approximately two years. She reports no current problems with her back and neck stemming from this accident. Julie has an ongoing chronic medical problem i.e., asthma. To help manage more serious / severe episodes of it she has been prescribed medication i.e., inhaler, for it. She reports her asthma is not causing any serious or severe problems, and if it does she has the inhaler. Julie reports she is not currently pregnant at this time, and all though she is sexually active states she uses protection i.e., condoms. She does not 1

receive a disability due to the asthma, nor does she receive any type of financial compensation for any other medical or physical problems. Client Perception of Severity of Medical Problems and Desire for Treatment: Julie reports experiencing mild aches and pains in her knees on 3 of the past 30 days, the last time she experienced these problems was 5 days ago. She is only slightly bothered by them, and attributes this to getting older. Julie is not interested in obtaining medical treatment for these problems. Employment Section Employment History: Julie has been unemployed since leaving her last full time approximately 2 years ago. She worked in a hair salon from approximately 2009 to 2014, and has not worked full or part time since she left this job. This was her longest stretch of full time employment. The majority of her employment over the course of her lifetime has been in the beauty and hair salon business. Current Financial Resources: Julie has not worked or received income from any employment in the past 30 days. She received $250 in cash and food stamps this month from welfare, but did not receive any unemployment compensation, pension, social security or disability income. She has not received any money from family or friends in the past month. Julie reports earning $400 illegally in the past month, she states she would rather not discuss how she earned this income. Julie has no dependents that she supports financially. The majority of Julie's support, such as food, housing, etc., is taken care of by Julie's two roommates who currently pay most of the rent, utility and food bills. She states she is not in a position to be financially independent and living on her own. Education, Training and Resources: She completed 12 years of traditional education and received a high school diploma. She has had no other formal training or technical education. Julie has developed cosmetology skills from on the job employment, and has been able to obtain employment with them in the past. She does not have a valid driver's license or a car available for her discretional use. Julie s drivers license was suspended two months ago after being convicted of her second DWI. Client Perception of Severity of Employment Problems and Desire for Treatment: Julie is currently unemployed, and has not looked for work in the past 30 days. She stated while she was interested in obtaining work, and/or receiving more formal training, and possibly a license to practice as a cosmetologist sometime in the future, she does not think the time to do that is now. 2

Alcohol and Drug History Lifetime History of Alcohol Use: Julie began drinking alcohol when she was 16 years old. She began drinking regularly (three days a week or more) at the age of 26, and has for the past nine years. In the past 5 years, her drinking has been regular (three days a week or more) and heavy (generally defined as at least 3 drinks in a sitting, or 5 or more drinks in a day). Julie states she usually drinks vodka and wine, and occasionally will have a beer. Recent (Past 30 Day) History of Alcohol Use: In the past 30 days, she has drank alcohol on 6 days, 2 of which she reports drinking heavily (at least five drinks (vodka and beer) over the course of the evening). Her last use of any alcohol was 7 days ago. She does not report experiencing any withdrawal symptoms in the past 7 days, or during the course of the interview. Julie does not recall ever having experienced delirium tremens, or seizures when cutting down, or stopping her use of alcohol. She has reported more recently (in the past two years) experiencing difficulty sleeping and feeling anxious, when she stops her use of alcohol. Lifetime History of Drug Use: Julie has never used amphetamines, barbiturates, sedative hypnotics, tranquilizers, inhalants, hallucinogens, heroin or methadone. She began using opiates (i.e., Oxycodone) on a regular basis for a period of 2 years 2005 2007. She had prescription for them from a doctor due to back and neck problems (pain) she sustained in a car accident in 2005. Once her MD. discontinued the prescription she continued to obtain them illicitly and reports detoxing herself off of them over the next year and a half. She states she tried Marijuana when she was around 20, but it was not really her thing, and has not used it since. She started using cocaine/crack at age 25, and began using it more regularly (3 days a week or more) in the past five years. She initially was snorting the cocaine, however, has been primarily smoking it for the past five years. She stated "when I drink I do cocaine, when I do cocaine, I drink". Her history indicates the use of alcohol and cocaine/crack on a regular basis for the past five years. She denies ever having overdosed, intentionally or unintentionally, on alcohol or other drugs. Recent (Past 30 Day) History of Drug Use: Julie has not used amphetamines, barbiturates, sedative hypnotics, tranquilizers, inhalants, hallucinogens, heroin, methadone or marijuana in the past 30 days. She reports smoking crack cocaine on 5 of the past 30 days, last use was 7 days ago. She has used two or more substances i.e., alcohol and crack cocaine on 4 of the same days in the past month. In the past 30 days, Julie reports that she spent $200 dollars on drugs, and $50 on alcohol. 3

Alcohol and Drug Treatment History: Over the course of her lifetime, Julie has received treatment for alcohol and/or cocaine use a total of four times. One of those four times includes her most recent hospitalization for depression and suicidal ideation, during which she was being monitored and treated for any alcohol withdrawal symptoms. Her first treatment was at the age of seventeen due to her irregular and problematic use of alcohol, and the problems it was causing in school, with friends and at home. She attended an adolescent outpatient treatment program, afterschool, three days a week for approximately 3-4 months, until she stopped going. Her second treatment episode was in 2008 due to her use of alcohol and cocaine. She attended a standard outpatient program for approximately four months, she did not think it helped much and stopped going. The third treatment episode was in 2013 following her first DWI conviction. She was mandated to attend an outpatient treatment program as part of a plea agreement due to the DWI. She completed the six month program, however reports she did in fact use during the course of the six months. She has had no periods of abstinence of 30 days or more from either alcohol and/or cocaine in the past four years. She states she probably would have used more this month but couldn't due to her inpatient stay, and really doesn't want to end up in jail. In the past 30 days she has not received any formal outpatient substance abuse treatment, nor has she attended any 12 step or other recovery oriented groups or activities. Client Perception of Alcohol Problems: Julie reports experiencing alcohol problems on 5 of the past 30 days i.e., thoughts and urges to use alcohol, the last time was two days ago. She reports she is not troubled or bothered by these problems, as she has dealt with them her whole life. She does not feel her alcohol use is a big problem for her at this time, she states she has cut down her use since her hospitalization several weeks ago, and her second DWI conviction two months ago. She knows she must comply with any court mandates for treatment, or face the possibility of jail. Client Perception of Drug Problems: Julie reports experiencing drug related problems on 10 of the past 30 days i.e., thoughts, strong urges and cravings for crack cocaine. She last experienced these three days ago. She reports being moderately bothered by these problems. She states, the urges and cravings are nothing new, but crashing from the crack is becoming harder to handle. Julie states she is really not that interested in pursuing treatment at this time, however, will consider any recommendations if it keeps her from violating her probation and going to jail. During the course of the interview Julie acknowledges that she knows treatment works for some people, however, it has never really helped her. 4

Legal Section History of Charges and Arrests: Julie's participation in this evaluation was mandated as a condition of her probation related to her most recent DWI conviction. She has been charged and convicted of driving while intoxicated on two separate occasions, the most recent two months ago. The time before that was approximately 2 years ago, when she was arrested, charged and convicted of her first DWI in 2013. Julie has never been arrested and charged with any drug crimes. She has been arrested, charged and convicted on three occasions of prostitution; once in 2010, once in 2012, and once in 2014. She was arrested, charged and convicted of disorderly conduct, assault and resisting arrest in 2004. She was charged and convicted of disorderly conduct, and public intoxication on two occasions; in 2010, and 2014. She has never been charged with contempt of court. Julie reports as an adolescent she had been arrested on three occasions; once for assaulting a teacher s aide at age 13, a second time at age 14, for petty theft, and the third time for disorderly conduct, public intoxication, and resisting arrest at a high school basketball game, at the age of 16. No detention or jail time was ever served for these offenses. Current Legal Involvement: In the past 30 days, Julie has not been detained or incarcerated, she reports engaging in illegal activity for profit on 5 days. She is not awaiting any type of charges, trial, or sentencing. She is currently on probation due to her second DWI conviction two months ago. The court system (Probation Department) has mandated her evaluation, and if necessary subsequent treatment as part of her probation arrangement. Client Perception of Severity of Legal Problems and Desire for Treatment: Julie reports that while her legal problems are serious, a disposition has been reached, and therefore, she is not in need of, or interested in obtaining any legal assistance at this time. She states she has met with her probation officer several times since her conviction, and reports a good relationship with her. Family & Social Section Marital and Living Situation for Majority of the Past Three Years: Julie has been separated for the past two years, and is generally satisfied with this situation. She states her husband left her approximately three years ago. She reports that he also used cocaine/crack, and alcohol, and all of a sudden one day said, that she had a drug problem and left her. She states he was not all that anyway, and can live without him judging her. Prior to the separation Julie had been living with her husband for a total of seven years, and was generally satisfied with that situation. She states everything was fine till he started getting a holier than thou attitude about her alcohol and drug use. She believes she is better off without him. 5

Social Situation & Contacts: Julie currently lives with two of her girlfriends, both of which use alcohol and nonprescribed drugs i.e., crack cocaine, marijuana, alcohol and xanax. She explains their use makes her look like an amateur. She currently spends most of her free time with friends, and is generally satisfied with this situation. Her friends, not including her roommates, also use alcohol and other substances i.e., cocaine, marijuana, alcohol, xanax, and amphetamines. She states that while her friends use, and some engage in prostitution and a few other minor illegal activities, they are all good people in general. She reports having a close friend from grammar school who does not use alcohol or drugs, however, has not seen her in a few years. Relationship Problems Lifetime: Julie reports that she has not had "close", long lasting relationships with her mother, or two older siblings i.e., a brother and sister. She also states she has not had "close" long lasting relationships with friends, except one from grammar school, for as far back as she can remember. The last time she heard anything from her father was almost ten years ago. She reports he was not a great role model, and had served ten years for armed robbery and assault from the time Julie was approximately 14-24 years old. She reports significant problems getting along with her husband the three years prior to their separation. Julie states just before he left they were constantly arguing, and on several occasions it lead to physical confrontations between them. Over the course of her lifetime she acknowledges serious problems getting along with her mother and father. However, has not had any serious or significant problems getting along with her siblings, close friends, neighbors or co-workers. Julie reports being abused emotionally, physically and sexually during her lifetime. She was physically and sexually abused at age 14 by a senior in high school who lived in the neighborhood. She also reports she and her husband used to get into physical fights periodically during the course of their marriage, and it was really bad the two years before he left. She states it was usually do to arguing about my use and his use, and then it would escalate to physical violence. Relationship Problems Past Thirty Days: Julie reports being physically assaulted by one of her roommates in the past 30 days. They got into a fight about a week ago while they were both using alcohol and crack cocaine. She states this had never happened before, has not happened since, and does not expect it to happen again. She added "We were just really wasted". Client Perception of Severity of Family and Social Problems and Desire for Treatment: Julie she reports experiencing no family problems and is not troubled or bothered by a lack of closeness with her family. She has not seen or communicated with anyone in her family in the past two months. Consequently, she does not perceive a need for any counseling or treatment regarding the current status of her relationships with her family. She reports three days of loud arguing with her 6

roommate, which culminated in a physical fight between them. She reports she is slightly bothered by the fight they had, and does not think it will happen again. Subsequently, she is not interested in any kind of counseling or assistance to address the problem with the roommate. Psychiatric Section Emotional and/or Psychological Problems - Lifetime: Over the course of her lifetime Julie has had periods of depression, and has thought seriously about committing suicide, however, has never attempted it. Julie has been treated two times in her life for these emotional/ psychological problems. Her first treatment episode was in 2007, she was hospitalized inpatient for a period of two weeks due to depression and suicidal ideation. Following her inpatient hospitalization in 2007, she was prescribed Zoloft, and attended outpatient treatment for about 2 months. During this time she reports she did not take the Zoloft as prescribed, and eventually stopped taking it around the same time she stopped attending treatment. Julie was discharged three weeks ago from her most recent hospitalization for depression and suicidal ideation. She reports feeling better after getting out of the hospital, and states she is doing her best to take the medication (wellbutrin) as prescribed. She was referred to an outpatient Mental Health Clinic for follow up and continued care. She states she missed her first appointment, however, knew she was coming here due to her DWI related court case, and figured it would be the same thing anyway. She does not currently receive any financial compensation for a psychiatric or psychological disability. Recent Serious Emotional and Psychological Problems: Julie has had serious problems with depression and suicidal ideation in the past two months. She was admitted approximately five weeks ago (involuntarily ) to an inpatient psychiatric unit due to severe depression and suicidal ideation. She was discharged three weeks ago with a prescription for Wellbutrin, and a referral to follow up with an outpatient mental health clinic. She denies having any suicidal ideation since her discharge approximately 3 weeks ago. Client Perception of Severity of Emotional and Psychological Problems and Desire for Treatment: Julie reports experiencing symptoms of depression, and suicidal ideation approximately five weeks ago. In the past 30 days she reports feeling a little depressed, but not nearly as bad as she was feeling prior to her hospitalization. The last time she felt this way was approximately two weeks ago. She reports the days prior to being hospitalized she was feeling very down, depressed, sad, and hopeless. At the time she reports being considerably troubled and bothered by the way she was feeling, however, post discharge reports being only slightly bothered by feelings of depression. Subsequently, obtaining continued psychiatric treatment at this time is only slightly important to her. Julie states she is feeling better already, and as long as she continues to take her medication as prescribed she thinks she will be fine. 7