SlideShare a Scribd company logo

What's New in The ASAM Criteria

•
•
Ted Moore
Ted Moore

http://www.ASAMcriteria.org This slide presentation provides an overview of what is new in The ASAM Criteria, Third Edition, including a new title, new sections, new terminology, as well as improved functionality and design. Releasing along with the book will be a new enhanced web-based version as well as The ASAM Criteria Software.

1 of 51
www.ASAMcriteria.org
 Around 1989, NAATP and ASAM assemble taskforce to integrate two existing admission/continued stay criteria sets:  The Cleveland Criteria  The NAATP Criteria  NAATP decided to relinquish any ownership/branding of the Criteria
 Historical and current development of The ASAM Criteria  Collaborative consensus process  Experienced clinical experts and researchers as Editors  Coalition of stakeholders (Coalition for National Clinical Criteria, est. 1992) — ASAM and addiction physicians not the sole stakeholders
To unify the addiction field around a single set of criteria
 Previous Editions  Patient Placement Criteria (1991)  Patient Placement Criteria-2 (1996)  Patient Placement Criteria-2R (2001)
 Upcoming Edition:  The ASAM Criteria – Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions  Released in Fall 2013  Editor-in-Chief: David Mee-Lee, MD
 What are the ASAM Criteria?  Guidelines for assessment, service planning, placement, continued stay, and discharge  Framework for multidimensional patient assessment
 What are the ASAM Criteria?  Description of levels of care (service continuum)  Algorithm for determining appropriate Intensity of Service based on assessment of patient’s Severity of Illness (IS/SI)
What's New in The ASAM Criteria
1. Acute Intoxication and/or Withdrawal Potential 2. Biomedical conditions and complications 3. Emotional/Behavioral/Cognitive conditions and complications
4. Readiness to Change 5. Relapse/Continued Use/Continued Problem potential 6. Recovery Environment
Levels of Service 1. Outpatient Treatment 2. Intensive Outpatient and Partial Hospitalization 3. Residential/Inpatient Treatment 4. Medically-Managed Intensive Inpatient Treatment
 More levels of care within each of the broad levels  Changes from Roman numerals to Arabic numerals, e.g.:  ―Level I‖ becomes ―Level 1‖  ―Level II.1‖ becomes ―Level 2.1‖  ―Level II.5‖ becomes ―Level 2.5‖  ―Level III.1‖ becomes ―Level 3.1‖
 Workgroup chairs and small committees developed drafts  Extensive field review online with input from Steering Committee of the Coalition for National Clinical Criteria and others
 Release date of October 2013 at ASAM’s ―State of the Art Conference‖ in Arlington, VA  Criteria updated to reflect current science – impact on The ASAM Criteria Software
 The six assessment dimensions  The overall levels of care (though not Roman numerals) for addiction management  The ―decision rules,‖ which link Intensity of Service back to the Severity of Illness maintained except for some updates in Withdrawal Management (―Detox‖)
The Process: (from http://www.asam.org/publications/the-asam-criteria )  Oversight and revision of the criteria is a collaborative process between ASAM leadership and the Steering Committee of the Coalition for National Clinical Criteria (CNCC)
The Process: (from http://www.asam.org/publications/the-asam-criteria )  The coalition represents major stakeholders in addiction treatment and has been meeting regularly since the development of the first ASAM Patient Placement Criteria in 1991
The Process: (from http://www.asam.org/publications/the-asam-criteria )  Coalition addresses feedback and ensures that the Criteria adequately serves and supports medical professionals, employers, purchasers, and providers of care in both the public and private sectors
 New Title: The ASAM Criteria -- Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions  Shift away from ―placement‖ criteria to ―treatment‖ criteria: it’s more than just ―placement‖
 Diagnostic Admission Criteria terminology changed to be compatible with DSM-5  Section on working with managed care
 Table of contents  Re-ordered to be more user-friendly  Follows the flow from Historical Foundations to Guiding Principles to Assessment, Service Planning, and Placement decisions
 Adolescent Criteria  No longer separate/stand-alone  Consolidated Adult and Adolescent content to minimize redundancy while preserving adolescent-specific content
 Appendices  Withdrawal Management instruments  Dimension 5 constructs  Glossary
 Withdrawal Management  The wording in the Levels of Care  Former section ―Detoxification‖ becomes ―Withdrawal Management‖  Levels are now called WM-1, WM-2, WM-3, and WM-4  New approaches described to support increased use of less intensive levels of care for safe/effective management of withdrawal
 Withdrawal Management  New approaches described to support increased use of less intensive levels of care for safe/effective management of withdrawal  A broader range of severity of withdrawal syndromes is discussed in The Criteria as being able to be safely and appropriately managed on an outpatient basis
 Withdrawal Management  A Risk Rating Assessment Format is used in the first part of chapter to help understand how to link severity, function, and service needs when determining treatment plans and level of care  In the latter part of the chapter, updated PPC-2R criteria, linked to the algebraic ―decision rules‖ of The ASAM Criteria Software, appear.
 Updated/revised terminology Contemporary, strength-based, recovery- oriented: • ―dual diagnosis‖ becomes ―co-occurring disorders‖ • ―inappropriate use of substances‖ becomes ―high risk use of substances‖
 Opioid use disorder specialized services Opioid Maintenance Therapy‖ (OMT) becomes ―Opioid Treatment Services‖ (OTS)  Opioid antagonist medications  Opioid agonist medications  Their use in OTPs (regulated ―Opioid Treatment Programs‖) or in office-based opioid treatment (OBOT)
 Additional text to improve application to address addiction treatment for Special Populations: • Older Adults • Persons in Safety Sensitive Occupations • Parents with Children and Pregnant Women • Persons in the Criminal Justice System (CJS)
 Additional text to address treatment of conditions not traditionally included in specialty addiction treatment services: • Tobacco Use Disorder • Gambling Disorder
 Revision of the text to address emerging issues: • Healthcare Reform and the integration of addiction treatment into general medical care • The role of physicians on the care team, addiction specialist physicians in particular (addiction medicine physicians, addiction psychiatrists)
 ASAM’s New Definition of Addiction • http://www.asam.org/docs/publicy-policy- statements/1definition_of_addiction_long_4- 11.pdf?sfvrsn=2 • Implications for Substance Use Disorders and other Addictive Disorders • ―The pathological pursuit of reward or relief‖ • Involves alcohol, tobacco, and/or other substance use • Also involves addictive behaviors • ―Addiction involving alcohol, tobacco, other substances and gambling‖
 The ASAM Criteria book and The ASAM Criteria Software are companion text and application  The text delineates the dimensions, levels of care, and decision rules that comprise The ASAM Criteria
 The software provides an approved structured interview to guide adult assessment and calculate the complex decision tree to yield suggested levels of care, which are verified through the text
 The text and software are used in tandem:  The text provides background and instruction for proper use of software  The software enables comprehensive, standardized evaluation
 The ASAM Criteria text is synchronized with The ASAM Criteria Software  Definitions and specifications are in the text, such that the dimensions, levels of care, and admissions ―decision rules‖ serve as a reference manual for the software
 The ASAM Criteria Software is undergoing nationwide open-source release by U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)
 For Patients • Improves Patient Outcomes  For Payers • Improved Patient Outcomes > Lower Long-Term Costs • Standardizes prior approval process (utilization management) • I.T. can facilitate/automate approval process (U.M.) • Decreases expensive & unnecessary overtreatment • Improves inter-rater reliability  For Providers • Facilitates reimbursement process through fewer disputes, less administrative burden, & faster turnaround on payment • Provides training to new counselors • Generates sophisticated reports & analyses
Intuitive User Interface Data visualization elements.
Enhanced Report Dynamically driven report with variable content regions.
 Effective, reliable treatment planning requires that both the text and software be used together
The ASAM Criteria David Mee-Lee, MD dmeelee@changecompanies.net The ASAM Criteria Software David R. Gastfriend, MD gastfriend@gmail.com www.ASAMcriteria.org
 The Change Companies® (TCC) was contracted by ASAM to publish and market The ASAM Criteria  The new edition will feature these tools to help readers locate material quickly:  content-specific chapter tabs  color, graphic illustrations, and icons  cross-linking  A subscription web-based version will also release alongside the book in fall 2013  More info: www.ASAMcriteria.org
 New training model will be developed in collaboration with TCC  eLearning modules  onsite learning  consulting and coaching  Resources co-developed with TCC  www.ASAMcriteria.org
www.changecompanies.net
www.changecompanies.net
What's New in The ASAM Criteria
What's New in The ASAM Criteria
The Change Companies Carson City, NV www.changecompanies.net www.ASAMcriteria.org
Consider joining today …  Network with hundreds of other physicians employed at treatment centers across the country  Access to the Journal of Addiction Medicine and a free subscription of ASAM Magazine and ASAM Weekly for the latest developments in education, advocacy, top education and information resources  ASAM members receive a $10 discount on The ASAM Criteria book  Join online at www.asam.org

More Related Content

What's New in The ASAM Criteria

  • 2.  Around 1989, NAATP and ASAM assemble taskforce to integrate two existing admission/continued stay criteria sets:  The Cleveland Criteria  The NAATP Criteria  NAATP decided to relinquish any ownership/branding of the Criteria
  • 3.  Historical and current development of The ASAM Criteria  Collaborative consensus process  Experienced clinical experts and researchers as Editors  Coalition of stakeholders (Coalition for National Clinical Criteria, est. 1992) — ASAM and addiction physicians not the sole stakeholders
  • 4. To unify the addiction field around a single set of criteria
  • 5.  Previous Editions  Patient Placement Criteria (1991)  Patient Placement Criteria-2 (1996)  Patient Placement Criteria-2R (2001)
  • 6.  Upcoming Edition:  The ASAM Criteria – Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions  Released in Fall 2013  Editor-in-Chief: David Mee-Lee, MD
  • 7.  What are the ASAM Criteria?  Guidelines for assessment, service planning, placement, continued stay, and discharge  Framework for multidimensional patient assessment
  • 8.  What are the ASAM Criteria?  Description of levels of care (service continuum)  Algorithm for determining appropriate Intensity of Service based on assessment of patient’s Severity of Illness (IS/SI)
  • 10. 1. Acute Intoxication and/or Withdrawal Potential 2. Biomedical conditions and complications 3. Emotional/Behavioral/Cognitive conditions and complications
  • 11. 4. Readiness to Change 5. Relapse/Continued Use/Continued Problem potential 6. Recovery Environment
  • 12. Levels of Service 1. Outpatient Treatment 2. Intensive Outpatient and Partial Hospitalization 3. Residential/Inpatient Treatment 4. Medically-Managed Intensive Inpatient Treatment
  • 13.  More levels of care within each of the broad levels  Changes from Roman numerals to Arabic numerals, e.g.:  ―Level I‖ becomes ―Level 1‖  ―Level II.1‖ becomes ―Level 2.1‖  ―Level II.5‖ becomes ―Level 2.5‖  ―Level III.1‖ becomes ―Level 3.1‖
  • 14.  Workgroup chairs and small committees developed drafts  Extensive field review online with input from Steering Committee of the Coalition for National Clinical Criteria and others
  • 15.  Release date of October 2013 at ASAM’s ―State of the Art Conference‖ in Arlington, VA  Criteria updated to reflect current science – impact on The ASAM Criteria Software
  • 16.  The six assessment dimensions  The overall levels of care (though not Roman numerals) for addiction management  The ―decision rules,‖ which link Intensity of Service back to the Severity of Illness maintained except for some updates in Withdrawal Management (―Detox‖)
  • 17. The Process: (from http://www.asam.org/publications/the-asam-criteria )  Oversight and revision of the criteria is a collaborative process between ASAM leadership and the Steering Committee of the Coalition for National Clinical Criteria (CNCC)
  • 18. The Process: (from http://www.asam.org/publications/the-asam-criteria )  The coalition represents major stakeholders in addiction treatment and has been meeting regularly since the development of the first ASAM Patient Placement Criteria in 1991
  • 19. The Process: (from http://www.asam.org/publications/the-asam-criteria )  Coalition addresses feedback and ensures that the Criteria adequately serves and supports medical professionals, employers, purchasers, and providers of care in both the public and private sectors
  • 20.  New Title: The ASAM Criteria -- Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions  Shift away from ―placement‖ criteria to ―treatment‖ criteria: it’s more than just ―placement‖
  • 21.  Diagnostic Admission Criteria terminology changed to be compatible with DSM-5  Section on working with managed care
  • 22.  Table of contents  Re-ordered to be more user-friendly  Follows the flow from Historical Foundations to Guiding Principles to Assessment, Service Planning, and Placement decisions
  • 23.  Adolescent Criteria  No longer separate/stand-alone  Consolidated Adult and Adolescent content to minimize redundancy while preserving adolescent-specific content
  • 24.  Appendices  Withdrawal Management instruments  Dimension 5 constructs  Glossary
  • 25.  Withdrawal Management  The wording in the Levels of Care  Former section ―Detoxification‖ becomes ―Withdrawal Management‖  Levels are now called WM-1, WM-2, WM-3, and WM-4  New approaches described to support increased use of less intensive levels of care for safe/effective management of withdrawal
  • 26.  Withdrawal Management  New approaches described to support increased use of less intensive levels of care for safe/effective management of withdrawal  A broader range of severity of withdrawal syndromes is discussed in The Criteria as being able to be safely and appropriately managed on an outpatient basis
  • 27.  Withdrawal Management  A Risk Rating Assessment Format is used in the first part of chapter to help understand how to link severity, function, and service needs when determining treatment plans and level of care  In the latter part of the chapter, updated PPC-2R criteria, linked to the algebraic ―decision rules‖ of The ASAM Criteria Software, appear.
  • 28.  Updated/revised terminology Contemporary, strength-based, recovery- oriented: • ―dual diagnosis‖ becomes ―co-occurring disorders‖ • ―inappropriate use of substances‖ becomes ―high risk use of substances‖
  • 29.  Opioid use disorder specialized services Opioid Maintenance Therapy‖ (OMT) becomes ―Opioid Treatment Services‖ (OTS)  Opioid antagonist medications  Opioid agonist medications  Their use in OTPs (regulated ―Opioid Treatment Programs‖) or in office-based opioid treatment (OBOT)
  • 30.  Additional text to improve application to address addiction treatment for Special Populations: • Older Adults • Persons in Safety Sensitive Occupations • Parents with Children and Pregnant Women • Persons in the Criminal Justice System (CJS)
  • 31.  Additional text to address treatment of conditions not traditionally included in specialty addiction treatment services: • Tobacco Use Disorder • Gambling Disorder
  • 32.  Revision of the text to address emerging issues: • Healthcare Reform and the integration of addiction treatment into general medical care • The role of physicians on the care team, addiction specialist physicians in particular (addiction medicine physicians, addiction psychiatrists)
  • 33.  ASAM’s New Definition of Addiction • http://www.asam.org/docs/publicy-policy- statements/1definition_of_addiction_long_4- 11.pdf?sfvrsn=2 • Implications for Substance Use Disorders and other Addictive Disorders • ―The pathological pursuit of reward or relief‖ • Involves alcohol, tobacco, and/or other substance use • Also involves addictive behaviors • ―Addiction involving alcohol, tobacco, other substances and gambling‖
  • 34.  The ASAM Criteria book and The ASAM Criteria Software are companion text and application  The text delineates the dimensions, levels of care, and decision rules that comprise The ASAM Criteria
  • 35.  The software provides an approved structured interview to guide adult assessment and calculate the complex decision tree to yield suggested levels of care, which are verified through the text
  • 36.  The text and software are used in tandem:  The text provides background and instruction for proper use of software  The software enables comprehensive, standardized evaluation
  • 37.  The ASAM Criteria text is synchronized with The ASAM Criteria Software  Definitions and specifications are in the text, such that the dimensions, levels of care, and admissions ―decision rules‖ serve as a reference manual for the software
  • 38.  The ASAM Criteria Software is undergoing nationwide open-source release by U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)
  • 39.  For Patients • Improves Patient Outcomes  For Payers • Improved Patient Outcomes > Lower Long-Term Costs • Standardizes prior approval process (utilization management) • I.T. can facilitate/automate approval process (U.M.) • Decreases expensive & unnecessary overtreatment • Improves inter-rater reliability  For Providers • Facilitates reimbursement process through fewer disputes, less administrative burden, & faster turnaround on payment • Provides training to new counselors • Generates sophisticated reports & analyses
  • 40. Intuitive User Interface Data visualization elements.
  • 41. Enhanced Report Dynamically driven report with variable content regions.
  • 42.  Effective, reliable treatment planning requires that both the text and software be used together
  • 43. The ASAM Criteria David Mee-Lee, MD [email protected] The ASAM Criteria Software David R. Gastfriend, MD [email protected] www.ASAMcriteria.org
  • 44.  The Change Companies® (TCC) was contracted by ASAM to publish and market The ASAM Criteria  The new edition will feature these tools to help readers locate material quickly:  content-specific chapter tabs  color, graphic illustrations, and icons  cross-linking  A subscription web-based version will also release alongside the book in fall 2013  More info: www.ASAMcriteria.org
  • 45.  New training model will be developed in collaboration with TCC  eLearning modules  onsite learning  consulting and coaching  Resources co-developed with TCC  www.ASAMcriteria.org
  • 50. The Change Companies Carson City, NV www.changecompanies.net www.ASAMcriteria.org
  • 51. Consider joining today …  Network with hundreds of other physicians employed at treatment centers across the country  Access to the Journal of Addiction Medicine and a free subscription of ASAM Magazine and ASAM Weekly for the latest developments in education, advocacy, top education and information resources  ASAM members receive a $10 discount on The ASAM Criteria book  Join online at www.asam.org

Editor's Notes

  1. What is the ASAM Critera: Most widely used and comprehensive set of guidelinesUsed across all settings and by different levels of professionals (clinicians and non-clinicians) Criteria Development: 1980sASAM entrusted to unifying addiction field around national criteriaCriteria address board continuum of addiction servicesRequired in over 30 statesSince Frist Edition 1991, Criteria considered Board approved and endorsedRevised Edition: Major changes—(David Mee-Lee can chime in as needed) Updated to reflect changes in the addiction field since the last edition published in 2001Addresses application to special patient populationsApplies to a wide variety of clinical settingsImproved user-friendly designLead into next slide: How has the text been vetted?
  2. What is the ASAM Critera: Most widely used and comprehensive set of guidelinesUsed across all settings and by different levels of professionals (clinicians and non-clinicians) Criteria Development: 1980sASAM entrusted to unifying addiction field around national criteriaCriteria address board continuum of addiction servicesRequired in over 30 statesSince Frist Edition 1991, Criteria considered Board approved and endorsedRevised Edition: Major changes—(David Mee-Lee can chime in as needed) Updated to reflect changes in the addiction field since the last edition published in 2001Addresses application to special patient populationsApplies to a wide variety of clinical settingsImproved user-friendly designLead into next slide: How has the text been vetted?
  3. What is the ASAM Critera: Most widely used and comprehensive set of guidelinesUsed across all settings and by different levels of professionals (clinicians and non-clinicians) Criteria Development: 1980sASAM entrusted to unifying addiction field around national criteriaCriteria address board continuum of addiction servicesRequired in over 30 statesSince Frist Edition 1991, Criteria considered Board approved and endorsedRevised Edition: Major changes—(David Mee-Lee can chime in as needed) Updated to reflect changes in the addiction field since the last edition published in 2001Addresses application to special patient populationsApplies to a wide variety of clinical settingsImproved user-friendly designLead into next slide: How has the text been vetted?
  4. What is the ASAM Critera: Most widely used and comprehensive set of guidelinesUsed across all settings and by different levels of professionals (clinicians and non-clinicians) Criteria Development: 1980sASAM entrusted to unifying addiction field around national criteriaCriteria address board continuum of addiction servicesRequired in over 30 statesSince Frist Edition 1991, Criteria considered Board approved and endorsedRevised Edition: Major changes—(David Mee-Lee can chime in as needed) Updated to reflect changes in the addiction field since the last edition published in 2001Addresses application to special patient populationsApplies to a wide variety of clinical settingsImproved user-friendly designLead into next slide: How has the text been vetted?
  5. What is the ASAM Critera: Most widely used and comprehensive set of guidelinesUsed across all settings and by different levels of professionals (clinicians and non-clinicians) Criteria Development: 1980sASAM entrusted to unifying addiction field around national criteriaCriteria address board continuum of addiction servicesRequired in over 30 statesSince Frist Edition 1991, Criteria considered Board approved and endorsedRevised Edition: Major changes—(David Mee-Lee can chime in as needed) Updated to reflect changes in the addiction field since the last edition published in 2001Addresses application to special patient populationsApplies to a wide variety of clinical settingsImproved user-friendly designLead into next slide: How has the text been vetted?
  6. What is the ASAM Critera: Most widely used and comprehensive set of guidelinesUsed across all settings and by different levels of professionals (clinicians and non-clinicians) Criteria Development: 1980sASAM entrusted to unifying addiction field around national criteriaCriteria address board continuum of addiction servicesRequired in over 30 statesSince Frist Edition 1991, Criteria considered Board approved and endorsedRevised Edition: Major changes—(David Mee-Lee can chime in as needed) Updated to reflect changes in the addiction field since the last edition published in 2001Addresses application to special patient populationsApplies to a wide variety of clinical settingsImproved user-friendly designLead into next slide: How has the text been vetted?