The ASAM Level of Care Cheat Sheet is a tool designed to help assess a patient's needs based on specific criteria. This form guides healthcare providers in determining the appropriate level of care for individuals seeking treatment for substance use disorders. By evaluating various dimensions of a patient's condition, it ensures that they receive the most effective support possible.
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The ASAM Level of Care Cheat Sheet is a vital tool designed to guide healthcare professionals in assessing and determining the appropriate level of care for individuals struggling with substance use disorders. This form is based on the American Society of Addiction Medicine's (ASAM) Adult Patient Placement Criteria and serves as a comprehensive checklist for evaluating clients across six key dimensions. Each dimension addresses critical aspects of a patient’s condition, including withdrawal potential, biomedical conditions, emotional and behavioral issues, readiness for change, relapse potential, and the recovery environment. By systematically rating clients in these areas, practitioners can ensure that emergency needs are prioritized and that patients receive the least intensive level of care that is still safe and effective. The form outlines specific service levels, ranging from outpatient care to inpatient hospitalization, helping professionals navigate the complexities of treatment options. Ultimately, this cheat sheet not only streamlines the assessment process but also enhances the likelihood of successful patient outcomes by aligning treatment strategies with individual needs.
Patient Placement Criteria Checklist - Kentucky Edition 2012
Based upon ASAM Adult Patient Placement Criteria-Second Edition Revised
Client Name: ____________________________________ Date:_______________________ Case Number__________________
Directions: Rate the client or patient on each of the six Dimensions first and then analyze for Level of Care; emergency needs come first, then the least intensive LOC that is safe and can effectively help client reach goals.
ASAM-PPC Levels
and Services
Level of Care I
Level of Care
II.1
Level of
Care III.1
Care III.3
Level of Care III.5
Care IV
OUTPATIENT
TRANSITIONAL
RECOVERY CENTER
INTENSIVE OUTPATIENT
RESIDENTIAL TREATMENT
INPATIENT HOSPITAL
(Less
than 6
weekly
(including
(Staffed by peers and may include
Service Levels:
(6 to 20 service hours per week.
(Clinically managed. Includes licensed short
(Including medical
service
hours.
Includes
sober
living
facility with
credentialed or
non-credentialed
Can be combined
with
housing
or long term
rehabilitation
unit, crisis
detoxification and
Medication Assisted
5+
hours
of clinical
staff rather
than clinically
and supports to be
level
III care.)
stabilization
unit, licensed
detox unit)
inpatient psychiatric units)
Treatments/MAT*)
services per week)
managed.)
Admission
Meets
all Dimensions
Meets all
Dimensions
Meets one of Dimensions
Meets Dimensions 1,2 & 3 at this
Meets all Dimensions below at this
Meets all Dimensions at this level plus
1, 2, or 3; plus meets
specifications
below
at this
level (if
at this level; has
for each Level
not, consider
a higher
level (if applicable),
and one of
completed
services for
level plus meets
the criteria for a
meets criteria for a Substance Dependence
criteria for
a Substance
Dimensions 4,5, or
6 at this level
Substance Dependence Disorder
Disorder
Dependence
Disorder or
of Care:
level of care)
acute symptoms
severe mental disorder
Dimension 1:
No withdrawal
If present, minimal risk of
If present, mild to moderate risk of
High risk of severe
Acute
needs OR needs can
No withdrawal needs OR
No signs or
severe withdrawal that can
severe withdrawal that can be
withdrawal which
Intoxication
be safely managed
needs can be safely
symptoms of
be managed at a social
managed at a social setting detox
cannot be managed
and/or
at this level, such as
managed at this level.
withdrawal
setting intake level with no
level with possible medication
in a social-setting
Withdrawal
with MAT.
medication support
support
detox
Potential
Dimension 2:
If present, stable OR
If present, stable and
If present, stable and can
If present, stable and can self-
Biomedical
no medical
self-administer meds OR able
administer meds OR severe enough
Severe enough to
None or sufficiently
receiving concurrent
Conditions
monitoring needed,
to obtain medical supports
to warrant medical monitoring but
warrant inpatient
stable
medical attention that will
and
OR can be monitored
from outside provider
not in need of inpatient treatment.
medical care
not interfere with treatment.
Complications
by outside provider.
May include pregnancy.
If present, mild to moderate severity
Dimension 3:
If present, stable, OR if
If present, mild to moderate
needing a 24-hour structured
Severity of mental
If present, mild severity
severity: needs structure to
setting; repeated inability to control
Emotional,
distracting, can
disorder requires
None or very stable
responds to outpatient
focus on recovery. Could be
impulses; personality disorder
Behavioral or
respond to the level
medical monitoring,
(cognitively able to
monitoring to minimize
referred out to MH services.
requires high structure to shape
Cognitive
of 24-hour structure
such as for danger to
participate and no
distractions from recovery;
If stable a DDC** program is
behavior. Needs
in this program; can
self or others
risk of harm)
can receive concurrent
appropriate. If not a DDE***
counseling/therapy. If stable a
receive concurrent
COD services.
program is required.
DDC** program is appropriate. If
not a DDE*** program is required.
CLIENT NAME:________________________________________________ DATE: _____________________ CASE NUMBER:________________________ ____
Care
Level of Care III.3
Level of Care IV
Transitional
(6 to
20 service hours per
(Clinically
managed. Includes
licensed short
week. Can
be combined
credentialed or non-credentialed
or long
term
supports
of
clinical
staff rather than clinically
to
be level III
care.)
services per
week)
Ready to change and
Has marked difficulty with or
Willing to cooperate
Resistance is high
Has little awareness & needs
opposition to treatment, with
cooperate at this
or is ambivalent and
enough to require
interventions available only
dangerous consequences; or there
Dimension 4:
level, OR externalizes
needs motivation,
structured program,
at this level to engage & stay
is high severity in this dimension but
Readiness to
problems and needs
recovery support,
but not so high as to
in recovery. May have
not others. The client therefore
Change
this level of structure,
and monitoring
render outpatient
external leverage to support
needs a motivational enhancement
motivation and
strategies
treatment ineffective.
participation.
program with 24 hour structure.
support.
Intensification of
Client is at high risk
intervention available only at
Able to maintain
for imminent relapse
this level to prevent
intervention available only at this
symptoms despite
Dimension 5:
abstinence and
with dangerous
continued use, with
level to prevent continued use, with
active participation in
Relapse,
recovery goals or
consequences. Client
dangerous consequences to
dangerous consequences to self or
Outpatient, OR high
Continued Use or
achieve awareness
needs 24-hour
self or others.
others.
likelihood of relapse
Continued
of a substance use
structure and support
Does not recognize triggers,
Does not recognize triggers, unable
without close
Problem Potential
problem with minimal
OR needs this support
unable to control use, in
to control use, in danger of relapse
monitoring and
to transition into
danger of relapse without
without close 24-hour monitoring
community.
close 24-hour monitoring
and structure.
Has a using,
Supportive recovery
Lacks social contacts
unsupportive,
Homelessness or lack of
environment OR
or social contacts
dangerous, or
Environment is dangerous or
Dimension 6:
safe, supportive recovery
willingness to obtain
aren’t conducive to
victimizing social
unsupportive of recovery and client
Recovery
environment and client
such OR supports
recovery, but with
network, or lacks a
lacks skills to cope outside of highly
Environment
needs 24-hour structure to
need professional
structure or support,
social network,
structured 24-hour setting.
learn to cope.
interventions.
the patient can cope
requiring this level of
24-hour support.
*Medication Assisted Treatments (MAT) can occur at any level of care and includes methadone, buprenorphine, and medications to control cravings and withdrawal when other criteria are met for level of care. Methadone and Suboxone clinics are generally outpatient, but clients on MAT may sometimes need a higher level of care.
**DDC: Dual Diagnosis Capable Program - has a primary target population of individuals with substance related disorders but also has an expectation and willingness to treat individuals with co-occurring mental health conditions, in-house or by
referral to concurrent mental health services.
***DDE: Dual Diagnosis Enhanced Program – the program has the combined capacity to treat both mental health and substance related disorders equally.
Rater’s Signature: ____________________________________________________________
Last revision: 4-3-12, Lynn Posze/Dave Mathews
Filling out the ASAM Level of Care Cheat Sheet form requires careful consideration of the patient’s needs across six dimensions. Each dimension assesses different aspects of the patient’s situation to determine the appropriate level of care. Make sure to gather all necessary information before you begin, as this will help streamline the process.
What is the purpose of the ASAM Level Of Care Cheat Sheet form?
The ASAM Level Of Care Cheat Sheet form serves as a comprehensive guide for assessing the appropriate level of care for individuals seeking treatment for substance use disorders. It utilizes the ASAM Adult Patient Placement Criteria to evaluate clients across six critical dimensions. By systematically rating each dimension, professionals can determine the least intensive level of care that is safe and effective for the client, ensuring that their specific needs are met while facilitating their journey toward recovery.
How should a clinician use the dimensions outlined in the form?
Clinicians should begin by rating the client on each of the six dimensions, which encompass withdrawal potential, biomedical conditions, emotional and behavioral issues, readiness to change, relapse potential, and recovery environment. After completing the ratings, the clinician analyzes the results to identify the appropriate level of care. This process involves prioritizing emergency needs and ensuring that the selected level of care aligns with the client’s treatment goals and overall well-being.
What are the different levels of care indicated in the form?
The form categorizes care into several levels, ranging from Level I, which is outpatient care, to Level IV, which involves inpatient hospitalization. Each level is designed to meet varying degrees of need, from less intensive outpatient services to more intensive residential treatment and inpatient care. The levels reflect the complexity of care required, with higher levels indicating more significant medical or psychological needs that necessitate structured support and monitoring.
What factors influence the determination of a client’s level of care?
Several factors play a critical role in determining a client’s level of care. These include the severity of withdrawal symptoms, the presence of co-occurring medical or psychological conditions, the client’s readiness to engage in treatment, and their potential for relapse. Additionally, the recovery environment, including social support and stability, is assessed. All these factors collectively inform the clinician’s decision regarding the most appropriate and effective treatment setting for the client.
How does the form address co-occurring disorders?
The ASAM Level Of Care Cheat Sheet form recognizes the complexities of co-occurring disorders through its dual diagnosis capabilities. It differentiates between programs that can treat both substance use disorders and mental health conditions. Clinicians can identify whether a client requires a Dual Diagnosis Capable (DDC) or a Dual Diagnosis Enhanced (DDE) program based on their specific needs. This ensures that clients receive comprehensive care that addresses all aspects of their health, fostering a more holistic approach to recovery.
Filling out the ASAM Level of Care Cheat Sheet form can be a crucial step in ensuring that patients receive the appropriate level of care for their needs. However, many people make mistakes that can lead to misclassification and inadequate treatment. One common error is failing to provide accurate patient information. Incomplete or incorrect details about the client, such as their name, case number, or date, can create confusion and hinder the assessment process. It is essential to double-check this information before submitting the form to avoid unnecessary delays in care.
Another frequent mistake occurs when individuals overlook the importance of thoroughly assessing each of the six dimensions outlined in the form. Each dimension plays a critical role in determining the appropriate level of care. Skipping dimensions or providing vague responses can lead to an inaccurate assessment. It is vital to take the time to evaluate each dimension carefully, as this ensures that the patient's needs are fully understood and addressed.
People often underestimate the significance of documenting the patient's current condition and history accurately. For instance, failing to note the severity of withdrawal symptoms or the presence of co-occurring disorders can result in a misclassification of the level of care needed. A thorough understanding of the patient's medical and psychological history is crucial for making informed decisions about their treatment options. Always ensure that this information is detailed and reflective of the patient's actual situation.
Lastly, many individuals neglect to consider the patient's readiness for change and their motivation to engage in treatment. This aspect is vital in assessing the appropriate level of care. If the form reflects a lack of awareness or motivation but does not provide context, it can lead to inappropriate placement. It is essential to capture the patient's willingness to participate in treatment and any external factors that may influence their readiness. By doing so, you help ensure that the patient receives the most effective care possible.
The ASAM Level of Care Cheat Sheet is an essential tool used in assessing a client's needs for treatment. However, several other forms and documents often accompany it to ensure a comprehensive evaluation and appropriate care plan. Understanding these documents can help facilitate a smoother treatment process.
Incorporating these documents alongside the ASAM Level of Care Cheat Sheet can enhance the treatment process. They provide a framework for understanding the client's needs and ensuring they receive the appropriate level of care.
ASAM Criteria: This document outlines the criteria for placement in addiction treatment services, similar to the ASAM Level of Care Cheat Sheet. It focuses on dimensions that assess a patient's needs for effective treatment.
Patient Placement Criteria Checklist: Like the ASAM Cheat Sheet, this checklist helps evaluate a patient's level of care based on specific criteria. It provides a structured approach to determine the appropriate treatment setting.
Clinical Assessment Tools: These tools gather comprehensive information about a patient's condition. They share a similar purpose with the ASAM Cheat Sheet in assessing the severity of substance use and mental health issues.
Level of Care Determination Guidelines: These guidelines help professionals decide on the most suitable treatment level for patients. They align closely with the ASAM Cheat Sheet in their focus on matching patient needs to available services.
Substance Abuse Treatment Planning Forms: These forms assist in creating individualized treatment plans. They are similar in that they evaluate patient needs and recommend appropriate interventions.
Behavioral Health Screening Tools: These tools assess mental health and substance use issues. They are comparable to the ASAM Cheat Sheet as they help identify the level of care required based on specific criteria.
Risk Assessment Instruments: These instruments evaluate the risk factors associated with substance use and mental health. They serve a similar function to the ASAM Cheat Sheet in identifying the urgency and level of care needed.
Treatment Outcome Measures: These measures evaluate the effectiveness of treatment interventions. They are akin to the ASAM Cheat Sheet, as both focus on patient progress and appropriate care levels.
Care Coordination Tools: These tools facilitate communication among care providers regarding a patient's treatment plan. They share similarities with the ASAM Cheat Sheet by ensuring that care is aligned with patient needs.
Integrated Treatment Models: These models combine mental health and substance use treatment. They relate closely to the ASAM Cheat Sheet, as both emphasize the importance of addressing co-occurring disorders in care planning.
When filling out the ASAM Level Of Care Cheat Sheet form, consider the following guidelines:
Understanding the ASAM Level of Care Cheat Sheet can be challenging. Here are seven common misconceptions that may arise regarding this important tool:
In reality, the ASAM Cheat Sheet is designed for a range of cases, from mild to severe. It helps identify the appropriate level of care for each individual, regardless of the severity of their condition.
The ASAM criteria are adaptable. They take into account individual circumstances and needs, allowing for personalized treatment plans that can change as a patient progresses.
This is not true. Patients can enter at different levels of care based on their specific needs and the assessment results. Some may require only outpatient services, while others may need inpatient care.
While substance use is a key focus, the dimensions also address mental health, social environment, and medical conditions, providing a holistic view of a patient’s needs.
Any healthcare provider involved in patient care can benefit from using the ASAM Cheat Sheet. It provides valuable insights for a variety of professionals, including primary care physicians and mental health providers.
The ASAM criteria are used nationwide. While some states may have specific adaptations, the core principles are widely recognized and applicable across the country.
While the Cheat Sheet provides guidance, the final determination of a patient’s level of care depends on a comprehensive assessment by qualified professionals, taking into account all relevant factors.
Here are some key takeaways about filling out and using the ASAM Level of Care Cheat Sheet form: