192 -10 Ways to Use Patient Placement Criteria to Improve Treatment – Addiction Counselor Training Series
Counselor Toolbox

 
 
00:00 / 58:35
 
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Assessment and Patient Placement Tools
ASAM, FARS, LOCUS
Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs Counselor Education
Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery
Objectives
~ Differentiate between level of care guidelines and patient placement criteria
~ Learn about the Functional Assessment Rating Scale (Required in some states)
~ Learn about the ASAM (Required by most insurers)
~ Learn about the LOCUS (Often an alternate to the ASAM
~ Discuss why these tools are used and how they can benefit clinician and client

Patient Placement vs. Level of Care
~ Patient placement criteria suggests a treatment intensity level that meets the needs of the client
~ Level of Care Guidelines are defined by:
~ Insurance Providers
~ State Law (in some states)
Why Use Them
~ Provides a biopsychosocial approach to care management
~ Assists in defining potential strengths and obstacles to the recovery process as the client sees them
~ Helps guide treatment planning for
~ Biomedical Issues
~ Cognitive/Emotional/Behavioral Issues
~ Motivational Issues
~ Recovery Environment (including social supports)
~ Assists in providing Specific, Measurable, Achievable, Realistic, Time Limited Goals
FARS
~ Functional Assessment Rating Scale
~ Not a placement guideline per se
~ Helps more clearly define anchors for behavioral observations
FARS
FARS
FARS
ASAM– Assessment, Reassessment & Discharge
~ Physical
~ Acute Intoxication/Withdrawal Potential
~ Biomedical Conditions
~ Emotional/Cognitive
~ Emotional/Behavioral Conditions
~ Treatment Acceptance/Resistance (Readiness for change)
~ Behavioral
~ Relapse or Continued Use Potential
~ Social/Environmental
~ Recovery Environment
ASAM Levels
~ Level .05: Early Intervention (Relapse Prevention)
~ Level I: Outpatient (<9 hours per week)
~ Level II: IOP (9-19 hours per week)
~ Level II.5: PHP (20+ Hours per week)
~ Level 3: Residential
~ Level 4: Medically Managed Intensive Inpatient Services
LOCUS Dimensions
~ Risk of Harm
~ 1-Minimal
~ 2-Low
~ 3-Moderate
~ 4-Serious
~ 5-Extreme
~ Functional Status
~ 1-Minimal Impairment
~ 2-Mild Impairment
~ 3-Moderate Impairment
~ 4-Serious Impairment
~ 5-Severe Impairment
LOCUS Dimensions
~ Medical, Addictive and Psychiatric Comorbidity
~ 1-No Comorbidity
~ 2-Minor Comorbidity
~ 3-Moderate Comorbidity
~ 4-Major Comorbidity
~ 5-Severe Comorbidity
Recovery Environment
~ Level of Stress (A)
~ 1-Low
~ 2-Mild
~ 3-Moderate
~ 4-High
~ 5-Extremely Stressful
~ Level of Support (B)
~ 1-Highly supportive
~ 2-Supportive
~ 3-Limited Support
~ 4-Minimal Support
~ 5-No Support
LOCUS Dimensions
~ Treatment and Recovery History
~ 1-Fully Responsive
~ 2-Significant Response
~ 3-Moderate or Equivocal Response
~ 4-Poor Response (goals not achieved or gains not maintained)
~ 5-Negligible Response
LOCUS Dimensions
~ Engagement
~ 1-Optimal (Action)
~ 2-Positive (Preparation/Determination)
~ 3-Limited (Contemplation)
~ 4-Minimal (Contemplation)
~ 5-Unengaged (Precontemplation)
EXAMPLE Guidelines LOCUS Placement
~ Level 1 LOCUS Placement (up to 3h/week)
~ 1. Risk of Harm – clients with a rating of two or less
~ 2. Functional Status – clients should demonstrate ability to maintain a rating of two or less
~ 3. Co-morbidity – a rating of two or less
~ 4. Recovery Environment – a combined rating of no more than four on Scale “A” and “B”
~ 5. Treatment and Recovery History – a rating of two or less
~ 6. Engagement – a rating of two or less
Example Guidelines LOCUS Placement
~ Level 2 LOCUS Placement (L-IOP, more than 3 h/wk)
~ 1. Risk of Harm – clients with a rating of two or less
~ 2. Functional Status – clients should demonstrate ability to maintain a rating of 3 or less
~ 3. Co-morbidity – a rating of two or less
~ 4. Recovery Environment – a combined rating of no more than 5 on Scale “A” and “B” neither scale above 3
~ 5. Treatment and Recovery History – a rating of two or less
~ 6. Engagement – a rating of two or less
Example Guidelines LOCUS Placement
~ Level 3 LOCUS Placement (IOP/PHP)
~ 1. Risk of Harm – clients with a rating of 3 or less
~ 2. Functional Status – clients should demonstrate ability to maintain a rating of 3 or less
~ 3. Co-morbidity – a rating of two or less
~ 4. Recovery Environment – a combined rating of no more than 5 on Scale “A” and “B” neither scale above 3
~ 5. Treatment and Recovery History – a rating of two or less
~ 6. Engagement – a rating of 3 or less
Example Guidelines LOCUS Placement
~ Levels 4-6 correspond to residential
What Clinicians Need to Do at EVERY Level
~ 5 Ms
~ Motivate
~ Readiness for change and recovery environment; engagement and alliance building
~ Manage
~ Family, significant others, work/school, legal, financial
~ Medication
~ Detox; HIV/AIDS; Medication Assisted (Addiction) Treatment, psychotropic medication
~ Meetings
~ 12-Step, Smart Recovery, Celebrate Recovery, etc.
~ Monitor
~ Continuity of care; relapse prevention; recovery environment and social supports / family

Summary
~ The FARS is very helpful to conceptualize problems and rank severity
~ The FARS provides small “focus areas” that can form the subgoals of treatment plans
~ The ASAM and LOCUS are used relatively interchangeably to identify the appropriate level/intensity of treatment for clients
~ Treatment intensity does not necessarily = treatment program placement.
~ Insurance companies often define the services to be provided at each level of care for reimbursement purposes
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