The purpose of the assessment is to determine the most appropriate level of care for the patient using ASAM (American Society of Addiction Medicine) criteria. Approximately 15 patients are assessed each day by the Central Intake Assessment Department staff. The patient’s family, social, financial, medical, and psychiatric histories, as well as a current physical assessment are included in each assessment conducted by the department.
The Central Intake Admissions Department receives approximately 200 calls each day. Based upon an initial phone screen, some of these callers may be deemed more appropriate for another treatment agency or another type of service and are referred to such. Patients in any of the Detox programs that may need medical attention, or those who are being discharged from treatment, or who arrive at an Outpatient Program under the influence will also be appropriately referred.
Patients in Detox will be assessed and if treatment in the appropriate Haymarket Center program is not immediately available, the patient will be offered the options of a referral to another treatment agency or of receiving interim services at Haymarket Center while on a waiting list.
Levels of Care
Many organizations, including managed care organizations, have developed guidelines regarding levels of care to be used in treating AOD abuse. The ASAM guidelines are presented here as an example of such guidelines. Although they have not been empirically evaluated, the guidelines were developed through extensive collaboration with providers, payers, and other addiction experts. Listing them here should not be considered a recommendation or confirmation of their efficacy.
ASAM's four levels of care for AOD abuse treatment are described in Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders (Hoffman et al. 1991). They are presented here, with brief descriptions of settings and services:
- Level I: Outpatient treatment - An organized nonresidential treatment service or an office practice with designated addiction professionals and clinicians providing professionally directed AOD treatment. This treatment occurs in regularly scheduled sessions usually totaling fewer than 9 contact hours per week. Examples include weekly or twice-weekly individual therapy, weekly group therapy, or a combination of the two in association with participation in self-help groups.
- Level II: Intensive outpatient treatment (including partial hospitalization) - A planned and organized service in which addiction professionals and clinicians provide several AOD treatment service components to clients. Treatment consists of regularly scheduled sessions within a structured program, with a minimum of 9 treatment hours per week. Examples include day or evening programs in which patients attend a full spectrum of treatment programming but live at home or in special residences.
- Level III: Can be described as an organized service conducted by addiction professionals and clinicians who provide a planned regimen of around-the-clock professionally directed evaluation, care, and treatment in an inpatient setting. This level of care includes 24-hour observation, monitoring, and treatment. A multidisciplinary staff functions under medical supervision. An example is a program with 24-hour nursing care under the direction of physicians.
- Level IV: Medically managed intensive inpatient treatment - An organized service in which addiction professionals and clinicians provide a planned regimen of 24-hour medically directed evaluation, care, and treatment in an acute care inpatient setting. Patients generally have severe withdrawal or medical, emotional, or behavioral problems that require primary medical and nursing services.