ASAM Criteria Offer Roadmap for Science-Based Treatment

ASAM Criteria Offer Roadmap for Science-Based Treatment

To a greater extent than ever before, the substance use treatment industry’s primary guide to level-of-care assessment and treatment planning is moving the field toward more comprehensive service delivery. The fourth edition of The ASAM Criteria, released late last year, assumes treatment providers’ ability to address patient needs across the continuum of care, even if the only level of care they directly offer in their organizations is residential treatment.

In both the public and private insurance markets, The ASAM Criteria have steadily gained prominence as a roadmap for treatment decision-making. The Centers for Medicare & Medicaid Services’ guidance to states that have received Section 1115 Medicaid waivers cites use of the criteria in waiver programs. In the private market, meanwhile, numerous health plans across the country have licensed the criteria.

The senior managing director of behavioral health at national accrediting organization CARF, which offers ASAM level-of-care certification for residential treatment programs, believes use of the new edition of the criteria can help correct shortcomings in the industry’s level-of-care placement practices. Michael Johnson explained that while treatment programs generally conduct thorough biopsychosocial assessments to determine a sound treatment plan, many don’t look closely enough at which level of care is most appropriate for the patient.

“An algorithm in the fourth edition sets out, ‘Here are the risk factors in the different dimensions of the criteria, guiding where placement should be,’” Johnson said. “If you place someone in residential treatment and they don’t need it, you can make it worse.” Only those patients who exhibit moderate to severe impairment in areas such as acute withdrawal potential and biomedical and behavioral complications should be placed in the high-intensity residential level of care.

The new edition of the criteria also should resonate with those who advocate greater patient autonomy in the care received. The new sixth dimension in the criteria focuses on person-centered considerations, encompassing patient preferences and common barriers to care. This dimension replaces the previous sixth dimension of readiness to change, a factor that is now incorporated into all of the dimensions for patient assessment.

The criteria closely reflect the current state of scientific evidence guiding clinical treatment. Johnson said that while treatment providers as a whole have become more evidence-based in their approach than was the case a decade ago, a disconnect between science and treatment persists.

For example, “It’s dismaying that you have leaders who say, ‘We don’t believe in medication-assisted treatment,’” Johnson said. “This is science, not faith.”

For treatment facilities with payment sources that encourage or mandate use of the criteria, these centers will have to demonstrate the ability to meet the needs of patients with co-occurring substance use and mental health disorders. Even if they do this by referring these patients to a provider that offers integrated treatment for the dually diagnosed, they still will have to employ on staff a person with expertise in assessing patient mental health needs, according to ASAM leaders.

CARF intends to add new levels of care to additional entities beyond residential treatment centers, adding new levels of care into the future.

Look for more insight into the benefits of accreditation in upcoming blog posts, as we at Sigmund Software continue to highlight all of the components essential to being a quality-driven treatment provider.