Pennsylvania Client Placement Criteria, Third Edition PA Department of Drug and Alcohol Programs Rev. 11/15.

Pennsylvania Client Placement Criteria, Third Edition PA Department of Drug and Alcohol Programs Rev. 11/15

DDAP’s Mission The Department of Drug and Alcohol’s mission is to engage, coordinate and lead the Commonwealth of Pennsylvania’s effort to prevent and reduce drug, alcohol and gambling addiction and abuse and to promote recovery, thereby reducing the human and economic impact of the disease. Gary Tennis, First Secretary of DDAP

Goals To introduce the PCPC, providing basic knowledge and skill practice To provide the foundation training for those who will administer the PCPC

Objectives By the end of the training, participants will have: –Reviewed the purpose and use of the PCPC –Identified the levels of care, types of service and dimensions of the PCPC –Gained knowledge of Admission, Continued Stay, and Discharge criteria of the PCPC –Increased knowledge of placement considerations for special populations –Demonstrated understanding by applying the PCPC to case studies

Training Overview Background of PCPC Highlights of Manual Levels of Care, Types of Service, & Dimensions Continuum of Care and Placement Process Summary Sheet Special Populations Do/Don’t Matrix Case Studies Training Principles Principles of Treatment

Act 152 1988 PCPC Task Force Established 1993 Statewide Pilot Studies 1996 PCPC First Edition 1997 PCPC Second Edition 1999 BDAP Becomes DDAP 2012 PCPC Third Edition 2014 PCPC Background… a look back in time

What is the PCPC? Set of guidelines designed to provide clinicians with a basis for determining the most appropriate treatment setting for individuals with Substance Use Disorders (SUD) PCPC is a placement tool, a methodology for Level of Care (LOC) determination –Originally based on ASAM Criteria –For use with adults –Mandated for publicly funded individual –Evidence-based placement tool

Why use the PCPC? Developed to provide clear guidance for placement in Pennsylvania SUD treatment system Reflects expertise of professionals across the state Created for use with the public sector Includes placement considerations for special populations Creates common language and consistency in the field

Why use the PCPC? Three best predictors of positive outcomes relate to fidelity to the assessment and placement process: –Level of Care –Length of Stay –Treatment continuum All three are managed by the PCPC

Why use the PCPC? Required by Act 152 of 1988 Added to services covered by Medicaid (previously only covered limited outpatient and hospital services) –non-hospital residential detoxification –non-hospital residential rehabilitation –halfway house Requires use of criteria developed and/or approved by DDAP for governing level of care and length of stay –PCPC for adults –ASAM for adolescents

A note about Act 106 of 1989 Requires all commercial group health plans, HMOs, and the Children’s Health Insurance Program to provide comprehensive treatment for substance use disorders. Minimum benefits –30 days residential per year/90 days lifetime –30 sessions outpatient/partial hospitalization per year/120 days lifetime –30 additional outpatient/partial hospitalization sessions or 15 additional residential treatment days –Family counseling and intervention services Only lawful prerequisite is a certification and referral from a licensed physician or licensed psychologist Concurrent reviews are not required during this time

Principles of Treatment Individuals with Substance Use Disorder(SUD) require access to a coordinated continuum of services that are clinically appropriate in intensity, duration, and frequency. Foundation of Treatment Principles: –Science of SUD treatment, –Person-Centered and Community-Based paradigm of recovery. Principles based on the platform of recovery focus on the strengths of the person and his or her connections within a community of recovery supports.

Principles of Treatment Principle 1: Treatment is optimal when provided through individualized and coordinated treatment intervention, follow up, and recovery support services that lead to each individual’s long term recovery. Principle 2: Beyond cessation of substance use, SUD treatment should also address the individual‘s needs through the provision of comprehensive services provided within seamlessly linked systems of care.

Principles of Treatment Principle 6: Within the continuum of treatment services, treatment placement recommendations need to be based on a comprehensive assessment that includes a review of the severity and biopsychosocial impact of the individual’s substance use as well as the individual’s clinical, social, and recovery status. Principle 7: Remaining in treatment for an appropriate period of time is critical to positive outcomes. Principle 18: Treatment and recovery systems can and should continually evolve to serve individuals and communities appropriately.

Continuum of Care Prevention Early Intervention OPIOPPartial Halfway House Med Mon Detox Med Mon ST Residential Med Mon LT Residential Med Managed Detox Med Managed Inpatient

What is assessment? Definition: A face-to-face interview with the client to ascertain treatment needs based on the degree and severity of alcohol and other drug use/abuse through the development of a comprehensive, confidential personal history, including significant medical, emotional, social, occupational, education and family information. Conducted by qualified professional Vital element in placement process –Assessment is NOT placement –Assessment is the foundation for determining PCPC placement Assessment is NOT required for emergent care placement

PCPC Dimensions 1)Acute Intoxication and Withdrawal 2)Biomedical Conditions and Complications 3)Emotional/Behavioral Conditions and Complications 4)Treatment Acceptance/Resistance 5)Relapse Potential 6)Recovery Environment

PCPC Levels of Care and Types of Service Five Levels of Care –Broad Description of Services to meet the client’s needs in three areas: Medical Needs Therapeutic Contact (Counseling and Medical) Structure and/or Restrictions Ten types of service organized under the five broad levels of care –Nine types of D&A services are licensed in PA –Early Intervention is not licensed in PA

PCPC Levels of Care *based on service descriptions Types of Service Tx Contact/ Staff Ratio Structure*Medical*Setting Level.5Early InterventionNoneLowNoneCommunity Level I Outpatient 1A Low (<5hr/35:1) LowNoneCommunity Intensive Outpatient 1B Medium LowNoneCommunity (5-10 hr./15:1) Level II Partial Hospitalization 2A Medium NoneCommunity (10+ hr./10:1) Halfway House 2B Low (<5 hr./8:1) High (24 hr.)Low (phys. exam) Community/ Residential Level III Med Monitored Detox 3AHigh (7:1)High (24 hr.)Medium (exam in 24h)Residential Short Term Residential 3BHigh (8:1)High (24 hr.) Medium (physical exam) Residential Long Term Residential 3CHigh (8:1) High (24 hr.) Medium(phys. exam 48h) Residential (Longer tx) Level IV Med Managed Detox 4AVery High (5:1)High (24 hr.)Very High (24h Doc)Hospital Med Managed Tx 4BHigh (7:1)High (24 hr.)High (24h Nurs.)Hospital

Tips & Tricks for Placement Question 1: Is the individual’s life/health in danger because of the amount of drugs or type of drugs they have taken? (Dimension 1) –If YES, see 4A or 3A 4A if they will possibly need emergency care/life is in danger/crash cart & emergency on stand-by 3A if the symptoms aren’t extreme –If NO, move on (you’ve just eliminated 3A & 4A) Question 2: Does the individual’s medical or mental condition need frequent care or 24 hour nursing? (Dimension 2 & 3) –If YES, placement is 4B –If NO, move on (now you have eliminated ALL of LEVEL 4)

Tips & Tricks for Placement Question 3: How much structure and contact does the person need? (Dimension 3) A lot? (Level 3) A little? (Level 1) In between? (Level 2) –Start reviewing criteria in that level of care – look at the Dimensional Scoring Specification –Hint: you only need to look at dimensions 3, 4, 5, & 6 Question 4: Are you sure? –To check, look at the criteria in the services that are the next most intensive and the next least intensive The Next Step: Anything special about this individual?

Initial Placement Determination What type of help (medical, structure, contact) does the client need? Medication-Assisted Treatment Co-Occurring SUD and Mental Health Women/Women with Children Criminal Justice Cultural/Ethnic Sexual Orientation/ Gender Identity Co-Occurring SUD and Gambling Disorder Level of CareType of Service Special Considerations Provider Which Type of Service is designed to meet those needs? (TOS Placement ) Which Provider meets the needs?

LOUIS Admission Case Study

Completing the PCPC Summary Sheet Complete clinical assessment. Go to the Level of Care that appears most appropriate. Starting with the 1 st dimension that must be met, compare client symptoms with required criteria. Fill in the level of care and criteria by alpha numeric reference in the dimensional scoring section. Fill in the comments section with a brief, global statement of how the client meets the dimensional criteria. Summary Sheet must comply with 4 Pa Code 255.5 on confidentiality –As a provider in PA, one may not release additional information

Completing the PCPC Summary Sheet Forms are available online at www.ddap.pa.gov. Select “DDAP Document Library” and then “Forms”.www.ddap.pa.gov

Level of Care Overview Level 3 Professionally directed (“monitored”) Does not require full resources of medical facility Level 4 Medically directed (“managed”) 24-hour medical service is needed

Level of Care Overview 3A Admission criteria requires score of 3A in Dim. 1 and no higher than 3A for Dim. 2 & 3 Physical exam within 24 hrs. or physical exam completed within 7 days reviewed within 24 hrs. 4A Admission Criteria requires score of 4A in Dim. 1 or 3A if Dim. 2 or 3 are 4A Physician completes comprehensive history (D&A included) and physical exam within 24 hrs.

Level of Care Overview 3B Professionally directed Individuals in acute distress May have co-existing issues but they do not require frequent care Full resources of medical facility not available on- site 4B Medically directed Individuals in acute distress Have co-existing issues which require frequent care Full resources of medical facility available on-site

Level of Care Overview 3B Professionally directed Individuals in acute distress Moderate impairment of social, occupational, of school functioning Rehabilitation is goal 3C Professionally directed Individuals in chronic distress Severe impairment of social, occupational, or school functioning Habilitation is the goal

Level of Care Overview 3B (Dimension 3) Must meet one of dimensional specifications e.g. : Emotional/behavioral symptoms sufficiently interfering with recovery Moderate risk of dangerous behavior Self-destructive behaviors related to intoxication Impairment requires 24-hour setting 3C (Dimension 3) Must meet two of dimensional specifications e.g. : Disordered living skills Disordered social adaptiveness Disordered self adaptiveness Disordered psychological status

Continued Stay and Discharge Criteria Continued Stay –A set of criteria used to review and determine clinical necessity of a client’s status in a particular LOC and Type of Service. –Ultimately determines appropriate length of stay until admission criteria are met for another LOC or client is discharged from the continuum. –Once Continued Stay Criteria is no longer met, individual is referred to the next appropriate level of care. –Timeframes for continued stay review found on page 10 in PCPC manual. Discharge Criteria is only appropriate for Outpatient Treatment, Level 1A.

Placement Process STEP ONE ASSESS and apply PCPC admission criteria PLACE in appropriate LOC/TOS FORWARD PCPC summary sheet to provider & authorizing agency/payer STEP TWO REVIEW progress and apply continued stay criteria FORWARD PCPC summary sheet to provider & authorizing agency/payer STEP THREE MAKE REFERRAL to next appropriate LOC/TOS FORWARD PCPC summary sheet to provider & authorizing agency/payer USE strategies to maintain engagement STEP FOUR ASSESS and validate admission PCPC FORWARD PCPC summary sheet to authorizing agency/payer STEP FIVE (Outpatient Only) DISCHARGE from LOC CONNECT with recovery support services FOLLOW-UP

LOUIS Continued Stay Review Case Study

Special Populations/Considerations A vital component of the decision-making process in placement concerns the determination of the need for specialized services. Issues which must be considered prior to placement include (but are not limited to): –Medication-Assisted Treatment –Co-Occurring Substance Use and Mental Health Disorders –Women & Women with Children –Criminal Justice –Culture and Ethnicity –Sexual Orientation and Gender Identity –Co-Occurring Substance Use and Gambling Disorder

Special Populations/Considerations Medication-Assisted Treatment –MAT is the use of medication, in combination with counseling and behavioral therapies, to provide an integrated, person-centered approach to the treatment of SUD. –Ensure coordination of care and medication reconciliation to prevent medical errors and duplication of services. Co-Occurring Substance Use and Mental health Disorders –Where possible, treatment should be integrated or coordinated between SUD and MH providers. –Since each illness affects the course and severity of the other, both disorders are considered primary. –The Four-Quadrant Model provides a basis for placing individuals based on their specific needs.

Four-Quadrant Model (Ries, 1993) More severe SUD Less severe MH Type: Co-Occurring Capable More severe SUD More severe MH Type: Co-Occurring Integrated Less severe SUD Less severe MH Type: Co-Occurring Capable Less severe SUD More severe MH Type: Co-Occurring Capable Low severity High severity

Special Populations/Considerations Women & Women With Children –Medical, psychiatric, trauma and violence, childcare, and legal considerations must be understood to assure access and continued treatment. Criminal Justice –Since offenders are expected to be abstinent from the use of substances while incarcerated, the evaluation should examine substance use patterns in the 6 months prior to incarceration for the purpose of assessment. –Criminality and addiction often coexist, but each can be distinct and function independently of the other. –Treatment behind the walls followed by a community- based continuum of care leads to the best outcomes.

Special Populations/Considerations Cultural & Ethnic Considerations –The strengths of a culture can be used to reinforce prevention and treatment programs. –Certain behaviors have different meanings depending on the cultural context; failure to recognize the appropriate cultural context could result in misinformation or incorrect placement. Sexual Orientation –Not all individuals may feel safe revealing their non- heterosexual identity. –Some individuals, especially those who have experienced negative consequences related to their sexual orientation, might have better results in a program with targeted services.

Special Populations/Considerations Co-Occurring Substance Use and Gambling Disorder –Assessing for a co-occurring gambling disorder should be part of the process for every individual. –Because each individual’s case is extremely variable, treatment needs to be person-centered and highly individualized. –Where possible, treatment should be integrated or coordinated between SUD and gambling providers. –Many individuals are in denial of their gambling disorder, instead identifying it as “money problem”.

Special Considerations and Do/Don’t Matrix General –Detailed guidelines for how to and how not to address common placement considerations. –These do’s and don’ts are integrated in each level of care. Examples –Individual Declines Assessed LOC –Role of Funding Availability –Individuals in Controlled Environment –Knowledge of Resources –Co-Occurring SUD and MH Disorder Individuals

TONIA Admission Case Study

TONIA Continued Stay Review Case Study

PCPC Training Principles These principles represent guidelines for the PCPC training, for becoming trained and for having knowledge about the PCPC. This document outlines training principles for trainees who will administer the PCPC as well as for those who will not administer the PCPC but wish to understand the instrument. These principles ensure PCPC fidelity.

Pennsylvania Client Placement Criteria, Third Edition PA Department of Drug and Alcohol Programs Rev. 11/15.

Similar presentations

Presentation on theme: "Pennsylvania Client Placement Criteria, Third Edition PA Department of Drug and Alcohol Programs Rev. 11/15."— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Pennsylvania Client Placement Criteria, Third Edition PA Department of Drug and Alcohol Programs Rev. 11/15.

Similar presentations

Presentation on theme: "Pennsylvania Client Placement Criteria, Third Edition PA Department of Drug and Alcohol Programs Rev. 11/15."— Presentation transcript:

Similar presentations

About project

Feedback