# Presentation: 377698

## Module 2: Settings, Levels of Care, and Patient Placements

## Module 2 Objectives

- Define the types of settings for detox and treatment services
- Describe the role of the settings in the delivery of services
- Identify at least five issues to consider in determining whether inpatient or outpatient detox is the preferred setting

## Five Settings for Detoxification Services

- Physician’s office
- Freestanding urgent care center or emergency department
- Freestanding substance abuse treatment or mental health facility
- Intensive outpatient and partial hospitalization programs
- Acute care inpatient services

## Six ASAM Assessment Criteria for Patient Placement

- Acute intoxication and/or withdrawal potential
- Biomedical conditions and complications
- Emotional, behavioral, or cognitive conditions and complications
- Readiness to change
- Relapse, continued use, or continued problem potential
- Recovery/living environment

## Setting #1: Physician’s Office

- Ambulatory Detox *Without *Extended Onsite Monitoring
- Services provided by trained clinicians
- Services include medically supervised evaluation, detox, and referrals
- Patients are regularly monitored
- Patients must have a positive social support network
- Services delivered in an office, treatment facility, or the patient’s home

## Setting #1: Physician’s Office

- Ambulatory Detox *With *Extended Onsite Monitoring
- Services provided by RNs or LPNs
- Services include medically supervised evaluation, detox, and referrals
- Patients are monitored for several hours each day
- Patients must have a positive social support network
- Services are provided in a treatment setting such as a day hospital

## Setting #2: Freestanding Urgent Care Center or Emergency Department

- Care is for patients who require primary medical and/or nursing care services
- Services include physician-managed procedures and protocols
- Medically directed assessments and acute care include the initiation of detox and withdrawal
- Care does not likely include biomedical stabilization or 24-hour observation
- Triage to inpatient care can be facilitated
- Staffing is typically physicians and credentialed nurses

## Setting #3: Freestanding Substance Abuse Treatment or Mental Health Facility

- Inpatient:
- Medically managed intensive patient detoxification
- 24-hour supervision, observation, and support for intoxicated or withdrawing patients
- Stabilization and the facilitation of linkages to other services
- Staffing includes an interdisciplinary team of physicians, RNs, LPNs, counselors, social workers, and psychologists

## Setting #3: Freestanding Substance Abuse Treatment or Mental Health Facility

- Residential:
- Some provide medically managed detoxification/others use social detox model
- 24-hour supervision observation and support
- Emphasize peer and social support
- Staffing: credentialed personnel implementing physician-approved protocols for observation, monitoring, and supervision
- Medical evaluation and consultation available 24/7
- Some provide supervision of self-administered medication

## Setting #4: Intensive Outpatient and Partial Hospitalization Programs

- Regularly scheduled detox sessions
- Follows established protocols
- Onsite patient monitoring
- Linkages to treatment services
- Staffing includes interdisciplinary team of physicians, RNs, LPNs, counselors, social workers, and psychologists

## Setting #5: Acute Care Inpatient Settings

- Medically monitored inpatient detox
- 24-hour medically supervised eval and monitoring
- Follows established protocols
- Staffing includes interdisciplinary team of physicians, RNs, LPNs, counselors, social workers, and psychologists
- Counselors available 8 hours a day for planned interventions