Based on TIP 13

The Role and Current 

Status of Patient Placement

Criteria in the

Treatment of

Substance Use

Disorders

KAP Keys

For Clinicians

CSAT’s

Knowledge Application Program

KAP KEYS Based on TIP 13

The Role and Current Status of Patient

Placement Criteria in the Treatment of

Substance Use Disorders

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov
KAP KEYS Based on TIP 13

The Role and Current Status of Patient Placement Criteria in

the Treatment of Substance Use Disorders

These KAP Keys were developed to accompany the Treatment

Improvement Protocol (TIP) Series published by the Center for

Substance Abuse Treatment (CSAT), Substance Abuse and

Mental Health Services Administration. These KAP Keys are

based entirely on TIP 13 and are designed to meet the needs

of the busy clinician for concise, easily accessed "how-to" information.

For more information on the topics in these KAP Keys, readers

are referred to TIP 13.

Introduction

TIP 8, Intensive Outpatient Treatment for Alcohol and Other

Drug Abuse (1994) BKD139

TIP 11, Simple Screening Instruments for Outreach for Alcohol

and Other Drug Abuse and Infectious Diseases (1994)

BKD143

TIP 14, Developing State Outcomes Monitoring Systems for

Alcohol and Other Drug Abuse Treatment (1995) BKD162

TIP 20, Matching Treatment to Patient Needs in Opioid

Substitution Therapy (1995) BKD168

TIP 27, Comprehensive Case Management for Substance

Abuse Treatment (1998) BKD251

Other Treatment Improvement Protocols (TIPs)

that are relevant to these KAP Keys:
KAP KEYS Based on TIP 13

The Role and Current Status of Patient Placement Criteria in

the Treatment of Substance Use Disorders

Selected Terms 1

Biopsychosocial: A holistic approach to assessment and treatment that takes into account a person's medical (biological),

psychological, and social needs. This approach reflects the

understanding that addiction affects the whole person and is

influenced by a wide range of factors.

Bundling: An approach to treatment that ties or "bundles" several treatment services together, often delivering them in a

specific treatment setting. Because this approach often overlooks a patient's individual needs and can lead to inappropriate and unnecessary service provision, the current trend is

toward unbundling services, a more flexible approach.

Continuum of care: A structure of interlinked treatment modalities and services that is designed so that individuals' changing

needs will be met as they move through the treatment and

recovery process.

Dual diagnosis: A diagnosis that includes a concurrent substance use disorder(s) and a psychiatric disorder(s). 

Eligibility criteria: Factors which determine whether a patient

may receive treatment. These include: financial status, insurance coverage, age, severity of illness, geographic location,

and whether a patient is a member of a special population.

Intensity of service: The degree or extent to which a treatment

or service is provided, which depends on a patient's level of

need. Some treatments, for example, medically managed inpatient treatment, are inherently more intensive than other treatments, for example, outpatient treatment or a halfway house.

The provision of other services, such as vocational training,

can be more or less intense, depending on patient needs. (See

level of care.)

Level of care: As used in the ASAM criteria, this term refers to

four broad areas of treatment placement, ranging from inpatient to outpatient. Other levels of care within this range, such

as therapeutic communities, have been described in other criteria.

Matching: A process of individualizing treatment resources to

a patient's needs and preferences based on careful assessment. Matching has been shown to increase treatment retention, and thus improve treatment outcomes. It also improves

resource allocation by ensuring that patients receive the appropriate level of care and intensity of services. (See continuum of

care, unbundling.) 

Continued on back
KAP KEYS Based on TIP 13

The Role and Current Status of Patient Placement Criteria in

the Treatment of Substance Use Disorders

Patient placement criteria (PPC): Standards of, or guidelines

for, substance abuse treatment that describe specific conditions under which patients should be admitted to a particular

level of care (admission criteria), under which they should continue to remain in that level of care (continued stay criteria),

and under which they should be discharged or transferred to

another level (discharge/transfer criteria). PPC generally

describe the settings, staff, and services appropriate to each

level of care and establish guidelines based on substance

abuse diagnosis and other specific areas of patient assessment.

Placement: Selection of an appropriate level of care, based on

assessment of individual needs and preferences. 

Setting: A specific place in which treatment is delivered.

Settings for substance abuse treatment include hospitals,

methadone clinics, community mental health centers, and prisons or jails.

Unbundling: An approach to treatment that seeks to provide

the appropriate combination of specific services to match a

patient's needs. The goal of unbundling is to provide an array

of options for flexible individualized treatment, which can be

delivered in a variety of settings. 

Uniform Patient Placement Criteria (UPPC): A set of patient

placement criteria, not yet developed, that would provide

national standards for assessing and treating patients with

substance abuse disorders and that would be used by all

providers in the public sector and private sector.
KAP KEYS Based on TIP 13

The Role and Current Status of Patient Placement Criteria in

the Treatment of Substance Use Disorders

Why Use Placement Criteria? 2

• Promotion of quality, individualized care

• Improved quality of assessment

• More multidimensional treatment plan 

• Cost effective treatment

• Eventual economic benefits for providers

• Establishment of a common language

• Treatment outcomes more readily evaluated

• Identification of gaps in the continuum of care

• Identification of the elements to effective programs

• Opportunity for focused research studies on treatment and

cost effectiveness

• Establishment of generally accepted practice in the substance abuse treatment field, may prevent litigation
KAP KEYS Based on TIP 13

The Role and Current Status of Patient Placement Criteria in

the Treatment of Substance Use Disorders

Variables Considered in

Assessing and Placing a Client

3

Assessment Variables

Patient Preference

Diagnosis

Prior Treatment

Course of Illness

Response

Mental Status

Family History

Matching Variables

Psychological Conditions

Biomedical Conditions

Intoxication/Withdrawal

Treatment Readiness

Relapse Potential

Environmental Status

T

N

E

M

E

C

A

L

P

Modifying Variables

Age

Gender

Sexual Orientation

Service Availability/Access

Culture/Language/Ethnicity

Childcare/Eldercare

Patient Preference

• Assessment variables are general characteristics that form

the first level of data for input to decision rules.

• Matching variables are the specific data elements that are

level of care.then required for multidimensional matching to a discrete

• Modifying variables may be used to modify the level of care

the patient or treatment systemdetermination based on intervening factors that exist within
KAP KEYS Based on TIP 13

The Role and Current Status of Patient Placement Criteria in

the Treatment of Substance Use Disorders

What Issues Must Be Addressed 

By the UPPC of the Future?

4

An important area that must be considered in the creation of

uniform patient placement criteria (UPPC) is the need to keep

the criteria flexible and amendable. There are dangers in structuring treatment of any kind according to a defined set of criteria. Treatment must remain flexible to meet patients' individual

needs and incorporate evolving modalities of care. Clinicians

must remain able to exercise judgment in all cases. In addition, if a single approach to care is widely adopted and strictly

adhered to as the "correct" approach, treatment innovation

may be stifled. The chief value of any criteria set is the added

power it gives providers to identify specific patient needs by

means of a consistent and detailed assessment process, and

to choose a level of care that will specifically address those

needs.

To focus on the criteria themselves and forget their goal—placing patients in appropriate levels of care—is to value the rules

above the process and to make a rigid approach to the complex

biopsychosocial problem of substance abuse and dependence.

The principles of the criteria will outlast any single criteria set.

No matter how comprehensive a uniform set of criteria is,

individual providers will modify criteria to fit the needs of the

specific patients and populations they serve.

Future criteria must be flexible and amendable.

Clinicians must remain able to exercise judgment 

in all cases.
KAP KEYS Based on TIP 13

The Role and Current Status of Patient Placement Criteria in

the Treatment of Substance Use Disorders

Why Develop Various Treatment

Models?

Within the U.S., there has been just one major approach to

treatment, based on the Alcoholics Anonymous 12-Step philosophy and the fixed length of inpatient stay pioneered in

Minnesota. This treatment approach, with its inpatient treatment philosophy, has been more commonly used for treating

substance abuse than any other approach. This is the treatment model that has been used—in a "one size fits all"

approach—for all patients who meet the criteria for treatment. 

Today, in the treatment field, there is a movement toward using

a variety of treatment models to ensure access to quality treatment and conserve health care resources. Now clinicians must

focus on matching patients to appropriate, specific treatment,

rather than on placing patients in established programs. The

success of clinically driven treatment depends on the importance of an accurate diagnosis. However, it is not only a diagnosis of addiction, but also of the severity of addiction, that

must determine the kind of treatment an individual patient

should receive. This determination can result in: placement of

patients in the correct level of care, movement to less intensive or more intensive levels when appropriate, and matching

patients individually to a variety of treatment modalities at all

levels of care.

Implicit in this scenario is the existence of many types of treatment programs, such as narcotic addiction treatment, and outpatient and residential settings within a community. Also

implicit is the growth of a variety of treatment approaches creatively developed to address underserved populations and less

than adequate outcomes.

5
Easy Ways to Obtain Free Copies 

of All TIP Products

1. Call SAMHSA's National Clearinghouse for Alcohol and

Drug Information (NCADI) at 800-729-6686, 

TDD (hearing impaired) 800-487-4889.

2. Visit CSAT's Web site at www.csat.samhsa.gov

Do not reproduce or distribute this publication for a fee without specific, written authorization from the Office of

Communications, Substance Abuse and Mental Health

Services Administration, U.S. Department of Health and

Human Services.

Ordering Information

TIP 13

The Role and Current Status of Patient

Placement Criteria in the Treatment of

Substance Use Disorders

DHHS Publication No. (SMA) 01-3565

Printed 2001