Treatment Planning, Collaboration, and Referral
This domain tests individualized treatment planning, the ASAM Criteria, collaboration, and referral. Expect questions on matching level of care to need and on the stricter confidentiality rules for substance use disorder records.
Treatment planning
- Base the plan on the assessment; the client participates; goals are broad, objectives are measurable and time-bound; review and update.
- ASAM six dimensions: intoxication/withdrawal potential; biomedical conditions; emotional/behavioral/cognitive conditions; readiness to change; relapse/continued use potential; recovery/living environment.
- Levels: 0.5 early intervention; 1 outpatient; 2.1 intensive outpatient; 2.5 partial hospitalization; 3.1 clinically managed low-intensity residential; 3.5 clinically managed high-intensity residential; 3.7 medically monitored intensive inpatient; 4 medically managed intensive inpatient.
- Place at the least restrictive level that safely meets needs across all six dimensions.
Collaboration and referral
- Obtain written consent before sharing SUD records. 42 CFR Part 2 applies to federally assisted SUD programs, requires specific consent elements, and restricts redisclosure.
- Match referral to assessed need, make a warm handoff, confirm the appointment, and follow up.
Worked example
A client has alcohol use disorder, a CIWA-Ar score of 10, uncontrolled hypertension, and no housing, and wants help. Reasoning: dimension 1 (moderate withdrawal risk), dimension 2 (medical instability), and dimension 6 (homelessness) support a medically monitored residential level, 3.7, rather than routine outpatient. Arrange medical evaluation, then step down as dimensions improve. Document the ASAM rationale and obtain consent before sharing information with the housing provider.
Traps
- Writing goals for the client without participation.
- Choosing a level by diagnosis or preference alone.
- Sharing SUD information on a general HIPAA authorization.
- Referring and assuming the client connected.