Title: Using the Addiction Severity Index to Individualize Treatment and Track Outcomes in OST
1Using the Addiction Severity Index to
Individualize Treatment and Track Outcomes in OST
- Ron Jackson, M.S.W.
- Evergreen Treatment Services
- Seattle, WA
2Screening and Assessment
- Assessment initiates and guides the continuum of
care. - Assessment must occur throughout the treatment
process. - Assessment must be done with client involvement.
- Ongoing assessment is necessary, as an on-going
evaluation of treatment.
3Old Open-Ended Assessment Tools
- Drug History
- _________________________________________________
- _________________________________________________
- _________________________________________________
- _________________________________________________
- _________________________________________________
- _________________________________________________
- Medical History
- _________________________________________________
- _________________________________________________
- _________________________________________________
- _________________________________________________
- _________________________________________________
4New Improved Open-Ended Assessment Tools
- Drug History
- (drugs used, age of first use, amount frequency
) - _________________________________________________
- _________________________________________________
- _________________________________________________
- _________________________________________________
- _________________________________________________
- Medical History
- (List medical problems and hospitalizations)
- _________________________________________________
- _________________________________________________
- _________________________________________________
- _________________________________________________
- _________________________________________________
5Standardized Tools
- Facilitate the collection of accurate information
in a reliable and consistent manner. - Provide clinicians and treatment agencies with
increased accountability. - Identify change and or lack of it, in order for
clinicians to better match clients to treatment.
6 Screening / Assessment / Diagnosis
- Screening tools - establish the presence or
absence or the severity of a problem and indicate
the need for more comprehensive evaluation - CAGE / T-ACE
- MAST / DAST
- AUDIT
- Assessment / Placement Tools - initiate treatment
planning and guide the continuum of care - ASI
- ASAM PPCII
- GAIN
- Diagnostic Tools establish the presence of a
DSM-IV SUD diagnosis - SCID
- DIS
- CIDI-SAM
7Addiction Severity Index
- Standardized, semi structured multi-focused
screening and assessment tool - Designed for use primarily with adult substance
abuse clients /patients - Used to collect information regarding the nature
and severity of problems substance abusers often
have - Clinical, Program Evaluation and Research
Applicability
8Seven Potential Problem Areas
- Medical
- Employment
- Alcohol
- Drug
- Legal
- Family/Social
- Psychiatric
9What is Your Purpose Goal(s)
?
10Elements to Consider in Instrument Selection
- Clinical Utility
- Screening
- Assessment
- Diagnosis
- Patient Placement
- Treatment Planning
- Program Evaluation
- Measuring Outcomes
- Managing Resources
- Reports to Funding Sources
- Research
- Treatment Effectiveness
11Clinical Applications
- Guides initial assessment and admission
- Design intake summaries can be automated
- Make patient placement decisions using the
- ASAM PPCII (with additional questions and probes
added) - Develop individualized treatment plans based on
patients unmet need for services in a variety of
life domains - Make referrals
12Program Evaluation
- Identifies types of patients problems
presenting for treatment - Quantifies level of problems
- Measures patients response to treatment
- Identifies agencies/workers strengths and areas
for improvement with particular populations and
problems - Enables management by outcome
- Reports to funding sources
13Benefits of Using the ASI
- Reliable and valid assessment instrument
- Assists in identifying dually diagnosed clients
- Can be re-administered at different points in
treatment - Helps identify inconsistencies in client
responses - Widely used, can compare your program results
with others - Public domain tool
14Why use the ASI?
- NIDA Principle 3
- To be effective, treatment must address
individuals drug use and any associated medical,
psychological, social, vocational, and legal
problems. - ASI assesses all these dimensions
15Clinical use of ASI improves rapport
. . . If patients problems are accurately
assessed, they may feel heard by their
counselor potentially leading to the development
of rapport and even a stronger helping alliance.
Barber et al., 1999, 2001 Luborsky et al., 1986,
1996
16Using ASI to match services to patient problems
improves retention
. . . Patients whose problems are identified at
admission and then receive services that are
matched to those problems, stay in treatment
longer.
Carise et al., 2004 Hser et al., 1999 Kosten et
al., 1987 McLellan et al., 1999
17Implementation Considerations
- Staff buy-in and training
- Intake staff
- Counseling staff
- Medium paper or computer
- Supervision
- Fidelity to coding conventions
- Utilization in treatment planning
- Follow-up interviews? by whom how often
18Summary Data Analysis With the ASI
- Change in your client sample over time
- Gender comparisons
- Racial/ethnic group comparisons
- Legal status comparisons
- Primary problem substance comparisons
- Treatment history comparisons
- Psychiatric history comparisons
19Examples of Data Analysis Reports
Basic Demographic Information
20Examples of Data Analysis Reports
Change in Abstinence Rates Over Time
21Examples of Data Analysis Reports
22Mobile vs. Fixed Site OutcomesBaseline to 12
monthsDrug Use
23Mobile vs. Fixed Site OutcomesBaseline to 12
monthsSocial Functioning
24Agency Use of Information
- Internal Improvement
- Staff Kudos (evidence of job well done)
- Selecting clinical areas for improvement
- Selecting modalities for improvement
- Advocate results in community
- Use for fund-raising quests
- Use with Board of Directors
25S.M.A.R.T. Treatment Planning Utilizing the
ASIMaking Required Data Collection Useful
26What is included in any treatment plan?
271. Problem Statements
2. Goal Statements
3. Objectives
4. Interventions
281. Problem Statements are based on information
gathered during the assessment
2. Goal Statements are based on the problem
statements and reasonably achievable in the
active treatment phase
29- Van is experiencing increased tolerance for
alcohol as evidenced by the need for more alcohol
to become intoxicated or achieve the desired
effect.
- Meghan is currently pregnant and requires
assistance obtaining prenatal care.
- Toms psychiatric problems compromise his
concentration on recovery.
30- Van will safely withdraw from alcohol, stabilize
physically, and begin to establish a recovery
program.
- Meghan will obtain necessary prenatal care.
- Reduce the impact of Toms psychiatric problems
on his recovery and relapse potential.
313. Objectives are what the client will do to meet
those goals
4. Interventions are what the staff will do to
assist the client
- Other common terms
- Action Steps
- Measurable activities
- Treatment strategies
- Benchmarks
- Tasks
32- Van will report acute withdrawal symptoms.
- Van will begin activities that involve a
substance-free lifestyle and support his recovery
goals.
- Meghan will visit an OB/GYN physician or nurse
for prenatal care.
- Tom will list 3 times when psychological symptoms
increased the likelihood of relapse.
33- Staff medical personnel will evaluate Vans need
for medical monitoring or medications.
- Staff will call a medical service provider or
clinic with Meghan to make an appointment for
necessary medical services.
- Staff will review Toms list of 3 times when
symptoms increased the likelihood of relapse and
discuss effective ways of dealing with those
feelings.
341. Problem Statements (information from
assessment)
2. Goal Statements (based on Problem Statement)
3. Objectives (what the client will do)
4. Interventions (what the staff will do)
355. Client Strengths are reflected.
6. Participants in Planning are documented.
36ASI Resources
- www.tresearch.org Treatment Research Institute
- http//adai.washington.edu/sounddatasource
Sound Data Source at Univ. of Washington - www.inflexxion.com/inf/info/faq_asimv.html
ASI-MV