How Individualized Treatment Placement Helps Families Choose The Right Level Of Care

When you or a loved one is struggling with a substance abuse or mental health challenge, one of the most difficult decisions to make is the appropriate level of care. The options can be overwhelming as each option comes with different structures, expectations, and outcomes.

Without clinical appropriateness, families often rely on guesswork or availability. Unfortunately, placing someone in the wrong level of care can lead to relapse, repeated treatment attempts, and ultimate frustration.

Individualized treatment placement is essential. It involves matching each individual to the appropriate level of care at the appropriate time, based on a clinical and personal assessment.

What Is Individualized Treatment Placement?

Individualized treatment placement is a structured but clinically guided process. This process is used to determine the most appropriate level of care, based on the individual’s unique needs.

Unlike a one-size-fits-all approach, an individualized treatment placement model will take into account:

• The individual’s substance use history
• Mental health co-existing conditions
• The individual’s current physical health
• Family dynamics and support systems
• The individual’s motivation and readiness to change
• Environmental risks that may impede recovery

The goal of individualized treatment placement is to be supportive, have the individuals buy in, without being too restrictive.

Why Does Choosing The Right Level Of Care Make A Difference?

Choosing the right level of care is the first and most important step to the individual’s sustained recovery. Individualized placement will ensure that the individual receives treatment with the right level of structure, clinical support, and safety measures.

If the level of care is too low, the individual:

• May not receive the necessary support
• May relapse
• May be susceptible to triggers and risks that are unmanaged

If the level of care is too high:

• The individual may feel coerced or overwhelmed and not complete the treatment plan
• There could be unnecessary expenses involved
• Transitioning back to daily life and normal routine may be more difficult

How Is The Appropriate Level Of Care Determined?

Determining the appropriate level of care for the client is a complex process. This process begins with a comprehensive assessment, which is not a quick checklist but a detailed evaluation that determines the most appropriate level of care based on the following clinical guidelines.

• The clinical review
• The medical review
• The psychosocial assessment
• A risk evaluation
• Readiness assessment

The Clinical Review

The first step of the assessment is the clinical review. This step involves an interview where a thorough discussion of substance use history, mental health, behaviors, and current concerns is conducted. During this stage, it is also determined whether there are any acute concerns or withdrawal potential that could prove to be life-threatening.

The Medical Review

This is an evaluation of the client’s physical health, current medications, and any coexisting conditions that could potentially impact treatment and recovery.

The Psychosocial Assessment

During this assessment, family dynamics, work and personal relationships, and all environmental factors and triggers are assessed and evaluated. How the individual functions in daily life is also assessed during this stage.

The Risk Evaluation

Safety issues, withdrawal concerns, and the potential for relapse are thoroughly assessed during the risk evaluation.

The American Society of Addiction Medicine (ASAM) provides a framework for assessing individuals. This is invaluable when determining the appropriate level of care. Six Dimensions provide a holistic picture of the individuals’ unique needs and risks. The six dimensions of this assessment include:

1. Acute intoxication and or withdrawal potential – this is where the individual is evaluated to assess whether they are currently intoxicated or at a risk of withdrawal. The severe risk of its withdrawal may alter the initial treatment placement.
2. Biomedical conditions and complications – during this assessment, physical issues like chronic illness, current injuries, or coexisting medical conditions that may affect treatment are assessed.
3. Emotional, behavioral, or cognitive conditions – during this part of the assessment, conditions such as anxiety, depression, previous trauma, or current psychiatric conditions are assessed and evaluated.
4. Readiness to commit to treatment/ change – during this stage, the individual is evaluated to assess the willingness to commit to the treatment. During this stage, it is found that some individuals may be ambivalent or even resistant to treatment.
5. Relapse, continued, or continued problem potential – during this stage, the individual’s history of substance use patterns is evaluated. It is during this vital stage that the likelihood of relapse is assessed.
6. Recovery environment – individuals’ living situation support system and exposure to high-risk situations or triggers are evaluated.

What Are The Available Levels Of Care?

For families to understand how treatment is structured, they need to know the various levels of care that are available. Depending on the outcome of the assessment, the following levels of care, ranging from outpatient to 24-hour residential care, may be recommended: