Title : QGAdminCover tip13 10-22-01gvp.qxd (Page 2)
 Description : 
 Keywords : 
 Author : 

-----------------------------------------------
Quick Guide
For Administrators

Based on TIP 13
The Role and Current Status of
Patient Placement Criteria in
the Treatment of Substance
Use Disorders

-----------------------------------------------
Contents
Why a Quick Guide?  . . . . . . . . . . . . . . . . . . . 2
What is a TIP?  . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction  . . . . . . . . . . . . . . . . . . . . . . . . . 4
The Role of Patient Placement Criteria in a
Managed Care Environment  . . . . . . . . . . . . 7
Building Support of Adopting UPPC  . . . . . . 13
Implementation Strategies  . . . . . . . . . . . . 22
Future Directions  . . . . . . . . . . . . . . . . . . . . 26
Ethical and Legal Issues  . . . . . . . . . . . . . . 28
Glossary  . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

-----------------------------------------------
Quick Guide
For Administrators



This Quick Guide is based almost entirely on information con
tained in TIP 13, published in 1995 and based on information
updated through approximately 1993. No additional research
has been conducted to update this topic since publication of
the original TIP.
Based on TIP 13
The Role and Current Status
of Patient Placement
Criteria in the Treatment of
Substance Use Disorders

-----------------------------------------------

2
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


WHY A QUICK GUIDE?

This Quick Guide was developed to accompany
The Role and Current Status of Patient Placement
Criteria In the Treatment of Substance Use
Disorders, Number 13 in the Treatment
Improvement Protocol (TIP) Series published by
the Center for Substance Abuse Treatment (CSAT),
Substance Abuse and Mental Health Sevices
Administration. This Quick Guide is based entirely
on TIP 13 and is designed to meet the needs of
the busy administrator for concise, easily
accessed "how-to" information.

The Guide is divided into five sections (see
Contents) to help readers quickly locate relevant
material.

Terms related to placement criteria are listed on
page 30 in the Glossary. Some of them are used
in this Quick Guide; others are included to enable
administrators to talk knowledgeably with their
staff and others.

For more information on the topics in this Quick
Guide, readers are referred to TIP 13.

-----------------------------------------------
What Is a TIP? 3

WHAT IS A TIP?

The TIP series has been in production since 1991.
This series provides the substance abuse treat
ment and related fields with consensus-based,
field-reviewed guidelines on topics of substance
abuse treatment.

TIP 13, The Role and Current Status of Patient
Placement Criteria In the Treatment of Substance
Use Disorders

• Addresses the concerns of a broad range of
readers including program administrators, clini
cians, counselors, social workers, medical per
sonnel, mental health workers, and policymak
ers
• Lists numerous resources for further informa
tion
• Provides a reference on the status of patient
placement criteria in the treatment of sub
stance abuse disorders
See the inside back cover for information on how
to order TIPs and other related products.

-----------------------------------------------

4
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


INTRODUCTION

Nearly all substance abuse treatment programs
are influenced by some form of managed care in
its broadest sense. Virtually no payment system—
public or private—is free from eligibility, admission,
or discharge criteria. Lack of a single consistently
applied set of criteria has led to gaps in service in
both public and private systems.

In recent years, the substance abuse treatment
field has begun the process of standardizing
patient placement criteria (PPC). The goal is to
establish uniform patient placement criteria
(UPPC), accepted by all providers in the field, that
can accurately assess the severity of a client's
problems in three areas: medical, psychological,
and social.

Carefully developed UPPC will lead to effective
placement of clients in appropriate levels of care.
Such criteria can also be used as a basis for mak
ing decisions about moving clients through the
continuum of treatment services as treatment
progresses or relapse occurs.

-----------------------------------------------
Introduction 5

Advantages of UPPC
• UPPC can help alleviate the high cost of under-
treatment by ensuring patients get all the treat
ment they need based on continued stay criteria
rather than arbitrary monetary or time limita
tions.
• UPPC can alleviate the high cost of overtreat
ment by ensuring that patients get only the
treatment they need, based on assessed needs
and established criteria.
• Common definitions of levels of care, common
standards of assessment, and common stan
dards for continued stay and discharge can
establish the same framework for public and
private programs.
It is not the purpose of TIP 13 nor this Quick
Guide to write uniform patient placement criteria.
Rather these documents lay the groundwork for
developing UPPC and summarize the implications
it will have on assessment, treatment, outcomes
monitoring, and research.

For more detailed information, see TIP 13, 
pp. 1–4.

-----------------------------------------------

6
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


THE ROLE OF PPC IN A MANAGED
CARE ENVIRONMENT

Recommended Characteristics of Uniform
Criteria
PPC plays an important role in matching place
ment to cost-conscious, effective treatment. Both
payers and providers may accept patient place
ment criteria, assuming those criteria

• Accurately describe their levels of care
• Have validity regarding recommended place
ment level
• Are easy to use in real-time clinical decision-
making 
• Include reliable and objective tools and lan
guage
• Encourage positive treatment outcomes in the
least restrictive environment
Without uniformity, there are no common defini
tions of care, no common language, and no
capacity to effectively perform and compare the
essential research.

There are a variety of treatment models to ensure
quality while conserving health care resources.
Clinicians must focus on matching patients with
appropriate and specific treatment. The success

-----------------------------------------------
The Role of PPC in a Managed Care Environment 7

of clinically driven treatment relies on an accurate
diagnosis that must take into account the severity
of addiction. This can result in

• Placement of patients in the correct level of
care
• Movement to less intensive or more intensive
levels of care when appropriate 
• Matching patients individually to a variety of
treatment models at all case levels
Development of Patient Placement Criteria
The addiction treatment field needs

• Uniform criteria to guide proper patient place
ment
• Guidelines to promote the establishment of
effective individualized treatment modalities
• Data regarding outcomes to continually improve
both the criteria and the guidelines
Assessment Follows Theory
Attitudes about assessment across the country
are important. The many and varied beliefs that
exist must give way to a common standard if the
addiction field is to uniformly offer quality care.
The biopsychosocial definition (one that takes into
account biological, psychological and social per
spectives) of addiction provides a framework for
creating uniform assessment standards.

-----------------------------------------------

8
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


Biopsychosocial Perspective on Addiction 
Understanding addiction as a biopsychosocial ill
ness in its origins, expression, and treatment has
four important results.

1.Promoting the integration of different perspec
tives on the illness
2.Explaining and preserving common clinical
dimensions 
3.Necessitating multidimensional assessment
4.Promoting effective matching of the patient with
individually prescribed treatment
Biopsychosocial Treatment and Matching
• To achieve cost-conscious addiction treatment,
the next step, after a unified model of addiction
and assessment of severity is agreed upon, is to
define the biopsychosocial treatment to match
the patient's clinical severity.
• Biopsychosocial treatment of substance abuse
depends on the availability of a comprehensive
system of levels of care, a range of treatment
modalities within those levels, and a continuum
of care.
• Patient placement criteria are a necessary but
not a sufficient determinant of patient-treat
ment matching.

-----------------------------------------------
The Role of PPC in a Managed Care Environment 9

• Once a patient is placed in an appropriate level
of care, selection of the specific assessment-
based modalities, eventually guided by empiri
cally based practice guidelines, complete the
individualized treatment.
Levels of Care
The State of Minnesota, the Institute of Medicine
and the American Society of Addiction Medicine
(ASAM) have all established levels of care. 

• By Minnesota standards, patients are placed in
a particular level of care, ranging from residen
tial treatment to outpatient treatment, based on
their level of chemical involvement and other
criteria. 
• The Institute of Medicine defines four levels of
care: inpatient, residential, intermediate, and
outpatient.
• The ASAM patient placement criteria describes
four levels of care and describes the intensity of
service: outpatient treatment, intensive outpa
tient treatment/partial hospitalization, medically
monitored intensive inpatient treatment, and
medically managed intensive inpatient treat
ment.

-----------------------------------------------

10
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


Modalities of Treatment
• Biomedical modalities focus on improved detoxi
fication regimens and treating substance abuse
with medications.
• Psychological treatment modalities range from
addiction counseling to psychodynamic and cog
nitive–behavioral treatment modalities.
• Sociocultural treatment modalities include the
community reinforcement approach, family ther
apy, therapeutic communities, vocational reha
bilitation and various other techniques.
Implications
The "retooling" of the addiction treatment system
necessary to promote individualized treatment
requires a shift that has broad implications. If the
shift occurs successfully

• The substance abuse treatment field will devel
op one uniform set of clinically-based place
ment criteria.
• Public- and private-sector programs will develop
a single system of comprehensive care that can
be matched with the placement criteria.
• Programs will expand their continuums of care
to provide multiple levels of care with flexible
lengths of stay.

-----------------------------------------------
The Role of PPC in a Managed Care Environment 11

• Payers will reimburse and fund all levels of care
to allow patients to be placed in and move
among the most efficient and effective settings.
• Clinicians will become more skilled at compre
hensive assessment and have a broader knowl
edge of placement criteria and treatment
modalities.
• Patients will receive care that is not only more
cost efficient but more cost effective.
• As patients receive treatment in the least inten
sive yet safe setting, they can test recovery
skills in situations as close to "real world" condi
tions as possible and minimize reentry prob
lems.
Characteristics of a Comprehensive Set of
Patient Placement Criteria
Client Characteristics
• Age, gender, ethnic, and cultural background
• Severity and course of illness, experiences with
previous treatment
• Relapse potential 
• Need for medical or addiction treatment or
pharmacological, psychiatric, familial, and social
employment
• Need for legal services

-----------------------------------------------

12
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


• Attitude toward entering and continuing treat
ment
• Effects of environmental and social influences,
such as living situation, family support, and sus
ceptibility to abuse or neglect
Service Characteristics
• Intensity of services
• Intensity of environmental support
• Availability of medical services
• Variety of professional disciplines involved
• Availability of services specific to cultural back
ground, age, sex, or disabilities
• Program elements
• Discharge planning
• Patient-to-staff ratio
For more detailed information, see TIP 13, 
pp. 5–9.

-----------------------------------------------
Building Support for Adopting UPPC 13

BUILDING SUPPORT FOR ADOPTING
UPPC

Benefits of Adopting UPPC
• Effectively implemented, UPPC can provide a
common framework for matching patients to the
levels of care that best address their needs. 
• Once established within a continuum of treat
ment options, uniform placement standards can
help balance the sometimes competing needs
for quality and cost effectiveness.
• An additional result will be a more empirically
sound database to use in researching and eval
uating treatment content, system gaps, treat
ment needs of special populations, and geo
graphic distribution of services.
Improving Assessments
• Can be used to take into account the various
dimensions of patient care and to look at the
whole person
• Can become a positive force that assists
providers in looking at the broad range of treat
ment options
• Will guarantee that assessment addresses the
components necessary for successful treatment

-----------------------------------------------

14
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


• Will require physicians to focus on observable
measures of the severity of illness
• Will provide for the development of more pre
cise screening and assessment instruments
Improving Treatment Planning
• Because of a thorough assessment that identi
fies the patient's strengths and needs, the clini
cian will be able to make better decisions about
the level and models of treatment.
• Continued stay criteria will address why the
patient is staying in treatment and what out
comes are expected.
• Patients can be more effective partners in their
own treatment when the problems being
addressed and the desired outcomes are clearly
articulated.
Economic Benefits
Some managed care systems are finding that
patients are placed into a particular level of care
for treatment services simply because it is avail
able. For instance, some rural communities with
scarcity of social services find themselves paying
for higher cost residential substance abuse treat
ment services than are clinically necessary
because they are the only ones present in their
area. This is neither cost effective nor beneficial
to the patient. When implemented, UPPC can

-----------------------------------------------
Building Support for Adopting UPPC 15

• Clarify when communities are making inappro
priate clinical decisions
• Point to the need for more economic choices in
resource allocation
• Promote more efficient contracting for services
independent of the availability of treatment
slots
• Alter less effective treatment paths that can
result from established referral relationships or
other nonclinically based referrals
• Provide research opportunities that could fur
nish a firm scientific basis for treatment choices
Economic Benefits for Providers
• Financial payoffs for implementing UPPC are
more likely to occur over time as the continuum
of care becomes more cost effective and
patient care and outcomes improve.
• Uniform criteria will allow treatment providers to
focus on a single set of criteria that is clinically
relevant. Staff time and paper work related to
admission, continued stay, and payment
arrangements will decrease in proportion to the
number of funders.
• UPPC will help prepare public providers who
receive their funding from the State to receive
third-party reimbursements and become more
competitive with private programs.

-----------------------------------------------

16
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


• The most clear-cut economic necessity for pro
grams to adopt UPPC occurs in States where
licensing regulations include such requirements.
Treatment providers are not reimbursed for
treatment public-sector clients if those clients
were not assessed and placed according to the
State's PPC.
Establishing a Common Language
Uniform criteria can bring stability and consistency
to the substance abuse treatment field, allowing
diverse disciplines and organizations to work
together. Once implemented, they can provide a
common agenda, a common language, and
shared expectations about treatment across dif
ferent service providers, payers, policy makers
and others. In addition to standardizing terminolo
gy, UPPC can provide a common basis for under
standing the immediate and long-range needs of
patients in treatment. They constitute a frame
work for a variety of groups to use as they engage
in a collaborative planning process, especially
when more than one system is involved (such as
the criminal justice system or human services).

Special Considerations
• Not all areas will have the array of levels of care
described in the criteria. In some cases, criteria
can be adapted to fit the available resources.

-----------------------------------------------
Building Support for Adopting UPPC 17

• No set of criteria is likely to address the needs
of every client. The implementation of criteria
must allow for flexibility on the part of clinicians
to deviate from the levels of care to address the
needs of the individual client.
• Care must be taken to ensure creativity in pro
gram development is not stifled by PPC. The
substance abuse treatment field is continually
seeking ways to improve programs, and criteria
should not force providers to fit molds or adhere
to rigid descriptions of programs.
UPPC as an Element in Outcome Evaluation
UPPC, when implemented in conjunction with an
outcomes monitoring system, provide several
avenues for the improvement of treatment, as
they

• Allow for valid comparisons between programs
because common language is used to describe
each level of care
• Provide feedback on where the UPPC are being
uniformly applied
• Provide feedback on criteria validity based on
the outcomes of clients with certain characteris
tics who are placed in a specified level of care

-----------------------------------------------

18


ATTENTION: In rural and other areas where there
are limited treatment options, use of UPPC can
document the number of clients who would be
referred to a specific option if it were available,
Such documentation, used in conjunction with
information from the Federal minimum date
requirements and waiting lists can stimulate real
location and development of resources.



Other Benefits
• The establishment of UPPC will result in better
communication between managed care organi
zations and treatment providers, as both enti
ties will be using the same criteria for place
ment, continued stay, and discharge decisions.
• UPPC can bring a greater degree of consistency
and stability to the patient placement process.
• UPPC can be viewed by courts as reflecting gen
erally accepted medical practice, especially as
the criteria become wide spread.
Things to Keep in Mind
• The implementation of criteria must allow for
flexibility on the part of clinicians to deviate
from the levels of care to address the needs of
individual clients.
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

-----------------------------------------------
Building Support for Adopting UPPC 19
ATTENTION: It is frequently the cost-effectiveness
argument that most persuasively convinces stake-
holders of the value of UPPC, while improved
patient care is viewed almost as a byproduct. For
this reason, it is important to establish universal
standards of care that serve to balance quality
and cost-effectiveness.
• A rigid bureaucratic use of UPPC could result in
placement that could discount the treatment
provider's knowledge of the client.
• The criteria must be revised regularly to incorpo
rate new findings or they will become outdated.



Concerned Stakeholders
• State substance abuse treatment agencies and
policymakers
• Consumers and their families
• Managed care companies and other public and
private funders
• Other health care providers, mental health pro
fessionals, benefits administrators and consult
ants, criminal and juvenile justice personnel,
social service providers, and community advo
cates
• Professional societies
• State legislators

-----------------------------------------------

20
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


• Employers
• Labor leaders and union representatives
• Utilization reviewers
• Medical ethicists
• Individuals and groups who conduct research
• Leaders representing minority groups
• The general public
Support from the Substance Abuse
Treatment Field
• Not all providers will react the same way to a
proposal to implement uniform criteria. Those
providers who have initiated the use of patient
placement criteria in their programs will be valu
able resources. However, other providers have
not yet considered the use of PPC and have not
had the opportunity to examine the possible
benefits of systemwide implementation.
• The most compelling reason for providers to
support UPPC will be providers' enhanced ability
to consistently provide thorough assessments,
make appropriate placement determinations,
and monitor clients' progress through the
course of treatment.
• It is important that personnel in public pro
grams appreciate that UPPC may eventually
reduce the time required for proper placement

-----------------------------------------------
Building Support for Adopting UPPC 21

decisions by providing an easily accessible
framework for moving patients into and through
a continuum of substance abuse treatment.
• Treatment providers and other professionals
who fear that reallocation of resources will
result in decreased funding for their own pro
grams may see the redistribution of funds due
to UPPC as a drawback rather than a benefit.
For more detailed information, see TIP 13, 
pp. 23–30.

-----------------------------------------------

22
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


IMPLEMENTATION STRATEGIES

Linking PPC to Licensing Regulation
Licensure requirements can be established by
statute or rule and can include a requirement that
a program adopt UPPC in order to obtain or retain
a license. Some States have already implemented
these sorts of regulations.

Linking PPC to Funding
One of the strongest arguments in favor of UPPC
is the reality that every funding source a sub
stance abuse treatment facility has to deal with
may have different and/or conflicting criteria for
eligibility, admission, and continued stay.
Massachusetts linked placement criteria to the
procurement process, so that vendors agreed to
participate in the development of PPC in their
agencies as a condition for funding. Another
method is to require programs to have PPC in
place in order to obtain Medicaid approval.



ATTENTION: It is recommended that States devel
op a central directory identifying resources, levels
of care, program availability, and detailed informa
tion about the programs, including specialized
services and outcome data.

-----------------------------------------------
Implementation Strategies 23

Wraparound Services
A central resource directory can lead to referrals
to wraparound services which are often tied to
programs. Wraparound services are an important
adjunct to substance abuse treatment and can be
key to successful treatment, though they are not
usually considered treatment services in a clinical
sense. The value of these services lends support
to the concept that "medical necessity" is a broad
multidimensional concept that goes beyond the
narrow focus of physical and psychiatric severity.

Points about wraparound services
• Wraparounds assist patients in learning to deal
with real-life problems during treatment.
• Wraparound services can be divided into two
categories: those whose absence prohibits
access to treatment (childcare and transporta
tion) and those that are important to positive
treatment outcomes (primary health care, legal
aid, mental health services, etc.).
• A barrier to obtaining needed wraparound serv
ices can arise if receiving a certain type of treat
ment makes a patient ineligible for needed
services.
• Since placement decisions may affect eligibility
for wraparounds, the personnel making these

-----------------------------------------------

24
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


decisions should identify ways to maximize sup
port from other community agencies.
The relationship between eligibility criteria
and patient placement criteria
• Eligibility criteria establish whether patients can
get into the systems of care that are governed
by UPPC.
• The Federal Government requires States to set
aside a portion of their Federal funds for certain
types of programs or for services to a special
population.
• Programs established to serve special popula
tions are often limited to a specific level of care.
Program specialization tends to override PPC,
particularly for clients who fit well into the niche
described by the specialization.
• Rigid eligibility requirements will interfere with
the implementation of UPPC.
• Eligibility and patient placement criteria should
be merged.


ATTENTION: Urban systems handling large num
bers of patients are likely to have more compre
hensive assessment systems than smaller rural
systems, which may depend on informal evalua
tions by public health or criminal justice personnel
to place patients in treatment.

-----------------------------------------------
Implementation Strategies 25
ATTENTION: Adoption of UPPC will probably lead to
the development of more instruments that match
agreed upon assessment dimensions. 
Staffing and Training Considerations 
for Assessors
When UPPC are being implemented, it will be nec
essary for intake and assessment workers to be
thoroughly trained in the use of the criteria. While
the training of these personnel may be the high
est priority, all staff must be trained. The training
must include

• Information on the benefits of UPPC, both for
the delivery system and for individualized
patient care
• Specific skills in assessment, the application of
placement criteria, and documentation
• Assessment and placement issues for special
populations
Training will probably be the most expensive
aspect of UPPC implementation. It is also true
that programs and individual professionals have a
responsibility for continuing education. Existing
program budgets for training of personnel can
defray some of the expense.



For more detailed information, see TIP 13, 
pp. 31–40.

-----------------------------------------------

26
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


FUTURE DIRECTIONS

Immediate Task for Developing Consensus
Among Stakeholders
•Accumulate and analyze data on the effective
ness of PPC
•Continue to familiarize treatment providers with
information on PPC
•Develop criteria which are relatively easy to use
and implement
•Include all stakeholder groups in the consensus
process
Feedback Loops
In effect the criteria and the structure they provide
to the placement and treatment process create
the possibility for establishing several ongoing
feedback loops, allowing researchers to ask pre
cise questions and design appropriate studies.
There are several other areas where careful
research can improve treatment and cost effec
tiveness.

•Assessment: Important data about patient popu
lation might be lost if assessments are not con
ducted according to criteria.
•Resource management: This will provide invalu
able date for needs assessment and resource
management within agencies across systems.

-----------------------------------------------
Future Directions 27

•Outcome research and quality improvement:
One way that UPPC will greatly improve the qual
ity of treatment outcomes research is by improv
ing the capability to describe research samples.
Researchers will be able to focus on and com
pare specific samples and subsamples of
patients with a similar severity of illness and
with specific needs profiles. All research can
then be fed back into the process of reviewing
criteria.
Interaction Between UPPC and Assessment,
Treatment, and Outcomes



For more detailed information, see TIP 13, 
pp. 41–50.
Biopsychosocial
Assessment

 Uniform Patient
Placement Criteria

Patient Matching/
Treatment
Placement

Treatment
Outcomes

   Case
Management
  Program
Accountability
Total Quality
Management

-----------------------------------------------

28
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


ETHICAL AND LEGAL ISSUES

With respect to documenting and supporting sub
stance abuse treatment decisions based on
UPPC, the following recommendations are made:

•Every provider who makes an entry in a patient's
records should do so with the understanding
that it will be reviewed and scrutinized by the
insurer or third-party payers.
•Providers in facilities that have adopted patient
placement criteria must learn to speak the lan
guage of the criteria—the evaluation forms,
progress notes and other components of the
patient's record must relate specifically to the
criteria that use the same terminology.
•The patient record should include specific illus
trations to demonstrate that a patient has been
assessed on a specific dimension outlined in
the criteria and the ongoing attention is focused
on that area—include specific examples of
observed patient behavior, statements, or histo
ry that clearly indicate treatment resistance.
•Before making an entry, providers should review
previous entries—conflicting or inconsistent
entries damage credibility of the entire record.

-----------------------------------------------
Ethical and Legal Issues 29

•While a "defensive" or "patient welfare" approach
to recordkeeping is prudent, the integrity of
patient records should not be compromised by
misstatements or alterations.
For more information, see TIP 13, pp. 51–55.

-----------------------------------------------

30
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


GLOSSARY
American Society of Addiction Medicine (ASAM):
ASAM is an international organization of 3,000
physicians dedicated to improving the treatment
of persons with substance use disorders by edu
cating physicians and medical students, promot
ing research and prevention, and informing the
medical community and the public about issues
related to substance use. In 1991, ASAM pub
lished the first of a set of patient placement crite
ria that have been widely used and analyzed in
the substance abuse treatment field.

Assessment: The process of collecting detailed
information about a person's alcohol and other
drug use, emotional and physical health, family
and social problems, roles and supports, educa
tional and employment status, legal status, and
other areas as a basis for identifying the appropri
ate level and intensity of substance abuse treat
ment as well as needs for other services. 

Client: An individual receiving substance abuse
treatment. The terms client and patient are some
times used interchangeably, although staff in
medical settings more commonly use the term
patient.

-----------------------------------------------
Glossary 31

Dimension: A term used in the ASAM patient
placement criteria to refer to one of six patient
problem areas that must be assessed when mak
ing placement decisions.

Healthcare reform: Efforts occurring at the
national, State, and local levels to change the
delivery of healthcare services to meet three
goals: improved access to care, better quality
care, and reduced costs goals that are shared by
those seeking to implement uniform patient place
ment criteria. 

Instrument: A measurement tool, usually a ques
tionnaire, that is used for gathering information
about an individual to aid screening, assessment,
diagnosis, and/or clinical decisionmaking.

Managed care: An approach to delivering health
and mental health services that seeks to improve
the cost effectiveness of care (i.e., improved serv
ices at reduced cost) by monitoring service seek
ing and delivery. Methods include managing the
overall delivery of care by selecting providers (for
example, health maintenance organizations or
other provider networks) and managing treatment
decisions by individual providers for individual
patients (for example, utilization review).

Modality: A specific type of treatment (technique,
method, or procedure) that is used to relieve

-----------------------------------------------

32
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders


symptoms or induce behavior change. Modalities
of substance abuse treatment include, for exam
ple, inpatient social milieu treatment, group thera
py, and individual substance abuse counseling.

Needs assessment: A process by which an indi
vidual or system (e.g., an organization or commu
nity) examines existing resources to determine
what new resources are needed or how to reallo
cate resources to achieve a desired goal. Use of
patient placement criteria can reveal gaps in the
continuum of care and can aid in needs assess
ment at the community and State levels. 

Outcomes monitoring: Collection and analysis of
data from persons in substance abuse treatment
to determine the effects of treatment, especially
in relation to improvements in functioning (treat
ment outcomes monitoring); the same type of
process can be performed at the program level to
determine whether programs are meeting their
goals (program outcomes monitoring). In publicly
supported systems, outcomes monitoring will also
help to establish accountability for the expendi
ture of public funds. 

Patient: An individual receiving substance abuse
treatment. The terms client and patient are some
times used interchangeably, although persons in

-----------------------------------------------
Glossary 33

medical settings more commonly use the term
patient.

Rationing: The act of limiting treatment or other
services to certain individuals or populations, usu
ally due to limited resources. 

Third-party payers: Payers for services other than
the client or patient who receives the services,
including private insurance and public payers
such as intermediaries for Medicare and
Medicaid.

Utilization review: A method used in managed
care approaches in which an outside organization
reviews clinical decisions in areas such as hospi
tal admission, length of stay, and discharge, as
well as choices regarding placement and treat
ment modality in order to improve the quality of
care and reduce costs. 

Wraparound services: Services in addition to sub
stance abuse treatment that are provided to
patients to improve retention in treatment and
treatment outcomes. 

-----------------------------------------------

34
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

-----------------------------------------------
Ordering Information
TIP 13 The Role and Current
Status of Patient Placement
Criteria in the Treatment of
Substance Use Disorders



TIP 13-Related Products
KAP Keys for Clinicians
based on TIP 13
Quick Guide for Clinicians
based on TIP 13

Do not reproduce or distribute this publication for a fee without spe
cific, written authorization from the Office of Communications,
Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services.



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

-----------------------------------------------
Other Treatment Improvement
Protocols (TIPs) that are relevant to
this Quick Guide:



See the inside back cover for ordering information for all
TIPs and related products.


DHHS Publication No. (SMA) 01-3564
Printed 2001
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