• RIVER CITY ASAM ASSESSMENT ADULT SUBSTANCE ABUSE OUTPATIENT PLACEMENT

  • (Required for Direct Outpatient, Alcohol and Drug Treatment Program, and IOP Admissions)

    This ASAM-based placement tool is to be used as a guide to determine whether or not a consumer is appropriate for the ambulatory (outpatient/ADTP/IOP) level of treatment. It is required to be placed in all River City funded ambulatory treatment substance abuse records, but may be used for substance abuse treatment funded by other sources.

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  • DIMENSION 1 - WITHDRAWAL/DETOXIFICATION POTENTIAL:

  • DIMENSION 2 - BIOMEDICAL CONDITIONS AND COMPLICATIONS (not related to withdrawal):

  • DIMENSION 3 - EMOTIONAL/BEHAVIORAL/COGNITIVE CONDITIONS AND COMPLICATIONS:

  • *If answering "No", not appropriate for ambulatory treatment, to any of ASAM Dimensions 1, 2, or 3, consider a referral to an alternate level of treatment. Individuals with acute Medical and/or Psychiatric problems should be directly referred to Medical or Psychiatric emergency/urgent services for stabilization prior to referral and/or admission to treatment.

  • DIMENSION 4 - READINESS TO CHANGE:

  • DIMENSION 5 - RELAPSE/CONTINUED USE POTENTIAL

  • DIMENSION 6 - RECOVERY ENVIRONMENT

  • ***If answering “No”, not appropriate for ambulatory treatment, to two or more of ASAM Dimensions 4, 5 or 6, consider a referral to an alternate level of treatment.

    Consumer is appropriate for the following level of care (check THE most acute problem area that applies):

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