Home

10-16-25

 

Dimension 1 - Intoxicated and Associated Risks
Intoxication and Associated Risks
Risk Rating		Descriptions
4 = Level 4 3B = Min Level 3.7 BIO 3A = Min Level 3.7 (non-BIO) 2 = Min Level 2.7 Any Level of Care-Risk Rating Any 0 = No Specific Need Reason why Risk Rating was chosen:		Level 4 Actively, currently severely intoxicated... + - ReadMore Click to collapse 1. The patient is experiencing very severe signs and/or symptoms of intoxication that pose immediate or imminent risk to the patient or others. 2. The patient is experiencing severe signs and/or symptoms of intoxication-or signs and/or symptoms that are unexplained given known substance use-and requires integrated medical services and/or support that are only available in an acute care setting. 3. The patient is experiencing or anticipated to imminently experience severe signs and/or symptoms in the context of intoxication that a Level 3.7 BIO program is not expected to be able to control (eg, due to co-occurring physical and/or mental health conditions). Level 3.7 Bio - Risk Rating 3B Severe Signs of intoxication and IV use + - ReadMore Click to collapse ... 1. Biomedical Enhanced, The patient is experiencing moderately severe to severe signs and/or symptoms of intoxication - AND - The patient requires IV medications. Level 3.7 (non-BIO) - Risk Rating 3A 1. Experiencing moderate to severe intoxication and requires after hours medical management + - ReadMore Click to collapse The patient is experiencing or anticipated to imminently experience moderately severe to severe signs and/or symptoms of intoxication that otherwise meet Intoxication and Associated Risks criteria for treatment at Level 2.7. AND The patient requires after-hours medical management and/or nursing care.  Level 2.7 - Risk Rating 2 Patient requires daily (or near daily) medical management, no reliable access to external medical treatment, experiencing moderate acute health problems, requires nursing care + - ReadMore Click to collapse The patient is experiencing moderately severe acute but not life-threatening physical health problems that are explainable based on known history and expected to be controllable in this level of care (eg, with oral, SO, or IM medications). AND The patient requires frequent (ie, daily or near daily) medical management and/or nursing care. AND The patient cannot reliably access external medical treatment to adequately address their physical health needs; and/or the patient is assessed as needing integrated medical services. The patient is experiencing moderate acute health problems and requires integrated medical services and/or support that are not available in a less intensive level of care. The patient is experiencing moderate physical health problems (eg, complex partial seizure disorder, hypertension, diabetes) that otherwise meet Physical Health Concerns criteria for treatment at Level 1.7. AND The patient requires extended nursing care during program hours due to exacerbation of their physical health problems from intoxication or withdrawal (Dimension 1). Any Level of Care - Risk Rating Any 1. Mild to moderate symptoms of intoxication that doesn't require medical treatment + - ReadMore Click to collapse The patient is experiencing or anticipated to imminently experience mild to moderate signs and/or symptoms of intoxication that can be addressed in any level of care as needed (eg, with behavioral management strategies) and, thus, does not require a medically managed addiction treatment program for intoxication management. No Specific Needs - Risk Rating 0 1. The patient is not intoxicated.
--------------------------------	---------------------------------	-----------------------------------------------------------------------------------------------------
Withdrawal and Associated Risks
4 = Level 4 3B = Min Level 3.7 BIO 3A = Min Level 3.7 (non-BIO) 2 = Min Level 2.7 1 = Minimum 1.7 EVAL = Prompt Evaluation 0 = No Specific Need Reason why Risk Rating was chosen:		Level 4 - Risk Rating 4 Very severe symptoms of withdrawal, immediate risk, requires medical services, comobid physical or co‑occurring mental health, history of comlicated withdrawals + - ReadMore Click to collapse 1. The patient is experiencing or anticipated to imminently experience very severe signs and/or symptoms of withdrawal that pose immediate or imminent risk to the patient or others. 2. The patient is experiencing severe signs and/or symptoms of withdrawal and requires medical services and/or support that are only available in an acute care setting. The patient otherwise meets Withdrawal and Associated Risks criteria for treatment at Level 3.7 or 3.7 BIO. AND The patient has a comorbid physical or co-occurring mental health condition that complicates withdrawal management. 4. The patient is experiencing or anticipated to imminently experience severe signs and/or symptoms of withdrawal from alcohol and/or sedative-hypnotics. AND The patient has a history of complicated withdrawal syndrome-including development of delirium tremens and/or withdrawal-related seizures-that was difficult to control. Level 3.7 - BIO - Risk Rating 3B Biomedical Enhanced, Moderate to severe withdrawals AND requires medications + - ReadMore Click to collapse 1. The patient is experiencing moderately severe to severe signs and/or symptoms of withdrawal as described in Withdrawal and Associated Risks criteria for Level 2.7 or 3.7. AND The patient requires IV medications. Level 3.7 (non-BIO) - Risk Rating 3A Severe signs of withdrawal, requires medical services, comorbid physical or co‑occurring mental health and requires after hours monitoring.  + - ReadMore Click to collapse 1. The patient is experiencing or is anticipated to imminently experience severe signs and/or symptoms of withdrawal that are explainable based on known history and expected to be controllable at this level of care (eg, with oral, SQ, or IM medications). » Level 3.7 (non-BIO) does not provide IV medications. If a patient requires these services, they should be placed in a minimum of Level 3.7 BIO, 2. The patient is experiencing moderately severe signs and/or symptoms of withdrawal and requires medical services and/or support not available in a less intensive level of care. 3. The patient otherwise meets Withdrawal and Associated Risks criteria for treatment at Level 2.7. AND The patient has a comorbid physical or co-occurring mental health condition that complicates withdrawal management. 4. The patient is experiencing or anticipated to imminently experience moderately severe signs and/or symptoms of withdrawal from alcohol and/or sedative-hypnotics. AND The patient has a history of complicated withdrawal syndrome-including the development of delirium tremens and/or withdrawal-related seizures-that was controllable with standard treatment interventions. 5. The patient otherwise meets Withdrawal and Associated Risks criteria for treatment at Level 2.7. AND The patient requires monitoring after-hours but lacks sufficient monitoring in their current home environment to support safety after-hours and/or effective participation in intensive outpatient addiction treatment (Dimension 5). Level 2.7 - Risk Rating 2 Moderate to severe withdrawals, and requires medical management with extended care during business ours, or patient is unable to follow instructions, or requires close monitor + - ReadMore Click to collapse 1. The patient is experiencing or anticipated to imminently experience moderately severe signs and/or symptoms of withdrawal that are explainable based on known history and expected to be controllable at this level of care (eg, with oral, SQ, or IM medications). AND The patient requires medical management with extended nursing care available during business hours. 2. The patient otherwise meets Withdrawal and Associated Risk criteria for treatment at Level 1.7. AND The patient and/or their available support persons are unable to follow instructions necessary to support withdrawal management in a Level 1.7 program but can reliably access services in a Level 2.7 program. 3. The patient otherwise meets Withdrawal and Associated Risks criteria for treatment at Level 1.7. AND The patient has needs in Dimensions 2 and/or 3 that require closer nurse monitoring (eg, due to potential medication interactions). Level 1.7 - Risk Rating 1 Experiencing mild to moderate symptoms of withdrawals and minimal risk of severe withdrawal, and requires frequent check ins + - ReadMore Click to collapse 1. The patient is experiencing or anticipated to imminently experience mild to moderate signs and/or symptoms of withdrawal that interfere with daily functioning and/or treatment and recovery efforts. AND The patient has minimal risk of severe withdrawal. AND The patient requires frequent (ie, more than weekly) check-ins during the acute withdrawal phase but does not require extended nursing care. Prompt Evaluation - Risk Rating EVAL Mild symptoms of withdrawals, requires prompt medical evaluation, but not integrated management + - ReadMore Click to collapse 1. The patient is experiencing or anticipated to imminently experience mild signs and/or symptoms of withdrawal that can be addressed in any level of care as needed (eg, with behavioral management strategies, through referral to a qualified medical provider) and, thus, requires prompt medical evaluation but not integrated medical management and/or nursing care for signs and/or symptoms of withdrawal. No Specific Needs - Risk Rating O 1. The patient has no specific treatment needs related to withdrawal.
------------------------------------	------------------------------------	---------------------------------------------------------------------------------------------------
Addiction Medication Needs
C = Minimum level 3.7 B = Minimum Level 2.7 A = Minimum Level 1.7 EVAL = Prompt Evaluation ANY = Any Level of Care MOUD-C = MOUD Continuation Reason why Risk Rating was chosen:		Level 3.7 - Risk Rating C MAT expected to be complex, requiring daily management, or client is pregnant + - ReadMore Click to collapse 1. Initiation or titration of addiction medication is anticipated to be complex, requiring daily medical management and/or nursing care, including after-hours.+ 2. The patient is pregnant and otherwise meets Addiction Medication Needs criteria for treatment at Level 2.7. Level 2.7 - Risk Rating B Medication requires daily med management, and/or nurse care + - ReadMore Click to collapse 1. Initiation or titration of addiction medication is anticipated to be complex, requiring daily or near-daily medical management and/or extended nursing care. 2. The patient otherwise meets Addiction Medication Needs criteria for treatment at Level 1.7. AND The patient has needs in Dimensions 2 and/or 3 that require closer nurse monitoring (eg, due to potential medication interactions).  Level 1.7 - Risk Rating A Diagnosis of opiate use disorder, about to start MAT, history of poor outcomes with detox and not able to acheive recovery with out detox + - ReadMore Click to collapse The patient has OUD and is not currently on MOUD. AND Uncomplicated MOUD initiation is anticipated. The patient has a history of poor outcomes with clinically managed care and requires frequent (ie, more than weekly) medical management to initiate medications to stabilize signs and symptoms of SUD (eg, cravings, post-acute withdrawal) and prevent recurrence. AND The patient is assessed as not able to achieve recovery without integrated medical management. Prompt Evaluation - Risk Rating - EVAL History of difficulty with detox, requires prompt medical evaluation to stabalize symptoms, doesn't require daily medical attention + - ReadMore Click to collapse The patient has a history of difficulty with clinically managed addiction care and requires prompt medical evaluation for addiction medications to stabilize their signs and symptoms of SUD (eg, cravings, post-acute withdrawal) and prevent recurrence. AND The patient is not expected to require frequent (ie, more than weekly) medical management to initiate and titrate addiction medications. MOUD Continuation - Risk Rating - MOUD-C The patient is currently taking Medication for Opioid Use Disorder and needs to continue this medication, requiring care coordination but not direct provision by the addiction treatment program. Any Level of Care - Risk Rating ANY The patient's addiction medication needs, if any, can be addressed in any level of care.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Dimension 2: Biomedical Conditions ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
PHYSICAL HEALTH CONCERNS
Level 4 = 4 Risk Rating 4 Level 3.7 - BIO = Risk Rating 3B Level 3.7 (non-BIO) = Risk Rating 3A Level 2.7 - Risk Rating Level 1.7 - Risk Rating 1 Any Level of Care - Risk Rating - ANY No Specific Needs = Risk Rating 0 Reason why Risk Rating was chosen:		Level 4 = 4 Risk Rating 4 Severe physical health problems that require immediate hospital care + - ReadMore Click to collapse The patient is experiencing very severe physical health problems that require cute hospital care. The patient is experiencing severe physical health problems and requires medical services that are only available in an acute care setting. The patient is experiencing severe acute physical health problems that are currently undiagnosed and/or not expected to be controllable with the interventions available in a Level 3.7 BIO program. The patient is experiencing severe acute physical health problems that otherwise meet Physical Health Concerns criteria for treatment at Level 3.7 or 3.7 BIO. AND The patient has needs in Dimension 1 and/or Dimension 3 that complicate management of physical health problems. Level 3.7 - BIO = Risk Rating 3B Severe physical health problems and requires IV medication  + - ReadMore Click to collapse The patient is experiencing severe physical health problems as described in the Physical Health Concerns criteria for Level 3.7. AND The patient requires IV medications or wound vacuum-assisted closure (VAC). Level 3.7 (non-BIO) - Risk Rating 3А  Severe physical health problems, expected to be controlled (oral meds), but requires daily or after hours med management, + - ReadMore Click to collapse The patient is experiencing severe acute physical health problems that are explainable based on known history and expected to be controllable at this level of care (eg, with oral, SQ, or IM medications). AND The patient requires daily medical management and/or nursing care, including after-hours. The patient is experiencing moderately severe acute but not life-threatening physical health problems and requires integrated medical services and/or support that are not available in a less intensive level of care. The patient otherwise meets Physical Health Concerns criteria for treatment at Level 2.7. AND The patient requires daily medical management and/or nursing care, including after-hours, due to exacerbation of their physical health problems from intoxication or withdrawal but is not expected to require the full resources of an acute care hospital (Dimension 1). The patient otherwise meets Physical Health Concerns criteria for treatment at Level 2.7. AND The patient requires after-hours medical monitoring but lacks sufficient monitoring in their current home environment to adequately support safety after-hours and/or effective participation in intensive outpatient addiction treatment (Dimension 5). OR The patient otherwise meets Physical Health Concerns criteria for treatment at Level 2.7. AND The patient cannot reliably access daily care at Level 2.7. Level 2.7 - Risk Rating 2 Moderate to severe physical health problems (but not life threatening), requires frequent med management, no reliable access to external med treatment + - ReadMore Click to collapse The patient is experiencing moderately severe acute but not life-threatening physical health problems that are explainable based on known history and expected to be controllable in this level of care (eg, with oral, SO, or IM medications). AND The patient requires frequent (ie, daily or near daily) medical management and/or nursing care. AND The patient cannot reliably access external medical treatment to adequately address their physical health needs; and/or the patient is assessed as needing integrated medical services. The patient is experiencing moderate acute health problems and requires integrated medical services and/or support that are not available in a less intensive level of care. The patient is experiencing moderate physical health problems (eg, complex partial seizure disorder, hypertension, diabetes) that otherwise meet Physical Health Concerns criteria for treatment at Level 1.7. AND The patient requires extended nursing care during program hours due to exacerbation of their physical health problems from intoxication or withdrawal (Dimension 1). Level 1.7 - Risk Rating 1 Moderate health problems that impact daily living and recovery + - ReadMore Click to collapse 1. The patient is experiencing moderate acute health problems that impact daily functioning and/or interfere with addiction treatment and recovery. AND The patient requires frequent (ie, more than weekly) medical services in the short term (eg, medication initiation and/or adjustment). AND The patient cannot reliably access external medical treatment to adequately address their physical health needs; and/or the patient is assessed as needing integrated medical services. Any Level of Care - Risk Rating - ANY Mild to moderate health problems that doesn't require managed care. + - ReadMore Click to collapse 1. The patient is experiencing mild to moderate physical health problems that can be addressed in any level of care (eg, through referral or care coordination) and, thus, does not require a medically managed level of care. No Specific Needs = Risk Rating 0 1. The patient has no specific treatment needs related to physical health concerns.
----------------------------------------------------------------------		--------------------------------------------------------------------------------------------------
PREGNANCY-RELATED CONCERNS
Level 4 - Risk Rating 4 Level 3.7 - Risk Rating 3 Level 2.7 - Risk Rating 2 Level 1.7 - Risk Rating 1 Any Level of Care - Risk Rating - ANY No Specific Needs - Risk Rating 0   Reason why Risk Rating was chosen:		Level 4 - Risk Rating 4 Pregnancy is unstable and requires immediate medical attention. + - ReadMore Click to collapse 1. The patient's pregnancy is immediately or imminently unstable and requires fetal monitoring, 24-hour medical management, and/or the full resources of an acute care hospital. Level 3.7 - Risk Rating 3 Requires daily  and after hours monitoring. + - ReadMore Click to collapse 1. The patient otherwise meets the Pregnancy-Related Concerns criteria for treatment at Level 2.7. AND The patient requires after-hours monitoring but lacks sufficient monitoring in their current home environment to adequately support safety after hours and/or effective participation in intensive outpatient addiction treatment (Dimension 5). Level 2.7 - Risk Rating 2 Daily or near daily med management, not life threataning, fetal monitoring not needed. + - ReadMore Click to collapse 1. The patient is pregnant and requires daily or near-daily medical management and/or nursing care for pregnancy complications that are not life threatening and do not require fetal monitoring. Level 1.7 - Risk Rating 1 Low to average risk, unable to access care to outpatient care. + - ReadMore Click to collapse 1. The patient is pregnant with low to average risk of experiencing pregnancy complications and requires on site provision of prenatal care because they are unwilling or unable to reliably access care from an external provider. Any Level of Care - Risk Rating - ANY 1. The patient is pregnant with low to average risk of experiencing pregnancy complications and does not require on-site provision of prenatal care because they are willing and able to reliably access care from an external provider. No Specific Needs - Risk Rating 0 1. The patient is not pregnant.
-----------------------------------------------------------------------------------------------------------------------------------------------------------
Dimension 3: Psychiatric and Cognitive Conditions
---------------------------------------------------------------------------------------------------------------------------------------------------------
ACTIVE PSYCHIATRIC SYMPTOMS
Level 4 - Psychiatric - Risk Rating 4 Minimum - Level 3.7 - COE - Risk Rating 3B Level 3.5 - COE - Risk Rating 3A Level 2.7 - COE - Risk Rating 2B Level 2.5 - COE - Risk Rating 2A Level 1.7 - COE - Risk Rating 1C Level 1.7 - Risk Rating 1B Level 1.5 - COE - Risk Rating 1A Any Level of Care - Risk Rating - ANY No Specific Needs - Risk Rating 0 Reason why Risk Rating was chosen:		Level 4 - Psychiatric - Risk Rating 4  Active psychiatric symptoms that requires immediate medical attention + - ReadMore Click to collapse The patient is experiencing psychiatric signs and/or symptoms that pose immediate or imminent risk of serious harm to the patient (eg, severe deterioration) or others and requires urgent psychiatric management, 24-hour psychiatric nursing care, and/or a secure psychiatric setting.* The patient is experiencing psychiatric signs and/or symptoms that otherwise meet admission criteria for inpatient psychiatric hospitalization (ie, Level 4 Psychiatric). The patient meets Active Psychiatric Symptoms criteria for treatment at Level 3.7 COE (Co-Occurring Enhanced). AND The patient's psychiatric signs and/or symptoms are expected to be exacerbated by intoxication, withdrawal, and/or comorbid Dimension 2 concerns and require more intensive psychiatric management and/or nursing care than can be provided in a less intensive care setting to maintain safety. * If the patient meets admission criteria in Dimension 3 for Level 4 Psychiatric care and in Dimensions 1 and/or 2 for Level 3.7 BIO or 4 care, the patient should be treated in a Level 4 acute care medical unit or medical psychiatric unit, if available. If needed, transition to an inpatient psychiatric unit (ie, Level 4 Psychiatric) may be appropriate once the patient's intoxication, withdrawal, or biomedical conditions have been stabilized. Minimum - Level 3.7 - COE - Risk Rating 3B  Active psychiatric symptoms that require medical attention and needs after hours attention. + - ReadMore Click to collapse 1. Co-Occurring Enhanced.  The patient is experiencing psychiatric signs and/or symptoms at a level of acuity and/or complexity that requires active psychiatric management. AND The patient requires after-hours psychiatric management and/or nursing care to rapidly respond to changes in mental health status. 2. The patient is experiencing psychiatric signs and/or symptoms that would otherwise meet criteria for a subacute psychiatric residential treatment setting (eg, Level 5 in LOCUS)® 3. The patient otherwise meets Active Psychiatric Symptoms criteria for treatment at Level 2.7 COE. AND The patient's psychiatric signs and/or symptoms are anticipated to be exacerbated by concerns in Dimensions 1 and/or 2 such that the patient requires after-hours medical monitoring and/or nursing care, with potential need to rapidly adjust psychiatric medications. 4. The patient otherwise meets Active Psychiatric Symptoms criteria for treatment at Level 2.7 COE. AND The patient lacks sufficient support in their current home environment to enable effective participation in intensive outpatient addiction treatment (Dimension 5). AND The patient lacks sufficient skills and/or readiness to effectively participate in a recovery residence. Level 3.5 - COE - Risk Rating 3А  Mental health signs impacting safety that requires skilled staff. + - ReadMore Click to collapse 1. The patient is experiencing mental health signs and/or symptoms at a level of acuity and/or complexity impacting safety and/or function that requires intensive skilled mental health-focused interventions and/or readily available access to psychiatric oversight. AND The patient requires residential support or supervision to monitor for changes in status and rapidly respond to mental health concerns that may arise, but they have sufficient control to not require an acute or medically managed psychiatric setting. AND The patient's psychiatric medication regimen (if any) does not require frequent (ie, more than weekly) or urgent medical management and/or nursing care. 2. The patient otherwise meets Active Psychiatric Symptoms criteria for treatment at Level 2.5 COE. AND The patient lacks sufficient support in their current home environment and/or adequate functional skills to enable effective participation in clinically managed outpatient addiction treatment (Dimension 5). AND The patient lacks sufficient skills and/or readiness to effectively participate in a recovery residence. Level 2.7 - COE - Risk Rating 2B  Psychiatric signs that interfere with recovery and requires frequent nursing attention. + - ReadMore Click to collapse 1. The patient is experiencing psychiatric signs and/or symptoms at a level of acuity and complexity that interferes with addiction treatment and recovery. AND The patient requires frequent (ie, daily or near-daily) psychiatric management and/or nursing care to achieve sufficient stability to enable effective participation in addiction treatment. AND The patient has adequate impulse control to resist acting upon any thoughts of harm to self or others (if present) with daily or near-daily clinical support. AND The patient cannot reliably access external psychiatric care to adequately address their mental health needs, and/or the patient is assessed as requiring integrated skilled mental health interventions to permit participation in addiction treatment. 2. The patient meets Active Psychiatric Symptoms criteria for treatment at Level 1.7 COE. AND The patient's psychiatric signs and/or symptoms are likely to be exacerbated by intoxication, withdrawal, and/or comorbid Dimension 2 concerns and require daily or near-daily psychiatric management and/or nursing care (eg, due to the potential need for frequent medication adjustment). Level 2.5 - COE = Risk Rating 2A  Mental health signs that requires daily clinical management + - ReadMore Click to collapse 1. The patient is experiencing mental health signs and/or symptoms at a level of acuity that requires daily or near-daily clinical management of symptoms with a higher level of individualized staff support and skilled mental health interventions than provided at a standard (ie, co-occurring capable) level of care to address mental health signs and/or symptoms and maintain stability during addiction treatment. AND The patient has adequate impulse control to resist acting upon any thoughts of harm to self or others (if present) with daily or near-daily clinical support. AND The patient's psychiatric medication regimen (if any) does not require frequent (ie, more than weekly) or urgent medical management and/or nursing care. AND The patient cannot reliably access external mental health care to adequately address their mental health needs, and/or the patient is assessed as requiring integrated skilled mental health interventions to permit participation in addiction treatment. Level 1.7 - COE - Risk Rating 1C  Psychiatric signs that interfere with recovery and requires med management and no access to external pych care + - ReadMore Click to collapse 1. The patient is experiencing psychiatric signs and/or symptoms at a level of acuity and complexity that interfere with addiction treatment and recovery. AND The patient requires initiation or frequent (ie, more than weekly) adjustment of psychiatric medications, and psychotropic medication management is expected to be complicated (eg, titration of multiple psychotropic medications, known risks for significant adverse effects) such that psychiatric management is required. AND The patient cannot reliably access external psychiatric care to adequately address their mental health needs, and/or the patient is assessed as requiring integrated skilled mental health interventions to enable effective participation in addiction treatment. Level 1.7 - Risk Rating 1B  Psychiatric signs moderate to low complexity may interfere with recovery, and requires med but uncomplicated + - ReadMore Click to collapse 1. The patient is experiencing psychiatric signs and/or symptoms of low to moderate acuity and low complexity that may interfere with addiction treatment and recovery. AND The patient requires psychiatric medication initiation or adjustment, psychotropic medication management is expected to be uncomplicated (eg, no known risks for significant adverse effects), and the patient does not require integrated skilled mental health interventions. AND The patient is unable to access adequate and/or timely psychiatric medication management from a qualified external provider and/or is assessed as requiring integrated psychiatric management (eg, lacking sufficient motivation to follow through with off-site psychiatric appointments). AND The patient is able to sufficiently adhere to their psychiatric medication regimens and report effects and side effects to their prescriber during the adjustment phase without the need for regular monitoring or intervention by specialty psychiatric staff. 2. The patient is receiving psychiatric medication management externally but requires active co-management and care coordination from a physician or advanced practice provider with specialty addiction treatment experience due to potential risks associated with prescribed psychiatric medications (eg, when controlled medications are considered, or when there is concern for interactions between the medications prescribed for the patient's SUD and psychiatric conditions). Level 1.5 - COE - Risk Rating 1A   Mental health signs that present challenges with participating in recovery, unwilling or unable to access mental health care  + - ReadMore Click to collapse 1. The patient is experiencing mental health signs and/or symptoms eg, personality disorder, social anxiety) that present challenges with effective participation in standard ie, co-occurring capable) addiction treatment, such as managing the interpersonal intensity of group therapy and/or a therapeutic milieu; these mental health concerns require non-intensive (ie, less than three days per week) individualized support and redirection and/or integrated skilled mental health interventions to enable effective participation in addiction treatment. AND The patient is unwilling or unable to access mental health care externally, or they are not receiving sufficient external care to enable participation in standard (ie, co-occurring capable) treatment. AND The patient's mental health signs and/or symptoms do not require integrated medical management and/or nursing care. Any Level of Care - Risk Rating - ANY Mild to moderate mental health signs that can be address in any level of care + - ReadMore Click to collapse 1. The patient is experiencing active mild to moderate mental health signs and/or symptoms that can be addressed in any level of care with direct symptom management support or referral. Skilled mental health services (eg, medication management, psychotherapeutic interventions) are not required with such urgency to preclude engagement in addiction treatment while those services are being coordinated. 2. The patient is experiencing significant mental health concerns for which they are already receiving external mental health care with an appropriate level of medication management and/or therapeutic intervention for the acuity and complexity of their concerns. AND The patient does not require integrated mental health or psychiatric treatment services to enable participation in addiction treatment. No Specific - Needs - Risk Rating 0 1. The patient has no specific treatment needs related to active psychiatric signs or symptoms.
PERSISTENT DISABILITY		PERSISTENT DISABILITY
Level 1.5 - COE - Risk Rating 1Z Any Level of Care - Risk Rating No Specific Needs - Risk Rating 0 Reason why Risk Rating was chosen:		Level 1.5 - COE - Risk Rating 1Z  Baseline impairments to process information, participate in therapy, intellectual disability or TBI, and requires more flexible treatment environment + - ReadMore Click to collapse 1. The patient, at baseline, has impairments in their ability to process information, organize schedules, and/or participate in group therapy due to persistent mental health symptoms or disability, intellectual and/or developmental disability, acquired brain injury, or neurodiversity. AND The patient requires a more flexible treatment environment with greater individualized staff support and/or staff with a higher level of training in skills to support mental health treatment, address symptoms, or assist with functioning than are available in a standard (ie, co-occurring capable) level of care. Any Level of Care - Risk Rating - ANY  Mental health, TBI, intellectual disability, neurodivercity, that may require some level of support to help with addiciton treatment + - ReadMore Click to collapse 1. The patient has persistent mental health-related or cognitive disability-including acquired brain injury, intellectual and/or developmental disability, or neurodiversity-that may require some level of support to enable effective participation in addiction treatment. However, the patient does not require more individualized staff support than provided in a standard (ie, co-occurring capable) program nor integration of skilled mental health interventions into the addiction treatment program to address their persistent mental health disability. No Specific - Needs - Risk Rating 0   1. The patient has no specific treatment needs related to persistent disability.
------------------------------------------------------------------		-----------------------------------------------------------------------------------------------
Dimension 4: Substance Use-Related Risks
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
LIKELIHOOD OF ENGAGING IN RISKY SUBSTANCE USE
Level 3.5 - Risk Rating E Level 3.1 - Risk Rating D Level 2.5 - Risk Rating C Level 2.1 - Risk Rating B Level 1.5 - Risk Rating A Reason why Risk Rating was chosen:		Level 3.5 - Risk Rating E  High likelihood of substance use with serious risk of harm, requires residential + - ReadMore Click to collapse 1. The patient has a high likelihood of engaging in substance use with significant risk of serious harm or destabilizing loss. AND The patient requires 24-hour clinical support and supervision to prevent substance use while developing recovery-sustaining skills. 2. The patient otherwise meets Likelihood of Engaging in Risky Substance Use criteria for treatment at Level 3.1 but, due to interactions with Dimensions 2 and/or 3, requires 24-hour supervision and/or more intensive clinical services for safety or stability. 3. The patient otherwise meets Likelihood of Engaging in Risky Substance Use criteria for treatment at Level 2.5 but, due to interactions with Dimensions 3 and/or 5, requires 24-hour support and supervision to promote safety and stability and/or the patient requires residential support to enable effective participation in care and is assessed as unable to safely and/or effectively engage in outpatient care with recovery residence support. Level 3.1 - Risk Rating D Moderate likelihood of substance use with significant risk to harm, but is able to develop relapse prevention skills, or requires residnetial due to medical, mental health, or environmental concerns. + - ReadMore Click to collapse 1. The patient has a moderate likelihood of engaging in substance use with significant risk of serious harm or destabilizing loss. AND The patient is assessed as able to develop relapse prevention skills and prevent substance use with residential structure and 24-hour clinically managed support while practicing recovery-sustaining skills safely on a limited basis in the community. 2. The patient otherwise meets Likelihood of Engaging in Risky Substance Use criteria for treatment at Level 2.1 but, due to interactions with Dimensions 2, 3, and/or 5, requires 24-hour clinically managed structure and support for additional stability and/or the patient requires residential support to reliably participate in care and is assessed as unable to safely and/or effectively engage in outpatient care with recovery residence support. Level 2.5 - Risk Rating C Moderate risk to continued substance use with significate risk, or high likelihood of continued substance, but low risk of serious destabilizing consequences + - ReadMore Click to collapse 1. The patient has a moderate likelihood of engaging in substance use with significant risk of serious harm or destabilizing loss. AND The patient is assessed as able to develop relapse prevention skills and prevent substance use with daily or near-daily high-intensity clinical services with a therapeutic milieu. 2. The patient has a high likelihood of engaging in substance use with risk of negative but not seriously destabilizing consequences. AND The patient requires daily or near-daily high-intensity clinical services with a therapeutic milieu to develop relapse prevention skills. 3. The patient otherwise meets Likelihood of Engaging in Risky Substance Use criteria for treatment at Level 2.1 but, due to interactions with Dimensions 3 and/or 5, requires more intensive clinical services and/or a more consistent (ie, daily or near-daily) therapeutic milieu to achieve recovery goals. Level 2.1 - Risk Rating B Low likelihood of substance use with significant harm and requires several hours per week of services + - ReadMore Click to collapse 1. The patient has a low likelihood of engaging in substance use with significant risk of serious harm or destabilizing loss. AND The patient is assessed as able to develop relapse prevention skills and prevent substance use with intensive clinical services several times per week and/or a low-intensity therapeutic milieu. 2. The patient has a moderate likelihood of engaging in substance use with risk of negative but not seriously destabilizing consequences. AND The patient requires intensive clinical services several times per week and/or a low-intensity therapeutic milieu to achieve recovery goals. 3. The patient otherwise meets Likelihood of Engaging in Risky Substance Use criteria for treatment at Level 1.5 but, due to interactions with Dimensions 2, 3, and/or 5, requires more clinical service hours per week to support stability. Level 1.5 - Risk Rating A Low likelihood of substance use with significant risk, able to engage with low intense services. + - ReadMore Click to collapse 1. The patient has a very low likelihood of engaging in substance use with significant risk of serious harm or destabilizing loss. AND The patient is assessed as able to prevent substance use and achieve recovery goals with non-intensive clinical services. 2. The patient has a low likelihood of engaging in substance use with risk of negative but not seriously destabilizing consequences. AND The patient requires occasional clinical services to consolidate recovery goals.
------------------------------------------------------------------		-----------------------------------------------------------------------------------------------------
LIKELIHOOD OF ENGAGING IN RISKY SUD-RELATED BEHAVIORS
Level 3.5 - Risk Rating E Level 3.1 - Risk Rating D Level 2.5 - Risk Rating C Level 2.1 - Risk Rating B Level 1.5 - Risk Rating A No Specific Needs - Risk Rating 0 Reason why Risk Rating was chosen:		Level 3.5 - Risk Rating E High likelihood of substance use with significant risk of serious harm, requires residential treatment + - ReadMore Click to collapse 1. The patient has a high likelihood of engaging in SUD-related behaviors with significant risk of serious harm or destabilizing loss. AND The patient requires 24-hour clinical support and supervision to prevent risky SUD-related behaviors while developing recovery-sustaining skills. 2. The patient otherwise meets Likelihood of Engaging in Risky SUD-Related Behaviors criteria for treatment at Level 3.1 but, due to interactions with Dimension 3, requires 24-hour supervision to support safety or stability. 3. The patient otherwise meets Likelihood of Engaging in Risky SUD-Related Behaviors criteria for treatment at Level 2.5 but, due to interactions with Dimensions 3 and/or 5, requires 24-hour clinical supervision to support stability and/or the patient requires residential support to reliably participate in care and is assessed as unable to safely and/or effectively engage in outpatient care with recovery residence support. Level 3.1 - Risk Rating D Moderate likely hood of substance use with significant risk of harm, risky rellated SUD behaviors, requires residential + - ReadMore Click to collapse 1. The patient has a moderate likelihood of engaging in SUD-related behaviors with significant risk of serious harm or destabilizing loss. AND The patient is assessed as able to prevent risky SUD-related behaviors with residential structure and 24-hour clinically managed support while practicing recovery-sustaining skills safely on a limited basis in the community. 2. The patient otherwise meets Likelihood of Engaging in Risky SUD-Related Behaviors criteria for treatment at Level 2. 1 but, due to interactions with Dimensions 3 and/or 5, requires 24-hour clinically managed structure and support for additional stability and/or the patient requires residential support to reliably participate in care and is assessed as unable to safely and/or effectively engage in outpatient care with recovery residence support. Level 2.5 - Risk Rating C Moderate likelihood of substance use with significant risk of serious harm, needing daily or near daily services + - ReadMore Click to collapse 1. The patient has a moderate likelihood of engaging in substance use with significant risk of serious harm of destabilizing loss. AND The patient is assed as able to develop  relapse prevention skills and prevent substance use with daily or near-daily high. intensity clinical services and a therapeutic milieu. 2. The patient has a high likelihood of engaging in risky SuD-re ate behaviors with risk of negative but not seriously destabilizing consequences. AND The patient requires daily or near-daily high-intensity clinical services with a therapeutic milieu to learn risky behavior prevention skills. 3. The patient otherwise meets Likelihood of Engaging in Risky SUD-Related Behaviors criteria for treatment at Level 2.1 but, due to interactions with Dimension 3, requires more intensive clinical services and/or a more consistent (ie, daily or near-daily) therapeutic milieu to achieve recovery goals. Level 2.1 - Risk Rating B Low likelihood of substance use significant risk, able to develop skills with intensive services several times a week + - ReadMore Click to collapse 1. The patient has a low likelihood of engaging in SUD-related behaviors with significant risk of serious harm or destabilizing loss. AND The patient is assessed as able to develop recovery-sustaining skills and prevent risky SUD-related behaviors with intensive clinical services several times per week and/or a low intensity therapeutic milieu. 2. The patient has a moderate likelihood of engaging in SUD related behaviors with risk of negative but not seriously destabilizing consequences. AND The patient requires intensive clinical services several times per week and/or a low intensity therapeutic milieu to achieve recovery goals. 3. The patient otherwise meets Likelihood of Engaging in Risky SUD-Related Behaviors criteria for treatment at Level 1.5 but, due to interactions with Dimension 3, requires more clinical service hours per week to support stability. Level 1.5 - Risk Rating A Low likelihood of risky substance use, less than three days per week treatment needed + - ReadMore Click to collapse 1. The patient has a very low likelihood of engaging in risky SUD-related behaviors with risk of significant harm or destabilizing loss. AND The patient is assessed as able to avoid engaging in risky SUD-related behaviors with non-intensive (ie, less than three days per week) clinical services. 2. The patient has a low likelihood of engaging in risky SUD-related behaviors with risk of negative but not seriously destabilizing consequences. AND The patient requires occasional clinical services to consolidate recovery goals. No Specific Needs - Risk Rating 0 1. The patient has no specific treatment needs related to risky SUD-related behaviors.
Dimension 5: Recovery Environment Interactions
		ABILITY TO FUNCTION EFFECTIVELY IN CURRENT ENVIRONMENT
ABILITY TO FUNCTION EFFECTIVELY IN CURRENT ENVIRONMENT  Level 3.5 - Risk Rating D Level 3.1 - Risk Rating C Level 2.5 - Risk Rating B Level 2.1 - Risk Rating A Any Level of Care - Risk Rating ANY Needs - Risk Rating 0 Reason why Risk Rating was chosen:		Level 3.5 - Risk Rating D Severe impairment  in life activities, impairment in life + - ReadMore Click to collapse 1. The patient has very severe functional impairment in life activities (eg, taking care of household responsibilities and day-to-day work and/or school obligations) and/or social relationships (eg, creating and maintaining relationships, interacting appropriately with others). AND To learn the basic interpersonal skill and/or skills of independent living necessary to support sustained recovery, the patient requires therapist-led habilitative services with a high intensity therapeutic milieu. AND The patient is assessed as unable to safely and effectively learn these skills in a less intensive treatment setting 2. The patient otherwise meets Ability to Function Effectively in Current Environment criteria for treatment at Level 2.5 but lacks a safe and sufficiently supportive after-hours environment or requires an after-hours therapeutic milieu to effectively address functional impairment. AND The patient is unable to effectively participate in the rules-based milieu of a recovery residence (eg, insufficient interpersonal skills, inability to use community support without clinical guidance), or a recovery residence milieu is unlikely to provide sufficient support. 3. The patient otherwise meets Ability to Function Effectively in Current Environment criteria for treatment at Level 2.5 but is assessed as unlikely to reliably attend outpatient services. Level 3.1 - Risk Rating C Severe functional impairment , moderately severe functional impairment + - ReadMore Click to collapse 1. The patient has moderately severe functional impairment in life activities (eg, taking care of household responsibilities and day-to-day work and/or school obligations) and/or social relationships (eg, creating and maintaining relationships, interacting appropriately with others. AND To further develop the basic interpersonal skills and/or skills of independent living necessary to support sustained recovery, the patient requires 24-hour structure and support with a therapeutic milieu and opportunities to practice learned skills in the community on a limited basis. 2. The patient otherwise meets Ability to Function Effectively in Current Environment criteria for treatment at Level 2.1 but lacks a safe and sufficiently supportive after-hours environment or requires an after-hours therapeutic milieu to effectively address functional impairment. OR 3. The patient otherwise meets Ability to Function Effectively in Current Environment criteria for treatment at Level 2.1 but is assessed as unlikely to reliably attend outpatient services. Level 2.5 - Risk Rating B Impariment in life activities and in order to develop skills requires daily or near daily services + - ReadMore Click to collapse 1. The patient has severe functional impairment in life activities (eg, taking care of household responsibilities and day-to-day work and/or school obligations) and/or social relationships (eg, creating and maintaining relationships, interacting appropriately with others). AND To develop the basic interpersonal skills and/or skills of independent living necessary to support sustained recovery, the patient requires daily or near-daily high-intensity clinical services with a therapeutic milieu. Level 2.1 - Risk Rating A Moderate impairment in activities, requires services several times per wek or low intensity therapy. + - ReadMore Click to collapse 1. The patient has moderate functional impairment in life activities (eg, taking care of household responsibilities and day-to-day work and/or school obligations) and/or social relationships (eg, creating and maintaining relationships, interacting appropriately with others). AND To address these impairments and achieve recovery goals, the patient requires clinical services several times per week and/or a low-intensity therapeutic milieu. Any Level of Care - Risk Rating - ANY Functioning socially and in occupation, but not optimally, but do have interpersonal skills, functioning adequately + - ReadMore Click to collapse 1. The patient's functioning in social, occupational, or school settings is not optimal, but they have sufficient interpersonal skills and are able to function adequately in their current recovery environments (eg, home, social, work, school) to participate effectively in any level of care. Additional clinica services and case management can be provided as part of standard (ie, co-occurring capable) addiction treatment at any level of care. Needs - Risk Rating 0 1. The patient has no specific treatment needs related to their ability to function effectively in their current environments (eg, home, social, work, school).
SAFETY IN CURRENT ENVIRONMENT Level 3.1 - Risk Rating B No Specific Needs - Risk Rating 0		SAFETY IN CURRENT ENVIRONMENT Recovery Residence - Risk Rating A Current housing threatens safety and requieres different safe houseing + - ReadMore Click to collapse 1. The patient's current environment threatens their safety or well-being. AND The patient requires, at minimum, safe housing with appropriate support to safely participate in outpatient treatment. No Specific Needs - Risk Rating 0 1. The patient's current environment is safe
SUPPORT IN CURRENT ENVIRONMENT Level 3.1 - Risk Rating B Minimum Recovery Residence - Risk Rating A Any Level of Care - Risk Rating ANY No Specific Needs - Risk Rating 0 Reason why Risk Rating was chosen:		SUPPORT IN CURRENT ENVIRONMENT Level 3.1 - Risk Rating B Current environement will not provide sufficient support participation in outpatient treatment. + - ReadMore Click to collapse 1. The patient otherwise meets criteria for outpatient treatment, but, due to interactions in Dimensions 1, 2, 3, or 4, their recovery environment-including their home and/or a recovery residence-will not provide sufficient support or daily structure to allow for safe and effective participation in outpatient addiction treatment. Minimum Recovery Residence - Risk Rating A Current environment do not provide sufficient support and requires residential setting. + - ReadMore Click to collapse 1. The patient's current living and social environments do not provide sufficient support to help them cope with cravings to use or other recovery threats. AND The patient requires a safe, structured residential setting with a rules-based milieu to support participation in outpatient addiction treatment and is assessed as able to safely and effectively participate in the rules-based milieu of a recovery residence. Any Level of Care - Risk Rating - ANY Something in client's life isn't fully supportive to recovery, but is able to particiapte in recovery and treatment. + - ReadMore Click to collapse 1. One or more of the patient's current environments (eg, home, social, work, school) are not optimally supportive of recovery, but the patient is able to participate in outpatient treatment without residential or recovery residence support. No Specific Needs - Risk Rating 0 1. The patient's current environments (eg, home, social, work, school) are generally supportive of recovery.*
-------------------------------------------------------------------------		--------------------------------------------------------------------------------------------------------
Dimension 6: Person Centered Considerations
-------------------------------------------------------------		--------------------------------------------------------------------------------------
(Dimension 6 does NOT contribute to level of care recommendation) Level 0 Level 1 Level 2 Level 3 Level 4 Reason why Risk Rating was chosen:		(Dimension 6 does NOT contribute to level of care recommendation) Level 0 No barriers to care according client's preferences or culture, options, or environment Level 1 Some barriers to care according to client's preferences, culture, options and environment, but client is willing to work with clinician to find alternatives. Level 2 Some forms of treatment aren't an option due to person prefereance or barriers + - ReadMore Click to collapse More barriers to care, some methods, styles or forms of treatment aren't an option according to client's culture, options, preferences or environment. Examples: Work schedule isn't consistent Access to transportation isn't reliable or consistent Vehicle unreliable Bus schedule in conducive to work, life, and appointments Living situation stable but not ideal for care Level 3 Only a few options of treatment or care are available due to client's preferences, culture, options or environment. + - ReadMore Click to collapse Only a few options of treatment or care are available due to client's preferences, culture, options or environment. Examples: Work schedule interferes with some options Family obligations High Financial stress "couch hopping" for now Legal restrictions make it difficult to participate in care Level 4 Very few options available (if any) due to client's preferences, culture, option or environment. + - ReadMore Click to collapse Examples: Lack of access to transportation Legal restrictions No housing No money