Appendix C—Glossary

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

Dual diagnosis—A diagnosis that includes a concurrent substance use disorder(s) and a psychiatric disorder(s).

Eligibility criteria—Factors which determine whether a patient may receive treatment. These include: financial status, insurance coverage, age, severity of illness, geographic location, and whether a patient is a member of a special population.

Employee assistance program (EAP)—A department or organization created or hired by an employer organization to provide its employees with health, mental health, and AOD treatment services or to refer them to other providers.

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 placement criteria.

Incremental charges—Charges for treatment that start at a fixed rate for core-level treatment, with additional charges for each "unit" of treatment.

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

Intensity of service—The degree or extent to which a treatment or service is provided, which depends on a patient's level of need. Some treatments—for example, medically managed inpatient treatment, are inherently more intensive than other treatments—for example, outpatient treatment or a halfway house. The provision of other services, such as vocational training, can be more or less intense, depending on patient needs. (See level of care.)

Level of care—As used in the ASAM criteria, this term refers to four broad areas of treatment placement, ranging from inpatient to outpatient. Other levels of care within this range, such as therapeutic communities, have been described in other criteria.

Managed care—An approach to delivering health and mental health services that seeks to improve the cost effectiveness of care (i.e., improved services at reduced cost) by monitoring service seeking 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).

Matching—A process of individualizing treatment resources to a patient's needs and preferences based on careful assessment. Matching has been shown to increase treatment retention, and thus improve treatment outcomes. It also improves resource allocation by ensuring that patients receive the appropriate level of care and intensity of services. (See continuum of care, unbundling).

Modality—A specific type of treatment (technique, method, or procedure) that is used to relieve symptoms or induce behavior change. Modalities of AOD abuse treatment include, for example, inpatient social milieu treatment, group therapy, and individual AOD counseling.

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

Outcomes monitoring—Collection and analysis of data from persons in AOD abuse treatment to determine the effects of treatment, especially in relation to improvements in functioning (treatment 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 expenditure of public funds.

Patient—An individual receiving AOD abuse treatment. The terms client and patient are sometimes used interchangeably, although persons in medical settings more commonly use the term patient.

Patient placement criteria (PPC)—Standards of, or guidelines for, AOD abuse treatment that describe specific conditions under which patients should be admitted to a particular level of care (admission criteria), under which they should continue to remain in that level of care (continued stay criteria), and under which they should be discharged or transferred to another level (discharge/transfer criteria). PPC generally describe the settings, staff, and services appropriate to each level of care and establish guidelines based on AOD diagnosis and other specific areas of patient assessment.

Placement—Selection of an appropriate level of care, based on assessment of individual needs and preferences.

Private sector—The network of for-profit and not-for-profit AOD abuse treatment agencies, operated primarily with private rather than public funds. In general, treatment in the private sector is paid for by the patient or by private insurance. Many agencies in the private sector have developed their own patient placement criteria.

Public sector—The network of AOD abuse treatment providers supported by public (Federal, State, and local) funds. Within each State, public-sector agencies are overseen by a single State AOD agency that disburses funds. Several States have developed their own patient placement criteria.

Rationing—The act of limiting treatment or other services to certain individuals or populations, usually due to limited resources.

Setting—A specific place in which treatment is delivered. Settings for AOD abuse treatment include hospitals, methadone clinics, community mental health centers, and prisons or jails.

Single State AOD agency (SSA)—The agency in each State that functions to establish policies, disburse funds, and provide budget and program oversight for AOD abuse treatment within that State. In addition to State funds, the SSAs disburse funds from the Substance Abuse Prevention and Treatment Block Grant.

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

Unbundling—A approach to treatment that seeks to provide the appropriate combination of specific services to match a patient's needs. The goal of unbundling is to provide an array of options for flexible individualized treatment, which can be delivered in a variety of settings.

Uniform Patient Placement Criteria (UPPC)—A set of patient placement criteria, not yet developed, that would provide national standards for assessing and treating patients with AOD abuse disorders and that would be used by all providers in the public sector and private sector.