UP-REFERRALS

If you’re searching for a higher level of care for your patient, we call this an ‘up-referral.’  Identifying the necessary ingredients of the desired treatment is key.  This may include initiating treatment for the first time, assisting with medical detoxification needs or establishing a more comprehensive psychological formulation for a patient.

From Outpatient to Intensive Outpatient

Intensive Outpatient (Level 2.1 Care) is a helpful referral for patients requiring more structure in their care, but not necessarily full medical detox support.  This level of care will require moderate to strong motivation for recovery by the patient.  Most IOP centers will require the person to abstain from drugs of abuse and alcohol during treatment.  If the patient is able to build some early recovery, these programs can help extend this to long-term recovery.  For patients unable to effectively quit the addiction cycle, look to residential treatment.

Some good TreatmentMatching ratings to look for include:

From Outpatient to Residential Care

For patients unable to break out of their addiction cycle, especially alcoholic patients, residential treatment with medical detox is often necessary.  Some residential treatment programs function at Level 3.7 which means they can manage detox needs effectively.

Extended care involves structured residential treatment, but without the medical detoxification component.  By definition, extended care is Level 3.5.  When making an up-referral for a patient requiring these levels, pay particular attention to this distinction.  Many extended care programs will not accept a patient requiring detox support.

For opioid addicted patients requiring residential treatment, pay particular attention to options for Medication-Assisted Treatment.  Most of these patients will require Buprenorphine medication to stabilize from opioid use.  After residential treatment, options for MAT for relapse prevention have become the standard of care for treating opioid addiction.  Look for the following TreatmentMatching ratings for an opioid dependent patient requiring a higher level of care:

   

 

DOWN-REFERRALS

This topic is for clinicians within addiction treatment programs, looking to navigate the continuum of care.  The full continuum progresses from residential treatment, through extended care, and into outpatient services.  Once in outpatient services, patients will also utilize an IOP program with or without sober living for a period of time until finally maintaining in outpatient care.  The art of the clinical referral is incredibly important for achieving good outcomes with patients.  Our Levels of Care ratings clearly delineate treatment programs according to the ASAM patient placement criteria.

From Residential to Extended Care

Following primary residential treatment, many patients need more time to continue building a stable life of recovery.  This transition is moving from ASAM Level 3.7 to Level 3.5.  The patient has completed any medical detox and has a moderate amount of emotional stability.  At the same time, this treatment route is necessary for patients who have very complex social situations, high risk for relapse if returning to their current lifestyle, and clinical needs including coping skills, structure, and life skills to function well independently.

A common clinical question for extended care referrals involves treatment center policies about MAT, specifically Buprenorphine medication.  Our TreatmentMatching ratings for MAT are designed to filter through programs that either do or do not accept continuum of care patients taking such medications.  If your patient is currently prescribed relapse prevention medication such as Buprenorphine and the extended care treatment program does not score for our MAT rating, make sure to coordinate directly with them, as they will likely require the patient to taper off such medication prior to transitioning.

For young adults looking to grow independently from their family, pay particular attention to the Voc rating.  Programs with these qualities have curriculum to assist with schooling, career development, or other job placement options.  These traits can be a useful treatment component during extended care, as this also enhances structure in their lives.

Finally, the extend of Dual Diagnosis needs for your patient must be taken into account when looking to refer to extended care.  Look for our Dual rating, as this means the extended care either employs or actively connects with psychiatrists during the course of treatment, allows patients to take psychotropic medications during treatment, and can effectively manage such conditions as moderate Major Depressive Disorder while in the care center.  If you are looking to make a referral for a patient with more severe dual diagnosis conditions (such as Bipolar Disorder, Schizophrenia, or Anorexia Nervosa), we recommend looking for our specialty program qualities.  Search for these criteria to better link you with the appropriate services.  We acknowledge that Dual Diagnosis care falls on a spectrum of health capacity - some programs have the staff and services to treat very advanced and complicated conditions, some programs can only treat certain levels of severity.

The following TreatmentMatching ratings should be considered for these above topics:

From Residential to IOP

Some patients can effectively transition down from structured residential treatment to Level 2.1 care, Intensive Outpatient.  When making this referral, we look for multiple markers of recovery capital in someone's life, such as stable employment, a healthy long-term relationship, adequate motivation for recovery, and stable psychiatric co-morbidities.  It is common for patients to prefer IOP referrals instead of Extended Care, even if the treatment team is primarily recommending more a structured continuum approach.  In these instances, having the ability to offer some appropriate treatment referrals is very helpful.

When appraising an IOP program, one of the most important ingredients involves their treatment philosophies.  Some programs emphasize a Peer Support approach, and we give these treamtent centers our Peer grading.  Some programs use more of a Cognitive Behavioral Therapy model of recovery, and we given them a CBT grade.

It also is important to understand insurance coverage and costs for an IOP program, as this can be a limiting factor for many patients.  Look for our Access rating to showcase programs that take public health insurance including Medicaid and Medicare.  These Access programs also could be low-cost or highly subsidized options to meet patients' needs.

Finding an Outpatient Provider

TreatmentMatching showcases therapists and physicians who identify themselves as dedicated Addiction Treatment Providers.  These clinicians understand the addiction treatment continuum of care, are well-connected with multiple treatment programs in a given area, and utilize evidence-based approaches for recovery.  They are often well-trained in Motivational Interviewing practices, have a thorough understanding of Peer Support Programs, and have the ability to hold patients accountable for their recovery.  For outpatient medical providers who prescribe Buprenorphine, Naltrexone, or specialized medications for smoking cessation, you will find our MAT rating.

Look for some of the following ratings to review an Outpatient Provider referral.  Clinicians with these scores are likely to provide the best services for your client.  We emphasize trauma-focused therapy, expertise in process addictions, CBT and skillfulness in treating professionals in recovery.

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