Transcript Multidiscipinary, Residential Evaluation

Multidisciplinary,
Residential Evaluation
Jackie Fazeli, RN, MSW
Assessment Coordinator,
Bradford Health Services
Extended Care Program
Objectives
 Components
 Indications
 Advantages/Disadvantages
Evaluation Components
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History and Physical (Internal Medicine Evaluation)
Laboratory Data
Psychological & Neurocognitive Testing
Psychiatric Evaluation
Addiction Medicine Evaluation
Occupational/Education Assessment
Family component
Therapeutic Community Milieu
Collateral Data
Nursing Assessment
Psychosocial Assessment
Polygraph (if indicated)
History
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Gout
Peptic Ulcer Disease / Gastritis/ Esophagitis
Hepatitis C
Pancreatitis
Atrial Fibrillation
Seizures
Sleep Disturbances
Physical
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Hypertension
Tachycardia
Tremor
Hepatomegaly
Spider Angiomata
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Palmar Erythema
Needle Marks
Rosacea
Peripheral
Neuropathy
Laboratory Data
•Liver enzyme tests (îSGOT, SGPT, GGT)
•Hyperlipidemia
•Macrocytosis
•Carbohydrate-Deficient Transferrin
•Drug Screening
Urine Drug Screening
EtG; ETs
Phosphatidyl Ethanol Bloodspot Test (PEth)
Saliva Testing
Hair Testing
Neurocognitive Testing
Intellectual Measures & Organic Screening
 Where patients function in the Verbal,
Performance and Full Scale area
 What areas does the patient function best in
 Areas the patient has problems in as it
relates to substance abuse
 Different drugs affect different areas
Memory Testing
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Test for memory problems
Attention/concentration and mental control skills
are compared to the patient’s other cognitive abilities
Also measures visual alertness, visual recognition,
and visual identification
Identifies any significant strengths or weaknesses in
each area
If the patient has severe organic impairments it
usually affects their memory
Personality Testing
Millon Clinical Mutiaxial Inventory - III [MCMI-III],
Minnesota, Multiphasic Personality Inventory - 2 [MMPI-2]
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Assists with identifying any emotional issues, as well as
psychiatric and personality disorders
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Scales to address addiction and addiction potential
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Document emotional and personality variables which may
affect treatment.
Neurocognitive Findings
Split between verbal & performance IQ
• > 10 points
• Usually seen with alcohol,
benzodiazepines, sedatives, polydrug
• Impaired visual spatial functions & visual
perceptual speed
Psychiatric Evaluation
• Depressive Disorders
• Anxiety Disorders
• ADD/ADHD
• Bipolar Disorders
• Axis II Diagnosis
Medication Management
Appropriate Level of Care
Addiction Medicine Evaluation
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Diagnoses
Medical issues
Level of care
Determine other collateral information
needed (i.e. hospitalizations, medical
providers)
Occupational/Education
Assessment
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All past employers
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Reasons for changing jobs
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Past board issues in other states, etc.
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Potential collateral sources
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Problems in school
Family Component
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The family therapist meets with patient,
obtains releases of information
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Makes contact with pertinent
family/friends regarding family history
and any concerns they have about
possible substance, behaviors
Therapeutic community
Housed
in cottages with other peers who
are in evaluation phase and/or treatment
Attend
groups and 12-Step meetings
Attend
1st Step presentations
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“mirror image” off others in the
community
Collateral Data
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Current employer/partners/office staff are contacted to obtain
collateral information regarding their concerns
Sponsor if indicated
Questions regarding patient/coworker complaints; suspected
impairment on the job; diversion of drugs from the workplace;
behaviors; etc…
Have to know the “right” questions to ask
If other than self referral the referral source is contacted
(board/monitoring program; interventionist; employer)
Patient may be asked to sign releases of information for other
individuals that the team feels may have information critical to
the evaluation (i.e. former employer, psychiatrist, therapist,
medical providers, and medical records from previous
hospitalizations).
School
Additional Assessments
If Indicated
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Pain Assessment
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Boundaries (sexual, professional)
Indications for Residential
Evaluation
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Healthcare Professional
Unclear diagnosis (Rule out/Rule In)
Intervention (Secondary)
Determine Level of Care Needed
Fit to Return to Duty
Relapse Issues (not only use but behavior)
Advantages
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Thorough evaluation
Therapeutic Community
Multidisciplinary
Teamwork vs. Splitting
Stories Change
Greater opportunities to challenge inconsistencies
(through collateral information, lab results, etc…)
Disadvantages
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Cost
Travel
Perceived Conflict of Interest
Recommendations
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Patient meets with team to review
findings and recommendations
Each component is reviewed
Diagnoses explained/criteria
Consequences are at the forefront
Referral Sources
State Boards
Monitoring Programs
Employer
Partners
Self
For return to work
Family
Attorney
Wife, Friend
Military
School
Interventionist
Bradford Health Services
Extended Care Program
www.bradfordhealth.com
1111 Allbritton Road
Warrior, Alabama 35180
Jackie Fazeli, RN, MSW
Assessment Coordinator
(205) 907-4820