Multidisciplinary, Residential Evaluation

Jackie Fazeli, RN, MSWAssessment Coordinator,Bradford Health ServicesExtended Care Program

Objectives

Components

Indications

Advantages/Disadvantages

Evaluation Components 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

Gout Peptic Ulcer Disease / Gastritis/ Esophagitis Hepatitis C Pancreatitis Atrial Fibrillation Seizures Sleep Disturbances

Physical

Hypertension Tachycardia Tremor Hepatomegaly Spider Angiomata

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 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]

Assists with identifying any emotional issues, as well as psychiatric and personality disorders

Scales to address addiction and addiction potential

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

Diagnoses Medical issues Level of care Determine other collateral information

needed (i.e. hospitalizations, medical providers)

Occupational/Education Assessment All past employers

Reasons for changing jobs

Past board issues in other states, etc.

Potential collateral sources

Problems in school

Family Component

The family therapist meets with patient, obtains releases of information

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

Can “mirror image” off others in the community

Collateral Data 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

Pain Assessment

Boundaries (sexual, professional)

Indications for Residential Evaluation

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

Thorough evaluation Therapeutic Community Multidisciplinary Teamwork vs. Splitting Stories Change Greater opportunities to challenge inconsistencies

(through collateral information, lab results, etc…)

Disadvantages Cost Travel Perceived Conflict of Interest

Recommendations

Patient meets with team to review findings and recommendations

Each component is reviewed Diagnoses explained/criteria Consequences are at the forefront

Referral SourcesState Boards Monitoring ProgramsEmployerPartnersSelfFor return to workFamilyAttorneyWife, FriendMilitarySchoolInterventionist

Bradford Health ServicesExtended Care Program

www.bradfordhealth.com

1111 Allbritton Road

Warrior, Alabama 35180

Jackie Fazeli, RN, MSW

Assessment Coordinator

(205) 907-4820