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Appendix I

Appendix II

Acknowledgements

Appendix I

Wisconsin Uniform Placement Criteria (WI-UPC)

In recognition of the changing health care climate, the Wisconsin Bureau of Substance Abuse

Services, in close collaboration with the State Council on Alcohol and Other Drug Abuse and key treatment, insurance industry and managed care representatives, entered into a project in 1994 to develop and implement uniform placement criteria for substance abuse treatment in Wisconsin. The placement criteria, which evolved through this process, takes into account individual needs of the patient. It represents the full continuum of care ranging from residential to outpatient treatment service and all levels of detoxification services.

Purpose and Concept of Uniform Placement Criteria 

Development of WI-UPC for the State of Wisconsin was based upon the goal of establishing a common set of standards that will be accepted by providers, payers and agencies that develop public policy in Wisconsin. WI-UPC, when accepted by all stakeholders in the field of substance abuse treatment, promotes consistency in the identification of the patient's individual needs as well as formalizing the decision-making process. This in turn leads to the effective placement of the patient in the most appropriate, least restrictive treatment setting.

There are a variety of advantages associated with WI-UPC, including the following:

• WI-UPC developed a common language which describes the multidimensional assessment process and identifies the core components of the continuum of care. This enables clinicians, patients and payers to discuss treatment planning, utilizing a common language with uniform definitions of levels of care.
• WI-UPC helps to address placement consistency by ensuring that patients obtain treatment based upon appropriateness rather than on funding limitations or program availability. Conversely, WI-UPC helps to minimize costs by ensuring that patients obtain appropriate treatment based on agreed-upon criteria.
• WI-UPC has led to the adoption of uniform definitions, common standards of program admission, continued stay and discharge criteria in order to standardize a statewide system of care. This process offers a framework applicable to both public and private treatment and payer systems.
• WI-UPC provides a guideline that focuses upon the least intrusive and least restrictive form of treatment based upon the patient's individual needs as identified within standardized criteria.

• WI-UPC will lead to the standardized collection of data that will be useful in the development of evaluation studies to assess the efficacy of placement and treatment outcome.

Wisconsin Uniform Placement Criteria

Patient placement recommendations are determined by evaluating five dimensions of a patient's condition or status. These dimensions are:

1. Withdrawal Potential
2. Physical/Mental Health Condition(s) and/or Complication(s)
3. Emotional/Behavioral Condition(s) and/or Complication(s)
4. Relapse Potential
5. Recovery Environment
6. The WI-UPC is used for initial placement. Appropriate placement is determined by matching individual patient characteristics within each of these dimensions with the frequency and intensity of services needed as indicated by the patient's symptoms.

WI-UPC Levels of Care Rehabilitation Services

Level 1-A -- Transitional Residential Treatment Service

Level 1 -- Outpatient Treatment Service

Level 2 -- Day Treatment Service

Level 3 -- Medically Monitored Treatment Service

Level 4 -- Medically Managed Inpatient Treatment Service

Level 1-A

Transitional Residential Treatment Service

A clinically supervised, peer-supported therapeutic environment with clinical involvement. The service provides substance abuse treatment in the form of counseling for 3 to 11 hours per weekly.

Level 1

Outpatient Treatment Service

An ambulatory service totaling less than twelve hours of clinical services per week.

Level 2

Day Treatment Service

A medically monitored, structured, ambulatory service. The service consists of regularly scheduled sessions totaling a minimum of twelve hours weekly with at least three hours per day, four days per week.

Level 3

Medically Monitored Treatment Service

A medically monitored community or hospital based 24 hour non-ambulatory service which includes observation and monitoring under the supervision of a physician.

Level 4

Medically Managed Inpatient Treatment Service

Inpatient treatment service provided in a general or specialty hospital with 24 hour nursing care, physician management, and all the resources of a hospital.

Appendix II

References

CASAWORKS for Families. A Treatment and Training Program for Substance Abusing Women on Welfare and Their Families. The National Center on Addiction and Substance Abuse at Columbia University, (August 1998).

Center for Substance Abuse Treatment. Comprehensive Case Management for Substance Abuse Treatment, Treatment Improvement Protocol (TIP) Series 27. Rockville, MD: Department of Health and Human Services, (1998).

Center for Substance Abuse Treatment. Substance Abuse Treatment and Domestic Violence, Treatment Improvement Protocol (TIP) Series 25. Rockville, MD: Department of Health and Human Services, (1997).

Center for Substance Abuse Treatment. Welfare Reform and Substance Abuse Treatment Confidentiality: General Guidance for Reconciling Need to Know and Privacy, Technical Assistance Publication Series 24. Rockville, MD: Department of Health and Human Services, (1999).

Center for Substance Abuse Treatment. Practical Approaches in the Treatment of Women Who Abuse Alcohol or Other Drugs. Rockville, MD: Department of Health and Human Services, Public Health Service, (1994).

Covington, S., Surrey, J. The Relational Model of Women's Psychological Development: Implications for Substance Abuse. (1995).

Feinberg, F., et. al. Treatment Standards for AODA Services to Women. (1996).

Kirby, G., Pavetti, L., Kauff, J., and Tapogna, J. Integrating Alcohol and Drug Treatment Into a Work-Oriented Welfare Program: Lessons from Oregon. Mathematica Policy Research, Inc., (June 1999).

The National Alliance for the Mentally Ill (NAMI) Wisconsin. Family and Consumer Resource Guide, 4th Edition.

National Institute on Drug Abuse. A Collection of NIDA Notes Articles on Women, Gender Differences, and Drug Abuse. (1997).

Steps to Success. Helping Women with Alcohol and Drug Problems Move from Welfare to Work. Funded by Annie E. Casey Foundation. Legal Action Center, New York, New York, (May 1999).

Substance Abuse Services in Wisconsin 1998 Annual Report. Department of Health and Family Services, Division of Supportive Living, Bureau of Substance Abuse Services, (July 1999).

Wisconsin Works (W-2) Policy Manual. Releases 98-01 (January 1998) through 99-01
(March 1999).

 Acknowledgements

The Governor's W-2 & AODA Task Force would like to express our thanks to the following people for their contributions to this valuable project: Bill Adams, La Crosse County Human Services Department; Jim Jones, Kenosha County Community Intervention Center; Dan Hinton, Winnebago County Department of Community Programs; Virginia Halvensleben and Dr. George Krebs, Rock County Human Services Department; Ellie McLaughlin, Oneida Social Services; Pam Garrett and Dr. Sam Mak, Gateway Recovery; Michael Bauer and Reverend Dr. Bobbie Groth, Milwaukee Women's Center; Sheryl Dean, Meta House; Robyn Saviano and Sharon Sinclair, DHFS; Margaret McMahon, Yanmira Roswell-Yustiz, and Sharon Royston, DWD.