Multidisciplinary, Residential Evaluation

1. Multidisciplinary, Residential Evaluation Jackie Fazeli, RN, MSW Assessment Coordinator, Bradford Health Services Extended Care Program

2. Objectives • Components • Indications • Advantages/Disadvantages

3. 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)

4. History • Gout • Peptic Ulcer Disease / Gastritis/ Esophagitis • Hepatitis C • Pancreatitis • Atrial Fibrillation • Seizures • Sleep Disturbances

5. Hypertension Tachycardia Tremor Hepatomegaly Spider Angiomata Palmar Erythema Needle Marks Rosacea Peripheral Neuropathy Physical

6. 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

7. 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

8. 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

9. 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.

10. Neurocognitive Findings Split between verbal & performance IQ • > 10 points • Usually seen with alcohol, benzodiazepines, sedatives, polydrug • Impaired visual spatial functions & visual perceptual speed

11. Psychiatric Evaluation • Depressive Disorders • Anxiety Disorders • ADD/ADHD • Bipolar Disorders • Axis II Diagnosis Medication Management Appropriate Level of Care

12. Addiction Medicine Evaluation • Diagnoses • Medical issues • Level of care • Determine other collateral information needed (i.e. hospitalizations, medical providers)

13. Occupational/Education Assessment • All past employers • Reasons for changing jobs • Past board issues in other states, etc. • Potential collateral sources • Problems in school

14. 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

15. 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

16. 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

17. Additional Assessments If Indicated • Pain Assessment • Boundaries (sexual, professional)

18. 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)

19. 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

20. Recommendations • Patient meets with team to review findings and recommendations • Each component is reviewed • Diagnoses explained/criteria • Consequences are at the forefront

21. Referral Sources State Boards Monitoring Programs Employer Partners Self For return to work Family Attorney Wife, Friend Military School Interventionist

22. Bradford Health ServicesExtended Care Program www.bradfordhealth.com 1111 Allbritton Road Warrior, Alabama 35180 Jackie Fazeli, RN, MSW Assessment Coordinator (205) 907-4820