In our review of screening and assessment tools, we found two diagnostic criteria manuals - the Diagnostic and Statistical Manual - IV (DSM IV) and the American Society of Addiction Medicine (ASAM) Patient Placement Criteria - 2. The DSM IV and the ASAM criteria are not tools per se and are applicable to both mental health and substance abuse problems. Experts indicated that the DSM IV and ASAM criteria should only be used by a trained clinician and not by a layperson.
The DSM IV is a descriptive classification system published by the American Psychiatric Association and, as a system, is used to assess clients (but it is not an assessment tool per se). It provides clinical guidelines to tell the clinician whether symptoms are present and provides a list of symptoms. Clinicians rely on these guidelines in making diagnoses, often for medical insurance purposes. However, the application of these guidelines may vary their application by clinicians.
The ASAM criteria provides two sets of guidelines, one for adults and one for adolescents, and five levels of service for each group. The levels of service are:
Intensive Outpatient/Partial Hospitalization Services
Medically-Managed Intensive Inpatient Services69.
For each level of care, a brief overview of the services available by severity of addiction/illness and related problems is presented. Also presented is a structured description of the settings, staff and services, admission, continued service, and discharge criteria. The terminology used in ASAM has been updated to be consistent with the most recent language of the American Psychiatric Association's DSM IV.
In some states, the DSM IV and ASAM criteria are being used in relation to TANF either onsite or offsite. Clinically trained professionals - such as staff holding Masters of Social Work degrees - co-located onsite in TANF offices may use the DSM IV or ASAM criteria after clients have positively screened for mental health or substance abuse problems using one of the multi-barrier tools. Alternatively, a TANF client who is referred for services may receive a further diagnosis from an offsite clinical professional using the DSM IV and ASAM. Finally, the DSM IV or ASAM could be used as the foundation or guidelines for developing screening or assessment tools.
Officials in Utah specifically mentioned the use of DSM IV and ASAM criteria when the initial, multi-barrier screening tool suggests the possibility of a mental health problem. If a TANF client screens positive for mental health issues from the multi-barrier tool, the client is referred to a credentialed social worker. Social workers are located throughout the state in TANF offices and apply the DSM IV and the ASAM criteria. If a client is diagnosed as positive for substance abuse or a mental health disorder, they are referred to an offsite provider for further assessment and treatment.
69 American Society of Addiction Medicine (ASAM). Second Edition of Patient Placement Criteria, Annapolis Junction, MD, 1996.