Multidisciplinary, Residential Evaluation

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Multidisciplinary, Residential Evaluation

• Jackie Fazeli, RN, MSW
• Assessment Coordinator,
• Bradford Health Services
• Extended Care Program

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Objectives

• Components
• Indications
• Advantages/Disadvantages

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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)

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History

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

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Physical

• Hypertension
• Tachycardia
• Tremor
• Hepatomegaly
• Spider Angiomata

• Palmar Erythema
• Needle Marks
• Rosacea
• Peripheral Neuropathy

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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

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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

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Memory Testing

• Test for memory problems
• Attention/concentration and mental control skills
• are compared to the patients 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

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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.

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Neurocognitive Findings

• Split between verbal performance IQ
• gt 10 points
• Usually seen with alcohol, benzodiazepines,
  sedatives, polydrug
• Impaired visual spatial functions visual
  perceptual speed

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Psychiatric Evaluation

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

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Addiction Medicine Evaluation

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

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Occupational/Education Assessment

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

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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

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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

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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

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Additional Assessments If Indicated

• Pain Assessment
• Boundaries (sexual, professional)

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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)

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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

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Recommendations

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

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Referral Sources

• State Boards
• Monitoring Programs
• Employer
• Partners
• Self
• For return to work
• Family
• Attorney
• Wife, Friend
• Military
• School
• Interventionist

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Bradford Health ServicesExtended Care Program

• www.bradfordhealth.com
• 1111 Allbritton Road
• Warrior, Alabama 35180
• Jackie Fazeli, RN, MSW
• Assessment Coordinator
• [phone]