multidisciplinary, residential evaluation jackie fazeli, rn, msw assessment coordinator, bradford...
TRANSCRIPT
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