FHIR Implementation Guide for NJSAMS
1.0.0 - release
1.0.0 - release
NJSAMS - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Official URL: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/Questionnaire/Dimension4 | Version: 1.0.0 | |||
| Draft as of 2022-08-31 | Computable Name: | |||
Justification for level of care score (see ServiceRequest) in Dimension 4
Generated Narrative: Questionnaire Dimension4
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  | Justification for level of care score (see ServiceRequest) in Dimension 4 | Questionnaire | https://fhir.njsams.rutgers.edu/NJSAMS-fhir/Questionnaire/Dimension4#1.0.0 | |
  LOCI3Dimension4 | null | 0..1 | group | |
  Level0.5 | LEVEL 0.5 - EARLY INTERVENTION | 0..1 | group | |
  LOCI3Dimension4.D4Level0_5EIa | a. Willing to gain understanding of how current addictive behavior and/or use of alcohol, tobacco, and/or other drugs may be harmful or impair ability to meet responsibilities and achieve personal goals. | 0..1 | boolean | |
| Level1 | LEVEL 1 - OUTPATIENT SERVICES | 0..1 | group | |
| LOCI3Dimension4.Level1.D4Level1OPa | a. Willing to participate in treatment planning and attend all scheduled activities mutually agreed upon in the treatment plan; AND | 0..1 | boolean | |
| LOCI3Dimension4.Level1.D4Level1OPb | b. Acknowledges a substance-related or other addictive disorder and/or mental health problem and wants help to change; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level1.D4Level1OPc | c. Ambivalent about a substance-related or other addictive disorder and/or mental health condition. Requires monitoring and motivating strategies, but not a structured milieu program; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level1.D4Level1OPd | d. May not recognize the substance-related or other addictive disorder and/or mental health problem. May require monitoring and motivating strategies to engage in treatment and to progress through stages of change. | 0..1 | boolean | |
| Level2_1_OUTPATIENT | LEVEL 2.1 - INTENSIVE OUTPATIENT | 0..1 | group | |
| LOCI3Dimension4.Level2_1_OUTPATIENT.D4Level2_1IOPa | a. Requires structured therapy and a programmatic milieu to promote treatment progress and recovery because motivational interventions at another level of care have failed. Such interventions are not feasible or are not likely to succeed in a Level 1 program; AND | 0..1 | boolean | |
| LOCI3Dimension4.Level2_1_OUTPATIENT.D4Level2_1IOPb | b. Perspective inhibits ability to make behavioral changes without repeated, structured, clinically directed motivational interventions. Such interventions are not feasible or are not likely to succeed in a Level 1 program. However, patient’s willingness to participate in treatment and explore level of awareness and readiness to change suggest treatment at Level 2.1 can be effective. | 0..1 | boolean | |
| Level2_1_Enhanced | LEVEL 2.1 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension4.Level2_1_Enhanced.D4Level2_1DDEa | a. Reluctant to agree to treatment, ambivalent about commitment to change a co-occurring mental health problem; AND | 0..1 | boolean | |
| LOCI3Dimension4.Level2_1_Enhanced.D4Level2_1DDEb | b. Requires intensive services to improve awareness of the need to change. Such limited awareness of or commitment to change that patient cannot maintain an adequate level of functioning without Level 2.1 services; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level2_1_Enhanced.D4Level2_1DDEc | c. Follow through in treatment is so poor or inconsistent that Level 1 services are not succeeding or feasible. | 0..1 | boolean | |
| Level2_5_SERVICES | LEVEL 2.5 - PARTIAL HOSPITALIZATION SERVICES | 0..1 | group | |
| LOCI3Dimension4.Level2_5_SERVICES.D4Level2_5PHa | a. Requires structured therapy and a programmatic milieu to promote treatment progress and recovery because motivational interventions at another level of care have failed. Such interventions are not feasible or are not likely to succeed in a Level 2.1 program; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level2_5_SERVICES.D4Level2_5PHb | b. Patient’s perspective and lack of impulse control inhibit ability to make behavioral changes without repeated,structured, clinically directed motivational interventions, which are not feasible or unlikely to succeed in a Level 1 or Level 2.1 program. However, patient’s willingness to participate in treatment and explore level of awareness and readiness to change suggest that treatment at Level 2.5 can be effective. | 0..1 | boolean | |
| Level2_5_Enhanced | LEVEL 2.5 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension4.Level2_5_Enhanced.D4Level2_5DDEa | a. Little awareness of co-occurring mental disorder; AND | 0..1 | boolean | |
| LOCI3Dimension4.Level2_5_Enhanced.D4Level2_5DDEb | b. Requires more intensive engagement, community, or case management services than are available at Level 2.1 in order to maintain an adequate level of functioning; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level2_5_Enhanced.D4Level2_5DDEc | c. Follow through in treatment is so poor or inconsistent that Level 2.1 services are not succeeding or feasible. | 0..1 | boolean | |
| Level3_1_TREATMENT | LEVEL 3.1 - CLINICALLLY MANAGED LOW-INTENSITY RESIDENTIAL TREATMENT | 0..1 | group | |
| LOCI3Dimension4.Level3_1_TREATMENT.D4Level3_1HHa | a. Acknowledges existence of a psychiatric condition and/or substance use problem. Recognizes specific negative consequences and dysfunctional behaviors and their effect on desire to change. Patient sufficiently ready to change and cooperative enough to respond to treatment at Level 3.1; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_1_TREATMENT.D4Level3_1HHb | b. Appropriately placed at Level 1 or 2 and is receiving Level 3.1 services concurrently. May be at early stage of readiness to change and thus in need of engagement and motivational strategies; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_1_TREATMENT.D4Level3_1HHc | c. Requires a 24-hour structured milieu to promote treatment progress and recovery, because motivating interventions have failed in the past and are assessed as not likely to succeed in an outpatient setting; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_1_TREATMENT.D4Level3_1HHd | d. Perspective impairs ability to make behavior changes without structured environment support. Interventions assessed as not likely to succeed in outpatient setting. | 0..1 | boolean | |
| Level3_1_Enhanced | LEVEL 3.1 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension4.Level3_1_Enhanced.D4Level3_1DDEa | a.Ambivalence in commitment to change and reluctance to engage in activities necessary to address a co-occurring mental health problem. Patient is placed in the appropriate benchmark of a Level 3 co-occurring enhanced program [3.1, 3.3, 3.5, 3.7] when he/she is not consistently able to follow through with treatment,demonstrates minimal awareness of a problem, or is unaware of need to change. Such patient requires active interventions with family, significant others, and other external systems to create leverage and align incentives to promote engagement treatment. | 0..1 | boolean | |
| Level3_3_SERVICES | LEVEL 3.3 - CLINICALLY MANAGED POPULATION SPECIFIC HIGH-INTENSITY RESIDENTIAL SERVICES | 0..1 | group | |
| LOCI3Dimension4.Level3_3_SERVICES.D4Level3_3LTRa | a. Due to intensity and chronicity of the addictive disorder or cognitive limitations, patient has little awareness of need for continuing care or existence of substance use or mental health problem and need for treatment; thus has limited readiness to change; AND | 0..1 | boolean | |
| LOCI3Dimension4.Level3_3_SERVICES.D4Level3_3LTRb | b. Despite experiencing serious consequences or effects of the addictive disorder or mental health problem, patient has marked difficulty in understanding relationship between substance use, addiction, mental health, or life problems, and impaired coping skills and level of functioning; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_3_SERVICES.D4Level3_3LTRc | c. Continued substance use poses danger of harm to self or others, and patient demonstrates no awareness of need to address the severity of addiction or psychiatric problem or does not recognize need for treatment. Treatment interventions available at Level 3.3 may increase patient’s degree of readiness to change; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_3_SERVICES.D4Level3_3LTRd | d. Patient’s perspective impairs ability to make behavior changes without repeated, structured, clinically directed motivational interventions, delivered in a 24-hour milieu. Interventions in an outpatient setting are assessed as not feasible or likely to succeed. | 0..1 | boolean | |
| Level3_3_Enhanced | LEVEL 3.3 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension4.Level3_3_Enhanced.D4Level3_3DDEa | a.Ambivalence in commitment to change and reluctance to engage in activities necessary to address a co-occurring mental health problem. Patient is placed in the appropriate benchmark of a Level 3 co-occurring enhanced program [3.1, 3.3, 3.5, 3.7] when he/she is not consistently able to follow through with treatment,demonstrates minimal awareness of a problem, or is unaware of need to change. Such patient requires active interventions with family, significant others, and other external systems to create leverage and align incentives to promote engagement treatment. | 0..1 | boolean | |
| Level3_5_TREATMENT | LEVEL 3.5 - CLINICALLY MANAGED HIGH INTENSITY RESIDENTIAL TREATMENT | 0..1 | group | |
| LOCI3Dimension4.Level3_5_TREATMENT.D4Level3_5LTRa | a. Due to intensity and chronicity of addictive disorder or mental health problems, patient has limited insight and awareness of the need for continuing care or existence of substance use or mental health problem and need for treatment, thus limited readiness to change; AND | 0..1 | boolean | |
| LOCI3Dimension4.Level3_5_TREATMENT.D4Level3_5LTRb | b. Despite experiencing serious consequences or effects of the addictive disorder or mental health problem, patient has marked difficulty in understanding relationship between substance use, addiction, mental health, or life problems and impaired coping skills and level of functioning, often blaming others for general or alcohol- or drug-specific problems; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_5_TREATMENT.D4Level3_5LTRc | c. Patient demonstrates passive or active opposition to addressing severity of mental or addiction problem, or does not recognize need for treatment. Such continued substance use or inability to follow through with mental health treatment poses danger of harm to self or others. Treatment available at Level 3.5 may increase patient’s degree of readiness to change; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_5_TREATMENT.D4Level3_5LTRd | d. Requires structured therapy and a 24-hour programmatic milieu to promote treatment progress and recovery, because motivational interventions have not succeeded at less intensive levels of care and such interventions are assessed as not likely to succeed at a less intensive level of care; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_5_TREATMENT.D4Level3_5LTRe | e. Patient’s perspective impairs ability to make behavior changes without repeated, structured, clinically directed motivational interventions, which will enable patient to develop insight into the role he/she plays in substance use and/or mental condition, and empower him/her to make behavioral changes, which can only be delivered in a 24-hour milieu; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_5_TREATMENT.D4Level3_5LTRf | f. Despite recognition of substance use or addictive behavior problem and understanding of relationship between substance use, addiction, and life problems, patient expresses little to no interest in changing. Due to intensity or chronicity of patient’s addictive disorder and high-risk criminogenic needs, patient in imminent danger of continued substance use or addictive behavior. This poses imminent serious life consequences and/or continued pattern of risk of harm to others while under the influence of substances; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_5_TREATMENT.D4Level3_5LTRg | g. Attributes alcohol, drug, addictive, or mental health problem to other persons or external events, rather than substance use or addictive or mental disorder. Requires clinical directed motivation interventions to enable patient to develop insight into the role he/she plays in health condition, and empower him/her to make changes. Interventions adjudged as not feasible or unlikely succeed at a less intensive level of care. | 0..1 | boolean | |
| Level3_5_Enhanced | LEVEL 3.5 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension4.Level3_5_Enhanced.D4Level3_5DDEa | a.Ambivalence in commitment to change and reluctance to engage in activities necessary to address a co-occurring mental health problem. Patient is placed in the appropriate benchmark of a Level 3 co-occurring enhanced program [3.1, 3.3, 3.5, 3.7] when he/she is not consistently able to follow through with treatment,demonstrates minimal awareness of a problem, or is unaware of need to change. Such patient requires active interventions with family, significant others, and other external systems to create leverage and align incentives to promote engagement treatment. | 0..1 | boolean | |
| Level3_7_TREATMENT | LEVEL 3.7 - MEDICALLY MONITORED INPATIENT TREATMENT | 0..1 | group | |
| LOCI3Dimension4.Level3_7_TREATMENT.D4Level3_7STRa | a. Despite experiencing serious consequences or effects of the addictive disorder and/or behavioral health problem, patient does not accept or relate addictive disorder to severity of the presenting problem; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_7_TREATMENT.D4Level3_7STRb | b. In need of intensive motivating strategies, activities,and processes available only in a 24-hour structured,medically monitored setting; OR | 0..1 | boolean | |
| LOCI3Dimension4.Level3_7_TREATMENT.D4Level3_7STRc | c. Needs ongoing 24-hour psychiatric monitoring to assure follow through with treatment regimen, and to deal with issues such as ambivalence about adherence to psychiatric medications and a recovery program. | 0..1 | boolean | |
| Level3_7_Enhanced | LEVEL 3.7 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension4.Level3_7_Enhanced.D4Level3_7DDEa | a.Ambivalence in commitment to change and reluctance to engage in activities necessary to address a co-occurring mental health problem. Patient is placed in the appropriate benchmark of a Level 3 co-occurring enhanced program [3.1, 3.3, 3.5, 3.7] when he/she is not consistently able to follow through with treatment,demonstrates minimal awareness of a problem, or is unaware of need to change. Such patient requires active interventions with family, significant others, and other external systems to create leverage and align incentives to promote engagement treatment. | 0..1 | boolean | |
| Documentation for this format | ||||