THE RECOVERY CENTER - Maine Quality Counts

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... Scale with pt. their belief that they can be successful making needed changes with their Alcohol and or Drug Use. ... THE RECOVERY CENTER Author: rcuser Description:


|Date |TIME |Standing Orders: Screening – Brief Intervention- |Action | | | | |Referral to Substance Abuse Treatment |Taken | | | | | |Signatur| | | | | |e | | | | | | | | | | |SBIRT Stand Alone Apt | | | | | | | | | | | |SBIRT Integrated into Problem Focused Office Visit | | | | | | | | | | | |Complete initial high level SA Risk Screen | | | | | | For positive initial screen- Complete: | | | | | |Audit tool (ETOH) | | | | | |DAST (Drug or Poly Substance) | | | | | |CRAFFT (Adol. Pt. Only) | | | | | | Low Risk- Review results with pt., reinforce healthy | | | | | |consumption. | | | | | | Moderate Risk: Brief Intervention/Pt. Education | | | | | |Provide Education/Facts on Standard Drink measures | | | | | |Provide Education/Facts on Safer consumption volumes and | | | | | |implications on overall health/wellness management. | | | | | |Scale with pt., their belief that current consumption is | | | | | |or is not a problem; Scale with pt. their willingness to | | | | | |reduce consumption , Suggest to pt. reduction in | | | | | |consumption to comport with healthier consumption | | | | | |guidelines. | | | | | | Moderate High Risk- Brief Intervention/Referral to | | | | | |Treatment | | | | | |a Provide Education/Facts on Standard Drink measures | | | | | |b Provide Education/Facts on Safer consumption volumes| | | | | |and implications on overall health/wellness management. | | | | | |c Scale with pt., their belief that current | | | | | |consumption is or is not a problem; Scale with pt. their | | | | | |willingness to reduce consumption | | | | | |Refer to Specialty Addictions Treatment for Evaluation | | | | | |and recommendations. Referral provided to: | | | | | |____________________________________________ | | | | | |Follow Up with ______________________on the following | | | | | |date:__________ | | | | | |High Risk- Withdrawal Risk Assessed as part of Brief | | | | | |Intervention/Referral to Treatment | | | | | |COWS- Opioids: Score_________________ | | | | | |(Refer to Detox for scores of 10 or greater) | | | | | |CIWA- ETHO: Score__________________ (Refer to ED for | | | | | |scores of 8 or Higher) | | | | | |b Scale with pt., their belief that current | | | | | |consumption is or is not a problem; Scale with pt. their | | | | | |willingness to go to specialty care; Scale with pt. their| | | | | |belief that they can be successful making needed changes| | | | | |with their Alcohol and or Drug Use. | | | | | |c Refer to Specialty Addictions Treatment for Evaluation| | | | | |and recommendations. Referral provided to: | | | | | |___________________________________________________ | | | | | |d Follow Up with _____________________________ | | | | | |date:_____________ | | | | | |e Follow up clinician will spend ____________#of | | | | | |sessions to engage pt in plan for specialty care. | | | | | |Reassess results within 2 weeks of todays’ apt. | | | | | | Integrated BH Clinician Signature: | | | | | |_______________________Date:________ | | | | | |Provider Signature:_____________________ | | | | | |Date:_______________ | | |

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