Determining level of care

“Determine the appropriate level of care” (NBCC, 2027 task 2B.7)

Clients need the least restrictive setting that can safely and effectively meet their needs. Counselors decide whether outpatient counseling is enough or whether a client needs intensive outpatient, partial hospitalization, residential or inpatient care. The exam tests the continuum of care and the factors that drive the decision.

Key points

The continuum runs from outpatient, to intensive outpatient, to partial hospitalization, to residential, to inpatient hospitalization, with increasing structure and supervision.
Key factors: imminent risk to self or others, ability to care for oneself, severity of symptoms, medical needs (including withdrawal), support at home, response to previous treatment and the client's motivation.
The ASAM Criteria provide a multidimensional framework commonly used for substance use level of care decisions.
Choose the least restrictive level that keeps the client safe and gives a realistic chance of progress.
Involuntary commitment criteria and procedures are set by state law; generally they involve danger to self or others or grave disability.
Level of care is reassessed as the client improves or deteriorates; stepping up or down is a normal part of care.
Coordinate transitions with releases of information so the next provider has what they need.

In practice

A client with worsening depression has stopped eating and attending work but has no suicidal intent and a supportive partner. The counselor recommends an intensive outpatient program for added structure, with weekly individual sessions continuing.

A client with severe alcohol use reports drinking a fifth of liquor daily and having had withdrawal seizures. The counselor recognizes that medically monitored withdrawal management is needed before outpatient counseling and arranges a referral that day.

Check yourself

What principle guides selection of a level of care?

Use the least restrictive setting that can safely and effectively meet the client's needs.

Name three factors that help determine level of care.

Risk of harm, severity and functioning, and medical needs such as withdrawal, along with support and treatment history.

What framework is widely used for substance use level of care decisions?

The ASAM Criteria, which assess several dimensions to match clients to a level of care.

NBCC's knowledge and skills for 2B. Assessment

Knowledge of: Foundational knowledge of statistics; Diagnostic criteria - DSM-5-TR; Diagnostic Criteria - ICD-11; Symptoms of trauma; Medical diagnoses and symptoms that can contribute to mental health symptoms; Differential diagnoses, co-occurring diagnoses, and comorbidities; Risk assessment and risk factors or symptoms; Cultural idioms of distress; Cultural implications of diagnosis.

Skill in: Conducting a diagnostic assessment and evaluation; Conducting and interpreting assessments; Conducting formal assessments; Conducting informal assessments; Conducting lethal means restriction.

A study guide written by ExamDragon from NBCC's published task; not NBCC material and not part of the exam.