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Alcohol and Drug Abuse Treatment Center Admission Criteria

Regional Referral Form for Admission to a State Psychiatric Hospital or ADATC (DOC, 82 KB)

Flow Chart Decision Tree for Admission to ADATC Acute Care Unit (PPT, 438 KB)

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There are two types of admissions to ADATCs: Acute Rehabilitation Services (ARS) and Acute Care (ACU).

Acute Care (Scheduled) Services

Acute Care (Scheduled) Services admissions are referred to the Alcohol and Drug Abuse Treatment Center (ADATC) through "Single Portal of Entry" agreements with the Local Management Entities (LMEs)/Managed Care Organization (MCO) or their contract agents/providers within their region.

Prior to admission, the LMEs/MCOs will ensure that individuals meet the ADATC admission criteria and that the ADATC is the most appropriate site for treatment.  The LME/MCO will assess appropriateness for placement as defined by ASAM level III.7 or other widely accepted criteria. The individual should also be assessed as meeting the diagnostic criteria for Psychoactive Substance Use disorder as defined by the current Diagnostic and Statistical Manual of Mental Disorders (DSM) or other standardized and widely accepted criteria.  Individuals under the age of 18 are not admitted.  Patients meeting special population criteria (HIV/AIDS, communicable disease, IV drug users and pregnant women) are given priority status during admission. 

Referral Process

The Regional Referral Form for Admission to a State Psychiatric Hospital or ADATC (PDF, 82KB) will be faxed to The Admissions Office. After referral information is screened for appropriateness, the Admissions Office will provide an admission date and time, pending bed availability. 

Reasons for Denial

The following conditions may preclude full participation in the ARS treatment program:

• Clinical condition that would prevent the individual from participating in the treatment program.
• Exhibiting bizarre or violent behavior or ideation, or acute psychosis such that the person is dangerous to himself and/or others and who would be better managed on an intensive acute unit.
• Suicidal or homicidal ideations.
• Dangerous to him/herself and/or others and is in need of more intensive monitoring.
• Medical Acuity.
• The ADATC complies with the Medical Clearance Policy to screen for medical issues.
• LME/MCO Provider referrals or direct court referrals without appropriate required clinical assessment and documentation are subject to denial. 

On the Day of Admission

The admission evaluation process occurs between the hours of 8am and 5pm Monday – Friday. In order to complete the admission process (which includes medical and psychiatric evaluations and nursing screenings), individuals must arrive at the scheduled time as assigned by the Admission Office. The transporter of the referred individual is asked to remain until completion of screening by the Admission Team.

Upon arrival and successful completion of initial processing, the potential patient will be screened and evaluated by the Admission Team to determine appropriateness for admission.  If admission is recommended, the transporter of the patient will be cleared to leave after he/she has spoken to a family counselor.  If admission must be denied, the transporter of the referred individual will be asked to return the individual to the referral source.  In all cases of denial of admission, the Admissions Office will fax a copy of the denial to the LME/MCO referral source. The Admissions Office will also notify the Facility Director, Medical Director, Program Director and Utilization Review Nurse of any denials.

Scheduled Admissions Office Contacts

Hours of admission are 8 a.m. – 5 p.m. daily, except weekends and holidays

Julian F. Keith

Admissions Coordinator
(828) 257-6230
(828) 257-6231 fax

R.J. Blackley

Admissions Coordinator
919-575-7000
919-575-7001 fax

Walter B. Jones

Admissions Coordinator
(252) 707-5009
(252) 752-6137 fax

Acute Care (Emergency) Services

Admissions

Acute Care (Emergency) Services shall accept for admission, upon the order of the attending physician, any individual in need of stabilization services who has a substance related disorder, including those patients that have an additional co-occurring psychiatric illness, who meet the following general admission guidelines:

1. The person served may be on involuntary commitment for substance abuse or mental illness or the person must be referred/authorized by a local management entity (LME)/ Managed Care Organization (MCO) or an approved representative within the region. 
2. A decision for admission is facilitated through a collaborative discussion between the ADATC staff, the referring source, LME/MCO and Medical Staff as needed, to determine appropriateness.  Medical Staff will utilize the Division’s Medical Clearance Policy to help guide these decisions.  Information about the referred patient should be faxed to the ADATC using the Regional Referral form.  Patients meeting special population criteria (HIV/AIDS, intravenous (IV) Drug Users, and pregnant women) are given priority status during admission.
3. Pregnant patients may need stabilization and detoxification at an ASAM IV level of care before they can be accepted. Pregnant patients are considered high priority for access to state ADATC services. Pregnancy referrals should be immediately referred for consideration to the ADATC Medical Staff which will work with ADATC Leadership to ensure access to services as quickly as possible.
4. The LME/MCO will assess appropriateness for placement as defined by the American Society of Addiction Medicine (ASAM) level III.9 (NC Division of MH/DD/SA modified ASAM level of care reflecting Level IV on Dimension 3 and Level III.7 on Dimension 1 and 2).
5. Individuals under the age of 18 are not admitted.
6. If a patient is on medication that cannot be interrupted and is not immediately available at the ADATC, then a supply of medications (as deemed necessary by the referring physician in consultation with the ADATC Medical Staff) will be sent with the patient. 
7. The transporter of the patient is asked to remain until completion of screening by the Admission Team.
8. Patients that have co-morbid Psychiatric and SA diagnosis are reviewed on a case by case basis.  The following issues will be reviewed to make the determination for admission: level of aggression or homicidal ideation, delirium, high active suicide risk, disorientation, degree of psychoses, severe dissociative states, refusal to take meds, forensic patients with high elopement risk, legal involvement, House bill (HB) or Senate bill (SB) detainer status, patients needing prolonged psychiatric stabilization, Clozaril patients, hearing impaired individuals, etc.

Acute Care (Emergency) Services are designed to assist individuals who:

1. Have incapacitating distress and/or gross dysfunction with an inability to care for self or maintain sobriety due to any of the following: Suicidal/Homicidal Ideations, Depression, Severe anxiety, Hallucinations, Delusions, Periods of disorientation or have memory impairment, Panic, Obsessive-Compulsive behaviors, Psychomotor agitation or retardation, Alcohol/Drug abuse or dependence 
2. Experience toxic effects and potentially dangerous withdrawal symptoms from psychotropic drugs, alcohol, prescription, and /or illegal drugs. 
3. Have a need for supervised medication management.
4. Have a diagnosed mental illness and/or substance abuse disorder and in need of active professional monitoring and treatment of behavior, mood or thought disorder.
5. Have difficulty making sufficient clinical gains within a traditional outpatient setting. 
6. Have been discharged from an inpatient setting and need further daily monitoring and support and cannot be served in ARS. 

Emergency Admissions Office Contacts

Julian F. Keith

Charge Nurse
(828) 257-6265
(828) 257-6268 fax
24/7/365 Admissions

R.J. Blackley

Charge Nurse
919-810-5174
919-575-7001 fax

Walter B. Jones

Charge Nurse
(252) 707-5159/5160
(252) 695-9047 fax
24/7/365 Admissions