Brief Overview of the Seven Domains
AccessHSI uses an innovative 7 Diagnostic Domain approach developed by leaders in the mental health industry keenly aware of the challenges confronting providers, facilities and care management organizations. Using a 7 Diagnostic Domains approach, the whole patient is realized, meaning it doesn't matter if a patient's issue is a traumatic childhood full of abuse, a drinking problem, or problems with their medication.
AccessHSI breaks down a patient's life into domains, and assesses what's going on in all the parts, so it might be one domain that stands out or several. No part of a patient is discounted or less important than any other. So when Level of care recommendations are determined by algorithms based on standard medical necessity guidelines used across todays leading care management organizations, our users will know that predjudice and poor documentation won't be an issue. Every part of the patient's story is important to us.
The Symptom Severity domain is used to record whether the patient has a Mental Health disorder, Substance Abuse disorder, or dual diagnosis, and if the patient has an eating disorder. It is also used to record and verify the patient’s Axis I and II diagnoses. Item 1 requires you to make a sequence of responses. First, click on one of the radio buttons in the column on the left to record whether the patient has a Mental Health disorder, a Substance Abuse disorder, or a MH and SA dual diagnosis. If you select “mental health (MH) alone the eating disorder check box labeled “eating disorder” enables. Click on the check box if the patient has an eating disorder.
The next step is to verify the diagnosis. While verifying the diagnosis is optional, it is strongly recommended (a) to assure that the selected diagnosis is correct and (b) to create a complete clinical record. To verify the diagnosis, click the “Verify” link to the right of the diagnosis. A list of symptoms associated with the selected diagnosis will open. The symptoms are presented in categories corresponding to the DSM-IV-TR clinical criteria for the diagnosis. Using the check boxes, indicate which symptoms are exhibited by the patient. Then click the Submit button at the bottom of the window (at the end of the list).
Item 3 is used to record information about the patient’s alcohol and drug abuse. You can enter detailed information for up to four substances. Enter information about the primary substance in the fields to the right of the label “Primary”. Click on the first drop down field to select the substance (e.g., alcohol, street drugs), the second field to select the frequency of use (e.g., daily, 1 to 2 X per week), and the third field to select the route (e.g., oral, smoked, intravenous). The field labeled “Amount” allows you to enter a description of the amount of the substance using text or numbers. Enter the patient’s “Age at first use” by typing a number into the field, and indicate the “Date of last use” by typing in a date or click on the calendar icon to open the pop-up calendar and select a date. A drop down box is provided to indicate how long the patient has been continuously using the substance.
The primary focus of the Lethality domain is the patient’s risk for suicide or homicide, or being gravely disabled, and factors that could contribute to the patient’s risk status such as depression, impulsiveness, hallucinations, delusions, intoxication, or a history of risk.
If there is “no observable presence of lethality” selected in question 1, questions 2 through 6 remain hidden. If either “a clear presence of lethality” or “a potential for lethality” are selected, the questions will enable and the page automatically expands to show the various options.
The focus of the Functional Impairment domain is the patient’s ability or impairments in fulfilling his/her role obligations in their everyday activities. Taken together, the items in this domain comprise the information used to determine a patient’s GAF Score (Global Assessment of Functioning) for an Axis 5 diagnosis.
Item 1 asks if the patient has any co-morbid medical conditions, how well they are being controlled or managed, and if a delay in treatment for the patient’s mental health or substance abuse condition would negatively impact any of the medical conditions.
If the patient has one or more co-morbid medical conditions, either type in the CPT code and the values will be presented or click the “Search” link to open the ICD-9 diagnosis search window to find the diagnosis code and label.
The focus of the Provider Resources domain is the patient’s history of treatment, and requirements for special services upon admission to treatment, change in level of care, or continuation at the same level of care.
What is a “treatment failure”?
A treatment failure refers to a person having completed treatment at a specific level of care, or is currently receiving treatment at a specific level of care, and the patient’s symptoms are becoming more severe or her level of function is getting worse such that it is unlikely that her symptom severity or level of functioning will improve at that LOC or any alternate lower level of care. Consequently, it is likely that the person will require a higher level of care. In the case of substance abuse, relapse is the primary indicator of treatment failure. In eating disorders, ongoing weight loss is the primary indicator of treatment failure in anorexia, and frequency of purging is the primary indicator in bulimia. In all instances, it is important to establish that the patient was in fact motivated for and compliant with treatment as a prerequisite to determining treatment to be a failure.