Frequently asked questions

General

What's the difference between The ASAM Criteria and Continuum?

The ASAM Criteria is the most widely used and comprehensive text of guidelines for treating patients with substance use disorders. Continuum is a software which guides clinicians through a standardized ASAM Criteria assessment and assists them with determining the least intensive, but safe and appropriate level of care placement. Continuum and The ASAM Criteria should be used in tandem—the text provides background and guidance for proper use of the software, and the software enables comprehensive, standardized evaluation. With Continuum, clinicians can easily conduct a comprehensive biopsychosocial patient risk and needs assessment along all six ASAM Criteria dimensions while determining The ASAM Criteria levels of care recommendation.

What’s the difference between Continuum and Co-Triage?

Both are clinical decision support tools that assess individuals with substance use disorders and co-occurring conditions and can identify ASAM dimensional needs that require immediate medical attention including any withdrawal, co-occurring or bio-medically enhanced conditions. Co-Triage is a brief, provisional assessment that generates an initial level of care placement recommendation where the patient may receive a comprehensive assessment. Continuum is a comprehensive biopsychosocial assessment that generates two thorough patient reports that detail DSM-5-TR SUD diagnoses, severity and imminent risks as well as a recommended level of care determination.

Which tool is right for me?

How has Continuum been tested and validated?

Multiple controlled studies were conducted with the earlier versions of The ASAM Criteria software on which Continuum is based. Alpha testing was done for three years in ten centers across Norway. Beta testing was conducted in Milwaukee County in their Central Intake Centers. The National Demonstration Project tested the software for six months in real-world, routine clinical practice with 20 systems across the US.

Will Continuum be released in another language?

Continuum is currently only available in English. The platform has been programmed so it can be easily translated into other languages. In fact, Continuum was successfully tested in Norway and translations have been made into French and Norwegian. ASAM, the Continuum developer, will be conducting surveys to determine what languages it will be translated into.

Software integration and distributor information

How does Continuum look in my software?

The appearance of Continuum may vary based on the EHR vendor and technological setup of the user.

What if I don't have an EHR?

FEI Systems offers a lite front-end system that is fully integrated with the Continuum software.

Does Continuum work with all EHRs?

Continuum and Co-Triage are available through any EHR platform or other practice management or billing software that stores patient data. Please reference our Authorized Distributors page to view current authorized distributors. If Continuum is not integrated with your EHR, please discuss your interest in Continuum with your EHR representative. ASAM and FEI Systems can provide further technical and integration information to interested EHRs.

How can I become a distributor of Continuum?

Please visit the Developer page and Authorized Distributor page for more details.

How long does it take to integrate Continuum?

The length of integration varies based on the EHR technical department and degree of integration that is desired. On average, integration can be completed in 10 to 12 weeks.

I don't want to go through a third-party vendor, can I purchase Continuum directly from ASAM?

Yes. FEI Systems provides a lite front-end system to access ASAM’s tools and can discuss this option further with interested customers.

Can Continuum be integrated with our online web application?

Yes.

Can Continuum be integrated into speech software?

ASAM has not yet developed this capability.

Clinical use

What level of expertise is needed to use Continuum and Co-Triage?

Continuum and Co-Triage are computer-guided, structured interview tools that assist clinicians and non-clinicians in conducting expert level assessments for individuals with substance use disorders and co-occurring conditions. Clinicians, counselors and other addiction treatment staff for whom biopsychosocial assessment is within the scope of their practice can conduct a Continuum assessment. Non-clinicians, with training and supervision can conduct a Co-Triage assessment. ASAM does not require specific credentials to use the tool when conducting assessments, however, states or other regulatory bodies may have specific requirements around who is considered qualified to conduct an assessment.

Are there training or certification requirement to purchase Continuum?

There is no training or certification required to purchase Continuum, however, it’s recommended that providers participate in our Continuum training modules to appropriately navigate and utilize the software. ASAM provides several training options, including a live training course instructed by clinicians, a self-paced online course and a hybrid course of live and self-paced instruction.

How long does it usually take to complete Continuum and Co-Triage assessments?

The average time to complete a Co-Triage assessment is 10 minutes. The time to complete an intake Continuum assessment is variable depending on the complexity of the patient, but on average it takes 60 minutes to complete for an experienced clinician. There is a learning curve in that the first 15-20 assessments may take longer as the clinician becomes familiar and experienced with the tool. These first 15-20 can take between 90 minutes to two hours for an intake assessment.    

Continuum can be used to reassess a patient, which typically takes 30 minutes to complete. The clinician has the option to pull forward responses from the previous assessment when completing a reassessment. 

How does the Continuum assessment improve treatment retention?

Research has demonstrated that patients who are matched to treatment with Continuum are more likely to engage in treatment. More than half of patients incorrectly matched to treatment dropped out, compared to about a third of patients who were matched with Continuum. Patients also exhibit two to three times better multidimensional outcomes at three months.

Can Continuum collect before and after treatment measures to assess patient growth, continued treatment needs and other patient outcomes?

Yes. Continuum is designed for reassessment over time. Statistical information on treatment outcomes can be obtained from the DSM-5-TR diagnostic calculations, the Addiction Severity Index sub-scale composite scores and the CIWA/CINA withdrawal scores. More detailed views of pre- vs. post-treatment may be derived from comparing individual items or groups of items over time.

How often should a patient receive a Continuum assessment?

There is no required schedule for conducting a Continuum interview. The Continuum assessment should be administered according to the agency’s policies.

Will patient misrepresentation affect the level of care recommendation?

Yes. Continuum and Co-Triage require a clinical relationship and process. It is possible for misrepresentation to confound any clinical process; however, the thoroughness and multiple perspectives obtained through the Continuum’s structured interview are designed to reduce this risk. Furthermore, interviewers are prompted to consider patient comprehension and misrepresentation in each major section of the interview process and to rate these parameters.

Does Continuum meet Joint Commission and CARF requirements?

Continuum is a comprehensive biopsychosocial assessment that collects much of the information required in reporting for Joint Commission and CARF accreditation. Continuum’s items are based on The ASAM Criteria, decision rules and validated assessments, such as the CIWA, CINA and ASI. This means the Continuum items as written may not elicit all the information required by these accrediting bodies. However, the comments box may be used to capture supplementary information.

How does the Continuum incorporate the ASI composite scores to measure change in patient outcomes?

Continuum internally calculates the Addiction Severity Index (ASI) composite scores for all seven subscales: medical, employment, alcohol, drug, legal, family/social and psychological. These scores, on a 0–1.000 scale, may be compared across time-points to measure change over time. EHR developers are given instructions (API code) to access these ASI scores, so the change scores can be calculated within the EHR for clients.

How is tobacco use disorder addressed in Continuum?

Tobacco use disorder, according to DSM-5-TR, is a formal, diagnosable substance use disorder. The ASAM Criteria, therefore, recommends screening and treatment services for tobacco use disorder should be available at all levels of care and intensities of treatment.

Why does Continuum ask for the patient's blood pressure and heart rate?

In Continuum, blood pressure and heart rate items are presented as a “yes/no” item. It is understood that some interviewers/agencies do not have the capacity to collect clinical measures of this sort. When blood pressure and heart rate can be assessed, the Continuum algorithm uses these to determine the need for withdrawal management.

If the program has a client experiencing homelessness, what should they enter in the assessment?

In Co-Triage, there is an item in Dimension 6 of the screener which provides a response option reflecting instability of the living environment or homelessness. In the General Information section of the Continuum assessment, the information icon for the item determining residential status instructs the interviewer on how to respond if the patient is unhoused. The tool’s goal is to assess the functional impact of housing or homelessness on the patient’s risk for continued use or relapse. The ASAM Criteria 2013 edition specifies the importance of determining if the “living…environment is not supportive of good mental health functioning,” specifically, whether “the patient is unable to cope with continuing stresses caused by homelessness.” The mere state of homelessness alone is not prescriptive, however, as to the patient’s needs. Further details on homelessness and how it affects the patient should be entered into the Comment box at the end of the Family and Social History section. These comments will be printed in the Narrative Report print-out.

How does the Continuum assessment incorporate questions related to sexual history and gambling behaviors?

Continuum specifically prompts the interviewer to assess risks for sexual abuse during the interview. As in any clinical assessment process, if further details emerge, the interviewer is empowered to gather this information, and it should be recorded in further depth in the Comments box at the end of the Family and Social History section. Gambling disorder is not specifically assessed or diagnosed in Continuum or Co-Triage, as it does not directly participate in guiding level of care decision-making. Gambling behavior is, however, an important concern for some patients, and Continuum does prompt the interviewer to probe for any behaviors that may adversely impact readiness for recovery and risk for continued use or relapse to substance use. If such behaviors include gambling, the interviewer is empowered to indicate this in the Comments box at the end of multiple sections. Appropriate places for gambling problem comments may include the Drug and Alcohol, Employment, Legal Information, Family and Social History and/or Psychological sections. These comments will appear in the Narrative Report print-out.

How would I adapt the Continuum for adolescent use?

Continuum and Co-Triage are built on The ASAM Criteria’s adult standards, therefore, it’s not appropriate for use with patients under the age of 18. Continuum does not assess the developmental and cognitive nuance present for individuals 18 and under and therefore cannot make an accurate level of care recommendation or assessment. At present, there are no adolescent versions of the Continuum or Co-Triage assessments.

Can Continuum be used in criminal justice settings?

Continuum is currently in use within several criminal justice settings across the U.S. If the patient will re-enter the community within a few months after assessment, a Continuum Re-entry Interview Script Enhancement (RISE) configuration of the Third edition software is available. This version takes into account the context of the controlled environment in producing the appropriate level of care to which the patient should be referred to upon their release.

For administrators

How do I setup a Continuum demo, and is it free?

Yes. A Continuum demo is free. Request a demo.

How do I know if Continuum or Co-Triage are right for me?

Which tool is best for me?

If you’re interested in a more detailed discussion, please contact us or request a demo.

What is the benefit of using the software?

Research shows improved patient outcomes, including 30 percent better patient retention and two to three times better multidimensional outcomes at the three-month mark. The Continuum software also streamlines and more easily secures revenue through care authorization.

How much does Continuum and Co-Triage cost?

If your EHR is not currently an authorized distributor, there is an initial $4,000 integration fee for EHRs, which includes customer support, and a $1,000 implementation technical support fee. The retail price of Continuum is $504 per user per year with a discount applied with 50 or more subscriptions. Resellers of Continuum may charge up to $504 per user per year.

Does Continuum ease the billing process?

Continuum can reduce your staff’s utilization review burden, improve payment authorization and save patient worry. Programs in the product beta test and demonstration project phases reported substantial numbers of hours saved per patient on prior authorization and utilization review—with both commercial and public payers. Reports output from the Continuum assessments can be submitted for the utilization review process to indicate level of care recommended based on Continuum’s ASAM-endorsed ASAM Criteria assessment.

Other key ways that the Continuum can assist with the billing and utilization review process are:

Organizing all critical information for effective managed care evaluations
Tracking progress of individuals as they move along The ASAM Criteria continuum of care
Assessing effectiveness of treatment with quantitative outcomes
Evaluating consistency of practice
Identifying gaps in treatment
Reporting on access to care issues and other needs in the health system

Are the training modules free?

No, training is an additional charge and varies depending on training format.

How can I purchase Continuum and Co-Triage?

Continuum can be purchased directly through an authorized distributor or FEI Systems. ASAM is working with several health technology companies (typically companies that offer EHR systems) on a non-exclusive basis to offer Continuum to the providers.

Can I purchase Continuum or Co-Triage separately?

Yes, subscriptions for Continuum and Co-Triage must be purchased separately. During the integration process, both tools are incorporated into the EHR platform, however, subscriptions need to be purchased separately.

Does Co-Triage come with Continuum?

No, Co-Triage requires a separate license.

Am I required to buy a subscription to use Continuum?

Yes, you are required to purchase a subscription to access the Continuum. For more information on pricing, please visit the distributors page.

How many assessments can a user give?

Users can conduct an unlimited number of assessments once they have access to the Continuum.

What types of systems benefit from the use of Continuum?

Continuum can be implemented in a variety of settings, including:

Public health

Criminal justice

Private health systems

Key Features	ASAM CONTINUUM	ASAM CO-Triage
Used By	Behavioral health and specialty SUD treatment programs	Behavioral health intake centers, non-addiction specific or emergency medical settings
Administered By	All members of the behavioral health clinical care team, including counselors, social workers, and medical staff	Clinicians, probation officers, social workers, first responders, recovery support service staff, and other non-clinicians supervised by an SUD specialist
Administration Time	~60 minutes	~10 minutes
Outputs	Comprehensive level of care recommendation Summary and Narrative reports that include information essential to patient diagnosis and treatment planning	Provisional level of care recommendation A report that includes dimensional scoring, provisional care recommendation
Key Benefits	Standardize the assessment process to produce more accurate patient placement and treatment planning Improve patient outcomes and reduce no-shows Streamline the utilization management process Collect data for program evaluations and to inform policy decisions	Quickly assess patient’s overall needs Increase the likelihood that patients are referred to the appropriate level of care Streamline the referral process by sharing key problems and needs from program to program
Annual Cost of Subscription	$504/user*	$144/user*

Frequently asked questions

General

Software integration and distributor information

Clinical use

For administrators

Which tool is best for you?

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