To fully understand the different ASAM Levels of Care and appropriate matching of services to patient needs, refer to the Service Planning and Placement chapter in The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions (2013). !LxVB6Qh(x7QE|YF522zq"5BM].niIA6Abg 61A88 Q%oX+1~X0!Sx)A, 1atp=iq XX_o0"""zT~X 08pL oK9V Receive updates from ASAM regarding CME, online education, and events on a variety of addiction-related topics. Formerly known as the ASAM patient placement Receive the latest news and updates from ASAM's science, health technology, quality care, and publications. The American Society of Addiction Medicine (ASAM) has separate assessment criteria for adolescents and adults and determines levels of care by using both levels of treatment and dimensions. Called the Medically Monitored High-Intensity Inpatient Services for adolescents and Medically Monitored Intensive Inpatient Services Withdrawal Management for adults, this level of care provides 24-hour nursing care with a physicians availability for significant problems in Dimensions 1, 2, or 3. professional clinical counselor interns (PCCIs). five broad levels of treatment that are based on the degree of direct medical management provided, the structure, safety and security provided, and the intensity of treatment services provided. Subscribe>>>. on avoiding common pitfalls. 3. Home Subscribe>>>, Receive the latest news and updates from ASAM's science, health technology, quality care, and publications. Certification currently covers adult residential programs at levels 3.1, 3.5, and 3.7 of The ASAM Criteria. intensive level of carte. 2112 0 obj <>stream 485 0 obj <>stream This information is used to determine III. A detailed description of the services typically offered in this level of care, the care setting, and how to identify what patients would benefit best from these services based on an ASAM dimensional needs assessment, begins on page 265 of The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions (2013). Level 2 encompasses services that are capable of meeting the complex needs of people with addiction and co-occurring conditions. Called Partial Hospitalization Services for adolescents and adults, this level of care typically provides 20 or more hours of service a week for multidimensional instability that does not require 24-hour care. and can create an ASAM Level of Care determination. endstream endobj 2071 0 obj <>stream Ask additional questions about CONTINUUM products and more. only way to be certain that a program has this ability. 2023 Rating Element Updates are effective January 15, 2023, The ASAM Level of Care Certification Manualdescribes the level of care standards derived fromThe ASAM Criteria, the rating elements that will be assessed during the certification survey, and the policies, in the future. Subscribe>>>, Receive timely and useful news briefings of top stories in addiction policy, combined with ASAM developments related to national and state addiction medicine advocacy. I`v^yoerD3N:[;gt>o+,\{03z^|v4y9X;9gou1k\Uy_I0K8U ?X=r`%JD c$\9" "&`(( PG @ r C64%>$Bhg*Fr-V 5-ZT_AtR&.BqAlxax?fa_ 3 by Train for Change Inc. are tailored to the organization with the goal of guiding and supporting successful conformance with the rating elements and standards necessary to achieve the relative level(s) of care certification(s). validated health risk assessment tool that meets regulatory requirements for the care delivery setting and . View, The ASAM Level of Care Certification Preparation Workbookoutlines the rating elements that will be assessed by certification surveyors and provides a template for programs to conduct self-assessments to identify strengths and areas for improvement. Subscribe>>>. defines the standards for conducting a comprehensive biopsychosocial assessment to inform patient placement and treatment planning. he ASAM Criteria. endstream endobj startxref that, when determining service and care recommendations, he ASAM Criteria . Join leaders in the field of addiction medicine. l5Y|AY5 V$. Called Medically Managed Intensive Inpatient Services for adolescents and adults, this level of care offers 24-hour nursing care and daily physician care for severe, unstable problems in ASAM Dimensions 1, 2 or 3. Counseling is available 16 hours a day to engage patients in treatment. Yes No Referral source: Self Access/Crisis Line (ACL) Drug Dependency Court . American Society of Addiction Medicine is the Nations leading addiction medicine society representing physicians, clinicians and other professionals. These levels of care (Levels 0.5-4) span a continuum of care that represent various levels of care. The ASAM Level of Care Certification Program provides an independent assessment of a treatment programs ability to deliver services consistent withThe ASAM Criteria. 5 0 obj It does not dictate a particular standard of care or speciic treatment decisions. WithThe ASAM Criteria, managed care organizations can easily work with treatment providers to ensure plan participants are receiving the treatment that best fits their needs and that resources are wisely used. Adolescent and adult treatment plans are developed through a multidimensional patient assessment over Receive updates from ASAM regarding CME, online education, and events on a variety of addiction-related topics. Called Outpatient Services for adolescents and adults, this level of care typically consists of less than 9 hours of service/week for adults, or less than 6 hours a week for adolescents for recovery or motivational enhancement therapies and strategies. find treatment programs capable of delivering a specific level of care, use the advanced search feature to select the appropriate level of care from the "Program" drop down menu. Developed by ASAM and the UCLA Integrated Substance Abuse Programs with funding from the California Department of Health Care Services, this addiction treatment resource supports increased quality and consistency of patient assessments and individualized, patient-centered care. American Society of Addiction Medicine. All rights reserved. VK} endobj The ASAM CriteriaAssessment Interview Guide is the first publicly available standardized version of the ASAM Criteriaassessment. apply for and successfully complete a recertification survey. Because it is paper-based, offered free to all clinicians, and can be used in many different clinical contexts, the Guide enhances the public utility of The ASAM Criterias multidimensional assessment approach for the addiction treatment community. The ASAM CONTINUUM Helps you to assess the needs of your patient quickly and accurately LEARN How The ASAM CONTINUUM Collect information across the six dimensions of The ASAM Criteria LEARN How The ASAM CONTINUUM Easily print out assessment reports to include in the patient's file or for utilization management purposes LEARN HOW 2021 American Society of Addiction Medicine. pays attention to the whole patient, including all of his or her life areas, as well as all risks, needs, strengths, and goals. of rating elements applicable to the applied-for Level(s) of Care and issue an independent certification decision. %DK%>kEYzT+S5BjoQ5/!#1QN:EW]W'oOx? Subscribe>>>. Definition: American Society of Addiction Medicine (ASAM)'s Level of Care is a fancy way of saying "the amount of treatment a person needs to recover." Using the ASAM criteria to determine how severe the person's needs are, this should be reassessed often throughout treatment, usually every 30-90 days.. Today the criteria have become the most widely used and comprehensive set of guidelines . More information about oversight and revision: 2021 American Society of Addiction Medicine. The levels of care include: Degree of direct medical management provided Structure Safety Security provided Intensity of treatment services provided ASAM CONTINUUM is an electronic assessment tool that allows clinicians, counselors, and other staff to leverage a computerized clinical decision support system (CDSS) to assess individuals with addictive substance use disorders and co-occurring conditions. Have a question about government service? hbbd```b``"gIg`DeFH f$'4eY H2&+@$C($Mfd`30R NU procedures, and systems a program should have in place to meet the standards. Complete all Diagnostic Determination Tools and Stay Reviews for program treatment clients. endstream endobj 2067 0 obj <>/Metadata 244 0 R/OCProperties<>/OCGs[2091 0 R]>>/Outlines 500 0 R/Pages 2062 0 R/StructTreeRoot 547 0 R/Type/Catalog/ViewerPreferences<>>> endobj 2068 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 30/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 2069 0 obj <>stream <> Keep in mind that . XcAWGpnZ@l;Kn+_Y 8]L{Y. _z&6IC).EYX'[]#Myg`-E4hSKKPb4nQV`~,j" y#-y>+V+vg}L>7/x_"bV,{ w, -flPW;D3hRfGgx',-AJt@*~U!%4 )NJ0Joe8J^j'- z#ddw$["h(Q`R+(x({oGx0KNh!ECj `Rn!$8~=)N&cKC*v8$ 2L=v%L@?=$ Qn >psoaCl^CaBY>^pinTUc is an educational tool. 5600 Fishers Lane, Rockville, MD 20857 Licensed-eligible LPHAs are psychological assistants, associate social workers (ASWs), marriage and therapy family interns (MFTI/IMFT). Brief ASAM Screening Tool Client Name: _____ City/geographic r egion: _____ Were responses provided by a third party? Receive the latest news and updates from ASAM's science, health technology, quality care, and publications. Course Hero is not sponsored or endorsed by any college or university. A detailed description of the services typically offered in this level of care, the care setting and how to identify what patients would benefit best from these services based on an ASAM dimensional needs assessment, begins on page 184 of The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions (2013). All rights reserved. 2021 American Society of Addiction Medicine. ASAM CONTINUUM. n Outpatient Treatment (Level 1.0): Dimensions 1, 2, 3, 5 and 6 only mild problems. The ASAM levels of care include: 3 Level 0.5, which is called Early Intervention. Receive updates from ASAM regarding CME, online education, and events on a variety of addiction-related topics. A web-based tool to assist treatment providers in determining appropriate levels of care for clients. Visit SAMHSA on Instagram Switch to Chrome, Edge, Firefox or Safari, Visit the SAMHSA Facebook page To develop updated rating elements, ASAM and CARF completed a review of over two years of data from the ASAM Level of Care Certification. %PDF-1.5 % The ASAM Level of Care Certification gives patients, loved ones, payors, and regulators the knowledge that a given treatment program is capable of administering evidence-based addiction treatment that is appropriately matched to a patient's individual needs. is an educational tool. Timeline (Subject to Change) endstream General Approach. Increasing patient access to evidence-based addiction treatment is critical to overcoming the devastating and deadly challenges of addiction. <> A detailed description of the services typically offered in this level of care, the care setting and how to identify what patients would benefit best from these services based on an ASAM dimensional needs assessment begins on page 280 of The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions (2013). For treatment providers,The ASAM Criteriaprovides a holistic approach for determining individualized and outcome-driven treatment plans for patients. in a plan of action submitted to CARF and annually attest to continued satisfaction of the applicable rating elements. y1vrHDDj[NR[5M w[+W$\n1A6,[n_An(}vn+[mDDDTZ'zeh|k]m Dimensions 5 and 6 are potentially problematic. With the ASAMCONTINUUM, clinicians are able to conduct a multidimensional assessment that explores individual risks and needs, as well as strengths, skills and resources. Subscribe>>>, Receive timely and useful news briefings of top stories in addiction policy, combined with ASAM developments related to national and state addiction medicine advocacy. However, ASAM Level of Care Certification is the ASAM Level of Care Certification demonstrates a programs capacity to deliver a specific Level of Care, thereby differentiating between the many Levels of Care available for addiction treatment. When patients and their loved ones see the ASAM Level of Care certification seal, they will feel secure in knowing that the treatment program is equipped to deliver the evidence-based treatment needed.. ASAM Criteria Levels of Care Level Same Levels of Care for Adolescents except Level 3.3 Early Intervention 0.5 Assessment and education for at risk individuals who do not meet diagnostic criteria for Substance-Related Disorder Outpatient Services 1 Less than 9 hours of service/week (adults); less than 6 hours/week (adolescents) . Subscribe>>>, Join leaders in the field of addiction medicine, https://sitefinitystorage.blob.core.windows.net/sitefinity-production-blobs/images/default-source/continuum/continuum.png?sfvrsn=34de0e37_0, https://www.asam.org/asam-criteria/asam-criteria-software/asam-continuum/contact-us/distributors. who it pertains unless otherwise permitted by law. Visit CARF's provider locator and search "ASAM" to find all certified programs. The ASAM Criteriadefines the standards for conducting a comprehensive biopsychosocial assessment to inform patient placement and treatment planning. This means it pays attention to the whole patient, including all of his or her life areas, as well as all risks, needs, strengths and goals. Recommendation III.1: Level of care determination should be based on a patient's current signs and symptoms; level of risk for developing severe or complicated withdrawal or complications of withdrawal; and other dimensions such as recovery capital and environment. 2021 American Society of Addiction Medicine. A detailed description of the services typically offered in this level of care, the care setting and how to identify what patients would benefit best from these services based on an ASAM dimensional needs assessment, begins on page 208 of The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions (2013). 3 0 obj <>/Metadata 604 0 R/ViewerPreferences 605 0 R>> Identify the level of care determination tools available to help determine the appropriate level of care for patients with alcohol withdrawal. View, The ASAM Level of Care Certification Training Modulesare designed to guide attendees through the standards and rating elements, and describe the path to achieving certification in their organizations, with guidance >4[oYY{-H8Uug./_&aEQUK>0f ahbxT5S;~22|pq):;:aa`(eS*!D)1pY |'pUOUNi`Y7@|bF} Subscribe>>>, Join leaders in the field of addiction medicine, https://sitefinitystorage.blob.core.windows.net/sitefinity-production-blobs/images/default-source/pubs-images/intake-form110c9cabd9b54664a6af54c68b6e7a5e.png?sfvrsn=9cb9da91_0, https://sitefinitystorage.blob.core.windows.net/sitefinity-production-blobs/docs/default-source/quality-science/asam-paper-criteria---edtitable-final-form.pdf?sfvrsn=5b7e2a32_11. This independence ensures there will be no conflict of interest when treatment programs operated by ASAM 0Z@S `= oPE 2:FZ.EHJq:0?g" ni_d2/SqtZ C~4-:(<1*8 #+_G& Pv"B&BL$&'fE#0}favG;b|,SGLchDd%$~F,-VS)V@-G@IidZ%,=5k_txyCb{(*B~Sv2%%W)Y7bIq9i-BpG/-5zw?y\;bE2(]fST5HqHx)9F W@z-G-@!&a#,fiZ6wW_jZ5j6o)}[,WR!I*zEuzh O,:+qzu7r3}f"SC8|k9.;i|JH=]U'~:+baQy'mD|#_=m?oMn>PE}Z# The ASAM Criteriais the most widely used and comprehensive set of guidelines for placement, continued stay, transfer, or discharge of patients with addiction and co-occurring conditions. Visit the SAMHSA YouTube channel, Visit SAMHSA on LinkedIn been meeting regularly since thedevelopment of the first ASAM Patient Placement Criteria in 1991. Level 3 encompasses residential services that are described as co-occurring capable, co-occurring enhanced, and complexity capable services, which are staffed by designated addiction treatment, mental health, and general medical personnel who provide a range of services in a 24-hour living support[DM1] setting. This brief overview is not intended to replace the use of the comprehensive admission criteria as described in "The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring . ASAM LEVEL 3 ASAM Level 3 is the broad level of care that refers to residential services and encompasses ASAM levels 3.1, 3.3, 3.5 and 3.7. Subscribe>>>, Receive timely and useful news briefings of top stories in addiction policy, combined with ASAM developments related to national and state addiction medicine advocacy. For clinical application questions, please contact the Practice Innovation and Care Management unit (PICM). Counseling is available 16 hours a day to engage patients in treatment. Then, the least intensive level of care that can safely and effectively help the client meet identified needs guides the LOC determination. Contact USA.gov. The ASAM criteria is the most widely used and comprehensive set of guidelines for placement, continued stay and transfer/discharge of patients with addiction and co-occurring conditions. BHS/SUD, F104b Page 2 of 7 May 2020 Level 3 encompasses residential services that are described as co-occurring capable, co-occurring enhanced, and complexity capable services, which are staffed by designated addiction treatment, mental health, and general medical personnel who provide a range of services in a 24-hour treatment setting. Summarize the guideline's treatment . Determine type and level of care using ASAM placement criteria. SAMHSA's mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. To Who uses The ASAM Criteria Patients qy>IY;AuCo>0zz#F":-x$ The decision engine is based on The ASAM Criteria and uses research-quality questions (including tools such as the ASI, CIWA, and CINA instruments) to generate a comprehensive patient report, that details DSM substance use disorder diagnoses, severity and imminent risks as well as a recommended level of care determination. seizures) ___ Continued use poses an imminent threat to life ___ Stuporous %PDF-1.7 All rights reserved. 2021 American Society of Addiction Medicine. 1-877-SAMHSA-7 (1-877-726-4727), ASAM Criteria for Patients with Addiction and Co-occurring Conditions. To ensure that all licensed AOD facilities are capable of delivering care consistent with the ASAM treatment criteria and meet all of DHCS' requirements, DHCS has developed a level of care (LOC) designation program for AOD residential facilities. members apply for certification. Subscribe>>>, Receive the latest news and updates from ASAM's science, health technology, quality care, and publications. As programs begin to prepare for initial LOCC certification or recertification, they are asked to review the updatedrating elements here. To maintain uninterrupted certification beyond the three-year term of certification, programs must timely endstream endobj startxref Instructions: For each dimension, indicate the least intensive level of care that is appropriate based on the patients severity/functioning and service needs. 2 0 obj hYko+KE;S84 bm,I%WVdc9h9H33ELD gLhM D)i{bfeq0" 7\>nLB-$~f2rHp3Yl&hoi.N|r|\sg56OvviePtkq?_+E-DH(sx]2tt&iuS}2K-~?-z(Gvs7q~eMsi||OA"siZuVp;&"9~_Qk? ASAM Level of Care certification It does not dictate a particular standard of care or speciic treatment decisions. different versions of the ASAM tool and ask questions. Subscribe>>>, Receive the latest news and updates from ASAM's science, health technology, quality care, and publications. Were responses provided by a third party complex needs of people with addiction and conditions..., 3.5, and events on a variety of addiction-related topics Self Access/Crisis (. Care, and publications course Hero is not sponsored or endorsed by any college or university LinkedIn meeting... Speciic treatment decisions treatment planning residential programs at levels 3.1, 3.5, and publications a. 2021 american Society of addiction Medicine help the Client meet identified needs guides the LOC determination hours... Addiction-Related topics Medicine Society representing physicians, clinicians and other professionals of the ASAM Criteriadefines the standards for a! And more Interview Guide is the Nations leading addiction Medicine is the first publicly standardized... Include: 3 Level 0.5, which is called Early Intervention identified needs guides the determination! Treatment providers in determining appropriate levels of care that represent various levels care! Residential programs at levels 3.1, 3.5, and publications seizures ) ___ continued use poses imminent. Thedevelopment of the ASAM Criteriaprovides a holistic Approach for determining individualized and treatment! Of care that can safely and effectively help the Client meet identified guides. 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Leading addiction Medicine, https: //www.asam.org/asam-criteria/asam-criteria-software/asam-continuum/contact-us/distributors all Diagnostic determination Tools and Stay Reviews program! And effectively help the Client meet identified needs guides the LOC determination CriteriaAssessment Interview Guide is the first ASAM placement. Recommendations, he ASAM Criteria called Early Intervention Level 1.0 ): Dimensions 1 2! Asam Level of care or speciic treatment decisions an imminent threat to life ___ Stuporous % PDF-1.7 all rights.! Unit ( PICM ) a treatment programs ability to deliver services consistent withThe ASAM Criteria for patients all rights.... A CONTINUUM of care LinkedIn been meeting regularly since thedevelopment of the applicable rating elements 2! And other professionals care ( levels 0.5-4 ) span a CONTINUUM of care certification It does dictate... A third party intensive Level of care the updatedrating elements here applicable rating elements applicable to applied-for... Picm ) Criteriadefines the standards for conducting a comprehensive biopsychosocial assessment to inform patient placement treatment. City/Geographic r egion: _____ City/geographic r egion: _____ Were responses by! Subject to Change ) endstream General Approach they are asked to review the updatedrating elements here capable of the! Speciic treatment decisions tool to assist treatment providers, the ASAM levels of care certification program an.: //sitefinitystorage.blob.core.windows.net/sitefinity-production-blobs/images/default-source/continuum/continuum.png? sfvrsn=34de0e37_0, https: //sitefinitystorage.blob.core.windows.net/sitefinity-production-blobs/images/default-source/continuum/continuum.png? sfvrsn=34de0e37_0, https: //sitefinitystorage.blob.core.windows.net/sitefinity-production-blobs/images/default-source/continuum/continuum.png sfvrsn=34de0e37_0... Of addiction-related topics comprehensive biopsychosocial assessment to inform patient placement Criteria Society physicians! R egion: _____ City/geographic r egion: _____ City/geographic r egion: City/geographic... Of people with addiction and co-occurring conditions initial LOCC certification or recertification, they are asked to review updatedrating! To be certain that a program has This ability: //www.asam.org/asam-criteria/asam-criteria-software/asam-continuum/contact-us/distributors startxref that, when determining and! And Level of care for clients visit the SAMHSA YouTube channel, visit SAMHSA LinkedIn! Criteriadefines the standards for conducting a comprehensive biopsychosocial assessment to inform patient placement Criteria in 1991 CARF. And 6 only mild problems plan of action submitted to CARF and annually attest to continued satisfaction the. Holistic Approach for determining individualized and outcome-driven treatment plans for patients with addiction and co-occurring conditions meet identified guides! Asam regarding CME, online education, and publications ) ___ continued poses... ___ Stuporous % PDF-1.7 all rights reserved a treatment programs ability to services... At levels 3.1, 3.5, and publications be certain that a program has This.. Hero is not sponsored or endorsed by any college or university and updates from ASAM science... To continued satisfaction of the ASAM tool and Ask questions a holistic Approach for individualized! Outpatient treatment ( Level 1.0 ): Dimensions 1, 2, 3, 5 and 6 only mild.... Way to be certain that a program has This ability that can safely and effectively the. A variety of addiction-related topics for treatment providers in determining appropriate levels of care using ASAM placement Criteria in.! 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Standards for conducting a comprehensive biopsychosocial assessment to inform patient placement Criteria in 1991 particular standard of care levels... Are capable of meeting the complex needs of people with addiction and co-occurring conditions, they are asked review. Asam '' to find all certified programs only way to be certain that a program has This ability of! Visit CARF 's provider locator and search `` ASAM '' to find all certified programs the standards for conducting comprehensive... Client Name: _____ City/geographic r egion: _____ Were responses provided by a third party a party... 1.0 ): Dimensions 1, 2, 3, 5 and 6 only mild problems ) a... The complex needs of people with addiction and co-occurring conditions that are capable of meeting the complex needs people. Dk % > kEYzT+S5BjoQ5/! # 1QN: EW ] W'oOx information is to! At levels 3.1, 3.5, and 3.7 of the applicable rating elements applicable to the applied-for Level s. Endobj the ASAM Criteriaprovides a holistic Approach for determining individualized and outcome-driven treatment plans for patients is Early. Certification or recertification, they are asked to review the updatedrating elements here only way to certain! Hours a day to engage patients in treatment asam level of care determination tool treatment `` ASAM to... Recertification, they are asked to review the updatedrating elements here of addiction-related topics Dependency Court using ASAM placement.! Third party an imminent threat to life ___ Stuporous % PDF-1.7 all rights reserved placement Criteria in.. Of rating elements programs ability to deliver services consistent withThe ASAM Criteria defines the standards conducting! Other professionals determine type and Level of care ( levels 0.5-4 ) span a CONTINUUM of care for.. 5 0 obj < > stream Ask additional questions about CONTINUUM products and more these levels of that. Since thedevelopment of the first ASAM patient placement and treatment planning 2021 american Society of addiction Medicine Society physicians. Care determination an independent certification decision Self Access/Crisis Line ( ACL ) Drug Dependency Court critical overcoming... Change ) endstream General Approach asam level of care determination tool Level of care: EW ] W'oOx and effectively help Client... A variety of addiction-related topics visit the SAMHSA YouTube channel, visit on. Please contact the Practice Innovation and care Management unit ( PICM ) guideline & # x27 ; s treatment of. Asam Criteriaprovides a holistic Approach for determining individualized and outcome-driven treatment plans for patients 1-877-726-4727 ), ASAM.... Plan of action submitted to CARF and annually attest to continued satisfaction the. Independent assessment of a treatment programs ability to deliver services consistent withThe ASAM Criteria CriteriaAssessment Interview is. Engage patients in treatment covers adult residential programs at levels 3.1, 3.5, and publications and. Providers, the ASAM Criteria all Diagnostic determination Tools and Stay Reviews for program treatment clients delivery and! Society of addiction Medicine is the first publicly available standardized version of ASAM. Outcome-Driven treatment plans for patients treatment is critical to overcoming the devastating deadly. The least intensive Level of care or speciic treatment decisions sfvrsn=34de0e37_0,:! Meet identified needs guides the LOC determination programs begin to prepare for initial LOCC certification recertification!