Release Notes – June 2024

CONTINUUM Interface Updates – Medical History Section

1. In response to user feedback, we have updated the Medical History section HIV and TB test questions (ASm03cRn and ASm03eRn). These questions now include a parenthetical statement at the end of each question: "Leave blank if unsure." Importantly, leaving ASm03cRn and ASm03eRn blank will not impact the Final Level of Care recommendation. 

2. In response to user feedback, we also have updated the Medical History section questions about assessing blood pressure and heart rate (CIWABPa & CIWAhrs). We have added information icon text for CIWABPa and CIWAhra, stating, "If unable to assess, select 'No.'" This response may apply when users are unable to measure vital signs (e.g., due to telehealth).

3. We have additionally updated the answer choices for question ASm03b for increased clarity.

• If current pregnancy is endorsed in question ASm03a (“Are you pregnant?”), ASm03b will appear:
  • Does the pregnancy involve any high risk? Is there any unstable problem that might require monitoring, such as bleeding, leaking amniotic fluid ('water breaking'), contractions, or an unstable fetal heartbeat?
  • Question ASm03b includes guidance that responding 'yes' will result in Level 4 hospitalization:
    • (Responding “yes” will commit the patient to Level 4 hospitalization. If unsure, consult a nurse or physician.)
  • However, two of the answer choices for ASm03b began with 'yes,' introducing potential confusion. We have updated the second answer choice to clarify that “possible high risk” does not independently produce a Level 4 recommendation:

Previous answer choices for ASm03b:

• No
• Yes, possible high risk such as elevated blood pressure, placenta previa, or past high-risk pregnancy
• Yes, immediately unstable

Updated answer choices for ASm03b (change in bold):

• No
• Possible high risk such as elevated blood pressure, placenta previa, or past high-risk pregnancy
• Yes, immediately unstable

CONTINUUM Interface Update – Drug and Alcohol Section

1. In the Drug and Alcohol section, Opioid Treatment Services (OTS) subsection, we have added text to the information icon for question ASd25g: "Is the patient likely to be or being gradually withdrawn from Opioid Treatment Services (OTS)?"

Now, when users hover over the information icon, they will see the following guidance: "If patient might need support for withdrawal from MOUD, “Yes” is the appropriate response."

CONTINUUM Interface Updates – Psychological section, Psychological Interviewer Rating subsection

1. We have revised the wording of question ASp18b and added text to its information icon. This update, made in response to a Help Desk ticket, aims to clarify the intent of the question since the interviewer may not have been able to interact with the patient during the previous 24 hours.

• Previous question text: Showing fluctuating orientation in the past 24 hours?

• Updated question text (changes in bold): Does the patient show fluctuating orientation at the time of the interview or during the past 24 hours?

• Information icon: “If no information is available about the past 24 hours, answer based on whether the patient shows fluctuating orientation during the interview.”

2. In response to user inquiries, we have also updated question ASp19f to enhance clarity.

• Previous question text: “Given any past history of symptoms of psychiatric decompensation (e.g., paranoia, psychotic thinking) how likely is a recurrence at this time?”

• Updated question text (changes in bold): “Given any past history of symptoms of psychiatric decompensation (e.g., paranoia, psychotic thinking, or potential for mental health crisis), how likely is a recurrence at this time?”

• Previous question text (RISE): Given any past history of symptoms of psychiatric decompensation (e.g., paranoia, psychotic thinking) how likely is a recurrence upon re-entry?
• Updated question text (RISE): Given any past history of symptoms of psychiatric decompensation (e.g., paranoia, psychotic thinking, or potential for mental health crisis) how likely is a recurrence upon re-entry?

3. In response to a Help Desk ticket, we have also updated question ASp19k to help interviewers assess cognitive symptoms.

• Previous question text: Does the patient carry or show evidence of a chronic organic mental disability, such as Alcohol Amnestic Disorder (Korsakoff’s Dementia) of Alzheimer’s Disease?

• Updated question text (changes in bold): Does the patient display symptoms indicative of long-term dementia, confusion, or memory loss, or do they have a diagnosis of chronic organic mental disability, such as Alcohol Amnestic Disorder (Korsakoff's Dementia) or Alzheimer's Disease?

Summary Report Updates

1. In the Summary Report, Access to Treatment Issues section, we have updated output for question ASp19k (“Does the patient display symptoms indicative of long-term dementia, confusion, or memory loss, or do they have a diagnosis of chronic organic mental disability, such as Alcohol Amnestic Disorder (Korsakoff's Dementia) or Alzheimer's Disease?”).

• Previously, when the interviewer selected "Not sure or possibly" or "Yes” for question ASp19k, the output stated: "The clinician deduced from the interview or has information that indicated that patient may have a major neurocognitive disorder, a category which includes alcohol amnestic-confabulatory type, or Alzheimer's Disease.”
• The output has been updated so that when the user selects “Not sure or possibly,” it will read: “The clinician is unsure about or has information that the patient may possibly have long-term dementia, confusion, memory loss, or a major neurocognitive disorder, a category which includes alcohol amnestic-confabulatory type, or Alzheimer's Disease.”

• The output also has been updated so that when the user selects "Yes," it will read: “The clinician indicated that the patient shows evidence of a chronic organic mental disability, such as Alcohol Amnestic Disorder (Korsakoff’s Dementia), or Alzheimer’s Disease.”

2. In the Summary Report Critical Items section, we have updated output for ASm03b to support treatment planning.

• If current pregnancy is endorsed in question ASm03a (“Are you pregnant?”), ASm03b will appear: “Does the pregnancy involve any high risk? Is there any unstable problem that might require monitoring, such as bleeding, leaking amniotic fluid ('water breaking'), contractions, or an unstable fetal heartbeat?”
• If the user selects “Possible high risk such as elevated blood pressure, placenta previa” for ASm03b, the following output will appear: “[Patient] indicated a possible high-risk pregnancy.”

• If the user selects “Yes, immediately unstable” for ASm03b, the following output will appear: “[Patient] indicated an immediate unstable pregnancy.

Narrative Report Update

1. For patients who receive Medicaid, there is a new option to display date of birth (DOB) and Medicaid ID number in Narrative and Summary Report headers.

In the General Information section, PtIns question, the interviewer can select Medicaid and then enter the patient’s Medicaid ID number in the MdcdIDNo field if known:

If Medicaid is selected in the PtIns question, the Narrative and Summary Report headers will display the patient’s date of birth and Medicaid ID number (if supplied in the MdcdIDNo field):

If the Medicaid ID number is not supplied, this line will read, “Not provided.”

Release Notes – March 2024

CONTINUUM Level of Care Output – Sustained Remission

The Summary and Narrative Report Final Level of Care Recommendations will now include personalized output for patients in sustained remission from substance use disorder (i.e., they have not met any DSM-5-TR criteria for substance use disorder (besides craving) in the past 12 months.

• NOTE: As per The ASAM Criteria, Level 1 is recommended for ongoing remission monitoring.
• If the patient also needs service coordination for psychiatric, biomedical, or housing needs, the output will specify those needs.
  
  
  
  
• For patients who meet diagnostic criteria for sustained remission, but report substance use within the past 30 days, the Summary Report’s Diagnostic Findings section will display an asterisk with an associated message: “Recent substance use was reported.” This modification will alert the clinician that recent use may destabilize the patient’s remission. 
  
  
  
  
• For patients in sustained remission who have used any substance in the past 30 days, the Final Level of Care Recommendations will also indicate a potential need for escalation beyond Level 1 services: 
  
  

CONTINUUM Level of Care Output – Level 2.1 + 3.1

We are introducing a new recommendation in the Summary and Narrative Reports, Final Level of Care Recommendations section, for Level 2.1 + 3.1 to further personalize CONTINUUM results.

• This new recommendation is appropriate for patients who meet dimensional admission criteria for Level 2.1 (i.e., they need 9 to 19 clinical service hours per week) but also require a residential component because their living situations or recovery environments are incompatible with their recovery goals.
• Patients may now receive a Final LOC recommendation for:

• Level 2.1+ Level 3.1;
• Level 2.1 Co-Occurring Capable (COC) + Level 3.1; or
• Level 2.1 Co-Occurring Enhanced (COE) + Level 3.1.
  

CONTINUUM Level of Care Output – Opioid Treatment Services for MOUD Taper

We are also introducing new output in Final Level of Care Recommendations for Opioid Treatment Services (OTS) for patients who will undergo an opioid agonist taper and need assessment and treatment of associated withdrawal symptoms.

• This new output will provide context for an OTS recommendation when the clinician indicates that a patient will be gradually withdrawn from a medication for opioid use disorder (MOUD) such as buprenorphine or methadone.
  
  

Co-Triage Level of Care Output: Level 2 for Withdrawal Management Needs

Drug class diagnoses will output for opioids, stimulants, and sedative/hypnotics, for example, when a patient meets one DSM-5-TR criterion in each of two drug categories in the same drug class.

• For instance, if a patient meets one criterion in “heroin/fentanyl” and another criterion in “other opioids”, they will receive an opioid use disorder diagnosis.
• The DSM-5-TR Substance Use Disorder(s) table will display this diagnosis under the new “Drug Class” section.
  
  

 

CONTINUUM Interface Update - ASdMAT

• A new question in the Drug and Alcohol section, Addiction Treatment History subsection, prompts interviewers to ask, “Have you been taking ongoing medication for addiction treatment?” (ASdMAT).
  • Interviewers will be able to indicate if the patient is taking ongoing medication for alcohol use disorder, opioid use disorder, or nicotine use disorder.
  • This question will be used to inform new decision logic for sustained remission diagnoses and associated level of care output.  
    
  

CONTINUUM Interface Update – Illicit versus prescribed fentanyl (SubsUse)

• In the Drug and Alcohol section, we have refined response options for the SubsUse question: "Which substances have you had problems with?" to better distinguish between illicit versus prescribed fentanyl.
  • “Heroin/fentanyl” has been changed to "Heroin/illicit (street) fentanyl."
  • The response option for other opioids has been updated to: "Opioid or narcotic other than heroin, methadone, or buprenorphine, even if by prescription, including prescribed fentanyl." 
    
    

CONTINUUM Interface Update – ASd25f

We have also introduced a new Warning message in the Drug and Alcohol section, Opioid Treatment Services subsection, to emphasize the importance of MOUD (medication for opioid use disorder) as the preferred approach for treating heroin or opioid withdrawal symptoms.

• Users will now receive a Warning message for item ASd25f if they select “Withdrawal management with no medication” AND the patient reports recent, frequent opioid use and/or current opioid withdrawal symptoms.
  

CONTINUUM Interface Update – ASd25g

In response to a help desk ticket, we have revised the wording of question ASd25g within the Drug and Alcohol section, Opioid Treatment Services subsection. This update aims to enhance the accuracy of user responses.

• Previous question text: Is the patient to be or being gradually withdrawn from Opioid Treatment Services (OTS)?
• Updated question text: Is the patient about to be withdrawn or is the patient being gradually withdrawn from Opioid Treatment Services (OTS)? 123
  
  

  
  CONTINUUM Interface Update – Revision of DSM-5-TR Items

  We have revised the DSM-5-TR questions to enable SUD diagnoses of early and sustained remission.

  • "Early remission" means that symptoms other than craving have been absent for at least the past 3 months, but less than 12 months.
  • "Sustained remission" means that symptoms other than craving have been absent for 12 months or longer.

For each DSM-5-TR criterion, users can select from four options to specify the time frame in which the patient experienced that symptom:                                      

1. No
2. Yes, but not in the last year
3. Yes, in the last year, but not in the last 3 months
4. Yes, in the last 3 months
5. Yes, even currently (in the last few days) *
   
   * This response, “yes, even currently (in the last few days),” only appears as an option for the DSM-5-TR question related to withdrawal, which asks if the patient has gotten physically sick when they stop using or continued to use to prevent getting sick (CUAXxx02).

 

Release Notes – Version 3.27 (February 13, 2024)

Update to CONTINUUM Legal Information Section

In response to a Help Desk inquiry, we have streamlined the process of reporting charges and arrests by prepopulating ASl03-ASl15 criminal offense questions with a value of “0”. This enhancement is designed to optimize user efficiency. When “Yes” is chosen for ASl01z (“Have you ever been arrested or charged for any reason?”), the Warning message will prompt the user to update the criminal offense fields with the message, “WARNING: The response indicates the patient has been arrested or charged. Please report specific charges in ASl03 – ASl18 below.”

Release Notes – Version 3.25 (October 24, 2023)  

Update to CONTINUUM General Information Section

To provide clinicians with additional data to support care navigation and treatment planning, we have developed a new, optional question to determine the type of insurance a patient has.

• The new insurance options include No, Medicaid, Private commercial insurance (employer-sponsored), Private commercial insurance (non-employer sponsored), Medicare, Tricare, and Other:

  

• If the patient has Medicaid insurance, a prompt will ask for the Medicaid ID number:

  

  • There is also a new link to an external resource with alternative Medicaid names by state.
• If “Other” is selected, another prompt will ask, “Please specify other insurance”:

  

  • When something other than Medicaid or Other is selected, there will be no additional prompt.
• When an assessment is pulled forward to reassess a patient, it will retain the insurance information and ID number when applicable. Please be sure to double-check with the patient that this information is still accurate.

   

  Update to CONTINUUM Drug and Alcohol Section, Opioid Treatment Services Subsection

  Per CONTINUUM user feedback, question ASd25f (Will the patient be treated using an opioid withdrawal protocol?) will be reworded to help interviewers differentiate between opioid agonist tapers versus ongoing use of opioid agonists to support OUD recovery.

• The updated question will appear as follows: What is the likely opioid management plan? Will the patient receive opioid maintenance therapy (methadone or buprenorphine) or undergo an opioid taper (withdrawal)?
• The first response option for ASd25f has been updated from "Not applicable - the patient will start or remain on opioid maintenance treatment (e.g., methadone, buprenorphine)" to "No taper/withdrawal - the patient will start or remain on opioid maintenance treatment (e.g., methadone, buprenorphine)."
  • This revision clarifies that the patient will not undergo a taper or withdrawal process, but rather initiate or continue MOUD (medications for opioid use disorder).

     

Release Notes – Version 3.24 (September 12, 2023)

Update to CONTINUUM Psychological Section, Psychological Interviewer Rating Subsection

• CONTINUUM is discontinuing the use of the Global Assessment of Functioning (GAF) scale, as it is no longer supported by the American Psychiatric Association (APA). We are shifting to the Symptom-Function Scale (SFS), a new 5-point scale. This scale ranges from 0 (in dark green, below) to 4 (in red). The scale appears in the Psychological Interviewer Rating section, in new required question SxFctSc.
  • When determining the SFS score, clinicians should consider the patient's psychological, social, and vocational/educational symptoms and functional issues, if any. Then, they should rate the severity of the patient's most concerning issue(s) among these, excluding functional impairment due to physical or environmental limitations (e.g., inability to ambulate without a cane).

    

• Narrative and Summary Report: The Symptom-Function scale output will replace the GAF output in both the Narrative and Summary reports, as shown below.
  • The selected response will appear first, followed by the full SFS score range for reference.