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DAPPER-3TMDimensional Assessment for Patient Placement Engagement and RecoveryNorman G. Hoffmann, Ph.D., David Mee-Lee, M.D., & Gerald D. Shulman, M.A., M.A.C., FACATAName:Gender:MaleID:Date of Birth:/Female/Age:Evaluation DatesDate for A-1://Date for A-2://Date for B-1://Date for B-2:///Date for C-2:yearHighest degree earned:(1) No high school diploma earned(2) High school diploma or GED(3) Vocational/technical/business school grad.(4) Associate degree(5) Bachelor’s degree(6) Master’s, doctoral, or other postgrad. degreeEmployment status upon entry into treatment:(1) Working full time for pay (30 hr./wk. or more)(2) Working part time for pay ( 30 hr./wk.)(3) Unemployed(4) Not working for pay by choice(5) Disabled(6) RetiredyearPrimary job type when working for pay:(1) Professional(2) Upper-level management/business owner(3) Mid-level management(4) Sales/marketing(5) Supervisory(6) Craft/skilled trades/technical(7) Office/white collar/clerical(8) Transportation/equipment operator(9) Laborer/unskilled worker(10) Service worker (waiter/waitress)(11) Domestic worker (housekeeper, etc.)(12) Military service(13) Other (specify)Diagnostic ImpressionsSubstanceSevereCurrent marital status at entry into treatment:(1) Never married(2) Divorced(3) Separated(4) Widowed(5) Living as married(6) Married/dayModerateWith which ethnic grouping does patient identify:(1) Hispanic/Latino – white(2) Hispanic/Latino – non-white(3) African-American(4) Native American(5) Native Hawaiian/Pacific Islander(6) Asian(7) Middle Eastern(8) Caucasian/White(9) Multiracial/Biracial/Other/monthMilddayNo Diagnosis/monthNotDeterminedDate for C-1:AlcoholMarijuanaCocaine (powder or crack)Stimulants of any cinogensOther/unknown/mixed Norman G. Hoffmann—Copyright, 2000, 2014 All Rights Reserved.Evince Clinical Assessments, 29 Peregrine Place, Waynesville, NC 28786 USADistributed by The Change Companies , 5221 Sigstrom Drive, Carson City, NV 89706; Phone: 888-889-8866; 775-885-2610Reproduction or adaptation in any form, in whole or in part, by any means, is a violation of copyright and constitutes unethical and unprofessional conduct.
DAPPER-3 PLACEMENT INDICATIONSTMDimensional Assessment for Patient Placement Engagement and RecoveryName:ID #:Dimensional Specifications for AdmissionLevel 0.5Assessed as meeting at least one of the specifications in Dimensions 4, 5, or 6. Identifiable problems in Dimensions 1,2, or 3 are stable or being addressed appropriately in outpatient medical or mental health services.(The ASAM Criteria (2013) pp. 179-183)Level 1.0All six dimensions meet Level I criteria or present no problem (Analogous to Level 0.5.(The ASAM Criteria (2013) pp. 184-196)Level 2.1Direct admission to Level 2.1 advisable for patient who meets specifications in Dimension 2 (if biomedical conditionsor problems exist) and Dimension 3 (if emotional, behavioral, or cognitive conditions or problems exist), as well as in atleast one of Dimensions 4, 5, or 6. (The ASAM Criteria (2013) pp. 196-207)Level 2.5Direct admission to Level 2.5 advisable for patient who meets specifications in Dimension 2 (if biomedical conditionsor problems exist) and in Dimension 3 (if emotional, behavioral, or cognitive conditions or problems exist), as well as inat least one of Dimensions 4, 5, or 6. (The ASAM Criteria (2013) pp. 208-218)Level 3.1Assessed as meeting specifications in each of the six dimensions. (The ASAM Criteria (2013) pp. 222-224)Level 3.3Assessed as meeting specifications in each of the six dimensions. (The ASAM Criteria (2013) pp. 224-243)Level 3.5Assessed as meeting specifications in each of the six dimensions. (The ASAM Criteria (2013) pp. 244-262)Level 3.7Assessed as meeting specifications in at least two of the six dimensions, at least one of which is in Dimension 1, 2, or 3.(The ASAM Criteria (2013) pp. 265-279)Level 4.0Assessed as meeting specifications in at least one of Dimensions 1, 2, or 3. (The ASAM Criteria (2013) pp. 280-290)Level OTPAssessed as meeting the required opioid treatment program specifications in Dimensions 1 through 6.(The ASAM Criteria (2013) pp. 293-298)PLACEMENT PROFILEIndicate the level of care recommended on each dimension for each .6thAsmt.2. Biomedical Conditions/Complications3. Emotional/Behavioral/Cognitive4. Readiness to Change5. Relapse/Cont. Use/Problem Potential6. Recovery Environment/ // // // // // /Level of Care Indicated:Level of Care Received:Reason for Placement Difference, if any1. Intoxication/WithdrawalDate of Assessment:Reasons for Differences: Blank if no difference; 1. Service not available; 2. Provider judgment; 3. Patient preference; 4. On waiting list for appropriate level;5. No payment resource; 6. Geographic accessibility; 7. Family responsibility; 8. Language; 9. Other – not listed.Outcome If Indicated Level of Care Was Not Provided: circle only one number -(see The ASAM Criteria 2013, p 126)1. Admitted to acute care setting;2. Discharged to street;3. Continued stay in acute care facility;4. Incarcerated;5. Client dropped out;6. Other (Specify)Document specific areas of concern for the treatment plan on the last page of this booklet.Hoffmann, Mee-Lee & ShulmanDAPPER 2000, 2014, Norman G. Hoffmann, Ph.D.
DAPPER-3 Dimension 1: Acute Intoxication / Withdrawal PotentialUSE SCALEA-1 B-1 C-11.1. Last UseANo use in past month. 0No use in past 3 days . 1Use in past 3 days . 2Use within past day . 3Use within past 12 hours . 4B01234C012341.2. Quantity of Recent UseNo use or far below intoxication e.g. 1-2 drinks. 0Increased use with well-controlled social behavior . 1Use of substance results in obvious intoxication . 2Use of substance results in uncontrolled behavior . 3Heavy quantities result in ongoing dysfunction. 4012341.3. Frequency of Recent UseNo use or used once or twice . 0Sporadic or less than weekly. 1At least weekly use . 2Daily use . 3Multiple substances used on a daily basis. 41.4. Potentiating Substances – Additive EffectsNo use of multiple potentiating substances . 0Possible potentiating combinations ingested . 1Ingested small amount of potentiating substances . 2Ingested substantial quantity of substances . 3Potentially lethal combination of substances . 4WITHDRAWAL SCALE44A-1 B-1 C-11.8. Physical Signs and Symptoms of Withdrawal ANo problems: vital signs, tremor, sweats, GI. 0Mildly abnormal vital signs, tremor, sweats, etc . 1Mod. unstable vital signs, CNS or GI problems . 2Severe unstable vital signs, CNS or GI problems. 3Life-threatening vital signs, seizures . 4B01234C01234012341.9. Mental Status Signs & Symptoms of WithdrawalOriented, alert, full mental function . 0Mild anxiety, agitation, depression, dysfunction . 1Mod. Depression, anxiety, agitation, dysfunction . 2Severe depression, agitation, anxiety, dysfunction . 3Suicidal, psychotic, disoriented, hallucinating . 4012340123401234012341.10. History of Withdrawal ProblemsNo prior history of withdrawal problems . 0Minor problems noted in prior withdrawal . 1History of moderate withdrawal problems . 2History of severe withdrawal problems . 3History of life-threatening withdrawal problems . 401234012340123401234If rating on Item 1.1 is 0, go to next Dimension.INTOXICATION SCALEDisoriented, clouded consciousness, or psychotic . 4A-1 B-1 C-11.5. Level of Current IntoxicationNone – not indicated . 0Sub intoxication level . 1Mildly intoxicated . 2Very intoxicated . 3Stuporous . 401234012341.6. Physical Signs and Symptoms of IntoxicationVital signs, gait, speech, coordination normal . 0Mildly unstable vital signs, speech, gait, coordination 1Mod. unstable vital signs, speech, gait, coordination . 2Severely unstable vital signs, gait, coordination . 3Life-threatening changes in vital signs . 401234012341.7. Mental Signs & Symptoms of IntoxicationOriented, alert, normal mental function . 0Mild disturbance of mood, cognition, function . 1Mod. disturbance of mood, cognition, function . 2Fluctuating orientation, severe disturb. in function . 301230123MODIFICATION FACTORS SCALEA-1 B-1 C-11.11. Client’s Coping Skills with Intoxication/WithdrawalSymptomsFully able to cope with intoxication/withdrawal . 0 0 0Mild difficulty tolerating symptoms/functioning . 1 1 1Moderate difficulty tolerating symptoms/coping . 2 2 2Severe difficulty tolerating symptoms/functioning . 3 3 3Unable to tolerate or cope with symptoms . 4 4 41.12. Living Arrangement Regarding WithdrawalManagementPersons can fully assist in withdrawal management. 0Someone available to offer partial assistance . 1Unreliable persons available . 2No one available for withdrawal management . 3Living in environment that encourages use . 4Comments:0123401234
DAPPER-3 Dimension 2: Biomedical Conditions / ComplicationsMEDICAL SEVERITY SCALEA-1 B-1 C-12.1. Acute Medical ConditionANo acute medical condition . 0Few medical problems, mild symptoms . 1Acute, non life-threatening problems . 2Serious, unstable medical condition . 3Severe, acute, incapacitating medical condition(s) . 4B01234TREATMENT ISSUES SCALEA-1 B-1 C-1C012342.7. Adherence to Medication RequirementsANo medication required . 0History of good adherence . 1Mostly adherent . 2Mostly non-adherent . 3Not at all adherent with medications . 4B01234C0123401234012342.2. PregnancyNot pregnant. 0Pregnant and receiving prenatal care . 1Pregnant, but no prenatal care; or having problems . 2Near term pregnancy or moderate complications . 3Severe, acute pregnancy complications . 401234012342.8. Biomedical Impacts on FunctioningNo impact on functioning . 0Mild impediment to functioning . 1Moderate impediment to functioning . 2Substantial impediment to functioning . 3Serious impediment to functioning in treatment . 42.3. Chronic Medical Condition/DisabilityNo chronic medical problem . 0Mild chronic medical condition . 1Moderate condition poses treatment challenges . 2Unstable condition interferes with treatment . 3Severe, unstable condition . 401234012342.9. Ability to Tolerate and Cope with SymptomsFull ability to tolerate, cope with discomfort. 0Adequate ability to tolerate, cope with discomfort . 1Some difficulty to tolerate, cope with discomfort . 2Poor ability to tolerate, cope with discomfort . 3Unable to tolerate, cope with discomfort . 401234012342.10. Impediments to Treatment and RecoveryNo impact on treatment and recovery . 0Mild impediment and distraction . 1Moderate impediment and distraction . 2Substantial impediment and distraction . 3Severe impediment to functioning in treatment. 40123401234If Items 2.1, 2.2, and 2.3 are all 0, go to next Dimension.MEDICAL MANAGEMENT SCALEA-1 B-1 C-12.4. Need for StabilizationNo stabilization required . 0Stabilization does not require close supervision . 1Stabilization requires daily supervision . 2Stabilization requires 24 hour observation . 3Life-threatening condition requires stabilization . 401234012342.5. Need for Medical/Nursing ObservationNo observation required for chronic condition . 0At least weekly observation/tests required . 1Nursing observation required several days/wk . 2Daily observation required . 324-hour intensive observation required . 401234012342.6. Frequency of Medication ManagementNo medications . 0Medication management 3-4 times/year . 1Medication management monthly. 2At least weekly medication management . 3Close daily medication management essential . 40123401234Hoffmann, Mee-Lee & ShulmanComments:DAPPER 2000, 2014, Norman G. Hoffmann, Ph.D.
DAPPER-3 Dimension 3: Emotional/Behavioral/Cognitive Conditions and ComplicationsVIOLENCE POTENTIAL SCALEA-1 B-1 C-13.1. Violence PotentialANo history or indication of violence . 0Mild tendency toward violence . 1History of occasional violence toward objects . 2History of occasional violence toward people . 3Chronic violent behavior; currently violent . 4B01234C012343.8. Social FunctioningANo impairments in social functioning. 0Adequate functioning despite mild problems . 1Moderate impairments in social relationships . 2Significant functional impairments. 3Serious and persistent impairments . 4B01234C012343.2. Emotional VolatilityNot volatile. 0Volatile only with substantial provocation . 1Volatile with moderate provocation. 2Prone to volatility with minimal provocation . 3Very volatile and unpredictable . 401234012343.9. Medication AdherenceNo medications needed . 0Highly adherent . 1Inconsistent adherence . 2Non-adherence poses potential problem . 3Non-adherence poses serious problems . 401234012343.3. Dangerousness to SelfNo indication of self-harm thoughts . 0Occasional thoughts of self-harm . 1Frequent suicidal thoughts but not current. 2Currently suicidal without plan or means . 3Currently suicidal with plan and means . 401234012343.10. Self-careFully able to care for self . 0Minimal self-care problems . 1Moderate level of self-care problems . 2Severe self-care problems . 3Unable to care for self. 401234012343.4. Dangerousness to OthersNo thoughts about harming others . 0General thoughts of harming others . 1Specific target but no plan . 2Current desire to harm someone . 3Has target and intent or plan to harm . 401234012343.5. Dangerousness Due to Addictions or Mental ConditionNo indication of dangerousness . 0 0 0Slight risk to self/others due to mental condition . 1 1 1Moderate risk . 2 2 2Significant risk . 3 3 3Mental condition poses imminent danger . 4 4 4FUNCTIONING SCALEA-1 B-1 C-13.6. Cognitive/Intellectual FunctioningNormal cognitive ability; no problem . 0Slight deficit(s). 1Moderate deficit(s) . 2Severe deficit(s) . 3Profound deficit(s) . 43.7. Attention/Ability to Focus on TreatmentNo difficulty focusing on tasks . 0Some distractibility . 1Moderately distractible . 2Short attention/very distractible . 3Unable to stay focused on tasks . 401234012340123401234CO-OCCURRING SCALEA-1 B-1 C-13.11. Thought Disorder IndicationsNo thought disorder or well controlled . 0Eccentric behavior – possible thought disorder . 1Thought disorder affects functioning. 2Thought disorder is pronounced . 3Thought disorder severely affects functioning . 401234012343.12. Mood Related ProblemsNo mood related problems. 0Mild mood problems or controlled condition . 1Moderate mood symptoms . 2Meets criteria for mood disorder . 3Disorder severely affects functioning . 401234012343.13. AnxietyNo anxiety problems . 0Mild anxiety or controlled condition . 1Moderate anxiety symptoms . 2Meets criteria for anxiety disorder . 3Anxiety disorder seriously affects functioning . 401234012343.14. PTSD or other trauma disorderNo indication of traumatic experience . 0Traumatic events recalled, not diagnostic . 1Possible diagnosis, monitoring for other indications . 2Meets criteria for PTSD . 3Disorder is highly detrimental to treatment . 40123401234
Dimension 3 Emotional/Behavioral/Cognitive Conditions and Complications (Continued)3.15. Eating DisorderNo indication of a problem . 0Some concern about diet/eating behaviors . 1Possible diagnosis, monitoring for other indications . 2Meets criteria for an eating disorder . 3Disorder is highly detrimental to treatment . 401234012343.16. Gambling DisorderNo indication of a problem . 0Some concern about wagering . 1Possible diagnosis, monitoring for other indications . 2Meets criteria for a gambling disorder . 3Disorder is highly detrimental to treatment . 401234012343.17. Other Axis I Disorder ProblemsNone indicated . 0Mild symptoms or indications . 1Moderate symptoms or indications . 2Meets criteria for a disorder . 3Disorder is detrimental to treatment . 40123401234PERSONALITY DISORDER SCALEA-1 B-1 C-13.15. Antisocial Personality BehaviorsANo antisocial behaviors noted . 0Few indications of antisocial behaviors . 1Moderate level of antisocial behaviors . 2Meets criteria for Antisocial Personality Disorder . 3Disorder seriously affects functioning . 4B01234C012343.16. Other Personality Disorder ProblemsNone indicated . 0Mild symptoms or indications . 1Moderate symptoms or indications . 2Meets criteria for a disorder . 3Disorder is detrimental to treatment . 401234012343.17. GuiltGuilt feelings not severe/positive motivation . 0Guilt is mild distraction for treatment . 1Guilt is moderate distraction . 2Guilt impairs treatment efforts. 3Guilt paralyzes treatment efforts . 40123401234Comments:Hoffmann, Mee-Lee & ShulmanDAPPER 2000, 2014, Norman G. Hoffmann, Ph.D.
DAPPER-3 Dimension 4: Readiness to ChangeUNDERSTANDING SCALEA-1 B-1 C-14.8. Willing to Accept Help for ChangeAFully accepts help . 0Mostly accepts help . 1Ambivalent about help . 2Little acceptance of need for help . 3Hostile unwillingness to accept help . 4B01234C012344.9. Personal Treatment GoalsCan articulate clear personal treatment goals . 0Significant sense of personal treatment goals . 1Some sense of personal treatment goals . 2Little sense of personal treatment goals. 3No personal treatment goals . 401234012344.1. Awareness of ConditionAAware of substance related problems . 0Voices awareness of problems . 1Acknowledges, but ambivalent about problems . 2Lacks awareness of problems . 3Actively rejects existence of problems . 4B01234C012344.2. Acceptance of Responsibility for BehaviorFully accepts responsibility for problems . 0Mostly accepts responsibility for problems . 1Some acceptance of responsibility for problems . 2Little acceptance of responsibility for problems . 3Blames others for virtually all problems . 401234012344.3. Rationalization/MinimizationNo rationalization or minimization . 0Little rationalization or minimization . 1Some rationalization or minimization . 2Frequently rationalizes and minimizes . 3Very high level of rationalization/minimization . 401234012344.10. Openness to Involve Family/OthersCompletely open (family/others positive resource) . 0Mostly open, but some questions. 1Ambivalent, has reservations, or no one available . 2Refuses permission to contact; may be persuaded . 3Hostile refusal of any involvement in treatment. 401234012344.4. Understands Mental Health ProblemsNo problem identified or excellent understanding. 0Mostly understands mental health issues . 1Some understanding of mental health issues . 2Little understanding of mental health issues . 3No discernible ability to recognize issues . 401234012344.11. Willingness to Cut Ties with Negative InfluencesNo negative influences identified . 0 0Willing to distance from negative influences . 1 1Ambivalence . 2 2Resistant to distancing from negative influences . 3 3Unable/totally unwilling to cut ties. 4 4012344.5. Interest In ChangingActive interest in making changes . 0Willing to change but has mild reservations . 1Marked ambivalence to making changes . 2Little interest in change; many preconditions . 3Sees no reason for change . 401234012344.12. Comfort with Self-help/Support GroupsActively engaged or willing to engage . 0Mild reservations about utilizing self-help/support . 1Ambivalent about self-help/support . 2Resistant to attending self-help/support groups . 3Refuses to use self-help/support groups . 4012344.6. Testing Ability to Control UseNo intent to try using again . 0Mild interest in trying controlled use . 1Ambivalent about testing ability to control use . 2Considering attempt to try controlled use . 3Plans to try controlled use . 40123401234COMMITMENT SCALEA-1 B-1 C-14.7. Confidence in Ability to ChangeRealistic confidence in ability to change . 0Mostly confident about ability to change. 1Some confidence about ability to change . 2Little confidence in ability to change. 3Lacks confidence or is unrealistically optimistic . 40123401234INTERPERSONAL SCALEFOLLOW-THROUGH SCALEA-1 B-1 C-101234A-1 B-1 C-14.13. Follow-through on Plan for ChangeExcellent indication of ability to follow-through . 0Good indication of ability to follow-through. 1Some indication of ability to follow-through . 2Poor indication of ability to follow-through . 3Refuses or is unable to follow-through . 401234012344.14. Follow-through & Need for ActionNo problems associated with follow-through . 0Failure to follow-through could result in some prob. . 1Follow-through failure could result in moderate prob. 2Follow-through failure likely to result in serious prob. 3Follow-through failure poses imminent dangers . 40123401234
DAPPER-3 Dimension 5: Relapse / Continued Use / Continued Problem PotentialENGAGEMENT SCALEA-1 B-1 C-15.1. Engagement in Ongoing RecoveryAHighly willing to do whatever is necessary . 0Moderate willingness to do whatever is necessary . 1Ambivalent about taking necessary steps . 2Unwilling to engage in recovery efforts . 3Actively opposed to recovery activities . 4B01234C01234REACTIVITY SCALE5.2. Self Help Recovery InvolvementHigh level of willingness to participate . 0Moderate willingness to participate . 1Ambivalent about participation. 2Generally unwilling to participate . 3Actively opposed to participation . 401234012345.3. Engagement in Recovery Maintenance ServicesHigh level of willingness to participate . 0Moderate willingness to participate . 1Ambivalent about participation. 2Generally unwilling to participate . 3Actively opposed to participation . 401234012345.4. Expectancies about TreatmentRealistic and positive expectancies . 0Positive but somewhat unrealistic expectancies . 1Mixed expectancies about change . 2No expectancies for positive change. 3Negative/grossly unrealistic expectancies . 40123401234RISK FACTORS SCALE5.8. Mental Health Related Risk FactorsANo co-occurring mental health problems . 0Acute MH problems pose minimal risks . 1Moderately stable MH problems pose moderate risk . 2Serious/chronic MH problems pose ongoing risk . 3Unstable MH problems pose high risk . 4A-1 B-1 C-15.5. Demographic Risk Factors (under 25; never married,unemployed; no H.S. diploma or GED)No demographic risk factors . 0 0 0One or two changeable demographic risk factors . 1 1 1One or two durable demographic risk factors . 2 2 2Three demographic risk factors . 3 3 3Four or more significant demographic risks . 4 4 45.6. Alcohol Related Risk FactorsNo use . 0Episodic use (less than weekly) . 1Regular use (once or twice a week) . 2Frequent use (3 or more times a week) .
(The ASAM Criteria (2013) pp. 280-290) Level OTP Assessed as meeting the required opioid treatment program specifications in Dimensions 1 through 6. (The ASAM Criteria (2013) pp. 293-298) PLACEMENT PROFILE Indicate the level of care recommended on each dimension for each assessment. 1st 2nd 3rd 4th 5th 6th Asmt. Asmt. Asmt. Asmt. Asmt. Asmt. 1.
