DUI Level II Four Plus frequently asked questions

1. What is Level II Four Plus? 

1. In response to the felony DUI legislation passed in 2015, the Office of Behavioral Health (OBH), in conjunction with the Colorado Task Force on Drunk and Impaired Driving, created the new level of DUI treatment, Level II Four Plus. The OBH rules providing for this new treatment Level went into effect July 1, 2017 (2 CCR 502-1, Volume 21 CDHS Behavioral Health Rules 21.240.85).
2. Level II Four Plus is a specialized treatment program for those individuals who have been convicted of four or more impaired driving offenses. It establishes a more comprehensive treatment service provision under the Level I and Level II Education, Therapy, and Treatment provision authorized in Section 42-4- 1301.3(3)(c)(IV), C.R.S.

2. How is Level II Four Plus different than other levels of DUI treatment?

1. Individuals participating in Level II Four Plus treatment are engaged for a minimum of 18 months and a minimum of 180 clinical contact hours.
2. Although not considered traditional Level II Therapy, Level II Four Plus has been assigned a "Track F" for the purpose of probation referrals and the DMV Affidavit of Enrollment.
3. Agencies are required to conduct additional screening and assessments beyond what is normally required (cognitive functioning, traumatic brain injury, adverse childhood experiences, grief & loss, and cooccurring mental health issues). And an assessment tool specifically designed to identify co-occurring mental health issues in the DUI population must be used.
4. The entire service plan and service delivery must be based on each client's clinical assessment. As a result, it is anticipated many of the offenders enrolled in Level II Four Plus will not engage in traditional Level II Education or Level II Therapy as a component of their treatment engagement.
5. Individualized service planning is conducted more frequently and is done in collaboration with the supervising probation officer a minimum of every 60 days to discuss an individual's service plan and their progress, and make adjustments in the planned treatment activities.

3. When did Level II Four Plus go into effect?

1. OBH started granting licenses to applicants to provide Level II Four Plus on July 1, 2017.
2. Probation started referring individuals to Level II Four Plus with evaluations completed on or after July 1, 2017.

4. Who is eligible for a referral to Level II Four Plus?

1. All offenders sentenced to probation who are on their fourth or subsequent impaired driving conviction (misdemeanor or felony). Priors include convictions from any US State or Territory. This also includes those convicted of a felony for vehicular homicide and vehicular assault where alcohol or other drugs has been involved. Prior successfully completed deferred sentences count as prior offenses for the purpose of establishing the fourth or more conviction for a referral to Level II Four Plus.
2. Probation officers may also refer individuals to Level II Four Plus who have not had four convictions but have had four or more arrests for alcohol/drug related driving offenses and would benefit from this higher level of treatment.

5. Where should offenders who are eligible for Level II Four Plus treatment be referred? 

1. OBH agencies licensed for Level II Four Plus can accept referrals.
2. If there is not a Level II Four Plus agency in the desired community yet, consideration may be given to agencies who are in the process of applying for Level II Four Plus licensing - OBH must be consulted in such situations.
3. OBH should be advised of any identified gaps in service areas for Level II Four Plus.

6. Which clinicians may provide Level II Four Plus services?

1. Only services provided by qualified clinicians at licensed Level II Four Plus agencies, or qualified clinicians they refer to, will count toward required hours. Services provided by unqualified individuals may be part of the client's service plan and help them achieve their goals, however, they will not count toward the required hours.

7. Can adjunct services, such as treatment at a mental health center or cognitive behavioral therapy, be counted towards the 180 hours?

1. Yes, as long as the clinician is qualified and the treatment service is supported by the clinical assessment and the client's individualized service plan.

8. What will the Level II Four Plus 180 hours of treatment consist of?

1. A combination of education and treatment strategies that are determined by the results of the screenings and clinical assessment.
2. Services will include individual counseling. As clinically indicated, services will also consist of: group therapy, family/other supportive adult therapy, education, medication-assisted therapy, and residential treatment. Traditional DUI Level II Education or Level II Therapy are only included if the clinical assessment specifically indicates that it is necessary. Interlock counseling will be required if the client has an ignition interlock installed in their vehicle.
3. Specialized treatment services determined by the assessment and service plan will be conducted by the Level II Four Plus agency or by referral to qualified clinicians in the community. The Level II Four Plus agency shall case manage any community based specialized treatment services to ensure the coordination of client services and needs, and the continuity of care, with other services.

9. How will Level II Four Plus agencies collaborate with probation and community providers?

1. Level II Four Plus agencies must collaborate with supervising probation officers in the development and review of the client's individualized service plan. Since all client services are assessment driven, having the entire collaborative care team weigh in on the service plan is essential for a successful treatment outcome. The collaborative care team must include the client, agency, PO and any specialty service providers involved in a client's care.
2. Level II Four Plus agencies must have established referral linkages in place for services they are unable to provide within their agency. In order for these hours to count toward the requirements, Level II Four Plus agencies must have ongoing collaboration and case management that is documented in the client record.

10. Who will pay for all the assessments and treatment required in the Level II Four Plus program?

a. As with traditional DUI Level II education and therapy, Level II Four Plus is primarily self-pay. b. Vouchers may be available from probation to assist in paying for Level II Four Plus services. c. Medicaid (if eligible) or other health insurance may cover some Level II Four Plus services provided criteria for medical necessity are met.

11. Will Level II Four Plus count towards the Level II requirement for DMV driver's license reinstatement?

1. Colorado DMV has agreed to accept Level II Four Plus completion as fulfillment of the Level II requirements that are required when someone is designated a persistent drunk driver. An individual in Level II Four Plus is not required to complete Level II Education.
2. Although not a traditional Level II Therapy track program, in order to accommodate DMV's requirements for driver's license reinstatement, OBH has assigned a "Track F" to be associated with Level II Four Plus. When completing an Affidavit of Enrollment for clients to reinstate their driver's licenses early, a "Track F" can be entered only when an actual referral to Level II Four Plus has been made by the courts/probation. A track "D" can be entered until such time as a "Track F" is confirmed.

12. Who should apply to be licensed for Level II Four Plus?

1. Any DUI licensed agency in good standing can apply for Level II Four Plus.
2. Both small and large agencies are encouraged to apply. Small agencies can provide the array of required services by

13. What is the OBH application process to be licensed for Level II Four Plus?

1. Submit one OBH Substance Use Disorder License Application for each site. This is considered a license modification for "Additional service/level of care."
2. Submit agency operating policies and procedures that describe how the agency will comply with each of the Level II Four Plus Treatment rules in 21.240.85.
3. Include a description of entire process for assessment that addresses all the required areas identified in 21.190.3 D and 21.240.85 F.
4. Include names/credentials and duties/areas of expertise for those clinicians who will be providing Level II Four Plus services.
5. Describe how the array of services will be provided to individuals in Level II Four Plus. Include information about specific linkages/MOUs that are in place for referral and provision of community based services.
6. Modification applications to add Level II Four Plus should be sent directly to the OBH staff person assigned to your agency.

14. How do I get additional information about implementing Level II Four Plus?

1. A Level II Four Plus implementation guide is available that includes information about screening, assessment, comorbidity, service planning and testing, including suggested tools.
2. For a copy of the implementation guide or other questions email Webster Hendricks at OBH (Webster.hendricks@state.co.us)

Rev. November 2017