Abstract
Objectives
The process of service intensity (SI) or level of care (LOC) determination regarding mental health services has a problematic history. There is a need for reliable and valid SI/LOC determination tools for youth in the child welfare system.
Methods
In 2004 and 2005, the Tennessee Child Program Outcome Review Team (CPORT) reviewed 437 children and youth in the child welfare system (277 in state custody, 160 at risk of custody) of whom 61.6% were male, 64.8% Caucasian and 28.4% African American. Instruments used included the CASII, CAFAS, CBCL, YSR, TRF, and the CPORT Child and Family Indicators.
Results
All CASII subscales significantly correlated to the CAFAS Total Scores (Pearson coefficients 0.225 to 0.454). The CASII Total Score and the CASII SI determinations were highly correlated to CBCL, YSR, and TRF total and sub-scales. Significant correlations between the CASII SI determinations were found across all of the 13 CPORT Child and Family Indicators, while actual placement significantly correlated with only three of the 13 dimensions. The actual SI/LOC placements were significantly divergent from the placement recommendations derived using the CASII instrument (p < 0.000) with the majority of CASII SI/LOCs recommendations being for less restrictive placements.
Conclusions
The CASII SI/LOC tool demonstrates high levels of reliability and validity in multiple care contexts, including child welfare, juvenile justice, and mental health settings. Expanded use of the CASII could potentially result in less restrictive, more appropriate, and less costly services becoming available to youth in these systems.
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References
Achenbach, T. (1991). Manual for the child behavior checklist/4-18 and 1991 profile. Burlington, Vermont: University of Vermont Department of Psychiatry.
Alegria, M., Vallas, M., & Pumariega, A. J. (2010). Racial and ethnic disparities in pediatric mental health. Child & Adolescent Psychiatry Clinics of North America, 19(4), 759–774. https://doi.org/10.1016/j.chc.2010.07.01.
American Academy of Child and Adolescent Psychiatry, Work Group on Systems of Care. (2004). Child and adolescent service intensity instrument user’s manual. Washington, D.C.: American Academy of Child and Adolescent Psychiatry.
Baker, A., Kurland, D., Curtis, P., Alexander, G., & Papa-Lentini, C. (2007). Mental health and behavioral problems of youth in the child welfare system: Residential treatment centers compared to therapeutic foster care in the Odyssey Project population. Child Welfare, 86(3), 97–123.
Bickman, L., Karver, M., & Schut, L. (1997). Clinician reliability and accuracy in judging appropriate level of care. Journal of Consulting Clinical Psychology, 65(3), 515–520. https://doi.org/10.1037/0022-006×.65.3.515.
Chamberlain, P., Price, J., Reid, J., Landsverk, J., Fisher, P., & Stoolmiller, M. (2006). Who disrupts from placement in foster and kinship care? Child Abuse & Neglect, 30, 409–424. https://doi.org/10.1016/j.chiabu.2005.11.004.
Chamberlain, P., & Reid, J. B. (1987). Parent observation and report of child symptoms. Behavioral Assessment, 9, 97–109.
Children’s Mental Health Division, Minnesota Department of Human Services. (2008). Outcome measures pilot: SDQ and CASII. Report for Minnesota Children’s Mental Health Action Group (MMHAG). Minneapolis, MN: Minnesota Department of Human Services. Retrieved from: https://leg.mt.gov/content/Committees/Interim/2015-2016/Children-Family/Committee-Topics/HB-422/jan2016-mn-outcome-measures-pilot-summary.pdf.
Daleiden, E. (2004). Child status measurement: Operating characteristics of the CALOCUS and CAFAS. Honolulu; HI: State of Hawaii, Department of Health, Child and Adolescent Mental Health Division.
Daleiden, E., & Chorpita, B. (2005). From data to wisdom: Quality improvement strategies supporting large-scale implementation of evidence-based services. Child & Adolescent Psychiatry Clinics of North America, 14, 329–349. https://doi.org/10.1016/j.chc.2004.11.002.
Fallon, T., Pumariega, A. J., Sowers, W., Klaehn, R., Huffine, C., Vaughan, T., & Grimes, K. A. (2006). Level of care instrument for children’s systems of care: Construction, reliability and validity. Journal of Child and Family Studies, 15, 140–152. https://doi.org/10.1007/s10826-005-9012-y.
Hodges, K., & Wong, M. (1996). Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale. Journal of Child and Family Studies, 5, 445–467.
Lanier, P., & Rosen, R. (2017). Admission to psychiatric residential treatment facilities among youth from families investigated for maltreatment. Journal of Child and Family Studies, 26, 306–316. https://doi.org/10.1007/s10826-016-0541-3.
Lyons, J. (1999). The Child and Adolescent Needs and Strengths for children with mental health challenges. Winnetka, IL: Buddin Praed Foundation.
Lyons, J., Libman-Mintzer, L., Kisiel, C., & Shallcross, H. (1998). Understanding the mental health needs of children and adolescents in residential treatment. Professional Psychology: Research and Practice, 29(6), 582–587.
Lyons, J., Weiner, D., & Lyons, M. (2004). Measurement as communication: the Child and Adolescent Needs and Strengths tool. In M. Mariush (Ed.), The use of psychological testing for treatment planning and outcome assessment (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.
Lyons, J. S. (1997). The measure and management of clinical outcomes in mental health. New York: Wiley.
Lyons, J. S. (1998). Severity and acuity of psychiatric illness manual: Child & adolescent version. San Antonio, TX: The Psychological Corporation.
Lyons, J. S., & Abraham, M. E. (2001). Designing level of care criteria in the integrated behavioral health continuum. In L. Kiser L., P. Lefkowitz & L. Kennedy (Eds.), The integrated behavioral health continuum: Theory and practice (pp. 123–142). Washington, DC: American Psychiatric Press.
Marx, L., Benoit, M., & Kamradt, B. (2003). Foster Children in the Child Welfare System. In A. J. Pumariega & N. C. Winters (Eds.), Handbook of community systems of care; The new child & adolescent community psychiatry (pp. 332–350). San Francisco: Jossey Bass Publishers.
Park, J., Jordan, N., Epstein, R., Mandell, D., & Lyons, J. (2009). Predictors of residential placement following a psychiatric crisis episode among children and youth in state custody. American Journal of Orthopsychiatry, 79(2), 228–235. https://doi.org/10.1037/a0015939.
Pumariega, A. J., Atkins, D. L., Rogers, K., Montgomery, L., Nybro, C., Caesar, R., & Millus, D. (1999). Mental health and incarcerated youth. II: Service utilization in incarcerated youth. Journal of Child and Family Studies, 8, 205–215.
Pumariega, A. J., Johnson, N. P., & Sheridan, D. (1995). Emotional disturbance and substance abuse in adolescents in residential group Homes. Journal of Mental Health Administration, 22(4), 426–431.
Pumariega, A. J., Millsaps, U., Moser, M., & Wade, P. (2014). Level of care determination in a juvenile justice population. Adolescent Psychiatry., 4(4), 305–313. https://doi.org/10.2174/221067660404150115163555.
Pumariega, A. J., Nace, D., England, M. J., Diamond, J., Mattson, A., Fallon, T., & Wiegand, D. (1997). Community-based systems of care approach to children’s managed mental health services. Journal of Child and Family Studies, 6, 149–164.
Pumariega, A. J., & Winters, N. (2017). Community-Based Treatment and Services. In: F. Volkmar & A. Martin (Eds.) Lewis’s child and adolescent psychiatry: A comprehensive textbook (pp. 873–884; 5th ed.). Philadelphia: Lippincott, Williams, & Wilkins.
Pumariega, A. J., & Winters, N. C. (2003). Handbook of community systems of care; The new child & adolescent community psychiatry. San Francisco: Jossey Bass Publishers.
Rubin, D., O’Reilly, A., Luan, X., & Localio, A. (2007). The impact of placement stability on behavioral well-being for children in foster care. Pediatrics, 119(2), 336–344. https://doi.org/10.1542/peds.2006-1995.
Shrout, P. E., & Fleiss, J. L. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin, 86, 420–428.
Sieracki, J., Fuller, A., Leon, S., Bai, G., & Bryan, F. (2015). The role of race, socioeconomic status, and system of care services in placement decision-making. Children and Youth Services Review, 50, 3–11. https://doi.org/10.1016/j.childyouth.2014.12.013.
Sieracki, J., Leon, S., Miller, S., & Lyons, J. (2008). Individual and provider effects on mental health outcomes in child welfare: A three level growth curve approach. Children and Youth Services Review, 30, 800–808. https://doi.org/10.1016/j.childyouth.2007.12.008.
Snowden, J., Leon, S., Bryant, F., & Lyons, J. (2007). Evaluating psychiatric hospital admission decisions for children in foster care: An optimal classification tree analysis. Journal of Clinical Child & Adolescent Psychology, 36(1), 8–18. https://doi.org/10.1080/15374410709336564.
Sowers, W., George, C., & Thompson, K. (1999). Level of care utilization system for psychiatric and addiction Services (LOCUS): A preliminary assessment of reliability and validity. Community Mental Health Journal, 35(6), 545–563.
Sowers, W., Pumariega, A., Huffine, C., & Fallon, T. (2003). Level of care decision-making in behavioral health services: The LOCUS and the CALOCUS. Psychiatric Services, 54, 1461–1463.
Stroul, B, Blau, G., & Friedman, R. (2010). Updating the system of care concept and philosophy. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health. Retrieved from: https://www.psy0-18.be/images/SOC_Brief2010.pdf.
Weiner, D., Leon, S., & Stiehl, M. (2011). Demographic, clinical, and geographic predictors of placement disruption among foster care youth receiving wraparound services. Journal of Child and Family Studies, 20(6), 758–770. https://doi.org/10.1007/s10826-011-9469-9.
Winters, N. C., & Pumariega, A. J., Work Group on Community-Based Systems of Care, Committee on Community Psychiatry, & Work Group on Quality Issues. (2007). Practice parameter for child mental health in systems of care. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 284–299. https://doi.org/10.1097/01.chi.0000246061.70330.b8.
Author Contributions
AJP: designed and executed the study, assisted with the data analyses, and wrote the paper. WF collaborated in the writing and editing of the final manuscript. UM: analyzed the data and wrote part of the results. MM and PW collaborated on the design and execution of the study.
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A.P and W.F. are members of the CASII Subcommittee of the American Academy of Child and Adolescent Psychiatry. The authors declare that they have no conflict of interest.
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The study was approved by the Institutional Review Board of the Quillen College of Medicine, East Tennessee State University (QCOM- ETSU).
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Informed consent was obtained by the C-PORT Review staff as they conducted the review. The QCOM-ETSU IRB waived inform consent since data was shared by the CPORT Review with the investigators in a de-identified manner after collection.
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Pumariega, A.J., French, W., Millsaps, U. et al. Service Intensity/Level of Care Determination in a Child Welfare Population. J Child Fam Stud 28, 1502–1511 (2019). https://doi.org/10.1007/s10826-019-01393-w
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DOI: https://doi.org/10.1007/s10826-019-01393-w