A Level of Care Instrument for Children's Systems of Care: Construction, Reliability and Validity
- 266 Downloads
The Child and Adolescent Level of Care System/Child and Adolescent Service Intensity Instrument (CALOCUS/ CASII) is designed to help determine the intensity of services needed for a child served in a mental health system of care. The instrument contains eight dimensions that are rated following a comprehensive clinical evaluation. The dimensions are risk of harm, functionality, co-morbidity (psychiatric, substance abuse, development disability and medical), environmental stressors, environmental supports, the child's resiliency, and the child and family's willingness to engage in treatment. An algorithm connects the ratings to a level of care recommendation. The instrument specifies six levels of care defined flexibly enough to consider whatever services are available. The results of psychometric testing using raters with a broad range of clinical experience and training from four different systems of care around the country are presented. The testing demonstrates excellent reliability when rating vignettes. Using children and adolescents in live system of care clinical settings, the CALOCUS/CASII demonstrates reasonable validity when compared with the Child Global Assessment Scale, and the Child and Adolescent Functional Assessment Scale.
KEY WORDS:The Child and Adolescent Level of Care System/Child and Adolescent Service Intensity Instrumen intensity of services for children and adolescents level of care
The field study was supported in part by a Federal grant from the Center for Mental Health Services Branch of Substance Abuse Mental Health Services Administration contract #282-98-0029, sub-task C through the American Institute for Research. All the logistical support for the development of the instrument and national field study came from the unflagging work of Kristin Kroeger-Ptakowski and through the workgroup on Community Based Systems of Care of the American Academy of Child and Adolescent Psychiatry.
- Ambrosini, P., & Dixon, J. F. (1996). K-SADS-IV-R Manual. Unpublished manuscript.Google Scholar
- Curtiss, F. R. (1985). Analysis of nationwide pharmacy charges per DRG. American Journal of Hospital Pharmacology, 42, 2168–2174.Google Scholar
- Deane, F. P., Huzziff, R., & Beaumont, G. (1995). Discharge planning: levels of care and behavioral functioning in long-term psychiatric inpatients transferred to community placements. Community Mental Health in New Zealand, 9, 18–27.Google Scholar
- Fallon, T. J., & Dogin, J. (2005). Public sector dynamics for child mental health. In T. Petti & C. Salguero (Eds.), Community child and adolescent psychiatry: A manual of clinical practice and consultation (pp. 17–30). Washington, DC: American Psychiatric Press, Inc.Google Scholar
- Haley, M. J. (1980). What is a DRG? Top Health Care Finance, 6(4), 55–61.Google Scholar
- Hodges, K., Doucette-Gates, A., & Kim, C. S. (2000). Predicting service utilization with the Child and Adolescent Functional Assessment Scale in a sample of youths with serious emotional disturbance served by center for mental health services-funded demonstrations. Journal of Behavioral Health Services Research, 27, 47–59.PubMedCrossRefGoogle Scholar
- McKay, J. R., Cacciola, J. S., McLellan, T., Alterman, A. I., & Wirtz, P. W. (1997). An initial evaluation of the psychosocial dimensions of the American Society of Addiction Medicine criteria for inpatient versus intensive outpatient substance abuse rehabilitation. Journal of Studies on Alcohol, 58, 239–252.PubMedGoogle Scholar
- Pumariega, A. J., & Cross, T. L. (1997). Cultural competence in child psychiatry. In J. Noshpitz & N. Alessi (Eds.), Basic handbook of child and adolescent psychiatry (Vol. IV, pp. 473–484). New York: John Wiley & Sons.Google Scholar
- Shaffer, D., Schwab-Stone, M., Fisher, P., Cohen, P., Piacentini, J., Davies, M., et al. (1993). The Diagnostic Interview Schedule for Children-Revised Version (DISC- R): I. Preparation, field testing, inter rater reliability, and acceptability. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 643–650.PubMedCrossRefGoogle Scholar
- Stroul, B., & Friedman, R. (1996). A system of care for children and youth with severe emotional disturbances. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center.Google Scholar
- Welner, Z., Reich, W., Herjanic, B., Jung, K.G., & Amado, H. (1987). Reliability, validity, and parent-child agreement studies of the Diagnostic Interview for Children and Adolescents (DICA). Journal of the American Academy of Child and Adolescent Psychiatry, 26, 649–653.PubMedCrossRefGoogle Scholar