Journal of Child and Family Studies

, Volume 15, Issue 2, pp 140–152 | Cite as

A Level of Care Instrument for Children's Systems of Care: Construction, Reliability and Validity

  • Theodore FallonJr.Email author
  • Andres Pumariega
  • Wesley Sowers
  • Robert Klaehn
  • Charles Huffine
  • Thomas VaughanJr.
  • Nancy Winters
  • Mark Chenven
  • Larry Marx
  • Albert Zachik
  • William Heffron
  • Katherine Grimes

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.


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.


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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Theodore FallonJr.
    • 1
    • 12
    Email author
  • Andres Pumariega
    • 2
  • Wesley Sowers
    • 3
  • Robert Klaehn
    • 4
  • Charles Huffine
    • 5
  • Thomas VaughanJr.
    • 6
  • Nancy Winters
    • 7
  • Mark Chenven
    • 8
  • Larry Marx
    • 7
  • Albert Zachik
    • 9
  • William Heffron
    • 10
  • Katherine Grimes
    • 11
  1. 1.Psychoanalytic Center of PhiladelphiaPhiladelphiaUSA
  2. 2.Child and Adolescent PsychiatryEast Tennessee State UniversityJohnson CityUSA
  3. 3.Allegheny County Office of Behavioral HealthPittsburghUSA
  4. 4.Maricopa Integrated Health SystemPhoenixUSA
  5. 5.Department of PsychiatryUniversity of WashingtonSeattleUSA
  6. 6.Behavioral Health, Children's Hospital of BirminghamBirminghamUSA
  7. 7.Psychiatry, Oregon Health Sciences UniversityPortlandUSA
  8. 8.Clinical OperationsSan DiegoUSA
  9. 9.Director of Child and Adolescent ServicesMaryland Department of Mental HealthBaltimoreUSA
  10. 10.Department of PsychiatryUniversity of KentuckyLouisvilleUSA
  11. 11.Department of PsychiatryHarvard Medical SchoolBostonUSA
  12. 12.Chester SpringsUSA

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