Service Intensity/Level of Care Determination in a Child Welfare Population
- 17 Downloads
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.
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.
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.
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.
KeywordsService intensity Level of care determination Child welfare Child mental health Placement
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.
Compliance with Ethical Standards
Conflict of Interest
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.
The study was approved by the Institutional Review Board of the Quillen College of Medicine, East Tennessee State University (QCOM- ETSU).
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.
- Achenbach, T. (1991). Manual for the child behavior checklist/4-18 and 1991 profile. Burlington, Vermont: University of Vermont Department of Psychiatry.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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., & Reid, J. B. (1987). Parent observation and report of child symptoms. Behavioral Assessment, 9, 97–109.Google Scholar
- 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.Google Scholar
- 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.CrossRefGoogle Scholar
- Lyons, J. (1999). The Child and Adolescent Needs and Strengths for children with mental health challenges. Winnetka, IL: Buddin Praed Foundation.Google Scholar
- 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.Google Scholar
- Lyons, J. S. (1997). The measure and management of clinical outcomes in mental health. New York: Wiley.Google Scholar
- Lyons, J. S. (1998). Severity and acuity of psychiatric illness manual: Child & adolescent version. San Antonio, TX: The Psychological Corporation.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- Pumariega, A. J., & Winters, N. C. (2003). Handbook of community systems of care; The new child & adolescent community psychiatry. San Francisco: Jossey Bass Publishers.Google Scholar
- 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.
- 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.CrossRefGoogle Scholar
- 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.
- 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.CrossRefGoogle Scholar