What is the CASII?
The Child and Adolescent Service Intensity Instrument (CASII) is a standardized tool developed by the American Academy of Child and Adolescent Psychiatry. It links clinical assessments to levels of care for youth with mental health challenges.
Definition and Purpose
The CASII, previously known as CALOCUS, is a structured assessment instrument designed to determine the appropriate level of care for children and adolescents. Its primary purpose is to match a client’s needs with the correct service intensity. It achieves this by evaluating six key dimensions of a child’s functioning, ensuring that the services provided are proportionate to the severity of their condition. This standardized approach aids clinicians in making informed decisions about placement, treatment planning, and monitoring progress throughout the care process, promoting effective and efficient service delivery. It helps organize mental health services for a team approach;
CASII Dimensions
The CASII assesses six key dimensions⁚ risk of harm, functional status, co-morbidity, environmental stress and support, resiliency, and response to services. These dimensions help determine a client’s needs.
Risk of Harm
This dimension of the CASII evaluates the immediate danger a child or adolescent poses to themselves or others. It considers the presence of suicidal or homicidal thoughts, plans, or past behaviors. It also assesses the severity and frequency of these risks, and whether there are any current imminent threats. This is a crucial part of the assessment, as it helps determine the level of intervention needed to ensure safety. The risk of harm dimension is particularly important when considering the need for 24-hour monitoring and services. It also includes the assessment of the child’s or adolescent’s impulsivity and potential for accidental harm.
Functional Status
This CASII dimension assesses a child’s or adolescent’s ability to perform daily activities and meet developmental expectations. It examines areas like school performance, social interactions, self-care, and adaptive skills. The evaluation considers the impact of mental health challenges on these functions. It looks at whether the youth can maintain relationships, attend school, engage in age-appropriate activities, and manage basic personal needs. Significant impairments in these areas may indicate a need for more intensive services, including interventions to improve skills and functioning. The aim is to support the youth’s overall development and well-being.
Co-morbidity
The co-morbidity dimension of the CASII considers the presence of other conditions alongside the primary mental health concern. This includes physical health issues, substance use disorders, and additional mental health diagnoses. The assessment evaluates the impact of these co-occurring conditions on the youth’s overall functioning and treatment needs. The presence of multiple conditions often complicates treatment and can require integrated interventions. It highlights the need for a holistic approach that addresses all aspects of the youth’s health and well-being. A comprehensive understanding of co-morbidities is essential for effective treatment planning and service delivery.
Environmental Stress and Support
This CASII dimension assesses the level of stress and support within a child’s or adolescent’s environment. It examines factors such as family dynamics, school environment, and community resources. The evaluation includes the presence of stressors like poverty, trauma, or lack of stability, as well as available supports like family, friends, or community services. The goal is to understand how these environmental factors impact the youth’s mental health and treatment needs. A supportive environment can enhance treatment outcomes while significant stress may hinder progress, necessitating targeted interventions to improve stability and support.
CASII Scoring
The CASII uses a structured scoring system across its dimensions. Raters assess each dimension based on severity, assigning numerical values that contribute to a total score.
Scoring Process
The scoring process involves evaluating the youth across six key dimensions. Each dimension is rated independently using a defined scale, reflecting the severity of the presenting issues. Raters select the most appropriate option within each dimension, then record the corresponding score. These individual dimension scores are then summed to obtain a total score. The total score is used to determine the recommended level of care. The scoring process provides a standardized approach to assessing a youth’s needs and helps to ensure consistency in application of the CASII tool, resulting in a level of care that is appropriate for the individual.
CASII Levels of Care
The CASII outlines several levels of care, ranging from basic services for prevention to intensive, 24-hour support with psychiatric monitoring. Each level corresponds to specific service intensity needs.
Service Intensity Levels
The CASII defines distinct service intensity levels that guide the provision of care. Level 0 focuses on basic prevention and maintenance, while Level 1 emphasizes recovery and health management. Level 2 provides more structured support, and Level 4 delivers intensive services without psychiatric oversight. Level 5 is the most intensive, involving non-secure 24-hour care with psychiatric monitoring. These levels, ranging from 0 to 5, help clinicians match the severity of a child’s needs with the appropriate level of intervention, ensuring the most effective and efficient use of resources.
CASII Use Cases
The CASII is applied in clinical settings to determine appropriate care levels for children and adolescents with emotional disturbances. It helps guide treatment planning and monitor progress over time.
Application in Clinical Settings
Clinicians utilize the CASII to assess the service needs of youth with serious emotional disturbance. It aids in organizing mental health services and community resources to create a team approach. The instrument supports care in various settings, including homes, to address issues like behavior and relationship problems, developmental delays, and trauma-related concerns. The CASII helps match a clinical assessment with standardized levels of care, ensuring that youth receive the appropriate intensity of services. It is a comprehensive tool for evaluating service needs and making informed decisions about treatment.
Related Instruments
The Early Childhood Service Intensity Instrument (ECSII) is a related tool. It is used to assess the service intensity needs of children under the age of six years, differing from the CASII’s target age range.
ECSII for younger children
The Early Childhood Service Intensity Instrument (ECSII) is specifically designed to assess the needs of children from birth to five years old. Because the CASII is intended for children aged 6 to 18, the ECSII is used to evaluate the service intensity needs of younger children. This ensures that the unique developmental stages and needs of very young children are taken into account when determining appropriate levels of care. The ECSII helps professionals identify the necessary resources and interventions to support early childhood development.
CASII and CALOCUS
The CASII, previously known as CALOCUS, is a tool for determining the appropriate level of care for children and adolescents. It provides guidance in treatment planning and monitoring progress.
Relationship between CASII and CALOCUS
The Child and Adolescent Service Intensity Instrument (CASII) was formerly known as the Child and Adolescent Level of Care Utilization System (CALOCUS). The CASII is essentially an updated and refined version of CALOCUS, retaining the core principles of assessing service intensity needs. The CALOCUS-CASII provides standardized, age-appropriate guidance for developing treatment plans and monitoring progress over time for children and adolescents with behavioral health and/or substance use concerns. It draws from clinical experience and a number of values, principles, and resources. The CASII provides a method for matching clinical assessment with standardized levels of care.