AACP Newsletter, Volume 10,
Number 3, Summer 1996
LOCUS Adopted by AACP Board to Aid Service Need Placement Determinations
The Level of Care Utilization System for Psychiatric and Addiction Services ( LOCUS) was developed by the AACP’s Health Care Systems Committee Task Force on Levels of Care Determinations in response to these needs and has three main objectives. The first is to propose a system for assessment of service needs for adult clients, based on six evaluation parameters. The second is to propose a continuum of service arrays that vary according to the amount and scope of resources available at each “level” of service in each of four dimensions of intensity. The third is to propose a methodology for quantifying the assessment of service needs to permit reliable determinations for placement in the service continuum.
Although a wide variety of documents have been developed for both public and proprietary purposes, those currently in existence fail to address many aspects of behavioral health care adequately. They are often unable to achieve consensus between providers and payers. Even those instruments that do a relatively good job of defining need and service levels are often quite complicated and create difficulties in the important process of matching those needs to appropriate service arrays. In some cases these systems are overly prescriptive, allowing little flexibility for the provider to adapt them to local variables and unique clinical circumstances.
Although LOCUS is a work in progress and has not yet been subjected to any formal process of validity or reliability testing, it is being circulated in order to obtain the preliminary feedback needed to proceed to formal development of the instrument and to further explore its utility.
The instrument has multiple potential uses:
- To assess acute service needs (e.g., for clients in crisis)
- To plan resource needs over time, as in assessing service requirements for defined populations
- To monitor changes in status or placement at different points in time.
LOCUS is divided into three sections. The first section defines six evaluation parameters or dimensions:
- Dangerousness;
- Functional Status;
- Medical and Psychiatric Co-Morbidity;
- Recovery Environment;
- Treatment and Recovery History; and
- Attitude and Engagement.
The second section of the document defines six “Levels of Care”:
- Recovery Maintenance and Health Management;
- Outpatient;
- Intensive Outpatient;
- Intensively Managed Non-Residential;
- Non-Secure Residential; and
- Secure Residential.
In addition, Prevention and Health Maintenance “Basic Services” are defined. Each level in the service continuum is defined in terms of four variables:
- Physical Plant,
- Clinical/Medical Services,
- Support Services, and
- Crisis Resolution and Prevention Services.
Although the term “level” is used for simplicity, it is not meant to imply that the service arrays are static or linear. Rather, each level describes a flexible or variable combination of specific service types.
The particulars of program development are left to providers to determine based on local circumstances and outcome evaluations. Each level encompasses a multidimensional array of service intensities, combining crisis, supportive, clinical, and environmental interventions, which may vary independently. Patient placement criteria are then elaborated for each level of care. Separate admission, continuing stay, and discharge criteria are not needed in this system, as changes in level of care will follow from changes in ratings in any of the six parameters over the course of time. Unlike many documents of this kind, LOCUS integrates addiction and other mental health conditions for evaluation in one system.
The final section of LOCUS describes a proposed scoring methodology that facilitates the translation of assessment results into placement or level of care determinations. Both a grid chart and a decision flow chart are included for this purpose.
It is hoped that this initial version of LOCUS will stimulate considerable comment, discussion, and testing as we begin our own reliability and validity studies. It is recognized that a document of this type must, itself, be dynamic and that adjustments may be required either to accommodate local needs or to address unanticipated or unrecognized circumstances or deficiencies. The specific needs of special populations, such as children, adolescents, and the elderly will not be adequately addressed in the adult version. It is not intended to replace clinical judgment, and is meant to serve only as an operationalized guide to resource utilization that must be applied in conjunction with sound clinical thinking. It is being offered as an instrument which should have considerable utility as a first edition, but one which we anticipate will grow and improve with time and testing.
The AACP is interested in collecting pilot data on the use of the LOCUS. Anyone wishing to review LOCUS may request a copy from the AACP. Please send your requests to: Wesley Sowers, MD, St. Francis Medical Center, CAS-2 East, 400 45th Street, Pittsburgh, PA, 15201-1198, Phone 412-622-6717, Fax 412-622-6756, email: wsowers@mem.po.com. The document may also be downloaded from the AACP home page at http://www.pitt.edu/~kthomp. Comments and suggestions are welcome.
March 31, 2003 - Web Editor's Comment: All contact information above is outdated. To see Dr. Sowers' contact information, click on his name. The URL for the AACP Homepage is also outdated. It is now http://www.communitypsychiatry.org.
Back to Summer 1996 Table of Contents