xxAACP Newsletter, Volume 12,
Number 3, Summer 1998
LOCUS 2.0 and CALOCUS 1.4 Approved by Board
Strong Reliability Demonstrated
A simple design was used to quantify and formalize reliability and validy following anecdotal reports of good reliability from the field. Twenty case vignettes were developed based on actual cases encountered by public sector psychiatrists and ten were randomly chosen to be rated by ten clinicians who had previous experience using LOCUS, but without any standardized or comprehensive training. Level of Care recommendations were determined by the raters using the two methods contained in LOCUS (Grid and Decision Tree) and by entering raters' scores in to a computer assisted program based on the placement algorithm. Intraclass correlation coefficients of .63 and .68 were obtained for raters' recommendations and computer generated recommendations respectively, both falling into the range of strong agreement. The recommendations also showed expected covariance with experts' ratings of these same ten cases, indicating reasonable valildity relative to this "gold standard" in addition to significant face validity identified by users of the instrument. More extensive and more closely controlled testing will be developed over the next twelve months to further verify reliability and to determine the effects of professional background, experience and training on reliability.
A software version of LOCUS, "Clinical Reporter," has been available over the past several months, but this version has not had the capacity to store information or to generate reports based on collected data. Although sales of the software has been only modeate thus far, feedback from users has been positive. As LOCUS 2.0 was approved by the Board, the systems version of the software was officially available for sale after successful Beta Site testing in several locations and on several common systems. "Systems Manager", as this new version is called, not only stores reports, but generates several reports relevant to resource management and service planning for systems which will be using it. Although this new system is considerably more expensive than the very low priced "Clinical Reporter", it is very modestly priced relative to similar products available from other vendors and relative to the potential savings it may generate.
As LOCUS has become widely distributed and well known, requests for a child and adolescent version of the instruments were more and more common and sometimes, urgent. Conceptual work on a Child and Adoleslcent version of LOCUS began more than ten years ago within the deliberations of the Child and Adolescent Committee of the AACP, then chaired by Charles Huffine. (See President's Column of this issue). About a year ago, the new Chairman of that committee, Andres Pumariega, shared the idea with the American Academy of Child and Adolescent Psychiatry and generated a great deal of interest in the AACAP Work Group on Community Systems of Care, whichhe also chairs. A collaboration was conceived and consummated with the recent release of CALOCUS Version 1.4 at the APA's annual meeting in Toronto this past June. CALOCUS follows the basic structure and methodology of the Adult Version, but has some important substantive differences. It incorporates CASSP principles in its vision of service systems and expands the flexibility of the levels of care that was introduced in that adult version. It places a strong emphasis on family empowerment and developmental issues and the concept of resiliency.
As in the adult version, CALOCUS uses six evaluation parameters, but alters them slightlly. CALOCUS uses 1) Risk of Harm; 2) Functional Status; 3) Medical, Addictive, Developmental and Psychiatric Co-Morbidity; 4) Recovery Environment (with subscales for Stress and Support); 5) Resilency and Treatment and Recovery History; 6) Acceptance and Engagement (with a Child and Parent subscale). The scoring system and the placement algorithms are essentially the same, making it easy for clinicians to use both instruments. Levels of care are defined in a manner with will encourage the developement and use of alternatives to traditional care environments and which will allow children to be treated in less restrictive settings. The Level of Care system also recognizes the importance of the involvement of multiple service systems in contructing an adequate treatment plan to meet the needs of children and adolescents with multiple problems.
Preliminary testing by the development committee indicates that like the adult version, it appears that the instrument can be used reliably in developing treatment recommendations for children (over eight year of age) and adolescents, although more formalized testing is only beginning. Field testing will begin shortly to obtain feedback from clinicians in the field and to determine the need for any early revisions prior to extensive reliability and valildity testing. The availablity of this instrument has created a great deal of enthusiasm and excitement and its development over the past year has been somewhat of a minor miracle. Thsi process was carried out through the extraordinary efforts of Dr. Pumariega and Huffine; their diplomacy and determination are now legend.
Persons wishing to obtain copies of either LOCUS 2.0 or CALOCUS 1.4 should contact: Pat Evans; WPIC, 3811 O'Hara Street, Pittsburgh, PA 15213; 412-383-9805; Email, evanspl@msx.upmc.edu.
Wesley Sowers, MD
Editor
Web Editor's Note, June 19, 2002: The current version of LOCUS can be found in the AACP website.
Back to Summer 1998 Table of Contents