AACP Newsletter, Volume 13,
Number 4, Autumn 1999
LOCUS and CALOCUS Continue to Gain Recognition
- Risk of Harm;
- Functional Status;
- Psychiatric, Medical and Addictive Co-Morbidity;
- Recovery Environment;
- Treatment and Recovery History and;
- Attitude and Engagement.
It was developed from a practical clinical perspective that demanded user friendliness, and each dimension was developed considering both addictive and mental health placement issues, making it perhaps the only instrument of its kind which originated from a truly integrated perspective. The system also included a methodology for translating the completed assessment into a recommendation for a certain level of resource intensity to meet the needs indicated. LOCUS defines six "levels of care" which attempt to provide a flexible and easily adaptable framework for providing an individualized plan for care in the context of variable service intensity related to a client's level of need.
LOCUS had some immediate appeal to both providers and payers in mental health systems but also met significant pockets of skepticism early in its field testing phase. Two sets of revisions were completed prior to the onset of formal reliability and validity testing. LOCUS 2.0 is the version currently in use, and preliminary testing has demonstrated good reliability and validity. A software version of LOCUS became available in 1997, and its use in various systems of care has steadily grown. In 1998, following a productive collaboration with the American Academy of Child and Adolescent Psychiatry (AACAP) the Child and Adolescent version (CALOCUS 1.4) was approved and released for use. Reliability and validity testing is currently in process and a software version has recently been completed. CALOCUS incorporates the basic structure of LOCUS but adapts dimensional criteria, which is relevant to the unique developmental issues and service requirements of children and adolescents.
Although initial psychometric results are promising for both instruments, much remains to be done. Future research may focus on questions such as who can use LOCUS reliably? What level of training is required? Does the instrument adequately address both psychiatric and addiction issues? How can one achieve the ultimate validation of these instruments: More effective outcomes? Is the assessment system valid for use as an outcome indicator in addition to its placement function? The answers to these questions should be the guide to possible future revisions of these instruments. They will not be simply established however, and it is clear that significant additional funding will be required to develop the needed protocols.
Deerfield Behavioral Health has been our partner in the development of software versions of these instruments. Deerfield is a not-for-profit organization, which makes them a good fit for the AACP. They have developed individual software versions of both instruments, which can be installed on any personal computer and are available at an affordable price for independent users. They have also developed a systems version for both LOCUS and CALOCUS that will allow networks to store and analyze information regarding utilization of resources within their systems. As a greater number of large mental health systems consider the use of these instruments, it is within this market that Deerfield is focusing most of its attention. While there has been significant interest from various managed care companies, political interference has so far prevented their use on that level. Major markets using LOCUS have remained primarily in the East and Midwest. Maine, Vermont, Michigan, Minnesota, Ohio, Pennsylvania, New Jersey, and Virginia are a few of the states that have shown considerable interest. On the West Coast, both Washington and Oregon have been involved with LOCUS over the past few years and Portland will be one of the test sits for CALOCUS. Training manuals have now been developed for both LOCUS and CALOCUS and a standardized training package is available for systems interested in their use.
Although revisions of the original text of LOCUS has resulted in the present version which is being tested for reliability and validity, the LOCUS Development Committee continues to consider changes for future editions. While some relatively minor changes in the current version are being considered, most of those suggested would not significantly alter content or structure. A subgroup of the Committee is responsible for drafting these changes and also for considering expanded applications for this instrument. While the goal is to maintain the basic structure of the instrument, the possibility of using the scoring system to guide other clinical activities such as treatment planning is being explored. Development of modular type add-ons would allow the creation of methods of accomplish complex tasks as an option for users, without violating the principle of simplicity which has guided the instrument's development from its inception. Revisions for the CALOCUS will await the completion of field testing and psychometric testing.
LOCUS and CALOCUS represent significant advances for our field and our organization. It is hoped that their function in managing care and resources will continue to be recognized and that the dream of having a single standard for guiding these decisions will yet be realized. Any members interested in further information or anyone who would like to join the LOCUS Development Committee can contact Wesley Sowers at 412-622-6717.
March 22, 2003 - Web Editor's comment: The current versions of LOCUS and CALOCUS are available in the Findings/Products section of the AACP Main Page.Wesley Sowers' new phone number is 412-350-3716.
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