Level of Care Utilization System for Psychiatric and Addiction Services
ABOUT LOCUS AND CALOCUS
Since the arrival of managed care programs and principles, the use of quantifiable measures to guide assessment, level of care placement decisions, continued stay criteria, and clinical outcomes has been increasingly important. Until the development of LOCUS by the American Association of Community Psychiatrists (AACP) in 1996, there had been no widely accepted standards to meet those needs. Healthcare reforms in recent years have emphasized implementation of objective and uniform measurements for decision-making throughout the health care system. LOCUS is now used extensively in 26 states and in several international locations, and provides a single instrument that can be used for these functions in diverse settings and systems.
The success of LOCUS exposed the need for a similar approach to support decision making for Child and Adolescent Services. As a result, the AACP, in collaboration with the American Association of Child and Adolescent Psychiatry (AACAP), set to work to develop CALOCUS. This derivative closely mirrors the structure of its parent, and its emphasis on simplicity and accessibility.
Integrating behavioral health and physical health concerns, it provides a common language and set of standards with which to make consistently sound judgments and recommendations. With LOCUS and CALOCUS, clinicians and managers of healthcare resources have an instrument that is simple, easy to understand and use, but is also meaningful and sufficiently sensitive to distinguish appropriate needs and services. It provides clear, reliable and consistent measures that are relevant for making decisions related to quality of care, quality improvement and resource allocation.
Both LOCUS and CALOCUS have four main objectives. The first is to provide a system for assessment of service needs based on six evaluation parameters. The second is to describe a continuum of service intensities, characterized by the amount and scope of resources available at each "level" of care, in each of four categories of service. The third is to create a methodology for quantifying the assessment of service needs to permit reliable determinations for placement in the service continuum. The fourth is to facilitate clinical management and documentation.
This system is a dynamic one, and it has evolved over the years of its development. Its simple style and structure has invited use not only by a variety of clinicians with various levels of training, but also by service users themselves. This allows assessment to become a collaborative process. Engagement in this collaboration is central to person centered treatment planning. We continue to encourage collaboration in the assessment process whenever this is possible, and the accessible language of the instruments accommodates that process.
The LOCUS and CALOCUS instruments continue to demonstrate multiple potential uses:
At the individual client level:
To assess immediate service needs (e.g., for clients in crisis)
To monitor the course of recovery and service needs over time
To provide valid, value driven guidance to payers for medical necessity criteria the application of which will better meet the needs of clients in real world systems
To inform treatment planning processes
At the system or population level:
To plan system level resource needs for complex populations over time and help identify deficits in the service array
To assist in the development of bundled payments or case rates for episodes of care for specific clinical conditions
To provide a framework for a comprehensive system of clinical management and documentation
To facilitate communication between systems of care regarding service intensity needs
While LOCUS and CALOCUS are simple and straightforward to use, we highly recommend anyone performing LOCUS or CALOCUS assessments be trained by a certified LOCUS trainer.
LOCUS and CALOCUS were developed by members of the American Association for Community Psychiatry (AACP) and transformed into electronic versions by Deerfield Solutions.
"Beyond assisting in service intensity placement decisions, these instruments (LOCUS and CALOCUS) can be used by systems to identify service gaps and to aid in projecting resource needs. The instruments provide guidance in treatment and recovery planning and help to ensure the best value for intended outcomes. They are useful for communication with managed care entities and to meet requirements for "least restrictive service alternatives" for Olmstead compliance. “
- Wesley E. Sowers, M.D., Director, Center for Public Service Psychiatry, Western Psychiatric Institute and Clinic