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 is rapidly expanding its recognition as the best practice standard for medical necessity decisions in behavioral health. It provides a single instrument that can be used for this and other necessary treatment 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 was released in 2001 and closely mirrors the structure of its parent, with its emphasis on simplicity and accessibility. The LOCUS family of Tools (LOCUS FTs) now includes ECSII (Early Childhood Service Intensity Instrument) developed by the AACAP for children between the ages of birth to 5 years old. Deerfield will soon add ECSII to its LOCUS software suite.
Integrating mental health, physical health and concerns related to substance use, these tools provide a common language and set of standards with which to make consistently sound judgments and recommendations. With the LOCUS FTs, clinicians and managers of healthcare resources have instruments that are simple, easy to understand and use, but is also meaningful and sufficiently sensitive to distinguish appropriate needs and services. They provide clear, reliable and consistent measures that are relevant for making decisions related to quality of care, quality improvement and resource allocation. Most importantly, they inform treatment planning for efficient use of resources.
The LOCUS tools 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 and objectifying the assessment of service needs to permit reliable determinations for placement in the service continuum and to mitigate the effects of bias in decision making.
- 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. The accessible language of the instruments encourages this collaboration in the assessment whenever it is possible.
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 for medical necessity determinations that 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.
- To enhance equity and fairness in service planning decisions by reducing the variability and bias inherent in idiosyncratic decision making.
While LOCUS and CALOCUS are simple and straightforward to use, it is highly recommended that anyone performing LOCUS or CALOCUS assessments should be trained by a certified LOCUS trainer. Training will enhance the reliability of ratings and allow users to transition easily into this unique system for matching services to identified needs in a way that serves the interests of all stakeholders.
