When a question comes up about the appropriate intensity or level of care, we usually rely on the LOCUS instrument that was developed by a group of expert psychiatrists affiliated with the American Association of Community Psychiatrists.
LOCUS is the only instrument of its kind that was developed by clinicians specifically to match patients to the most appropriate (as opposed to the least expensive) level of care.
The process is designed to select a level of care from one of six levels of care. When we use it we are usually focused on five levels of care:
- Low Intensity Community Based Services – Traditional outpatient care in an office based practice
- High Intensity Community Based Services – Sometimes called intensive outpatient care
- Medically Monitored Non-Residential Services – Sometimes called partial hospitalization
- Medically Monitored Residential Services – Crisis residential or other high intensity residential care
- Medically Supervised Residential Services – Usually provided in an inpatient unit
The LOCUS assessment considers several factors in assigning the most appropriate level of care:
1. Risk of Harm – evidence of suicidal or homicidal thought or other risks of harm.
2. Functional Status – how well the person is functioning across major areas such as family, friendships, work, education.
3. Co-Morbidity – co-occurring medical, psychiatric and substance use disorders.
4. Recovery Environment – how much stress there is where the person is living and how much support may be available.
5. Treatment and Recovery History – how well the person has responded in the past to treatment.
6. Engagement – how accepting the person is of treatment, how easily he or she makes trusting connections with clinicians.