Children's Behavioral Health Services
Children's Assessment Program
Children and adolescents 6 years through 18 years who are experiencing
emotional, behavioral and/or substance abuse challenges and are receiving
Level II Targeted Mental Health Case Management Services.
Summary and Procedures
Assessments for Children and Adolescents Ages 6 - 18
Target Population
Children and adolescents 6 years through 18 years who are experiencing
emotional, behavioral and/or substance abuse challenges and are receiving
Level II Targeted Mental Health Case Management Services. If a child
is in school beyond age 18, check with DHHS, Office of Quality Improvement
for appropriate use of the tools in this situation. (Children birth
through 5 years are covered under separate summary and procedures,
which are pending.)
Purpose
- Guide and inform decision-making on the appropriate level and
intensity of services and supports a child and family may need;
- Guide service and support planning for children and families;
- Measure and document child and family progress in identified functional
and strength areas;
- Guide and inform caseload and resource planning activities;
- Evaluate the effectiveness of services and supports provided to
children and families; and
- Guide statewide program and service system planning and development.
Description of the Tools:
Three assessment tools were selected for use within Mental Health
Targeted Case Management Services, as follows:
Child and Adolescent Level of Care Utilization System (CALOCUS).
The CALOCUS was developed by the American Association of Community
Psychiatrists (ACCP- Klaehn, O’Malley, Vaughn and Koreger, 1999).
This instrument is used to derive level of resource intensity appropriate
to the child and families needs and includes two primary components
1) an assessment of the child/adolescent and family along six dimensions
(i.e. Risk of Harm; Functional status; Co–morbidity or Co-existing
conditions; Recovery Environment–Environmental Stress and Support;
Resiliency; and Treatment Acceptance and Engagement) and 2) a structured
decision making guide that uses assessment results to determine an
appropriate level of resource intensity. The CALOCUS specifies six
levels of resource intensity. Each assessment dimension is rated from
least to most severe using a five-point scale. The assessment is completed
by the primary clinician or case manager based on knowledge of the
child and family. Summing the individual dimension ratings also generates
the composite score.
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Child and Adolescent Functional Assessment Scale (CAFAS).
The CAFAS (Hodges, 1977) is designed to measure the degree of functional
challenges in children and adolescents with emotional, behavioral,
and/or substance abuse problems. The instrument contains eight subscales,
including: 1) School/work, 2) Home, 3) Community, 4) Behavior towards
others, 5) Moods and Emotions 6) Self Harmful Behaviors, 7) Substance
Abuse, and 8) Thinking. Ratings on each subscale are determined based
on the rater knowledge and understanding of the child/adolescent’s
behaviors over a 90-day period.
Section 65H Children’s Behavioral Health Services Intensity
of Service Guide.
This tool provides a framework for mapping the CAFAS Total Youth
Score to recommended intensity of Children’s Behavioral Health
Services that might be needed.
Family Empowerment Scale (FES).
This 34-item instrument was developed by the Research and Training
Center (Koren, DeChillo, and Friesen, 1992) on Family Support and
Children’s Mental Health at Portland State University. Its purpose
is to assess parent/caregiver perceptions about their roles and responsibilities
within their local service systems and their ability to advocate on
behalf of their child. The FES is a self-report instrument that is
completed by the child/adolescent’s primary caregiver. Each
scale item is rated along a five-point scale from 1 (Never True) to
5(Almost Always True). The FES scoring procedure is based on a simple,
un-weighted sum of the items, resulting in scores in each of the following
areas: Parent/Caregiver Empowerment: Family, Service System Empowerment,
and Community/Political Empowerment. A Total Empowerment Score is
also derived by taking the sum of all 34 Items. The FES is a simple,
basic tool designed to be administered with minimal training.
Who Completes the Assessment Tools?
The CALOCUS and CAFAS are completed by the designated service provider
(i.e., Case Manager, based on their knowledge of and experience with
the child/family situation.
The CALOCUS and CAFAS tools are completed based on an intake interview/psycho-social
assessment by a qualified mental health professional (i.e., case manager).
It is expected that service providers will use existing intake/assessment
tools and procedures to gather the information necessary to complete
the CALOCUS and CAFAS. Both tools are completed by the case manager/service
provider after the necessary information has been obtained from the
child and family and other informants. Neither the CALOCUS nor CAFAS
was designed to be used as an interview and should not be administered
in this way. Only Individuals who have been trained and have met the
established CALOCUS and CAFAS reliability criteria are permitted to
use these tools.
The FES is completed by the child or adolescent’s primary caregiver
(i.e., parent, relatives, foster parents, or other caregiver) who
lives with and knows the child/adolescent. The questionnaire is completed
via pencil and paper. The service provider should be present to answer
questions and address any concerns that the parent/caregiver may have.
(Refer to Rev. April 2003 FES Administration Procedures for further
information.)
Administration Procedural Guidelines
Children/Adolescents Receiving Mental Health Targeted Case Management
Services with Emotional/Behavioral and/or Substance Abuse Challenges
Case Manager (CM) obtains and completes with parent/guardian all
required release of information forms.
Case Manager (CM) completes the initial/baseline CALOCUS, CAFAS,
and FES upon an eligible child/adolescent’s entry into Level
II case management services. The initial assessments are required
to be completed within 30 days of the child’s entry into Level
II case management services. For those individuals already enrolled
and receiving services, the initial (baseline) assessment is completed
at the child or adolescent’s next quarterly ISP review.
Annual Assessment Updates:
Case Manager (CM) completes all annual assessments as long as the
child/adolescent remains enrolled in service and upon exit from case
management services. The follow-up intervals are determined from the
date of the initial (baseline) assessment (i.e., the first follow-up
is completed 12 months from the date of the initial assessment, and
administered annually thereafter). If an assessment is completed outside
the interval time period, the administration must be checked as “other” and
then resumed on the regular schedule based on the date of the initial
(baseline) assessment. Each follow-up assessment should be completed
within a 30-day window of the target follow-up date.
Children/Adolescents Receiving Targeted Case Management Services
and Section 65H Children’s Behavioral Health Services
Case Manager (CM) obtains and completes with parent/guardian all
required release of information forms.
Case Manager (CM) completes Initial/Baseline assessments (i.e., CAFAS,
CALOCUS, and FES) (See Targeted Case Management Assessment Procedures)
and determines the recommended intensity of service using the Section
65H Children’s Behavioral Health Services Intensity of Service
Guide.
The Case Manager forwards copy of completed Baseline CAFAS assessment
along with the completed Section 65H Children’s Behavioral Health
Services Intensity of Service Guide, and other relevant documentation
including CALOCUS and FES to the Section 65H Provider.
The Section 65H provider coordinates a planning meeting for Section
65H services. The meeting should include, at a minimum, the parents/guardian(s)
Section 65 provider, and case manager. The purpose of the meeting
is to discuss and reach a common understanding of the intended goals
and objectives of Section 65H Children’s Behavioral Health Services;
review assessment information and other child and family documentation;
facilitate discussion of the intensity of behavioral services needed,
and ensure coordination with the child and family Individualized Support
Plan (ISP). If Section 65H services are determined to be warranted
by the assessment results, review of other relevant information, and
consultation with the Section 65H provider and Child and Family Team
(C&F Team), the Case Manager is responsible for appropriately
documenting the need for Section 65H services in the child’s
Individualized Support Plan (ISP).
Based on review of all supporting documentation, including C&F
Team recommendations, the Section 65H provider determines/approves
actual number of Children’s Behavioral Health Service hours
to be provided.
Annual Assessment Updates:
Case Manager completes all annual assessment updates and forwards
the completed CAFAS updates; Intensity of Service Guide Recommendations;
and other relevant documentation including CALOCUS and FES to the
Section 65H provider for review and possible adjustment to the intensity
of behavioral services provided. Follow-up assessments are completed
every 12 months as long as the child/adolescent remains enrolled in
services and upon exit from service. Follow-up assessments should
be scheduled 12 months, 24 months, etc. from the date of the initial/baseline
assessment.
Based on review of annual update documentation, including: annual
assessment results (i.e., CALOCUS, CAFAS, FES), along with other supporting
documentation, recommended intensity of Behavioral Services, and consultation
with C&F Team, the Section 65H provider assesses the current intensity
of services and, if warranted, makes adjustments to the services provided.
While regular assessment updates are required on an annual basis,
it is recommended that Section 65H providers complete the CAFAS and
Intensity of Service Guide whenever there is a significant change,
either positive or negative, in the child/adolescent’s status.
Mental Health licensing and the Section 65H MaineCare policy, requires
the Individualized Treatment Plan (ITP) be reviewed, changed if needed,
and reauthorized every 90 days. (This may be an appropriate time to
re-administer a CAFAS, if warranted, based on significant change in
child’s status over the preceding 90-day period.) It is the
responsibility of the Section 65H provider to inform the case manager
of any changes in the child’s status and/or adjustments in the
intensity of Section 65H services provided to ensure ongoing coordination
with the child’s (and family) ISP.
Change in Case Manager
When a child/adolescent’s case is transferred to another case
manager within the same provider agency, the new case manager assumes
responsibility for conducting the follow-up assessments. At the point
of transfer, an assessment summary, including all of the assessments
completed up to the point of transfer and the date of the next scheduled
follow-up should be provided to the new case manager. After a child/adolescent
is reassigned, the new case manager then continues to administer the
follow-up assessments according to the same assessment schedule.
Change in Provider Agency
If a child/adolescent and family transfers to another Case Management
Agency for services, this should be considered a new entry into services
and the assessment protocol administered according to the procedures
outlined above (i.e., initial assessment completed within 30 days
of entry into new program; follow-up schedule established based on
date of initial assessment; and follow-up assessments completed according
to the schedule).
Exit and Re-Entry into Case Management Services
In the event that a child/adolescent formally exits case management
services (case is closed) at a provider agency and later returns and
is re-enrolled into case management services, the following procedure
applies. Upon a child/adolescent’s re-entry into case management
services, regardless of the time spent away from service, the assessment
process would be reinitiated as if the child/adolescent was a new
entry into service (see procedures outlined above).
Assessment Exemption Form.
In some cases it may not be possible or appropriate to complete one
or all of the assessment tools (CALOCUS, CAFAS and FES) with a particular
child and family. In these instances, the rater is required to complete
a Children’s Screening and Assessment Exemption Form (parents
signature is required on form) and send it to the Department along
with those assessment tool(s) that were completed. The Assessment
Exemption Form also needs to be completed when a child/adolescent
is exiting from service and a previously administered tool is to be
used as the exit interview, if the assessment was completed within
the last three (3) months.
Training Requirements for Children/Adolescent Case Management Services
Training is required on all of the above assessment instruments.
The DHHS Office of Quality Improvement provides trainings on a monthly
basis for identified provider agency representatives on the use of
these assessment tools. For more information on trainings or to sign-up
for training contact Cindy McPherson by phone: 287-4319 or by email:
cynthia.mcpherson@maine.gov
Transmission of Information to BH
All initial and follow-up assessments are forwarded to DHHS QI Office
for quality review and tracking purposes.
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Preparation
and Transmission of Screening Data to
BH CALOCUS, CAFAS and FES Summary Form Descriptive Definitions |
|
Client ID: Unique identifier of child/adolescent being assessed.
The 8 character unique identifier is composed of the first letter
of the child/adolescent's last name, the first letter of the
child/adolescent's first name and date of birth. The unique
identification number must be placed in the space provided on
each CALOCUS, CAFAS & FES Scoring Sheet.
For example: Sara Jones who has a birth date of 07/28/92 would
be: JS072892 |
|
Date Assessed: Date screening tools completed whether initial
screening or update; |
|
Service Start Date: Date child/adolescent began receiving Level
II case management services or Section 65H services; |
|
Case Number: Agency assigned case number (If applicable); |
|
MaineCare Number: Child/Adolescent's MaineCare ID number (if
not applicable, indicate with N/A or pending in space provided)); |
|
DOB: Child/Adolescent's Date of Birth; |
|
Gender (M/F): Child/Adolescent's gender; |
|
Child's Residence (County): Refers to the county in which the
child/adolescent currently resides; |
|
BH Region: Refers to the region where the child is receiving
services. |
|
Rater Name & ID#: Name of person completing the Assessment
and Rater Identification Number; |
|
Agency/Program Name: Name of agency providing services; |
|
Administration: Refers to the scheduled assessment period in
which tools are being completed
Baseline or Entry into Services
(1st administration)
Annually
(every 12-months from initial assessment)
Exit from Service
Other (use only if assessed date occurs outside designated follow-up
interval time period)
Crisis Services (only use Entry into Service interval) |
|
Service/Program: Refers to the service/program (i.e., MH Case
Management; MR Case Management & Crisis Services 65H-BHS;
Section 24-CHS) the child/adolescent is currently receiving
and the program responsible for completing assessments.
Age: Refers to the age of child/adolescent receiving services
(School age or Birth to 5yrs)
Disability Group: Refers to diagnosis (MH, MR, MH/MR, Autism,
MR/Developmental Disabilities, Developmental Delays) the child/adolescent
has been assigned at the time of the assessment.
Relationship of Person Completing FES: Refers to family or caregiver
(Parent, Guardian, Foster Parent, Other). |
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Frequency of Transmission: |
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Copies of completed CALOCUS Scoring Sheet, CAFAS Summary Sheet
and FES should be mailed to Veronica Dumont (see address
below) at the end of every week. Required information
may be sent to the Department in electronic format if desired. Make
sure that individual names are crossed-out on all transmitted
copies and use the unique child ID# as described below:
Send Forms To: Veronica Dumont
#11 SHS, Marquardt Bldg.
Augusta, ME. 04333
(telephone: 287-4202 or fax: 287-9915)
Training inquiries can also be made to Cindy McPherson,
Assessment Training Coordinator (287-4319) or fax: 287-7571 |
CALOCUS -Child and Adolescent
Level of Care Utilization System
CAFAS - Child and Adolescent Functional
Assessment Scale
FES - Family Empowerment System
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