Background: The process of level of care (LOC) determination has been traditionally fraught with unreliability
and lack of objectivity. There is a similar need for reliable objective LOC determination tools for youth in the juvenile justice
systems, which have high prevalence of psychiatric disorders and unmet mental health needs and are disproportionately
from minority backgrounds. The CASII has already demonstrated significant interrater reliability and validity in
studies with mental health and child welfare populations.
Method: In 2004 and 2005, the Tennessee CPORT team reviewed 206 youth in the juvenile justice system ages 13 and
older, 92.8% male, with 37.4% Caucasian, 55.8% African American. Instruments used included the CASII, CAFAS,
CBCL, YSR, TRF, and the CPORT Child and Family Indicators.
Results: There was a significant correlation between all of the CASII subscales and the CAFAS Total Scores (Pearson
coefficients 0.210 to 0.618). The CASII Total Score and the CASII LOC were both highly correlated to CBCL, the YSR,
and the TRF total scores and sub-scales. Significant correlations between the CASII LOC were found in 10 of the 13
CPORT Child and Family Indicators, while actual LOC placement was significantly correlated with only 4 of the 13 dimensions.
The actual LOC placement was significantly different than recommended CASII LOC (p < 0.0000), with the
majority of recommended LOCs being lower.
Conclusions: This LOC tool is demonstrating high levels of reliability and validity in different systems of care settings,
including juvenile justice, child welfare, and mental health contexts. Use of the CASII could result in significant savings
in resources that could be used to provide services for adolescent offenders, and in reduction in unnecessary restrictiveness