Child and Adolescent Service Intensity Instrument (CASII)

I. Risk of Harm
minimal risk of Low risk of harm Moderate risk of harm 3 Serious risk of harm 4 Extreme risk of harm 5
harm 1 2
a. No indication of a. Past history of a. Significant current suicidal a. Current suicidal or a. Current suicidal or
current suicidal or fleeting suicidal or or homicidal ideation with homicidal ideation homicidal behavior or
homicidal thoughts homicidal thoughts some intent and plan, with with either clear such intentions with a
with no significant with no current the ability of the child or expressed intentions plan and available
distress, and no ideation, plan or adolescent and her/her means to carry out this
and/or past history of
history of suicidal intention and no family to contract for safety behavior; without
or homicidal significant distress. and carry out a safety plan.
carrying out such expressed ambivalence
ideation, b. Mild suicidal Child or adolescent behavior. Child or or significant barriers to
b. No indication or ideation with no expresses some aversion to adolescent has doing so, or with a
report of physically intent or conscious carrying out such behavior. expressed ambivalence history of serious past
or sexually plan and with no b. No active about carrying out the attempts which are not
aggressive past history. suicidal/homicidal ideation, safety plan and/or of a chronic, impulsive
impulses. c. Indication or but extreme distress and /or his/her family’s ability or consistent nature, or
report of a history of to carry out the safety in presence of command
occasional suicidal/homicidal behavior. plan is compromised. hallucinations of
impulsivity, and/or c. Indication or report of delusions which
b. Indication or report of
some physically or episodic impulsivity, or threaten to override
significant impulsivity
sexually aggressive physically or sexually and/or physical or sexual usual impulse control.
impulses with aggressive impulses that are aggression, with poor b. Indication or report of
minimal moderately endangering to judgment and insight, repeated behavior,
consequences for self or others (e.g. status that is/are significantly including physical or
self or others. offenses, impulsive acts sexual aggression, that
endangering to self or
d. Substance use while intoxicated; self- is clearly injurious to self
others (property
without significant mutilation; running away o others (e.g., fire
destruction; repetitive
endangerment of from home or facility with fire setting or violence setting with intent of
self or others. voluntary return; fire toward animals). serious property
e. Infrequent, brief setting; violence toward c. Indication of consistent destruction or harm to
lapses in the ability animals; affiliation with deficits in ability to care others or self, planned
to care for self dangerous peer group). for self and/or use violence with other
and/or use d. Binge or excessive use of perpetrators) with
environment for safety.
environment for alcohol or other drugs history, plan or intent,
d. Recent pattern of
safety. resulting in potentially excessive substance use and no insight and
f. Some risk for harmful behaviors. resulting in clearly judgement (forcible and
victimization, e. Episodic inability to care harmful behaviors with violent, repetitive sexual
abuse, or neglect. for self and/or maintain no demonstrated ability acts against others),
g. Other: physical safety in of child/adolescent or c. Relentless engaging in
developmentally acutely self-endangering
family to restrict use.
appropriate ways. behaviors.
e. Clear and persistent
F. Serious or extreme risk for inability, given d. A pattern of nearly
victimization, abuse, or developmental abilities, constant and
neglect. to maintain physical uncontrolled use of
g. Other: safety and/or use alcohol or, other drugs,
. environment for safety. resulting in behavior
that is clearly
f. Other:
endangering.
*a score of 4 indicates
e. Other:
Medically Monitored
Residential Services *a score of 5 indicates
24 hour secure medical
care
Child and Adolescent Service Intensity Instrument (CASII)
II. Functional Status

Minimal Mild Moderate Serious Impairment 4 Severe Impairment

Impairment Impairment 2 Impairment 3 5
1
a. Consistent a. Evidence of minor a. Conflicted, withdrawn or a. Serious deterioration a. Extreme
functioning deterioration, or episodic otherwise troubled in of interpersonal deterioration in
appropriate failure to achieve relationships with peers, interactions with interactions with
to age and expected levels of adults, and/or family, but consistently conflictual peers, adults, and/or
development functioning, in without episodes of or otherwise disrupted family that may
al level in relationships with peers, physical aggression. relations with others, include chaotic
school adults, and/or family b. Self-care/hygiene which may include communication or
behavior (e.g., defiance, deteriorates below usual or impulsive or abusive assaultive behaviors
and/or provocative behavior, expected standards on a behaviors. with little or no
academic lying/cheating/not frequent basis. b. Significant provocation, minimal
achievement, sharing, or c. Significant disturbances withdrawal and control over impulses
relationships avoidance/lack of follow in vegetative activities, avoidance of almost all that may result in
with peers, through); school such as sleeping, eating social interaction. abusive behaviors.
adults, and behavior and/or habits, activity level, or c. Consistent failure to b. Complete
family, and academic achievement sexual interest), that do not achieve self- withdrawal from all
self- (difficulty turning in pose a serious threat to care/hygiene at levels social interactions
care/hygiene homework, occasional health. appropriate to age c. Complete neglect of
/control of attendance problems), or d. School behavior has and/or developmental and inability to attend
bodily biologic functions deteriorated to the point level. to self-
functions. b. (feeding or elimination that in-school suspension d. Serious disturbances care/hygiene/control
No more problems) but with has occurred and the child in vegetative status of biological functions
than adequate functioning in is at risk for placement in such as weight change, with associated
transient at least some areas an alternate school or disrupted sleep or impairment in physical
impairment and/or ability to respond expulsion due to their fatigue, and feeding or status.
in to disruptive behavior. elimination, which d. Extreme disruption
functioning redirection/intervention. Absenteeism may be threaten physical in vegetative function
following b. Sporadic episodes frequent. The child is functioning. causing serious
exposure to during which some repeating their grade. e. Inability to perform compromise of health
an aspects of self- e. Chronic and/or variably adequately even in a and well-being.
identifiable care/hygiene/control of severe deficits in specialized school e. Nearly complete
stressor with bodily functions ae interpersonal relationships; setting due to inability to maintain
consistent compromised. ability to engage in socially disruptive or aggressive any appropriate
and c. Demonstrates constructive activities, and behavior. School school behavior
normative significant improvement ability to maintain attendance may be and/or academic
vegetative in function following a responsibilities. sporadic. The child or achievement given
status. period of deterioration. f. Recent gains and/or adolescent has multiple age and
c. Other: d. Other: stabilization in functioning academic failures. developmental level.
have been achieved while f. Other: f. Other:
participating in treatment *a score of 5 indicates
in a structured, protected, *a score of 4 indicates 24 hour secure
and/or enriched setting. Medically Monitored medically managed care
g. Other: Residential Services
 Child and Adolescent Service Intensity Instrument (CASII)
III. Co-occurrence of Conditions: developmental, Medical, Substance use, and Psychiatric

No Co- Minor Co- Significant Co-Occurrence 3 Major Co-Occurrence Severe Co-Occurrence

Occurrence Occurrence 2 4 5
1
a. No a. Minimal a. Developmental disability a. Medical conditions a. Significant medical
evidence of developmental is present that may are present or have a condition is present that is
medical delay or disorder is adversely affect the high likelihood of poorly controlled and/or
illness, present that has no presenting problem, developing that may potentially life threatening
substances impact on the and/or may require require intensive, in the absence of close
use presenting problem significant augmentation or although not medical management
disorders, and for which the alteration of treatment for constant, medical (e.g., severe alcohol
or child or adolescent presenting problem or co- monitoring (e.g., withdrawal, uncontrolled
psychiatric has achieved morbid condition, or insulin-dependent diabetes mellitus,
disturbance satisfactory adversely affects the diabetes, hemophilia). complicated pregnancy,
s apart adaptation and/or presenting problem. b. Medical conditions severe liver disease,
from the compensation. b. Medical conditions are are present that will debilitating cardiovascular
presenting b. Self-limited present requiring adversely affect or be disease).
disorder. medical problems significant medical affected by, the b. Medical condition
b. Past are present that are monitoring 9e.g. diabetes presenting disorder. acutely or chronically
medical, not immediately or asthma). c. Uncontrolled worsens or is worsened by
substance threatening or c. Medical conditions are substance use is the presenting problem.
use, debilitating and present that may adversely present that poses a c. Substance dependence
developme have no impact on affect, or be adversely serious threat to is present, with inability to
ntal, or the presenting affected by, the presenting health if unabated and control use, intense
psychiatric problem and are not problem. impedes recover from withdrawal symptoms and
conditions affected by it. d. Substance abuse is presenting problem. extreme negative impact
are stable c. Occasional, self- present, with significant d. Developmental on the presenting
and pose limited episodes of adverse effect on delay or condition is disorder.
no threat substance use are functioning and the present that will d. Developmental disorder
to the child present that show presenting problem. adversely affect the is present that seriously
or no pattern of e. Recent substance use course, treatment, or complicates, or is seriously
adolescent’ escalation with no that has significant impact outcome of the compromised by, the
s current indication of on the presenting problem presenting condition. presenting condition.
functioning adverse effect on and that has been arrested e. Psychiatric e. Acute or severe
or functioning or the due to use of a highly symptoms are present psychiatric symptoms are
presenting presenting problem. structured or protected that clearly impair present that seriously
problem. d. Transient, setting or through other functioning, persist in impair functioning, and/or
c. Other: occasional, stress- external means. the absence of prevent voluntary
related psychiatric f. Psychiatric signs and stressors, and participation in treatment
symptoms are symptoms are present and seriously impair for the presenting
present that have persist in the absence of recover from the problem, or otherwise
no discernible stress, are moderately present problem. prevent recovery from the
impact on the debilitating, and adversely f. Other: presenting problem.
presenting problem. affect the presenting *a score of 4 indicates f. Other:
e. Other: problem. Medically Monitored *a score of 5 indicates 24
g. Other: Residential Services hour secure medically
managed care
Child and Adolescent Service Intensity Instrument (CASII)
IV. Recovery Environment: Environmental Stress

Absent 1 Mild 2 Moderate 3 Serious 4 Severe 5

a. Absence of a. Significant a. Disruption of a. Seriously disruption a. Traumatic or enduring
significant or normative transitions family/social milieu of family or social and highly disturbing
enduring requiring adjustment, (e.g., move to milieu to illness, circumstances, such as 1)
difficulties in such as change in significantly different death, divorce, or violence, sexual abuse or
environment and household members, living situation, separation of parent illegal activity in the home
life circumstances or new school or absence or addition and child or or community, 2) the child
not expected to teacher. of parent or other adolescent; severe or adolescent is witness to
change b. Minor primary care take, conflict; torment or a victim of a natural
significantly. interpersonal loss or serious legal or and/or disaster, 3) the sudden or
b. Absence of conflict, such as peer school difficulties, physical/sexual abuse unexpected death of a
recent transitions relationship ending serious drop in or maltreatment. loved one, 4) unexpected
or losses of due to change in capacity of parent or b. Threat of severe or unwanted pregnancy.
consequences residence or school, usual primary care disruption in life b. Political or racial
(e.g., no change in or illness or death of taker due to physical, circumstances, persecution, immigration,
school, residence, distant extended psychiatric, including threat of social isolation, language
or marital status family member that substance abuse, or imminent barriers, and/or illegal alien
of parents, or no has moderate effect other problem with incarceration, lack of status.
birth/death of on child and family. expectation of return permanent residence, c. Incarceration, foster
family member). c. Transient but to previous or immersion I alien home placement or
c. Material needs significant illness or functioning). and hostile culture. replacement, inadequate
are met without injury (e.g., b. interpersonal or c. Inability to meet residence, and/or extreme
significant cause pneumonia, material loss that has needs for physical poverty or constant threat
for concern that brokenbone0 significant impact on and/or material well- of such.
they may diminish d. Somewhat child and family. being. d. Severe pain, injury, or
in the near future, inadequate material c. Serious illness or d. Exposure to disability, or imminent
with no significant resources or threat injury for prolonged endangering criminal threat of death due to
threats to safety of loss of resources period, unremitting activities in family severe illness or injury.
or health. due to parental pain, or other and/or neighborhood. e. Other:
d. Living underemployment, disabling condition. e. Difficulty avoiding
environment is separation, or other e in neighborhood or substance use and it
conducive to factor. community, or effects.
normative growth, e. Expectations for sustained f. Other:
development, and performance at harassment by peers
recovery. home or school that or others.
e. Role create discomfort. e. Exposure to
expectations are f. Potential for substance abuse and
normative and exposure to its effects.
congruent with substance use exists. f. Role expectations
child’s or g. Other: that exceed child or
adolescent’s age, adolescent’s capacity
capacities, and/or given age, status, and
developmental developmental level.
level. g. Other:
f. Other:
 Child and Adolescent Service Intensity Instrument (CASII)
IV. Recovery Environment: Environmental Support

Optimal 1 Adequate 2 Limited 3 Minimal 4 None 5

A Family and ordinary a. Continuity of a. Family has a. Family or a. Family and/or other
resources are family or primary limited ability to primary care taker primary care takers are
adequate to address care takers is only respond is seriously limited completely unable to meet
child or adolescent’s occasionally appropriately to in ability to the child or adolescent’s
developmental and disrupted, and/or child or provide for the developmental, material,
material needs. relationships with adolescent’s child or and/or emotional needs.
b. Continuity of active, family or primary developmental adolescent’s b. Community has
engaged primary, care care takers are needs and/or developmental, deteriorated so that it is
takes, with a warm only occasionally problems, or is material, and unsafe and/or hostile to the
caring relationship inconsistent. ambivalent toward emotional needs. needs of children and
with at least one b. Family/primary meeting these b. Few community adolescents for education,
primary care taker. care takers are needs or supports and/or recreation, constructive peer
c. Other: willing and able to addressing these serious limitations relations, and mentoring
participate in problems. in access to from unrelated adults.
treatment if b. Community sources of support c. Lack of liaison and
requested to do so resources only so that material, cooperation between child-
and have capacity partially health, and/or servicing agencies.
to effect needed compensate for emotional needs d. inability of family or other
changes. unmet material are mostly unmet. primary care takers to make
c. Special needs and emotional c. Family and changes or participate in
are addressed needs and/or child other primary care treatment.
through successful or adolescent has takers display e. lack of even minimal
involvement in limited or limited ability to attachments to benevolent
systems of care inconsistent participate in other, or multiple
(e.g., low level access to network. treatment and/or attachments to abusive,
special education, c. Family or service plan (e.g., violent, and/or threatening
tutoring, and primary care unwilling, others.
speech therapy). takers inaccessible, f. Other:
d. Community demonstrate only cultural
resources are partial ability to dissonance).
sufficient to make necessary d. Other:
address child or changes during
adolescent’s the course of
developmental treatment.
and material d. Other:
needs. .
e. Other:
 Child and Adolescent Service Intensity Instrument (CASII)
V. Resiliency and/or Response to Services

Full Resiliency and/or Significant Moderate or Poor Resiliency Negligible Resiliency

Response to Services Resiliency and/or Equivocal and/or Response to and/or Response to
1 Response to Resiliency and/or Services 4 Services 5
Services 2 Response to
Services 3
a. Child/youth has a. Child/youth has a. Child/youth has a. Child/youth has a. Child/youth has
demonstrated demonstrated demonstrated an demonstrated demonstrated
significant and average ability to inconsistent or frequent evidence significant and
consistent capacity deal with stressors equivocal capacity of innate consistent evidence of
to maintain and maintain to dealt with vulnerability under innate vulnerability
development in the developmental stressors and stress and difficulty under stress, with lack
face of normal progress. maintain normal resuming progress of any resumption of
challenges, or to b. previous development. toward expected progress toward
readily resume experience with b. previous developmental expected
normal development services has been experience with level. developmental level.
following successful in services at low b. Previous services b. Past response to
extraordinary controlling level of intensity have not achieved services has been quite
challenges. symptoms but has not been complete remission minimal, even when
b. Prior experience more lengthy successful in relief of symptoms or treated at high levels of
indicates that efforts intervention is of symptoms or optimal control of service intensity for
in most types of required. optimal control of symptoms even extended periods of
services have been c. Significant ability symptoms. with intensive time.
helpful in controlling to manage c. Recovery has and/or repeated c. Symptoms are
the presenting recovery has been been maintained interventions. persistent and
problem in a demonstrated for for moderate c. Attempts to functional ability shows
relatively short extended periods, periods of time, maintain whatever no significant
period of time. but has required but only with gains that can be improvement despite
c. There has been structured settings strong professional attained in intensive receiving services.
successful or ongoing care or peer support or services have d. Developmental
management of and/or peer in structured limited success, pressures are life
extended recovery support. settings. even for limited changes have created
with few and limited d. Recovery has d. Developmental time periods or in sustained turmoil
periods of relapse been managed for pressures and life structured settings. and/or developmental
even in unstructured short periods of changes have d. Developmental regression.
environments or time with limited created temporary pressures and life e. Unable to transition
without frequent support or stress. changes have or accept changes in
services. structure. e. Able to created episodes of routine successfully
d. Able to transition e. Able to transition turmoil or sustained despite intensive
successfully and transition successfully and distress. support.
accept changes in successfully and accept change in e. Transitions with f. Other:
routing without accept changes in routine most of the change in routine
support; optimal routine with time with a are difficult even
flexibility. minimal support. moderate intensity with a high degree
e. Other: f. Other: of support. of support.
f. Other: f. Others.
Child and Adolescent Service Intensity Instrument (CASII)
VI. Involvement in Services: Child or Adolescent

Optimal 1 Adequate 2 Limited 3 Minimal 4 Absent 5

a. Quickly forms a a. Able to develop a. Ambivalent, a. A difficult and a. Unable to form
trusting and a trusting positive avoidant, or unproductive therapeutic
respectful positive relationship with distrustful relationship with working
therapeutic clinicians and relationship with clinician and other relationship with
relationship with other care clinicians and care providers. clinicians or other
clinicians and providers. other care b. Accepts no age care providers due
other care b. Unable to providers. appropriate to severe
providers. define the b. Acknowledges responsibility role withdrawal,
b. Able to define problem a existence of in development, psychosis, or other
problems(s) and developmentally problem, but has perpetuation, or profound
accepts others’ appropriate, but trouble accepting consequences of disturbance in
definition of the accepts others’ limited age the problem. relatedness.
problem(s), and definition of the appropriate c. Frequently b. unaware of
consequences. problem and its responsibility for disrupts problem or its
c. Accepts age consequences. development, assessment and consequences.
appropriate c. Accepts limited perpetuation, or services. c. unable to
responsibility for age-appropriate consequences of d. Other: communicate with
behavior that responsibility for the problem. clinician due to
causes and/or behavior. c. Minimizes or severe cognitive
exacerbates d. Passively rationalizes delay or
primary problem. cooperate in problem behavior speech/language
d. Cooperates and services. and impairment.
actively e. Others: consequences. d. Other:
participates in d. unable to
services. accept others’
e. Other: definition of the
problem and its
consequences.
e. Frequently
misses or is late
for treatment
appointments
and/or does not
follow the service
plan.
f. Other:
Child and Adolescent Service Intensity Instrument (CASII)
VI. Involvement in Services: Parent and/or Primary Care taker

Optimal 1 Adequate 2 Limited 3 Minimal 4 Absent 5

a. Quickly and a. Develops a. Inconsistent a. A difficult and a. No awareness
actively engages in positive and/or avoidant unproductive of problem.
a trusting and therapeutic relationship with relationship with b. Not physically
positive relationship with clinicians and clinician and other available.
therapeutic with clinicians and other care care providers. c. Refuses to
clinicians and other primary care providers. b. Unable to reach accept child or
other service takers. b. Defines shared definition adolescent, or
providers. b. Explores the problem but has of the other family
b. Sensitive and problem and difficulty creating development, members’ need to
aware of the accepts others’ a shared definition perpetuation, or change.
child’s or definition of the of development, consequences of d. Unable to form
adolescent’s problem. perpetuation, or problem. relationship with
needs and c. Works consequences of c. Able to accept clinician or other
strengths as they collaboratively the problem. child or care provider due
pertain to the with clinicians and c. Unable to adolescent’s need to significant
presenting other primary care collaborate in to change, but cognitive
problem. takes in development of unable or difficulties,
c. Sensitive and development of service plan. unwilling to psychosis,
aware of the service plan. d. unable to consider the need intoxication, or
child’s or d. Cooperates with participate for any change in major mental
adolescents service plan, with consistently in other family illness or
problems and how behavior change service plan, with members. impairment.
they can and good follow inconsistent follow d. Engages in e. Other:
contribute to their through on through. behaviors that are
child’s recovery. interventions e. Other: inconsistent with
d. Active and e. Others: the service plan.
enthusiastic e. Other:
participation in
services.
e. Other:

Scoring Grid
 Child and Adolescent Service Intensity Instrument (CASII)
Client Level 0 Level 1 Level 2 Level 3 Level 4 Level 5 Level 6
Score Basic Service Recovery Out Patient Intensive Intensive Non-secure Secure 24
for Maintenance Services Outpatient Integrated 24 hour hour
Prevention health Services with Services Psychiatric Psychiatric
and management Without 24 Management Management
Maintenance Hour
Psychiatric
Monitoring
I. Risk of Harm 2 or less 2 or less 3 or less 3 or less 4 required 5 required
3
admission admission
II. Functional 2 or less 2 or less 3 or less 3 or less 4 required 5 required
status 3 admission* admission
III. Co- 2 or less 2 or less 3or less 3 or less 4 required 5 required
Occurrence 3 admission* admission
IV. Recovery Sum of Level Sum of Level Sum of Level 3 or 4 4 or more 4 or more
Environmental 2 of Stress and of Stress and of Stress and
Stress Sum of Level Sum of Level Sum of Level
Recovery of Support is of Support is of Support is 3 or less 4 or more 4 or more
Environmental 2 Equal to 4 or Equal to 5 or Equal to 5 or
Support less less less
V. Resiliency 2 or less 2 or less 3 or less 3 or 4 3 or more 4 or more
3
and Response to
Services
VI. Involvement 2 or less 2 or less 3 or less 3 or 4 3 or more 4 or more
in Services: 2
Child or Use the
Adolescent higher
Involvement in of these two 2 or less 2 or less 3 or less 3 or 4 3 or more 4 or more
Services: Parent 3 subscales-
and/or Primary do not use
Care taker both scores)
Composite 7 to 9 10 to 13 14 to 16 17 to 19 20 to 22 23 to 27 28 or more
Rating 19
Level of Care
Indicated 3
*unless sum of level of stress and level of support equals 2
Level of Care Summary
Level 0. Basic Services-Prevention and Health maintenance- These are the basic services everyone should have available

• Prevention services
• Crisis services
• Most services are provided in the community- non clinical.
• Score 0 to 9

Level 1 Recovery Maintenance and Health Management

• Services may be provided in the community or the place of residence.

• Clinical Services: up to two hours per month, and usually not less than one hour every three months (Clients that
enter treatment at this level generally benefit from brief therapy, 1 x per week or less)
• Service types: individual or group supportive therapy
• Client’s stepping down to this level may have routine case management and medication therapy
• Support services are natural supports in the community
• Score 10 to 13 and sum of Level of Stress and Level of Support is 4 or less.

Level 2 Low Intensity Community Based Services

• Services may be provided in the community or place of residence

• Clinical Services: up to two hours per week but usually not less than one hour every two weeks
• Service types: individual, group, and family therapy- Case management is NOT required at this level
Child and Adolescent Service Intensity Instrument (CASII)
• Support service are generally natural supports in the community
• Medication and other therapies should be made available as needed
• Score 14 to 16 and sum of Level of Stress and Level of Support is 5 or less. The Treatment and Recovery History
is best at a 2 or less and the Engagement and Recovery Status is best at 2 or less.

Level 3 Intensive Out-Patient Therapy Services.

• Services may be provided in the community or place of residence

• Clinical Services: up to three days per week and about two to three hours per day
• Service Types: individual, group, family therapy, rehabilitative services (CSA), case management and multiple
community resources.
• Medication and other forms of therapy should be available if needed
• Support services are recommended with case management to help develop care team and access supports
• Score 17 to 19 and sum of Level of Stress and Level of Support is 5 or less. The Treatment Recovery History score
is best at a 2 and Engagement recovery status is best at 3 or less.

Level 4 Intensive Integrated Services without 24 hour monitoring

• Services may be provided in a clinic or by wrapping services around the client in the community
• Clinical Services: available to client and family at times that meet their needs, evenings and weekends as many
days per week as needed.
• Service types: medication services (self/family-administered), individual, group, and family therapy,
wraparound/ skills based services (CSA, OT, etc.), case management services, school based, Individual Service
Plan
• Crisis Stabilization Services
• Score 20 to 22. In some cases a rating of 4 or more in the Stress level score could be manage if the Support Scale
is a 1.

Level 5 Non-secure 24 hour Services with Psychiatric Management

• Services are provided in a residential community setting- non hospital, residential treatment center or
therapeutic foster care or a very tight wraparound team.
• Clinical Services: Psychiatric care available 24 hours day
• Service types: onsite nursing care for medication therapy as needed, individual, group, and family therapy
available seven days a week, rehabilitative services, supervision of daily activities
• Score 23 to 27. A rating of 4 for Risk of Harm, Functional Status, or Co-morbidity qualifies for this level of care
even if combined score is lower. This level is indicated if the client has a rating of a 3 or higher on one of the
following scales: Self Harm, Functional Status, Co-morbidity AND a rating of a 3 or higher in the Treatment
Recovery history or the Engagement and Recovery Status.

Level 6 Secure 24 hour Medically Managed In-patient Care

• Services are traditionally provided in a hospital setting that is locked and secure. Services may be provided in
other settings only if safety needs are met.
• Clinical Services: Services are available 24 hours a day, seven days a week
• Service types: Psychiatric, medical, nursing, individual, group and family therapy, medication therapy, support to
carry out activities of daily living, crisis care such as seclusion or restraint
• Score 28 or more. A rating of 5 for Risk of Harm, Functional Status or Co-Morbidity qualifies for this level of care
even if combined score is lower.

Please understand that this is an assessment for determining services for the Seriously Emotionally Disturbed client.
Clients may seek treatment for life transition and other problems that do not register a significant score. These clients
are still eligible for traditional out-patient therapy of individual or family therapy one hour a week, each week or less.
Child and Adolescent Service Intensity Instrument (CASII)
These scores are guidelines. Please use your clinical judgement when the scores do not match your professional opinion
regarding the intensity of services and level of care.

Reason for Deviation from CASII derived level of care recommendations:

___ Services or supports for recommended level of care are not available
___ Financial resources are not available to access services or supports at derived level of care
___ Support Team (parent, child, guardian, case mange, etc.) decision to use alternates level of care
___ Other (explain):