Overview
LOCUS v20 uses 6 evaluation dimensions (7 sub-scores, Dimension IV split into A/B), each scored 1-5. The composite score is the sum of all 7 sub-scores (range 7-35). Level of Care is determined by a decision tree that checks both composite score ranges and independent placement criteria on individual dimensions.
Seven Evaluation Dimensions
| Dim | Name | Score Range | What It Measures |
|---|
| I | Risk of Harm | 1-5 | Suicidal/homicidal ideation, substance-related harm, self-neglect |
| II | Functional Status | 1-5 | Social role, interpersonal, physical functioning, self-care |
| III | Co-Morbidity | 1-5 | Co-occurring medical, addictive, psychiatric conditions |
| IV-A | Recovery Env: Stress | 1-5 | Environmental stressors (trauma, instability, substance exposure) |
| IV-B | Recovery Env: Support | 1-5 | Support systems (family, professional, community, material) |
| V | Treatment & Recovery History | 1-5 | Past treatment response, recovery management success |
| VI | Engagement & Recovery Status | 1-5 | Insight, motivation, stage of change, trust, treatment activation |
Scoring rule: Each score level has multiple lettered criteria. Only one criterion needs to be met. Select the highest score where at least one criterion is met.
Six Levels of Care
| Level | Name | Composite Range | Description |
|---|
| 1 | Recovery Maintenance & Health Management | 10-13 | Quarterly outpatient, recovery support |
| 2 | Low Intensity Community Based Services | 14-16 | Weekly outpatient clinic |
| 3 | High Intensity Community Based Services | 17-19 | IOP (3x/week, 2-3 hrs/day) |
| 4 | Medically Monitored Non-Residential | 20-22 | Partial hospitalization / ACT |
| 5 | Medically Monitored Residential | 23-27 | Residential treatment (5A/5B/5C subtypes) |
| 6 | Medically Managed Residential | 28+ | Acute inpatient / locked facility (6A/6B subtypes) |
Level 5/6 Subtypes (Appendix 1)
| Subtype | Name | Typical Stay |
|---|
| 5A | Intensive Short-Term Residential (sub-acute/respite) | 7-10 days |
| 5B | Moderate Intensity Intermediate Stay | 2 weeks - 2 months |
| 5C | Moderate Intensity Long Term Residential | 2 months - 1 year |
| 6A | High Intensity Acute Medically Managed (locked) | Days - weeks, step down to 5A |
| 6B | Medically Managed Extended Care | Extended Level 6 |
Decision Tree Algorithm (Pages 33-34)
Level determination is NOT purely composite-based. The LOCUS decision tree checks independent placement criteria that can override the composite score. The algorithm is evaluated top-to-bottom; the first match wins.
// Step 1: Level 6 — Independent Criteria
IF Dim I ≥ 5 → Level 6 (extreme risk of harm)
IF Dim II ≥ 5 → Level 6 (severe functional impairment)
IF Dim III ≥ 5 → Level 6 (severe co-morbidity)
IF Composite ≥ 28 → Level 6 (average 4+ per dimension)
// Step 2: Level 5 — Dim I = 4 (no exceptions)
IF Dim I ≥ 4 → Level 5 (serious risk of harm, always residential)
// Step 3: Level 5 — Dim II or III = 4 (with IV-A/IV-B exception)
IF (Dim II ≥ 4 OR Dim III ≥ 4) AND NOT (IV-A = 1 AND IV-B = 1):
→ Level 5
Exception: If BOTH IV-A = 1 AND IV-B = 1, these patients may be managed at Level 4 (see Level 4 placement criteria p.28)
// Step 4: Level 5 — Dim V or VI ≥ 4 interaction
IF (Dim V ≥ 4 OR Dim VI ≥ 4) AND (Dim I ≥ 3 OR Dim II ≥ 3 OR Dim III ≥ 3) AND NOT (IV-A = 1 AND IV-B = 1):
→ Level 5
Exception: If BOTH IV-A = 1 AND IV-B = 1, composite 20-22 → Level 4; otherwise → lower levels
// Step 5: Level 5 — Both IV-A AND IV-B ≥ 4 interaction
IF (IV-A ≥ 4 AND IV-B ≥ 4) AND (Dim I ≥ 3 OR Dim II ≥ 3 OR Dim III ≥ 3):
→ Level 5
// Step 6: Composite Score Ranges
IF Composite ≥ 23 → Level 5
IF Composite ≥ 20 → Level 4
IF Composite ≥ 17 → Level 3
IF Composite ≥ 14 → Level 2
IF Composite ≥ 10 → Level 1
IF Composite 7-9 → Below Level 1 (Basic Services)
Determination Grid (Page 35)
The grid shows maximum individual dimension values at each level, plus independent criteria:
| Level | I | II | III | IV-A + IV-B | V | VI | Composite |
|---|
| 6 |
4 ⚠ |
4 ⚠ |
4 ⚠ |
≥4 each | ≥4 | ≥4 | ≥28 |
| 5 |
3* | 3* | 3 |
≥4 each | ≥3 | ≥3 | 23-27 |
| 4 |
≤3 | ≤3 | ≤3 |
3/4 + ≤3 | 3-4 | 3-4 | 20-22 |
| 3 |
≤3 | ≤3 | ≤3 |
Sum ≤5 | ≤3 | ≤3 | 17-19 |
| 2 |
≤2 | ≤2 | ≤2 |
Sum ≤5 | ≤2 | ≤2 | 14-16 |
| 1 |
≤2 | ≤2 | ≤2 |
Sum ≤4 | ≤2 | ≤2 | 10-13 |
⚠ = Score of 5 on Dim I, II, or III is an independent criterion — triggers Level 6 regardless of composite score.
* = Unless sum of IV-A + IV-B equals 2 (both = 1), which allows step-down to Level 4.
Note: Score of 4 on Dim I is an independent Level 5 criterion (no exceptions).
ACT: Assertive Community Treatment team presence is equivalent to IV-B = 1 (not currently captured in this form).
Simplified vs. Full Decision Tree
The algorithm implemented in this form covers the primary decision paths of the LOCUS decision tree (pages 33-34). The following nuances from the full decision tree are not yet implemented:
- ACT consideration: Presence of Assertive Community Treatment team (equivalent to IV-B = 1) can step down Level 5 to Level 4. No ACT field exists yet.
- IV-A + IV-B sum checks: Levels 1-3 have specific sum requirements (Level 1: sum ≤ 4; Level 2-3: sum ≤ 5). Not enforced.
- Level 2/3 max dimension exclusion: Score of 4+ on any dimension should exclude Level 2 and Level 3 (per placement criteria). Partially handled by independent criteria checks above, but edge cases with 4+ on IV/V/VI and low composite may not route correctly.
- "Completed higher level" check: Level 1 placement criteria require patient to have completed treatment at a higher level first.
- IV-B = 2 step-down: Level 2, Dim V: rating of 3 acceptable if stepping down from higher level AND IV-B ≤ 2.
This is a DRAFT implementation. The scoring algorithm must be certified by Deerfield Solutions before production use.
Source Reference
LOCUS v20 (Level of Care Utilization System), December 2016. © American Association of Community Psychiatrists (AACP). Scoring criteria from pages 10-20 (dimensions), pages 20-32 (level definitions & placement criteria), pages 33-34 (decision tree), page 35 (determination grid), pages 36-44 (Level 5/6 subtypes).