Level of Care

TOP Level of Care Tool

The TOP Level of Care (LOC) Tool uses 11–13 scientifically validated behavioral dimensions captured in a TOP assessment to determine an appropriate level of care along with appropriate services and support. Due to the depth of domains, use of multiple informants and general population norms, the TOP assessment provides a more complete assessment of all of a child’s well-being issues than traditional child welfare assessments (e.g. CANS, CALOCUS, CAFAS, etc.) Only by understanding all of a child’s issues, and evaluating the number, nature and severity of them, are we able to recommend a more appropriate level of care.

Level 1: In-home/foster home/kin with basic supports
Level 2: In-home/foster home/kin with extra supports
Level 3: Therapeutic foster home, or in-home/foster home/kin with therapeutic supports
Level 4: Residential, or therapeutic foster home, or in-home/foster home/kin with intensive therapeutic supports
Level 5: Hospital or JCHO-accredited facility (100% Medicaid)

The TOP LOC provides a score based on a combination of factors: [1]

  1. Supervision/Safety
    1. How easy/hard is someone to live with
    2. Is the child a danger to himself or others
  2. Behavioral/Psychological issues
    1. Number, type and severity of behavioral issues — how many issues does the child have? How out of the norm are they? And the nature of the issue
    2. Risk of hospitalization — is the child at risk of hospitalization within the next six months?
  3. Medical issues
    1. Number and type of medical issues
    2. Number and frequency of hospitalizations

The TOP LOC uses a different combination of factors for adolescents (age 11–21) and children (age 3–12), taking into account the varying needs of the different age groups. [2]

[1] TOP makes a distinction between different types of behavioral issues.  A high score on violence and conduct disorder has a different impact on LOC than a high score for ADHD and depression.  TOP LOC has automatic triggers (based on high-risk domains) for higher LOC regardless of the number and severity of other issues such as violence and suicidal ideation.

[2] TOP has three versions. child functioning for ages 3–18, adolescent functioning for ages 11–21, adult functioning for ages 16+.  The jurisdiction will determine when to use each version depending on agency protocol.