Linking resource use to consumer level of need: Field test of the level of need-care assessment (LONCA) method.

Abstract

A team of service system planners in King County, Washington, field-tested the feasibility of the LONCA (level of need-care assessment) method as a strategy to match resources to consumer level of need. LONCA links resources to need by first measuring the incidence and intensity of consumer needs in specific functioning domains. It then preliminarily specifies the type and intensity of services required to minimally but appropriately address specific consumer needs, calculates service costs, and identifies clusters of consumers with similar need and cost profiles. The field test supported the feasibility of performing LONCA tasks. The resulting scheme for clustering consumers appeared to have face validity and was modestly associated with at least 3 independent indicators of resource need: program status, residential status, and hospitalizations. Despite its limitations, the article supports further development of LONCA for use as a resource allocation tool for local service systems.

A Level of Care Instrument for Children's Systems of Care: Construction, Reliability and Validity

“…Both the Level of Care Assessment Tool (LOCAT) and the Green Spring Health Services' Medical Necessity Criteria for Utilization Management tool (Book, Harbin, Marques, & Silverman, 1995) were proprietary and not available, even to the clinical practitioners caring for the patients. Other instruments, such as the Level of Need-Care Assessment (Uehara, Smukler, & Newman, 1994), and American Society of Addiction Medicine criteria (ASAM; McKay, Cacciola, McLellan, Alterman, & Wirtz, 1997), were available publically.…”

A Population-based Needs Assessment for Mental Health Services

“…In needs assessments across a specific population, knowledge about the demand for intensity and level of care needed provides important information to guide service planning and resource allocation. There are relatively few validated methods available of determining level-of-care needed by clients of mental health services (Durbin, Cochrane, Goering, & Macfarlane, 2001;Srebnik, Uehara, & Smukler, 1998;Uehara, Smukler & Newman, 1994). One tool for which there is a validated means of determining level-of-care within mental health is the Colorado Client Assessment Record (CCAR) (Durbin et al, 2001;Ellis, Wilson, & Foster, 1984).…”

The need for research that is designed to support decisions in the delivery of mental health services.

“…A major difficulty in attempting to enact these recommendations is that of obtaining a believable database to determine what the appropriate progress-outcome criteria or what the expected social or treatment costs should be. Some have used expert panels to set the first draft of such criteria (e.g., Newman et al, 1989;Uehara et al, 1994). Howard et al (1996) have used baseline data from prior studies, along with measures taken on a nonpatient population.…”