CASII WORKSHEET

CASII - Child and Adolescent Service Intensity Instrument

Client Name:

Date:
IV-B. Recovery Environment Environmental Support

I. Risk of Harm
1. Low Risk of Harm

1. Optimal

2. Some Risk of Harm

2. Adequate

3. Significant Risk of Harm

3. Limited

4. Serious Risk of Harm

4. Minimal

5. Extreme Risk of Harm

5. None
Score:

Score:
V. Resiliency and/or Response to Services

II. Functional Status

1. Minimal Functional Impairment

1. Full Resiliency and/or Response to Services

2. Mild Functional Impairment

2. Significant Resiliency and/or Response to Services

3. Moderate Functional Impairment

3. Moderate or Equivocal Resiliency and/or Response to Serv

4. Serious Functional Impairment

4. Poor Resiliency and/or Response to Services

5. Severe Functional Impairment

5. Negligible Resiliency and/or Response to Services

Score:

Score:
VI-A. Child or Adolescent Involvement in Services

III. Co-Morbidity
1. No Co-Occurrence

1. Optimal

2. Minor Co-Occurrence

2. Adequate

3. Significant Co-Occurrence

3. Limited

4. Major Co-Occurrence

4. Minimal

5. Severe Co-Occurrence

5. Absent
Score:

Score:

The higher of VI A and B is used for computing composite

VI-B. Parent and/or Primary Care Taker Involvement in Services

IV-A. Recovery Environment Environmental Stress

1. Absent

1. Optimal

2. Mild

2. Adequate

3. Moderate

3. Limited

4. Serious

4. Minimal

5. Severe

5. Absent
Score:

Score:

The higher of VI A and B is used for computing composite

Note: Due to independent criteria, some scores require automatic admissions to a higher level of care regardless of combined score. A scor
dimensions I, II, or III results in placement at level five (These level V placements on II and III may be waived if "2" equals the sum of the IV-A
scores). A score of 5 on dimensions I, II, or III results in placement at level six.

Total Composite Score:

0
Nevada Derived Level of Care Recommendation:
7-9 = CASII Service Level 0: Basic Services for Prevention and Maintenance
10-13 = CASII Service Level 1: Recovery Maintenance & Health Management
14-16 = CASII Service Level 2: Outpatient Services
17-19 = CASII Service Level 3: Intensive Outpatient Services

Rater Name:

0
20-22 = CASII Service Level 4: Intensive Integrated Services w/o Psychiatirc Monitoring
23-27 = CASII Service Level 5: Non-Secure, 24-Hour w/Psychiatric Monitoring
28 +
= CASII Service Level 6: Secure, 24-Hour w/Psychiatric Management

nmental Support

vices

se to Services

Response to Services

ency and/or Response to Services

nse to Services

Response to Services
0

nt in Services

0
for computing composite score

er Involvement in Services

0
for computing composite score

ess of combined score. A score of 4 on

f "2" equals the sum of the IV-A and IV-B

Services w/o Psychiatirc Monitoring

w/Psychiatric Monitoring
Psychiatric Management