Georgia Association of Homes and Services for Children   

Level of Care
May 2003

What is the Level of Care System?

The Department of Human Resources (DHR) and the Department of Juvenile Justice (DJJ) have been working with Georgia's providers of residential care to create a Level of Care (LOC) system that purchases placement services for a child based upon the child's needs. This system establishes payment rates based upon the levels of care needed by children and the services required to meet those needs. We are hopeful that this new LOC system will provide the framework for our goals of choosing the most appropriate, least restrictive placement environment for our youngsters, reducing the number of their moves, and decreasing their overall length of stay in out-of-home care.

There are six levels of care that cover the entire continuum of out-of-home care provided by the private sector from basic Institutional Foster Care through Intensive Residential Treatment. For the Division of Family and Children Services (DFCS) this new system also incorporates the existing level of care special per diem program, which authorizes higher foster care rates in DFCS foster homes.

Descriptions of the Six Levels of Care

Level 1

Child has no more than occasional mild emotional and/or behavior management problems that interfere with the child's ability to function in the family, school, and/or community. The child has no specialized medical needs.

The focus of care is on reassurance, consistency, and regular parenting-type activities with guidance and supervision needed to develop normalized social skills and to ensure emotional and physical well-being. Services may be provided in a family foster home or basic care group home.

Level 2

Child has mild emotional and/or behavioral management problems that interfere with the child's ability to function in the family, school and/or community. The child leveled likely has a mental health diagnosis. Behaviors include infrequent impulsive or deliberate acts that may result in minor property destruction, nonviolent anti-social acts, and even some oppositional behavior, but the child does not present harm to self or others. Child may have minor medical problems that require monitoring by specialist(s).

Care, treatment and supervision are provided in the supportive settings of foster care or residential facilities.

Level 3

Child has moderate and/or occasional serious emotional and/or behavioral management problems that interfere with the child's ability to function in the family, school and/or community when outside of a therapeutic setting. From this level up, the child leveled will certainly have a mental health diagnosis. Possible behaviors include: sexual acting out w/o harming others, minor self-injurious behavior and/or suicidal intent (w/o actual attempt), running away with brief absence, and delinquent behaviors that are infrequent and not an established pattern. Child may have serious medical problems or be considered as medically fragile.

At this level, care, supervision, and treatment are provided in an environment in which many activities are therapeutically designed to improve the child's social, emotional and educational functioning and to teach the child pro-social, adaptive skills.

Level 4

Child has moderate to serious emotional and/or behavioral management problems that interfere with the child's ability to function in the family, school, or community when outside of a therapeutic setting. Behaviors include threats to harm adults/peers, occasional outbursts in which the child is dangerous to self/others, deliberate destruction of property, sexual acting out without aggression, self-injurious behavior and/or suicidal ideation, running away with absence of several hours or more, pre-delinquent and delinquent behavior, school suspensions and possible expulsions. The child experiences moderate to high levels of anxiety, depression, hyperactivity, moodiness, withdrawal and impulsivity. Child may have had psychiatric hospitalization (s) and may have a history of incarceration in a juvenile justice facility (ies).

At this level, services are provided in a therapeutic setting in which most activities are therapeutically designed to improve social, emotional, and educational adaptive behavior. This is the beginning level for MATCH services.

Level 5

Child has serious to severe emotional and/or behavioral management problems that
Interfere with the child's ability to function in the family, school and community when outside of a therapeutic setting. Behaviors treated appropriate at this level include: sexual acting out without aggression or with aggression and no injury, self-injurious behavior and/or suicidal intent that has not warranted medical or psychiatric treatment w/n 30 days, running away with prolonged absence, pre-delinquent or delinquent behaviors, bizarre or eccentric behavior w/o danger, little or no remorse for inappropriate behavior.

Child with serious medical problems at this level requires time-intensive/procedures to be performed frequently on a daily basis by caregiver. Medically fragile children at this level are cared for in specialized foster care settings.

Likely has a history of inconsistent response to treatment with multiple interventions. Will need intensive and /or specialized support services to be safe. May be stepping down from level 6. History would suggest one or more hospitalizations and may have a history of incarceration. At this level, services and treatment are provided in a therapeutic residential setting with 24-hour supervision or a highly trained and highly supported therapeutic foster home with only one therapeutic foster child in their home.

Level 6

Child at Level 6 has severe emotional and/or behavioral management problems that interfere with the child's ability to function in the family, school and community when outside of a therapeutic setting. Behaviors include: sexual acting out, self-injurious behavior and/or suicidal intent, running away with prolonged absence, delinquent behaviors, non-compliant with medications, cruelty to animals, fire-setting, community risk.

It can be anticipated that a child at this level who has serious medical problems will have future hospitalizations as a part of medical treatment.

Likely history of inconsistent response to treatment. Multiple interventions have been unsuccessful. Will need intensive and/or specialized support services to be safe. History would suggest multiple hospitalizations and may have a history of incarceration. At this level services and treatment are provided within an intensive, structured setting with 24/hour treatment, supervision, and medical care. Secure programming is available. There are formalized therapeutic interventions. Therapies occur more frequently, and the treatment plan is implemented in all aspects of the child's daily routine.

How will Level of Care be determined?

When county staff determine that a child needs a placement that is beyond a basic DFCS foster home, the case manager submits a Level of Care Package to the Treatment Services Unit.

How will Level of Care be Implemented in DFCS?

• The Level of Care (LOC) system was implemented first in Fulton and DeKalb Counties this year as a strategy to fund the development of resources to support alternatives to shelter care. The LOC assessments for Fulton began in October 2002 and for DeKalb County Children in January 2003.

• Funding of a statewide LOC system has been approved in the Governor's FY 2004 budget. DFCS began in March 2003 to "level" children in out-of-home care on a statewide basis, so we will be ready for statewide implementation of the LOC system in November 2003.