The social determinants of health are now well recognized by practitioners and scientists. Additionally, the relationship between childhood trauma and negative behavioral and physical health outcomes in adults was established by the ACE’s research ( (Felitti, 1998)) on 17,000 American adults. It was a retrospective study comparing childhood trauma and adult health outcomes. In the “Levels of CARE,” the complexity of problems and strengths is matched with the complexity of treatment which includes addressing the social determinants of health. This model is fashioned after ASAM criteria but adds health across SAMHSA Eight Dimensions of Health ( (SAMHSA, 2016).
The Eight Dimensions of Wellness include physical, emotional, social, intellectual, environmental, spiritual, vocational, and financial health. These eight were clustered into the 4 Domains of Health: Health (physical, emotional, social, intellectual, and Spiritual), Home (safety, stability, and attachment), community (social, and environmental), and purpose (vocational, community, and financial).
The ”Levels of CARE” uses principles of holistic and integrated care. This instrument uses the level of health in the 4 Domains of overall Health: Health, Home, Community, and Purpose (SAMHSA) to categorize the complexity of problems, skills, and treatment planning that a client may need. The health of each of these domains will impact a person’s overall health. If help is needed to improve the health in any of these domains, they should be addressed in the treatment plan to improve overall health. This is based on the concept that all types of health are interrelated and can affect other domains of health. The intensity/health of problem areas and coping skills can help determine what services are needed. The health/problems of each domain of health will inform the state of overall health. This, in turn, will inform the intensity, complexity, and multidisciplinary treatments that are needed. In like fashion, the treatment plan should match the needs of the client. In this way, all contributing factors to health can be addressed.
The Integrated Levels and Domains of care will be available on this site soon, so stay tuned.