Integrated Levels and Domains of CARE-2C Treatment Planner
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 Four Domains of Health ( (SAMHSA, 2016). The four Domains of Health include: Health (Physical, emotional, Social, intellectual and Spiritual), Home (relationships & environmental), Community (social, environmental), & Purpose (vocational and financial). Because trauma plays a large role in the development of later behavior problems of youth and adults, it plays a role in determining the level of care And types of treatment needed.
The ”Levels of CARE” uses principles of holistic and integrated care. This instrument uses the domains of Health, Home, Community and Purpose (SAMHSA) to categorize complexity of skill building and treatment that a client may need. The health of each of these domains will impact overall health. If help is needed in any of these domains, they should be addressed in the treatment plan. The balance between the intensity of problems and strength of coping skills can help determine what services are needed. This, in turn, will inform the intensity and complexity of treatments, and the need for multidisciplinary treatments. The treatment plan should match the needs of the client. The presenting problem may be complicated by other issues.
- Level I is for clients with low complexity problems, mild to moderate mental health issues, and low or resolved levels of trauma, and strong coping skills.
- Level II is for clients with Mental Health, trauma, and addictions issues with moderate coping skills.
- Level III is for clients involved in the criminal or Juvenile Justice systems who also have mental health problems, addictions, histories of trauma, and lower levels of coping skills.
- Level IV is for clients at risk to harm others. They typically have problems in the areas of mental health, addictions, trauma, and weak coping skills.