CASII Worksheet

Name

First NameLast Name

Please check the applicable ratings within each dimension and record the score in the lower right hand corner. Total your score and determine the recommended lvel of care.

Risk of Harm

Score - Risk of Harm

Functional Status

Score - Functional Status

Co-Morbidity

Score - Co-Morbidity

Recovery Environment - Level of Stress

Score - Recovery Environment - Level of Stress

Recovery Environment - Level of Support

Score - Recovery Environment - Level of Support

Resiliency and Treatment History

Score - Resiliency and Treatment History

Acceptance and Engagement Child/Adolescent

Score - Acceptance and Engagement Child/Adolescent

Acceptance and Engagement Parent/Caregiver

Score - Acceptance and Engagement Parent/Caregiver

Composite Score

Level of Care Recommendation

Level I

Level II

Level III

Level IV

Level V

Level VI