The Treatment Outcome Package (TOP): A multi-dimensional level of care matrix for child welfare

Child welfare level of care (LOC) tools have generally either failed to assess the multiple needs of children or failed to use this information to determine the most appropriate and least restrictive placement. LOC recommendations are usually presented on a uni-dimensional continuum, often masking divergent, multi-dimensional issues. We recommend a multi-dimensional LOC approach. Existing LOC measures are reviewed, a conceptual framework of four important dimensions of need (consisting of supervisory, psychological, medical and academic needs) is described, and the use of the Treatment Outcome Package (TOP; Kraus, Boswell, Wright, Castonguay, & Pincus, 2010) as a multi-dimensional LOC tool is illustrated. Other advantages of the TOP include its sensitivity to change, its use with multiple informants (including self-report) and its potential for identifying providers who are most appropriate for addressing a child's particular needs.