The Acuity Tools available in Clarity are intended to assist with determining the appropriate level of Case Management to be provided. The Acuity Tools assess multiple areas of a client's life and current situation (e.g. areas of functioning). Each area of functioning is assessed by choosing a description that best describes the client's situation. Each description produces an individual score which is used to produce a single score between 1 and 5, with 1 being the least reliant on assistance and 5 being the most reliant on assistance. It is important to note these tools are provided as a useful guide but not a determining factor by themselves.

This article includes:

  • How to access Acuity Tools in Clarity
  • How to use Acuity Tools
  • How Acuity Tools are scored 
  • Suggested actions based on the overall acuity score (as reported on the original PSH Acuity Tool, based on the Case Management Levels as described by the Veteran's Health Administration Directive 1162.05).

Accessing the Acuity Tools

Acuity Tools are assessments that can be accessed on the program level. There are three Acuity Tools currently available in Clairt:

  1. KEYS Level of Care
  2. PSH Acuity Tool
  3. Progressive Engagement Acuity Tool

1. First, find the client through the client 'SEARCH' or from the 'CASELOAD' link and click into the client record.

2. From the client search, click into the client profile and click on 'Programs' (skip to step 4 if accessing the client's enrollment record from the 'Caseload' tab).

3. Click the edit icon next to the desired project (skip to step 4 if accessing the client's enrollment record from the 'Caseload' tab) .

4. Click on the 'Assessments' tab then click the start button next to the available Acuity Tool ('KEYS Level of Care Tool', 'PSH Acuity Tool', or 'Progressive Engagement Acuity Tool').

Using Acuity Tools

Areas of Functioning

The Acuity Tools help case managers to evaluate different areas of functioning, such as life skills, disability, medical history, income, etc. Each Acuity Tool includes slightly different of areas of functioning.

For each area of functioning, case managers should choose from the 5 descriptions that best describe the participant's current situation. The first option will reflect the lowest level of reliance on assistance for that area. The fifth option will reflect the highest reliance on assistance. If a participant's situation falls in between two categories, choose the more acute/reliant option. If a question does not apply, answer with the lowest scored or least reliant option. Every question must be answered.

Suggested Actions Based on Acuity

Suggested next steps display for areas that reflect a reliance on assistance (descriptions 2 - 5).

Optional Score Override

At the end of the assessment, case managers are given the option to use a calculated score (described in more detail below) or manually assign an overall score.

If a case manager chooses 'Use Calculated Score' from the 'Optional Score Override' option list, the 'Overall Acuity Score' will display based on the data entered for each functional area. 

Case managers can also choose to override the calculated score by choosing the score manually.

Recommended case management levels will display once the score is determined.

Scoring and Case Management Level

As noted previously, answers associated with each functioning area are associated with a score. 

The Overall Acuity Score is calculated by averaging the sum of each functioning area, however, if a client is given a score of 5 in ANY of the critical areas (Life Skills, Medical, Disability, Domestic Violence, Substance Abuse, Mental Health, and High Risk Behaviors), then they will get an overall score of 5 regardless of any of the other scores. Please note, critical areas of functioning may vary based on the Acuity Tool completed.

The 'Overall Acuity Score' is used the recommended Case Management Level. (Ex. Overall score of 3 = Case Management Level 3). Descriptions about each of the Case Management Levels are as followed:

  • Level 5 - Intensive - The Case Management team works with the participant to obtain clinical stability. At a minimum, weekly home visits are required, but even more frequent interactions may be needed.

  • Level 4 - Stabilization - At this stage, participants are more adept at managing their housing responsibilities and their physical, mental health, and substance use disorders are more stable as the participant works on addressing those issues that are most likely to lead to housing instability. At least twice a month home visits are required, with additional interactions as needed.

  • Level 3 - Maintenance - Case management services ensure that needed treatment, support, and mentoring assistance continue after placement in housing. Home visits need to occur at least every month, once the Veteran demonstrates stability, independence, and improved coping skill use and recovery. Other interactions, such as phone calls, may be indicated.

  • Level 2 - Preparation for Discharge - Veterans who have functioned at a very independent level for at least one year and sustained a low acuity level may be considered for this phase to practice and plan for discharge from HUD-VASH. Case management can be provided in the home, community, or at the medical center. During this phase, contacts are to occur at least quarterly and the focus of case management would address steps towards graduation from case management, and/or discharge planning.

  • Level 1 - Graduation/Discharge - Graduation is for participants who no longer need the case management services in PSH, and thus, the participant is not required to participate in case management. A participant is discharged from PSH when he/she is no longer participating in case management. If the participant is retaining the PSH voucher for financial purposes only, he or she is considered in graduation status. 

Although overall acuity scores determined through the use of this tool can assist with determining the appropriate Case Management Level, good clinical judgement needs to be a factor in the final determination of the appropriate Case Management Level.

If your program does not currently have access to the Acuity Tool and would like to, please contact HMISsupport@end-homelessness.org.

Contact Us

If you need help, or wish to offer suggestions or feedback, please contact the Cincinnati/Hamilton County HMIS Support team at HMISsupport@end-homelessness.org or by calling 513-263-2790 9:00 a.m. - 3:00 p.m.  Monday through Friday (excluding holidays).

When contacting HMIS support about a particular client, please do not send personal identifiable information such as social security numbers, medical information, or other data that can be used to identify a client. Instead, use the Clarity Unique ID.