The TCU Assessment System: Utility for Client Management

and Program Efficacy

Wayne E.K. Lehman, Ph.D. Senior Research Scientist

TCU Institute of Behavioral Research

Presentation at the

National TASC Conference

Columbus, OH

May 9, 2013

www.ibr.tcu.edu

The TCU Assessment System

The Treatment Process Model

TCU client-level assessments

Linking assessments to stages of treatment

Using client-level assessments for monitoring

program performance

Retention Predicts Outcomes

Findings Consistent from National Studies

1970s (44,000 admissions in DARP)

1980s (11,000 admissions in TOPS)

1990s (10,000 admissions in DATOS)

Also in England’s NTORS (1990s)!

Conclusions from Major Reviews

Institute of Medicine (’90, ’96, & ’98)

© 2011

Not “Does Treatment Work?”

but “What Works and

How does it work?”

© 2011

“Process Model” for Treatment

Engage & Commit

Begin Changes

Sustain Efforts

User

Quitter: Drugs

& Crime

© 2011

“Process Model” for Treatment

Follow-up Outcomes

• Drug use

• Crime • Social Functions

Simpson, 2002, 2004 (J Substance Abuse Treatment)

Recovery in Treatment Early

Engagement

• Participation

• Therapeutic Relationship

Re-entry Services

or Support

Networks Adequate Retention

Early Recovery

Changes in --

• Thinking • Acting

Users: Problem Severity

& Treatment Readiness

© 2011

TCU Assessments

© 2011

Assessment of treatment process

is important in understanding “effectiveness”

© 2011

Measures of Client Functioning

Joe et al, 2002; Simpson, 2004 (JSAT): Simpson & Knight, 2007 (CJB)

Social Functioning

• Hostility

• Risk Taking

• Social Support

• Social Desirability

Psychological Functioning

• Self Esteem

• Depression/Anxiety

• Decision Making

• Expectancy

Treatment Engagement

• Satisfaction

• Rapport

• Participation

• Peer Support

Motivation

• Problems

• Desire for Help

• TX Readiness

• Needs/Pressures

Criminal Thinking

• Entitlement

• Justification

• Irresponsibility

• Power Orientation

• Cold Heartedness

• Rationalization

© 2010

TCU Short Forms for Client Assessments

A. Client Drug Use and Crime Risk Forms:

1. TCU Drug Screen II (DRUG SCREEN II)

2. Global Risk Assessment (A/Y-RSKFORM)

3. Criminal History Risk Assessment (CRHSFORM)

4. Criminal Thinking Scales (CTSFORM)

B. Client Health and Social Risk Forms:

1. Physical and Mental Health Status Screen (HLTHFORM)

2. Mental Trauma and PTSD Screen (TRMAFORM)

3. HIV/Hepatitis Risk Assessment (HVHPFORM)

4. Family and Friends Assessment (A/Y-FMFRFORM)

C. Client Evaluation of Self and Treatment (CEST) Forms:

1. Treatment Needs and Motivation (MOTFORM)

2. Psychological Functioning (PSYFORM)

3. Social Functioning (SOCFORM)

4. Treatment Engagement (ENGFORM)

© 2010

Assessing Client Needs and Progress During Treatment

Stages of Treatment

Retention & Change

Early Recovery

Changes in • Thinking • Acting

Early Engagement • Participation

• Therapeutic Relationship

Treatment Readiness: • Needs-Risks

• Severity • Motivation

Intake Interview

(eg, ASI)

Short ID & Background

Risk Info

Fam/Friends Networks

Motivation (from CEST)

Psychological (from CEST)

Social (from CEST)

Criminal Thinking(CTS)

Engagement (from CEST)

Fam/Friends Networks

Psychological (from CEST)

Social (from CEST)

Engagement (from CEST)

Psychological (from CEST)

Social (from CEST)

Criminal Thinking(CTS)

Engagement Psychological

10

15

20

25

30

35

40

45

50

Des

ire fo

r Hel

p

Tx Rea

dine

ss

Tx Nee

ds

Dep

ress

ion

Anxiety

Self E

stee

m

Dec

Mak

ing

Hos

tility

Risk

Tak

ing

Tx Sat

isfa

ction

Cou

nsel

or R

appo

rt

Tx Par

ticip

ation

Peer S

uppo

rt

Social S

uppo

rt

Entitlem

ent

Justifica

tion

Per Ir

resp

onsib

ility

Power

Orie

ntat

ion

Cold

Hea

rtedn

ess

Crim

Rat

iona

l

Norms for CJ-CEST Scale Profiles

25th-75th Percentile Scores (N=3,266)

Good

75th %tile

25th %tile

Client: A

Good? Motivation Social Red Flag Criminal Thinking

Red Flag

© 2011

Engagement Psychological

10

15

20

25

30

35

40

45

50

Des

ire fo

r Hel

p

Tx Rea

dine

ss

Tx Nee

ds

Dep

ress

ion

Anxiety

Self E

stee

m

Dec

Mak

ing

Self E

ffica

cy

Hos

tility

Risk

Tak

ing

Tx Sat

isfa

ction

Cou

nsel

or R

appo

rt

Tx Par

ticip

ation

Peer S

uppo

rt

Social S

uppo

rt

Entitlem

ent

Justifica

tion

Per Ir

resp

onsib

ility

Power

Orie

ntat

ion

Cold

Hea

rtedn

ess

Crim

Rat

iona

l

Motivation Social Criminal Thinking

Program-Level Functioning

© 2011

Using Assessment Results

© 2007

Longer Manuals (6-10 Sessions)

Stages of Treatment

Retention & Change

Early Recovery

Changes in • Thinking • Acting

Early Engagement • Participation

• Therapeutic Relationship

Treatment Readiness:

• Needs-Risks • Severity • Motivation

“TCU Mapping” Interventions for Adaptive Treatment Process

Orientation Re-Entry

Mapping Journey

Workshop for Men

Transition to Re-entry

Using Client Assessments

Mapping Care Plans

Downward Spiral

Mapping ’12 Steps’

Parenting Skills

Workshop for Women

Treatment A Treatment B

Preparing for Change

Getting Motivated

CM/Reward Strategies

Building Networks

Better Comm

HIV Risk Reduction

Unlocking Thinking

Reducing Anger

© 2011

“TCU Mapping-Enhanced Counseling”

“Get your facts first, then you can

distort them as you please.” Mark Twain

www.ibr.tcu.edu © 2010

That’s All Folks!

© 2007