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The Methadone Outpatient Forms include a comprehensive set of 14 intake, during-treatment, and follow-up data collection instruments for assessing client functioning and services in outpatient settings. An early version of the Intake Form was included in the Diagnostic Source Book on Drug Abuse Research and Treatment (1993) published by NIDA.  For technical questions, contact Dr. Grace Rowan-Szal at g.szal@tcu.edu.

Latest Forms Version: December 1998

List of Forms
Measurement and Psychometric Information
TCU Project using these forms
For Additional Information and References
Recommended Citation for TCU Methadone Outpatient Forms

List and Description of Forms
(Listed in sequence in which forms occur during treatment; times indicate typical length to administer.)

Initial Assessment is administered by the counselor and includes background and psychosocial information, a brief history of illegal drug use, and assessments of cocaine and alcohol dependency status based on DSM-IV criteria. (20 minutes)    (PDF; 31KB / 9 pages)     (PDF; 2 Answer Cards) 

Urinalysis Report at Intake reports presence or absense of nine commonly used illegal drugs.   (PDF; 6KB / 1 page)

Intake is administered by a counselor in a face-to-face interview held approximately one week after the Initial Assessment when the client has had time to reach greater stabilization and cognitive focus. (90 minutes)   (PDF; 831KB / 32 pages)    (PDF; 190KB / 8 Answer Cards) 

It includes the following sections: 

Self-Rating at Intake includes short scales for psychological adjustment (i.e.,self-esteem, depression, anxiety, and decision-making), social functioning (i.e.,childhood problems, hostility, risk-taking, and social conformity), and motivation scales (problem recognition, desire for help, treatment readiness, and external pressures). It takes approximately 15 minutes.   (PDF; 16KB / 6 pages) [Items from each scale are identified in the Item Scoring Guide. ]

Counseling Session Records

Counseling Session Record -- Individual (Counselor) describes the length and type of session as well as the issues addressed. (5 minutes)    (PDF; 18KB / 2 pages)

Counseling Session Record -- Individual (Client) is a 5-item questionnaire eliciting the client's reaction to the session. (2 minutes)    (PDF; 5KB / 1 page)

Counseling Session Record -- Group (Counselor) describes the length and type of session as well as the issues addressed. (5 minutes)    (PDF; 15KB / 4 pages)

Counseling Session Record -- Group (Client) is a 5-item questionnaire eliciting the client's reaction to the session. (2 minutes)    (PDF; 9KB / 2 pages)

During-Treatment Status is completed by the counselor in an individual session and re-assesses (for the previous 3-month period) major behavioral criteria such as employment, criminal involvement, drug use, and AIDS-risky behavior. Questions are a subset of the Intake Form. (25 minutes)    (PDF; 63KB / 16 pages)

Evaluation of Self and Treatment (for the previous 3 months) records client ratings of the counselor and the program in general. It also contains scales assessing psychological adjustment, social functioning, and motivation. (25 minutes)    (PDF; 18KB / 7 pages)  [Items from each scale are identified in the Item Scoring Guide.  ]

Counselor Rating of Client is completed by the counselor for the purpose of describing client functioning and therapeutic strategies used in the preceding 3 months. (5 minutes)    (PDF; 9KB / 2 pages)

Services Tracking Record (Monthly) serves as the overall monitoring record of client services and transactions, and is completed each month by agency staff. It contains information concerning counseling session attendance, medications prescribed, urinalyses results, and ancillary services provided. (Time to complete this form varies, depending on agency record-keeping systems.)    (PDF; 11KB / 2 pages)

Discharge Report documents dates and reasons for leaving treatment. (2 minutes)   (PDF; 5KB / 1 page)

Follow-up Interview is administered by a trained interviewer in a face-to-face session held at a designated time after discharge from treatment. It includes questions that are similar to the Intake Form, but also addresses functioning and outcome measures based on the posttreatment period. (90 minutes)    (PDF; 95KB / 26 pages)     (PDF; 6 Answer Cards)

It includes the following sections:

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Measurement and Psychometric Information

Griffith, J., Logan, S., Nucatola, D., & Joe, G. W. (June, 1997). TCU/DATAR forms: Description of composite variables. Fort Worth: Texas Christian University, Institute of Behavioral Research. (manual available on request)

Knight, K., Holcom, M., & Simpson, D. D. (February, 1994).  TCU Psychosocial Functioning and Motivation Scales: Manual on Psychometric Properties.  Fort Worth: Texas Christian University, Institute of Behavioral Reseach.  (Manual available as PDF download (PDF; 135KB / 43 pages).

Also see References below

TCU Project using these forms

DATAR Project Summary

DATAR Project Publications:

• Listed by Topic
• Listed by Year

For Additional Information and References

Griffith, J. D., Knight, D. K., Joe, G. W., & Simpson, D. D. (1998). Implications of family and peer relations for treatment engagement and follow-up outcomes: An integrative model. Psychology of Addictive Behaviors, 12(2), 113-126.  [Abstract]

Joe, G. W., Brown, B. S., & Simpson, D. D. (1995). Psychological problems and client engagement in methadone treatment. Journal of Nervous and Mental Disease, 183(11), 704-710.  [Abstract]

Joe, G. W., Knezek, L., Watson, D., & Simpson, D. D. (1991). Depression and decision-making among intravenous drug users. Psychological Reports, 68, 339-347.  [Abstract]

Simpson, D. D., & Joe, G. W. (1993). Motivation as a predictor of early dropout from drug abuse treatment. Psychotherapy, 30(2), 357-368.  [Abstract]

Simpson, D. D., Joe, G. W., Greener, J. M., & Rowan-Szal, G. A. (2000).  Modeling year 1 outcomes with treatment process and post-treatment social influences.  Substance Use & Misuse, 35(12-14), 1911-1930.  [Abstract]

Simpson, D. D., Joe, G. W., Rowan-Szal, G. A., & Greener, J. (1995). Client engagement and change during drug abuse treatment. Journal of Substance Abuse, 7(1), 117-134.  [Abstract]

Simpson, D. D., Joe, G. W., Rowan-Szal, G. A., & Greener, J. M. (1997). Drug abuse treatment process components that improve retention. Journal of Substance Abuse Treatment, 14(6), 565-572.  [Abstract]

Simpson, D. D., Knight, K., & Ray, S. (1993). Psychosocial correlates of AIDS-risk drug use and sexual behaviors. AIDS Education and Prevention, 5(2), 121-130.  [Abstract]

Rounsaville, B. J., Tims, F. M., Horton, A. M., & Sowder, B. J. (Eds.). (1993). Diagnostic source book on drug abuse research and treatment (NIDA Research Monograph). Washington, DC: U.S. Government Printing Office.

Recommended Citation for TCU Methadone Outpatient Forms

Simpson, D. D. (1998). TCU data collection forms for methadone outpatient treatment. Fort Worth: Texas Christian University, Institute of Behavioral Research. [On-line]. Available: www.ibr.tcu.edu.

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CJ Treatment Forms

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Methadone Outpatient Forms

Correctional Outpatient Forms

Correctional Residential Forms

Women & Children

Adolescents

Specialized Forms

Psychometric Information and Assessment Workshops

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