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Background and Overview
The TCU Treatment System includes a set of forms and manual-guided interventions that “target” specific client needs and their status in different stages of change during treatment.  Evidence for these stages provides the foundation for the TCU Treatment Process Model (Simpson, 2004, 2006) and involves induction into treatment, engagement in treatment, early recovery in treatment, adequate retention before treatment release, and preparation for community re-entry. 

The TCU assessments described below provide measurement tools for monitoring client needs and functioning that are essential for evidence-based care planning.  Recent adaptations using “automated data capture” technology enhance their clinical utility (see TCU ADC Forms below).  A set of TCU Intervention Manuals that uses a visual representation strategy (node-link mapping) are available, organized logistically according to their typical and strategic applications to the sequence of client needs and progression during treatment.  However, they can be integrated into “mix-n-match” combinations or as supplements to other treatment resources.  All TCU resources are “copyrighted” in an effort to limit commercial or for-profit applications, but there is no charge to service providers for downloading and using them. (See Permissions and Obtaining Forms.)

This section on TCU Forms summarizes major client and program measures related to the TCU Treatment Process Model.  Historically, these materials were developed in response to assessment needs of substance abuse treatment clients and programs participating in a series of NIDA-funded grants (DATAR, CETOP, Women with Children, CJ-DATS, and TCOM projects).  Treatment settings have included community-based outpatient methadone and drug-free services, prison-based treatment, and intensive residential care.  Clients have included men and women, sometimes with children, reporting a wide variety of drug use histories and legal involvement (such as in-prison treatments and diversion programs for parolees or probationers).  With modest adaptations, these assessments have been shown to be applicable across diverse settings.  They have been designed to be highly focused, practical, and flexible in order to meet the needs of “real-world” programs.

Some forms have been adopted (and adapted) for use in routine practice at a variety of field settings. As core tools in a continuing research program for “improving treatment resources,” however, there have been revisions and refinements made by TCU research staff to some of these assessments to allow especially for “generic” applications across treatment settings.  For instance, several instruments have undergone sequential editing in item wording and content over time according to applications needs of new projects. 

The most popular forms are grouped together according to their use in Community Treatment settings and Correctional Treatment settings.   Earlier versions of instruments developed for “specialized treatment programs” – that is, Methadone Outpatient, Correctional Outpatient or Residential, Women and Children, or Adolescents – also have been retained on the IBR Web site (including their scoring guides).  This allows early adopters of TCU assessments to continue their access to these forms while reviewing potential “instrument upgrades” based on opportunity and judgments about comparative benefits.  Collectively, these instruments address special applications such as intake, during-treatment progress, treatment phase tracking, and follow-up interviews.  Data included in numerous publications by the TCU research team were obtained using these forms and some have been adapted (in part or in whole) to serve related measurement needs of other treatment researchers and clinicians.

Selecting Forms
Most “established” treatment systems typically have a set of assessments they already use, especially for obtaining client intake and services tracking information.  Interest in adding new data collection instruments is usually initiated in response to special program needs and pressures for change.  However, the forms review and selection process is usually driven by concerns about resource requirements for adopting new assessments, level of staff and client response burdens, demonstrated validity of the tools, and practical benefits to clients and staff.  These are important implementation issues that are critical in determining the sustainability of their use.

Using the Treatment Process Model as a visual guide, several of the most common TCU forms available for downloading and adoption are identified (see chart above) in relation to client progression through discrete treatment stages.  These are listed across the bottom of the chart and discussed below.  With widespread emphasis on adoption of “evidence-based practices,” it also is important to recognize the growing awareness of organizational factors that influence the service delivery process of treatment agencies.  These factors are portrayed at the top of the chart.  They include staff perceptions of organizational needs and functioning, as well as staff responsiveness to training for innovations intended to improve client services (see Simpson & Flynn, 2007). 

An inventory of all TCU Forms can be found in the List of Forms.   It is organized according to types of treatment settings.  Some of the instruments have been translated (and validated) for use in multiple languages.  Psychometric evidence (including typical response profiles and norms) is provided under Assessment Fact Sheets.  The rationale and evidence for using these forms are summarized below, grouped by their respective treatment stage applications.

Clients: Screening and Intake
A major ingredient in achieving favorable treatment engagement and outcomes is the use of effective screening and assessment instruments to inform the treatment placement, planning, and decision-making process.  When combined with collateral records (physical/mental health status, urine test results, arrest records), information gathered at admission from brief screens and lengthier clinical assessments can help to optimize treatment placement and identification of problems that can benefit from specialized interventions.  Efficient and systematic data collection and management procedures are particularly important in view of the growing reliance on drug courts and correctional systems to address high-volume treatment needs of offender populations (see Knight, Flynn, & Simpson, 2007). 

Forms for Screening and Intake
The TCU Drug Screen is a brief self-administered tool for DSM-IV classification of drug use and dependence, and it is widely used in correctional settings where offender assessment resources tend to be limited.  Brief Intake and Comprehensive Intake interview instruments offer alternatives to other common assessments for obtaining detailed social background and drug-related information; several are customized for specific treatment settings.  The Client Evaluation of Self and Treatment (CEST-Intake) and the Criminal Thinking Scales (CTS) are self-administered by clients and gauge their motivation for change and readiness for treatment, psychological and social functioning, and cognitive orientation towards criminal behaviors.  They represent approximately 20 measures which can be re-administered over time to evaluate client changes during treatment.

Clients: Early Engagement and Recovery Progress
The first major step towards recovery in treatment is early engagement, which refers to the extent to which new admissions show up and actively engage in their role as a “client.”  Engagement is measured operationally in terms of program participation and the formation of therapeutic relationships during the initial weeks of treatment.  Evidence supports a sequential view of these components (Simpson & Joe, 2004); that is, clients with higher motivation at intake are at least twice as likely to participate in treatment (attend sessions and be “on-time”) in the first few months of treatment.  In turn, clients showing higher levels of participation double their chances of developing a favorable therapeutic relationship with their counselor.  While session attendance is generally required before clinical bonds are formed, it also is clear that participation and therapeutic relationships become interactive in the mutual strengthening of these early engagement components.

The second major step in treatment is early recovery, reflecting changes in thinking and acting that build on successes from the previous engagement stage. This also helps to sustain retention in treatment.  Clients reporting stronger therapeutic relationships in treatment are more than twice as likely to show positive changes in psychosocial functioning as measured by self-esteem, depression, anxiety, risk-taking, social conformity, and decision-making (Simpson & Joe, 2004).  Psychosocial functioning improvements, in turn, almost double the chances that favorable behavioral changes will follow (measured by urinalysis and self-reported drug use later in treatment).  And not surprisingly, favorable behavioral changes significantly enhance the chances that clients will meet treatment retention expectations. 

Forms for Clients Early Engagement and Recovery Progress
An expanded version of the Client Evaluation of Self and Treatment (CEST) gauges client motivation for change and psychosocial functioning, along with additional scales for engagement (participation, therapeutic relationship, and treatment satisfaction) and personal support from peers and family.   The CEST and the Criminal Thinking Scales (CTS) are designed for repeated applications to evaluate client progress throughout treatment.   During Treatment Status interviews provide details on many of the same client functioning domains addressed in the Intake forms, while the Counseling Session Records and Services Tracking Reports capture details about specific services being delivered.  Indicators of early recovery also are addressed by Counselor Rating of Client and the specialized HIV/AIDS Risk Assessment. 

Clients: Retention and Re-entry
The third stage of treatment process, retention and re-entry transition, rests on the evidence that clients must remain in treatment long enough to stabilize and maintain recovery habits, especially before treatment discharge and social re-entry decisions are made (Simpson, 2004).  This recognizes that successful transitions back into the community require a variety of health and social support services designed to address persistent mental health and social deficits.  Barriers to client success increase in proportion to the history and severity of addiction-related problems, and the role of transitional services is viewed as being especially crucial for corrections-based treatment systems (Simpson, Knight, & Dansereau, 2004).

Forms for Client Retention and Re-entry  
Discharge Reports are commonly used by programs to record date and circumstances related to treatment discharge.  When medications are used as part of the treatment regimen for clients, routine medical files (such as “date of last medication”) likewise can provide reliable information for determining the likelihood of retention.  Follow-up Interviews conducted on representative samples of clients, with a strategic protocol for scheduling interviews and carrying out fieldwork for locating former clients, can likewise provide useful information about treatment outcomes.

Staff: Program Needs and Functioning
There are widespread and growing pressures for behavioral health programs to adopt evidence-based practices.  New research is showing, however, that this can be challenging because sequential steps should be followed for addressing organizational needs and readiness, preparation for change, decision making, and actions as part of an innovation implementation process.  The TCU Program Change Model (Simpson, 2002; Simpson & Flynn, 2007) summarizes this process and provides a conceptual framework to help guide agencies in making practical decisions about initiating and managing innovation adoptions.  In particular, findings show the importance of establishing early staff involvement and positive engagement in program-level changes.  The overall quality of treatment programs depends on having not only an effective client-level service delivery plan (with integrated client assessments and interventions) but also a “healthy” staff environment in which services are delivered (Simpson & Dansereau, 2007).

Forms for Staff Program Needs and Functioning
The Program Training Needs (PTN) survey of staff focuses on important domains of program needs and related issues (e.g., facilities, resources, staff training needs and preferences, and barriers for innovation adoption decisions).  It is an efficient planning tool for programs that are beginning to explore organizational openness to innovations.  It also helps staff feel they have been consulted about program needs and planning for treatment innovations, including the types of training needed.  The PTN offers a preview of findings obtained from the more comprehensive Organizational Readiness for Change (ORC) assessment which includes 18 scales focused on staff perceptions of motivational pressures, resources, staff attributes, and organizational climate.  User-friendly respondent feedback reports are highly recommended (see sample reports for the PTN and ORC).  A companion to the ORC is the Survey of Organizational Functioning (SOF) which includes the ORC as well as nine additional scales measuring job attitudes and workplace practices.

Staff: Innovation Training and Adoption
Quality of training also is important in preparing counselors for change (Simpson & Flynn, 2007).  Indeed, research shows that higher staff ratings on relevance of innovation training to client needs, along with the adequacy of program resource allocations, predict more successful use of innovations following training.  Counselors face barriers in making changes in their clinical practice (such as lack of time and redundancy with current practices), but more positive staff-level responses to training and making progress in implementation are related to client reports of stronger therapeutic engagement. 

Forms for Staff Innovation Training and Adoption
The Workshop Evaluation (WEVAL) form collects counselor ratings on relevance of the training, desire to obtain more training, and program resources supporting the training and implementation.  The Workshop Assessment Follow-Up (WAFU) form includes a section on post-training satisfaction, trial adoption of workshop materials, and an inventory about implementation barriers.

 
TCU ADC Forms (for Automated Data Capture)

Several of our most popular TCU Forms have been adapted for use in single-page optical scanning applications.  These have been “reconfigured” by reorganizing items into separate sub-domains.  A few scales found in previous research to have marginal applications have been eliminated, and replacement items have been added to some forms (e.g., a social desirability response scale has been added).  The result is a more streamlined and focused series of one-page forms, enhanced with an automated scoring and feedback protocol for making normative clinical interpretations of results.  Preliminary evidence on the psychometrics of these “modified” single-page assessment formats indicates they are psychometrically consistent with earlier “original” aggregated versions of the forms, but further research is still in progress.  New TCU ADC Forms also are being developed in response to the needs of our field collaborators and on-going research.  In most cases, these represent abbreviations or subsections being adapted from previously studied TCU assessments.

Forms Section
Content

List of Forms

Permissions and Obtaining Forms

TCU ADC Forms

Community Treatment Forms

CJ Treatment Forms

Methadone Outpatient Forms

Correctional Outpatient Forms

Correctional Residential Forms

Women & Children

Adolescents

Specialized Forms

Psychometric Information and Assessment Workshops

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