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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
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
“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
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
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”