Transcript Effective treatment. Changing lives

Treatment Outcomes Profile (TOP)
Clinical usefulness
Gateway reference 13673
Effective treatment. Changing lives
The TOP is a useful clinical tool in helping service users and
workers to regularly review progress
TOP
NDTMS
The TOP is a validated tool
that has been designed &
implemented to monitor
changes in patterns of
drug use during treatment
for;
The information collected
from the TOP is reported
to the NTA through the
National Drug Treatment
Monitoring System
(NDTMS) – and used for
national, regional and
local level outcomes
analysis
 An individual client
Local treatment
outcomes
National treatment
outcomes
TOP: Key facts
Clinical usefulness
Validation
Clinical usefulness
The TOP was developed
to serve two main
functions:
1) As a useful clinical tool
2) For outcomes analysis
To be really useful as a
clinical tool, rather than
just as a form for
reporting to the NTA,
keyworkers need to
incorporate TOP in to
their daily practice
This section aims to suggest
some ways & outline some of
the benefits of using the TOP
to its full potential clinically
Effective treatment. Changing lives
The TOP is a clinically useful tool for monitoring progress and
identifying change during treatment
TOP: Key facts
Clinical usefulness
Validation
 A means of identifying and understanding change for an individual client
(comparing TOP scores)
 Allows the keyworker to feedback the progress a client has made. The client can
see these changes visually (using TOP Progress Tracker). Visual feedback may be
more effective than verbal feedback alone
How is TOP
useful
clinically?
 Assistance given in the care planning process; highlighting areas of difficulty that
may need addressing to increase the potential treatment gains
 Helps summarise the clients current situation and stimulates discussions in clinical
meetings and supervision
 Provides the keyworker with an additional source of information/evidence that
could be used when discussing a specific care plan
Effective treatment. Changing lives
Implementing the TOP may enhance keyworking / case
management
TOP: Key facts
Clinical usefulness
Validation
Keyworking*
TOP
Regular reviews of care plans &
treatment goals with the client
Measuring progress can help in setting
achievable treatment goals
Provision of drug misuse related advice
& information
Help to ensure information is targeted to
specific client need
Interventions to reduce drug related
harm
Highlights and informs interventions
required for reducing harm
Psychosocial interventions to increase
motivation
Visually charting progress using TOP can
be powerful in increasing motivation
Help to address social problems such
as, housing & employment
Continuously monitors changes in client
circumstances
* The UK guidelines on clinical management describe keyworking as a delivery mechanism for a range of psychosocial components
Effective treatment. Changing lives
The TOP is a simple yet effective tool that can be used as
an information source to enhance client motivation for
change
TOP: Key facts
Clinical usefulness
Validation
Client motivation has for a long time been recognised as an important factor for achieving and maintaining change during
substance misuse treatment. A number of psychosocial interventions are commonly used to increase motivation. TOP can
provide an additional resource to assist in increasing motivation
Psychosocial interventions
Motivational Interviewing
Motivational Enhancement Therapy
Contingency management techniques
Externally imposed motivation such as DIP
Effective treatment. Changing lives
TOP
A simple and clinically useful set of questions
that are able to detect change over time may be
a useful aid for increasing motivation. Even
where progress is not being made, realism and
honesty are more motivating than overoptimistic evasion.
The changes can be presented to the client
visually using tools such as the ‘TOP progress
tracker’. Often seeing changes in black and
white can be a powerful motivational source
The client can benefit from seeing the progress
they have made since starting treatment and
easily identify any further progress to be made
The TOP provides an important source of information that is
useful for informing the development and evaluation of care
plan goals
TOP: Key facts
Clinical usefulness
Validation
The TOP provides valuable information across
4 key problem domains.
Care planning
Is the process of
setting goals and
interventions
based on the
needs identified in
an assessment
and then planning
how to meet
those goals with
the client.
 Information gathered by completing the TOP
with a client can be used as an additional source
of information to help inform the development of
care plans
 All care plans should be regularly reviewed
 Completing Review TOPs throughout the
client’s treatment journey also provides a source
of information that can be used to monitor
progress against the goals that have been agreed
in the care plan
 The TOP information, summarised using the
TOP Progress Tracker, can also be used to
stimulate discussion where the client has not
achieved their care plan goals
Effective treatment. Changing lives
TOP can be integrated into mapping exercises used within
the ITEP framework
TOP reviews
show*
 Client has not
made any changes
in the number of
days they are using
*Use TOP Progress
Tracker for visual
representation of
change
ITEP map
 Client and keyworker
decide that is would be useful
to develop a map
 Map is developed to
explore the things that are
preventing the client making
changes
 Map also asks the client to
look at the things that may
help them to make progress in
the future
TOP: Key facts
Clinical usefulness
Validation
Benefit
 Provides an environment
for highlighting & exploring
problems
 Provides a means for
addressing problems
 Focuses attention on a
specific topic
 Provides further
information for the
development of care plans
Feed into the development of care plans
Effective treatment. Changing lives
An ITEP map can be developed to focus on areas where little
or no progress has been made and identified using the TOP
TOP: Key facts
Clinical usefulness
Validation
Issue: I’m not making any changes in my drug use
What are the things that are stopping me?
Thinking
Relationships
Peers
Housing
All my
friends use
Drugs are
always
available
I get bored
when I am not
using – what
else is there to
do?
My partner
uses and
doesn’t want to
get “clean”
Develop non
using friendships
– attend mutual
aid groups to
meet clean
people
Look at
alternative
accommodation
options
Look at
employment,
education and
training options
Speak to my
partner about
and make
informed
decisions
How useful was this map & discussion?
1 2 3 4 5 6 7 8 9 10
What things might help?
Effective treatment. Changing lives
Develop care plan to address actions
TOP as a tool for assisting with the clinical management of
clients
Referral
Client need can
sometimes get
overlooked. Especially
when managing large
caseloads
TOP & case
management
TOP can be effective
in highlighting need in
each of the four
problem domains
And provide an
objective source of
information/evidence
when making referrals
Case discussion
Clinical meetings
At clinical meetings
new clients are
presented and
existing clients
regularly reviewed
TOP data can
provide useful
information in case
discussion
particularly when a
client’s progress is
measured
Supervision
TOP can serve as a
focal point when
discussing cases in
supervision
Effective treatment. Changing lives
Clinical decisions
Clinical decisions
require evidence
TOP will not provide
all the necessary
evidence but will
provide a useful
additional source
when presenting an
argument for a
specific intervention,
an increase or
reduction in
treatment intensity
or a change in
pharmacotherapy, or
supervision
TOP: Key facts
Clinical usefulness
Validation
Funding allocations
Some treatment
modalities require
funding to be sought
For example,
structured
counselling,
structured day care,
or residential
treatment
Evidence is required
to secure funding.
TOP may provide
evidence of a
client’s current
circumstances as
well as any progress
made
The TOP Progress Tracker provides a simple, yet effective
graphical summary of TOP scores over time
TOP
Progress
Tracker
Background
What is it?
The NTA report TOP
data back to
partnerships and
providers on a regular
(monthly/quarterly) basis
It is a function that has
been built into the Data
Entry Tool (DET) that
provides the opportunity
to print out graphical
reports that show the
client’s progress between:
These reports may be of
less direct benefit to the
keyworker and the client
during the keyworking
session
The progress tracker
reports client level data
in a format that is useful
to inform clinical
discussion
Treatment Start
Review
Treatment Exit
TOP data for all domains
It is also available in
paper format for providers
who do not use DET*.
* We are currently working to make the electronic application available to all information management systems
Effective treatment. Changing lives
TOP: Key facts
Clinical usefulness
Validation
Why use it?
Having evidence of
progress/lack of
progress and being able
to show this in a visual
format can be an
effective tool to highlight
and stimulate discussion
about key issues
It is also a very good
way to highlight
important treatment
gains and positively
reinforce the progress
that they have made
Select the client, the treatment episode and the TOP domains
and print the report
TOP: Key facts
Clinical usefulness
Validation
Search for the client using basic
attributors or client number
Select the client that you want to
print a report for
Select the treatment episode – multiple treatment
episodes can also be selected if you want to show
the difference between the current and previous
treatment episodes
Select the TOP domains that
you want to be included in the
report
Effective treatment. Changing lives
A graphical summary of all TOP data will be displayed for the
client. This displays clinically useful information
TOP: Key facts
Clinical usefulness
Validation
What can this tell you?
Treatment
Start TOP
3 x Treatment
Review TOPs
As a keyworker you will be best placed to contextualise
this information
It can be seen that the client has made substantial
progress in reducing the frequency of their opiate
consumption from daily use prior to starting treatment to ‘0’
days at the first and subsequent care plan reviews. This
equates to approximately 10 months of opiate abstinence
However, the second (alcohol) graph shows that the
client has started to drink alcohol much more frequently
during the same period after reporting ‘0’ days use at
treatment start and 28 days use at Review 3
Increase in
frequency of alcohol
use following a
reduction in opiate
use
Effective treatment. Changing lives
The frequency of alcohol use may be problematic and
require a specialist intervention in its own right. Further
investigation may be required. Clinical staff may choose
to consider the possible risk posed from the combination
of opioid substitution treatment (especially methadone)
and level of alcohol use
The benefits of the TOP continue to be recognised in clinical
settings with its application in the UK and abroad having
increased
TOP: Key facts
Clinical usefulness
Validation
Over the last 12 months the NTA has received several requests from European and International
colleagues to use the TOP to measure outcomes in their clinics and countries.
It’s recognised that the TOP benefits from being
Requests received from
Wales
Scotland
Northern Ireland
Italy
Taiwan
Iran
Australia
Chile
Russia
Finland
Canada
Malta
Finland
Spain
New Zealand
validated tool
short & easy to complete
Why?
clinically useful tool
captures a wide range of substances
broadly covers all other relevant treatment
domains
Effective treatment. Changing lives
TOP is being used by treatment providers in a range of
countries as a preferred measure of assessing the quality and
outcomes of substance misuse interventions
Effective treatment. Changing lives
TOP: Key facts
Clinical usefulness
Validation