1. Effective treatment. Changing lives Treatment Outcomes Profile (TOP) Clinical usefulness Gateway reference 13673

2. Effective treatment. Changing lives TOP: Key facts Clinical usefulness Validation The TOP is a useful clinical tool in helping service users and workers to regularly review progress The TOP is a validated tool that has been designed & implemented to monitor changes in patterns of drug use during treatment for;  An individual client  Local treatment outcomes  National treatment outcomes TOP 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 NDTMS 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 Clinical usefulness This section aims to suggest some ways & outline some of the benefits of using the TOP to its full potential clinically

3. Effective treatment. Changing lives TOP: Key facts Clinical usefulness Validation The TOP is a clinically useful tool for monitoring progress and identifying change during treatment How is TOP useful clinically?  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  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

4. Effective treatment. Changing lives TOP: Key facts Clinical usefulness Validation Implementing the TOP may enhance keyworking / case management * The UK guidelines on clinical management describe keyworking as a delivery mechanism for a range of psychosocial components Keyworking*TOP Regular reviews of care plans & treatment goals with the client Provision of drug misuse related advice & information Interventions to reduce drug related harm Measuring progress can help in setting achievable treatment goals Help to ensure information is targeted to specific client need Highlights and informs interventions required for reducing harm Psychosocial interventions to increase motivation Help to address social problems such as, housing & employment Visually charting progress using TOP can be powerful in increasing motivation Continuously monitors changes in client circumstances

5. 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 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 interventionsTOP 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 over- optimistic 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 Motivational Interviewing Motivational Enhancement Therapy Contingency management techniques Externally imposed motivation such as DIP TOP: Key facts Clinical usefulness Validation

6. Effective treatment. Changing lives TOP: Key facts Clinical usefulness Validation The TOP provides an important source of information that is useful for informing the development and evaluation of care plan goals 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. The TOP provides valuable information across 4 key problem domains.  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

7. Effective treatment. Changing lives TOP: Key facts Clinical usefulness Validation 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 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

8. Effective treatment. Changing lives TOP: Key facts Clinical usefulness Validation An ITEP map can be developed to focus on areas where little or no progress has been made and identified using the TOP How useful was this map & discussion? Issue: I’m not making any changes in my drug use Peers All my friends use Housing Drugs are always available Thinking I get bored when I am not using – what else is there to do? Relationships My partner uses and doesn’t want to get “clean” What are the things that are stopping me? What things might help? 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 Develop care plan to address actions 1 2 3 4 5 6 7 8 9 10

9. Effective treatment. Changing lives TOP as a tool for assisting with the clinical management of clients TOP & case management ReferralCase discussionClinical decisionsFunding allocations Client need can sometimes get overlooked. Especially when managing large caseloads 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 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 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 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 TOP: Key facts Clinical usefulness Validation

10. Effective treatment. Changing lives TOP: Key facts Clinical usefulness Validation The TOP Progress Tracker provides a simple, yet effective graphical summary of TOP scores over time TOP Progress Tracker BackgroundWhat is it?Why use it? The NTA report TOP data back to partnerships and providers on a regular (monthly/quarterly) basis 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 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:  Treatment Start  Review  Treatment Exit TOP data for all domains It is also available in paper format for providers who do not use DET*. 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 * We are currently working to make the electronic application available to all information management systems

11. Effective treatment. Changing lives TOP: Key facts Clinical usefulness Validation Select the client, the treatment episode and the TOP domains and print the report 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

12. Effective treatment. Changing lives Treatment Start TOP 3 x Treatment Review TOPs Increase in frequency of alcohol use following a reduction in opiate use 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 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 What can this tell you? 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 A graphical summary of all TOP data will be displayed for the client. This displays clinically useful information TOP: Key facts Clinical usefulness Validation

13. Effective treatment. Changing lives TOP: Key facts Clinical usefulness Validation The benefits of the TOP continue to be recognised in clinical settings with its application in the UK and abroad having increased 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. validated tool clinically useful tool short & easy to complete captures a wide range of substances broadly covers all other relevant treatment domains Wales Scotland Northern Ireland Italy Taiwan Iran Australia Chile Russia Finland Canada Malta Finland Spain New Zealand Requests received fromIt’s recognised that the TOP benefits from being Why?

14. Effective treatment. Changing lives TOP: Key facts Clinical usefulness Validation 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