FOR STAFF ONLY
STEP 3. REVIEW
(Australian Treatment Outcomes Profile)
UR Number:
Surname:
Given name:
Date of birth:
(Please fill in if no label available)
PURPOSE OF STEP
To monitor and review client
progress.
INTRODUCTION FOR CLIENT
“Now I’m going to ask you some questions to review where you are at/how you’ve been. You may
remember that we talked about similar issues during assessment, and this will provide information
about how you’ve progressed”
WHO CAN ADMINISTER
THIS COMPONENT?
This is a clinician
administered module that
can be administered at a
minimum of four weeks
after assessment.
INSTRUCTIONS
1. Record all information as instructed in the form.
2. You may like to use a simple calendar as a prompt to help the client think about the past four weeks.
3. Once the form is completed, compare results with information gathered during assessment
(remembering that the Australian Treatment Outcome Profile questions were embedded in Step1:
Initial screen and Step2: Comprehensive assessment).
4. Provide the client with feedback on their progress.
TREATMENT STAGE:
Start of service episode
Progress review
Discharge
Post Discharge
SECTION 1: SUBSTANCE USE
Record number of days used in each of the past four weeks
Ave qty
per day
a
Alcohol
b
Cannabis
c
Amphetamine type
substances (eg. ice, MDMA etc)
d
Benzodiazepines
Units
Week 4 (most
recent) 0–7
Week 3
0–7
Week 2
0–7
Week 1
0–7
TOTAL
0–28
Std drinks
(prescribed & illicit)
e
Heroin
f
Other opioids (not prescribed
methadone/buprenorphine)
g
Cocaine
h
Other substance
i
Other substance
j
Daily tobacco use?
Yes
No
Record number of days client injected drugs in the past four weeks (if no, enter zero and go to section 2)
Week 4 (most
recent) 0–7
k
Injected
l
Inject with equipment
used by someone else?
Week 3
0–7
Week 2
0–7
Week 1
0–7
Yes
TOTAL
0–28
No
FOR STAFF ONLY
Clinician name:
Position:
Signature:
Date:
1
FOR STAFF ONLY
UR Number:
Surname:
Given name:
Date of birth:
(Please fill in if no label available)
SECTION 2: HEALTH AND WELLBEING
Record days worked and at college, school or vocational training for the past four weeks
Week 4
0–7
a
Days paid work (incl. all paid work; not voluntary work)
b
Days at school, tertiary education, vocational training
Week 3
0–7
Week 2
0–7
Week 1
0–7
TOTAL
0–28
Record the following items for the past four weeks
c
Have you been homeless?
Yes
No
d
Have you been at risk of eviction?
Yes
No
e
Have you, at any time in the past four weeks, been a primary
caregiver for or living with any child/children?
(i) under 5 yo?
Yes
No
(ii) 5–15 yo?
Yes
No
Yes
No
f
Have you been arrested?
g
Have you been violent (incl. domestic violence) towards
someone?
Yes
No
h
Has anyone been violent (incl. domestic violence) towards
you?
Yes
No
i
Client’s rating of psychological health status (anxiety, depression and problem emotions and feelings)
012345678910
POOR
GOOD
j
Client’s rating of physical health status (extent of physical symptoms and bothered by illness)
012345678910
POOR
GOOD
k
Client’s rating of overall quality of life (e.g. able to enjoy life, gets on well with family and partner, satisfied with living
conditions)
012345678910
POOR
GOOD
FOR STAFF ONLY
Clinician name:
Position:
Signature:
Date:
2