Alcohol Outcome Measures
Scoping the outcome measures
available for alcohol treatment
services
November 2009
DH
Sue Baker
Cascade Health
sue@cascadehealth.org.uk
07957174661
Alcohol Outcome Measures
Scope of the review
Focus was on outcome measures for
treatment interventions for people with
alcohol problems
This presentation is based on a report of
the scoping study
Alcohol Outcome Measures
Work Undertaken
 Desk research on the literature available
 Checking out with some of the key
academics
 Contacting the alcohol leads
 Conversations with services and
commissioners
Alcohol Outcome Measures
Review of effectiveness of treatment – Duncan
Raistrick, Nick Heather and Christine Godfrey, NHS/NTA Nov 2006
 Identifies 5 packages
 Discusses factors important to the
development of a good package in addition to
validity and reliability
Alcohol Outcome Measures
 Comprehensive Drinker Profile
 Addiction Severity Index
 MAP
 Result
 Christo Inventory for Substance Misuse
Services
Alcohol Outcome Measures
Comprehensive Drinking Profile
(Miller and Marlatt 1987)
 Developed in late 80’s
 A detailed tool - assessment and treatment planning
tool with a follow up facility
 Covers 88 items and incorporates validated
assessment tools such as MAST
 Very alcohol focused and incorporates space for
client concerns and issues.
 Down side is size (despite a shorter version being
available)
Alcohol Outcome Measures
The Addiction Severity Index (McLellan et al 1980, updated
in 1992)
 Another detailed assessment tool covering
alcohol and drug dependence plus 5 other
common problem areas
 Uses a 30 day period to establish base line
 Said to be widely used in treatment and
research
 The alcohol component was included in respect
of drug users but is considered to cover the
issues know to be seen in people with alcohol
problems
Alcohol Outcome Measures
Maudsley Addiction Profile (MAP) (Marsden et al 1998)
 Short
 60 items in 4 domains using a 30 day period
 Developed and tested for use with drug and
alcohol misusers in tier 3 and 4
 Some limitations for alcohol misusers
 Widely used
RESULT (Raistrick and Tober 2003 )
Combines a range of validated measures in
packages to suit different outcome
measure requirements
 Incorporates QALYS, ICD-10;
LDQ,CORE, SSQ; QF + Agency Det
 Draws on measures from the field and
beyond – very credible
 Adaptable
ct contact with a client or from case notes. It covers social function, health, risk behaviour, psychological wellbeing, occupation, criminal activity, subs
Alcohol Outcome Measures
Christo Inventory for Substance Misuse
Services (Christo et al 2000)
• One page tool covering 10 domains
• Simple scoring system 0-2 leading to a
single overall score
• Validated
• Limitations re sensitivity for example
• Popular use to ease of use
Alcohol Outcome Measures
Since the Effectiveness Review?
 TOPs
 Outcome spider
 Outcome Star
 ATOM
Alcohol Outcome Measures
TOPs
 Designed as a drug treatment outcome
measurement tool
 Said to be equally appropriate for alcohol
 4 domains covering substance misuse,
injecting behaviour, crime and health and
social functioning
 Widely used, short and concise
 Disliked by many alcohol services
Alcohol Outcome Measures
Alcohol Star
 Adapted from the alcohol spider
 Measures change by quantifying steps on
the client journey across 8 domains
 Does not include measure of alcohol
misuse
 Service find it combines well with key
working
Alcohol Outcome Measures
ATOM/AATOM-C
New
tool developed in Australia
 Overall approach has commonalities with RESULT
building a range of existing measures
 Alcohol focused
 5 domains inc client demographics
 Short and validated
 Possible over reliance on client’s view of situation
 Difficult to assess applicability to UK
Alcohol Outcome Measures
Similarities
 Change is measure by comparing a period
of time (usually 1 month) with a previous
point in time
 Increasing convergence in the domains
covered – substance misuse, relationships,
economic issues, crime, physical and
psychological health
Alcohol Outcome Measures
Differences
 Combinations of areas within domains
 Choices re rating scales
 Focus on alcohol
 Client centred/purpose
 Length of time to complete
 Method of completion
Alcohol Outcome Measures
Issues
a)What are we wanting to measure
and why
 Effectiveness of treatment?
 Investment aims?
 Clients concerns?
Alcohol Outcome Measures
b) Agency ownership
 Tie in with what they aim to do
 Have value for clients
 Fit in with assessment and data collection
systems
 Needs to be simple as possible and short
Alcohol Outcome Measures
c) Client needs to be comfortable
 Follow up and confidentiality
 Question relevant to them
One key issue is: are we interested in
people with alcohol problems or the
clients of services ?
d) different services
Is there/could there be a one size fits all
(across the tiers)?
e) Be reliable and valid
 Universal
 Proven validity and reliability
 Sensitive to change
 Easy readable and neutral language
(Raistrick, Heather and Godfrey 2006)
Alcohol Outcome Measures
What are services doing and saying?
 Using measures as required by
commissioners
 TOPs not popular with alcohol services
 Most rely on indicators of output not
outcomes plus qualitative info
 Long term follow up difficult
 BI – might need to stick with repeated use
of assessment tool
Alcohol Outcome Measures
What are services doing and saying?
 Using measures as required by
commissioners
 TOPs not popular with alcohol services
 Most rely on indicators of output, not
outcomes plus qualitative info
 Long term follow up difficult
 BI – might need to stick with repeated use
of assessment tool
Alcohol Outcome Measures
What are commissioners doing?
 Reconsidering TOPs for alcohol services
 Some evidence of working with services
to devise tools and dash boards
 Balancing tensions within PCT and with
what services can deliver
Outcome
Measure
Short
Rel for
alcohol
Uni/Relia
b/valid
Independent
Tiers
Stakeholder interest
covered
CDP
No
Yes
Yes
No
3, 4
Clinical
ASI
No
?
Yes
Yes
3, 4,
Clinical
MAP
Yes
No
Yes
No
2,3, 4
RESULT
Yes
Yes
Yes
No
2,3, 4
Clinical Commissioner
but client interest tool is
available as an add on
Clinical, User &
Commissioner
CISS
Yes
?
Yes
No
2,3, 4
Clinical
2,3, 4
Clinical
Commissioner
TOPs
Alcohol
Spider
Alcohol
Star
ATOM
Yes
No
?
No
Clinical Commissioner
Yes
Yes
Yes
Yes
Yes
Yes
Not tested No
Not tested No
Yes
No
3, 4
3, 4
Clinical
Commissioner
2,3 & 4 Clinical, Commissioner
Conclusions
 No single tool exists that ticks all boxes
 Agreement about the kinds of domains that
are relevant (alcohol misuse, other
substances, physical and mental health, use of
time, relationships and something around
economic status/housing)
Alcohol Outcome Measures
 Need to increase universality for alcohol
misusers
 Package approach is required to cover the
needs of all stakeholders and is likely to
be achievable
 It might be that outcomes measure for
BIs are not in many settings achievable
other than repeating the assessment tool
Alcohol Outcome Measures
 Its a complex business and we need to
not loose sight of main goal
 Outcome measurement is no worst here
than in other parts of the health care
system
 One approach might be to consider a
Quality Account Approach - Patient Safety,
Effectiveness & Client Satisfaction
Alcohol Outcome Measures
Cornerstone points:•Client
•User
Focus
friendly
•Indicates public benefit from the
investment
Alcohol Outcome Measures
Sue Baker
Cascade Health
sue@cascade.org.uk
07957 174661