Community Forms: Methadone Outpatient Treatment

The Methadone Outpatient Forms include a comprehensive set of 14 intake, during-treatment, and follow-up data collection instruments for assessing client functioning and services in outpatient settings. An early version of the Intake Form was included in the Diagnostic Source Book on Drug Abuse Research and Treatment (1993) published by NIDA.

These forms have been updated conceptually and technically, however, as part of the more current TCU Core Forms. Interested users are strongly encouraged to consider a customized assessments approach based on selective “packaging” of the TCU Core Forms for intake and progress evaluations.

Initial Assessment is administered by the counselor and includes background and psychosocial information, a brief history of illegal drug use, and assessments of cocaine and alcohol dependency status based on DSM-IV criteria. [20 minutes]

Urinalysis Report at Intake reports presence or absence of nine commonly used
illegal drugs.

Intake is administered by a counselor in a face-to-face interview held approximately one week after the Initial Assessment when the client has had time to reach greater stabilization and cognitive focus. [90 minutes]

It includes the following sections:

Part Pages
A: Sociodemographic Background2-7
B:Family Background8-10
C:Peer Relations11-12
D: Criminal History13-15
E: Health and Psychological Status16
F: Drug History17-26
G: AIDS Risk Assessment27-29
H: Interviewer Comments30-31
I: Client Assessment Profile32

Self-Rating at Intake includes short scales for psychological adjustment (i.e.,self-esteem, depression, anxiety, and decision-making), social functioning (i.e.,childhood problems, hostility, risk-taking, and social conformity), and motivation scales (problem recognition, desire for help, treatment readiness, and external pressures). [approximately 15 minutes]

Counseling Session Records

Counseling Session Record — Individual (Counselor) describes the length and type
of session as well as the issues addressed. [5 minutes]

Counseling Session Record — Individual (Client) is a 5-item questionnaire eliciting the client’s reaction to the session. [2 minutes]

Counseling Session Record — Group (Counselor) describes the length and type of session as well as the issues addressed. [5 minutes]

Counseling Session Record — Group (Client) is a 5-item questionnaire eliciting the client’s reaction to the session. [2 minutes]

During-Treatment Status is completed by the counselor in an individual session and re-assesses (for the previous 3-month period) major behavioral criteria such as employment, criminal involvement, drug use, and AIDS-risky behavior. Questions are a subset of the Intake Form. [25 minutes]

Evaluation of Self and Treatment (for the previous 3 months) records client ratings of the counselor and the program in general. It also contains scales assessing psychological adjustment, social functioning, and motivation. [25 minutes]

Counselor Rating of Client is completed by the counselor for the purpose of describing client functioning and therapeutic strategies used in the preceding 3 months. [5 minutes]

Services Tracking Record (Monthly) serves as the overall monitoring record of client services and transactions, and is completed each month by agency staff. It contains information concerning counseling session attendance, medications prescribed, urinalyses results, and ancillary services provided. [Time to complete this form varies, depending on agency
record-keeping systems]

Discharge Report documents dates and reasons for leaving treatment.
[2 minutes]

Follow-up Interview is administered by a trained interviewer in a face-to-face session held at a designated time after discharge from treatment. It includes questions that are similar to the Intake Form, but also addresses functioning and outcome measures based on the posttreatment period. [90 minutes]

It includes the following sections:

Part Pages
A: Sociodemographic Background2-6
B: Family Background6-7
C: Peer Relations8-10
D: Criminal History10-12
E: Health and Psychological Status12-13
F: Drug History14-22
G: Gambling22
H: AIDS Risk Assessment23-25
I: Interviewer Comments
(to be completed after the interview)
26