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Effective treatment. Changing lives
Treatment Outcomes Profile (TOP)
Clinical usefulness
Gateway reference 13673
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 outcomesNational 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 developedto serve two mainfunctions:1) As a useful clinical tool2) 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
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
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
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 interventions 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 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
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
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
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 actions1 2 3 4 5 6 7 8 9 10
Effective treatment. Changing lives
TOP as a tool for assisting with the clinical management of clients
TOP & case management
Referral Case discussion Clinical decisions Funding 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 meetingsAt 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
SupervisionTOP 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
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
Background What 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 StartReview 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
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
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
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 ScotlandNorthern IrelandItalyTaiwanIranAustralia ChileRussiaFinlandCanadaMaltaFinlandSpainNew Zealand
Requests received from It’s recognised that the TOP benefits from being
Why?
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
