Over the past decade we have witnessed dramatic changes in health care systems, particularly in mental health,
chemical dependency and counseling. There is renewed emphasis upon objective and accurate problem identification,
appropriate referral and documented outcome. Decisions regarding the type of intervention needed, changes
in inpatient-outpatient status, continuation or completion of treatment and effectiveness of treatment are now
subject to review. Provider accountability, utilization review and substantiation of decision making are here to
stay.
The Adult Treatment Outcome (ATO) was developed to help meet these needs. The ATO is designed for test-retest
comparison at important stages of treatment intervention, e.g., intake, change of status, completion and outcome.
The ATO combines objective assessment with the client's perception of his or her own needs. As Ulenhuth (1970)
observed, "it is the patient's opinion with all its biases that is most relevant for the initiation and
maintenance of treatment." The Adult Treatment Outcome enables staff to compare patient's opinions with
empirically based objective measures of client problems and need.
The Adult Treatment Outcome (ATO) is an automated computerized assessment instrubment designed for use at intake
(pre-treatment) and post-treatment intervals. It enables comparison of client status prior to, during and upon
treatment completion. The ATO can be readministered to the same client at 30 day intervals or at important
decision making points in the treatment program, e.g., intake, referall and continuation or completion of treatment.
It includes true/false and multiple choice items and can be completed in 25 to 30 minutes. The ATO contains
twelve empirically based scales: Truthfulness, Outlook, Depression, Anxiety, Control, Violence, Suicide, Alcohol,
Drugs, Distress, Self-Esteem and Stress Coping Abilities. The ATO has been researched on outpatients, inpatients,
college students and others.
The ATO report explains client's attained scores and makes specific intervention and treatment recommendations. It
also presents Truth-Corrected scores, significant items, a concise "multiple choice" and much more. Comparison
reports compare pretest results with posttest results. This comparison report is an objective and standardized
procedure for evalutating client change, program effectiveness and outcome. The ATO is designed to measure the
severity of problems in clinical settings. It is a risk and needs assessment instrument. The ATO has demonstrated
reliability, validity and accuracy. It correlates impressively with both experienced staff judgement and other
recognized tests.
ATO users usually identify client risk, substance (alcohol and other drugs) abuse and client need prior to
recommending intervention, supervision levels and/or treatment. The ATO is to be used in conjunction with a
review of available records and respondent interview. No decision or diagnosis should be based solely on ATO
results. Client assessment is not to be taken lightly as the decisions made can be vitally important as they
affect people's lives. ATO research is ongoing in nature, so that evaluators can be provided with the most
accurate information possible.
The Adult Treatment Outcome (ATO) is an objective outcome test. It has 153 items and takes 35 to 40 minutes to
complete. ATO has twelve scales (measures): 1. Truthfulness Scale,
2. Self-Esteem Scale, 3. Outlook
Scale, 4. Distress Scale, 5.
Depression Scale, 6. Anxiety Scale, 7.
Suicide Scale, 8. Control Scale, 9.
Violence Scale, 10. Alcohol Scale, 11.
Drugs Scale and 12. Stress Coping Abilities Scale.
TWELVE ATO SCALES (MEASURES)
1. Truthfulness Scale: measures the truthfulness of the client while they
were completing the ATO. This scale identifies self-protective, defensive or guarded people who minimize or
even fake answeres.
2. Distress Scale: measures sorrow, misery, pain and suffering. Distress
incorporates pain (physical and mental), physical and mental abuse, agony and anguish. Distress involves both
mental and physical pain and strain. The Distress Scale was adopted from other clinical tests in which it is
used. Symptoms such as nervousness, apprehension, melancholy and dysphoria are measured.
3. Outlook Scale: measures a person's negation as reflected in their
resistance, oppositional outlook and attitudes towards help. A positive attitude is often a prerequisite
to behavioral change.
4. Depression Scale: provides a quantitative score that varies directly
with client's self-reported symptoms and concerns. The Depression Scale identifies depression and establishes
its magnitude or severity via multiple-choice answers, i.e., "rare or never," "sometimes," "often" or "very often."
5. Anxiety Scale: provides a quantative score that varies directly with
client's self-reported symptoms. The presence, severity and magnitude of these symptooms is measured by client's
multiple-choice answers, i.e., "rare or never," "sometimes," "often" or "very often."
6. Self-Esteem Scale: reflects a client's explicit valuing and appraisal
of self. Self-esteem incorporates an attitude of acceptance-approval versus rejection-disapproval. Self-esteem
refers to a person's perception of self.
7. Alcohol Scale: measures alcohol use and the severity of abuse. Alcohol
refers to beer, wine, and other liquors. This scale measures the severity of abuse while identifying
alcohol-related problems.
8. Drugs Scale: measures the severity of drug (marijuana, crack, ice, LSD,
ecstacy, amphetamines, barbiturates and heroin) use and abuse while identifying drug-related problems.
9. Control Scale: Control is two-fold concept: control of others and
control of oneself. The concept of control has emerged in violence literature as an important and in some
cases a focal issue. Control refers to control of self and others. Some theorists maintain the loss of
control can in fact be a way of controlling others. Other theorists emphasize the attitudes and behaviors
inherent in control of others. Controlling behaviors vary from swearing and intimidation to battering.
Control is often synonymous with power. Controlling behaviors can represent subtle acts of manipulation,
influence and persuasion to gain power over others, or these behaviors can escalate to anger and
agression. There are many techniques of manipulation, influence and persuasion used to advantage in business
and political arenas.
However, when individuals go beyond these subtle techniques and become aggressive to gain power over others, then
the controlling behaviors are deviant. People who lose their sense of power and ability to control others often
resort to acts of anger and violence. In its extreme form, control can become an obsession. Power is found through
the control of others. Unfortunately, deviant controlling behaviors can lead to serious acts of violence.
10. Violence Scale: measures propensity for using force to injure damage or
destroy. This scale identifies people that are dangerous to themselves and others.
11. Suicide Scale: measures a client's probability of committing suicide.
Suicidal persons give many warnings regarding their intentions. Any elevated (70th percentile and higher)
Suicidal Ideation Scale score should be taken seriously.
12. Stress Coping Abilities Scale: establishes how well the client copes
with stress. The National Institute for Occupational Safety and Health (NIOSH) evaluated the health records of
22,000 workers in 130 organizations. Their conclusion: stress affects workers in all types of job levels;
unskilled laborers are equally susceptible, as are top-line executives. Stress exacerbates symptoms of emotional
and mental health problems.
The Stress Coping Abilities Scale is much more than just a measure of stress. It is a measure of how well the
client copes with stress. Two people can be in the same stressful situation, however, one person is overwhelmed
and the other person handles it well. The Stress Coping Abilities Scale can account for these different reactions
to stress.
