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
instrument 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 re-administered to the same client at 30
day intervals or at important decision making points in the treatment program,
e.g., intake, referral 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 evaluating
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 judgment 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 answers.
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 symptoms 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, ecstasy, amphetamines, barbiturates and
heroin) use and abuse while identifying drug-related problems.
9. Control Scale: Control is a 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 aggression. 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.
