ASI – LITE/ CF
TOPPS II
MANUAL
How to use this manual...
This manual provides in-depth instructions on administering each ASI-Lite/CF-TOPPS II item. The manual is designed to provide information regarding five key areas that are important for correctly administering each ASI-Lite/CF-TOPPS II item. If a key area is clearly not appropriate to be discussed for a particular item, it is not presented within that item.
Five Key Areas:
Intent/Key points: The information contained in this section describes why the question was originally included on the instrument. Understanding the original intent of an item can help the interviewer use the appropriate judgment on how to code a response and/or elicit additional information concerning that item.
Suggested Interviewing Techniques: This section offers what seems to be the most efficient ways to phrase each item. Clients seem to be more open to answering questions if they are posed in a direct, non-confrontational manner. In most cases, simply reading the question off the page as written is recommended. In other cases, examples of effective ways to paraphrase the item are offered.
Additional Probes: A probe is a question that does not appear on the ASI-Lite-CF TOPPS II Instrument. The probe may provide information that helps to understand the client’s problems more fully and is asked in addition to the actual item. Identification of additional probes will be included where appropriate. Sometimes, asking many probes in the first part of the problem section helps the interview to flow more naturally.
Coding Issues: Coding is the term used to describe the act of recording the information received from the client into the boxes provided with a numerical “code.” For each item or set of items, some solutions are offered for coding issues that could potentially arise. However, it must be noted that this is not an exhaustive list and others could arise.
Cross-check item with: Similar and related information may be gathered elsewhere in the instrument. An alert interviewer can use these internal cross-checks to verify information with the client throughout the interview.
In addition to following the above instructions for each item and understanding the purpose of these key areas, comments may be made to further supplement the client’s response to a specific item. Some data collection methods may allow comments to be recorded; therefore, use the comments section to elaborate any answers.
Patient’s Rating Scale:
It is especially important that the patient develop the ability to communicate the extent to which he/she has experienced problems in each of the selected areas, and the extent to which he/she feels treatment for these problems is important. These subjective estimates are central to the patient's participation in the assessment of his/her condition.
In order to standardize these assessments, a 5 point (0-4) scale is employed for patients to rate the severity of their problems and the extent to which they feel treatment for them is important.
0-Not at all
1-Slightly
2-Moderately
3-Considerably
4-Extremely
For some patients it is adequate to simply describe the scale and its values at the introduction to the interview and occasionally thereafter. For other patients, it may be necessary to arrive at an appropriate response in a different fashion. The interviewer's overriding concern on these items is to get the patient's opinion. Getting the patient to use his/her own language to express an opinion is more appropriate than forcing a choice from the scale.
Several problems with regard to these ratings can occur. For example, the patient's rating of the extent of his/her problems in one area should not be based upon his/her perception of any other problems. The interviewer should attempt to clarify each rating as a separate problem area, and focus the time period on the previous 30 days. Thus, the rating should be made on the basis of current, actual problems, not potential problems. If a patient has reported no problems during the previous 30 days, then the extent to which he/she has been bothered by those problems must be 0 and the interviewer should ask a confirmatory question as a check on the previous information. "Since you say you have had no medical problems in the past 30 days, can I assume that, at this point you don't feel the need for any medical treatment?" Note: If the patient is not able to understand the nature of the rating procedure, then insert an "X" for those items.
Confidence Ratings:
Confidence ratings are the last two items in each section and appear as follows:
Is the above information significantly distorted by:
Patient's misrepresentation? 0 - NO 1 - YES
Patient's inability to understand? 0- NO 1 - YES
Whenever a "yes" response is coded, the interviewer should record a brief explanation in the "Comments" section.
The judgment of the interviewer is important in deciding the veracity of the patient's statements and his/her ability to understand the nature and intent of the interview. This does not mean a simple "gut hunch" on the part of the interviewer, but rather this determination should be based on observations of the patient's responses following probing and inquiry when contradictory information has been presented (e.g. no income reported but $1000.00 in drug use). The clearest examples are when there are discrepancies or conflicting reports that the patient cannot justify, then the interviewer should indicate a lack of confidence in the information. It is much less clear when the patient's demeanor suggests that he/she may not be responding truthfully and in situations where the patient will not make eye contact, or rapid, casual denial of all problems. This should not be over interpreted since these behaviors can also result from embarrassment or anxiety. It is important for the interviewer to use supportive probes to ascertain the level of confidence.
NOTE: It is the responsibility of the interviewer to monitor the consistency of information provided by the patient throughout the interview. It is not acceptable to simply record what is reported. Where inconsistency is noted (e.g., no income reported but claims of $500 per day spent on drugs) the interviewer must probe for further information (stressing confidentiality of the information) and attempt to reconcile conflicting reports. Where this is not possible, information should not be recorded and X's should be entered with a written note for the exclusion of information.
Specific Instructions for TOPPS II Items:
The TOPPS II items are distinguished from the ASI items by a different numbering system. The letter “T” is used to identify all TOPPS II items. For example, the first TOPPS II question appears as the following, “T1. Provider Identification Number.” The number accompanying the “T” reflects only the order in which they appear in the Core Data Set as a full instrument.
Several items in this instrument require the client to recall information from two specific time periods: Past 6 months and Past 30 days. These items are:
T11. and T12. Have you been in a controlled environment in the Past 6 months and Past 30 days? How many days in the Past 30 days?
T13. How many days have you stayed overnight in a hospital for medical problems in the Past 6 months and Past 30 days?
T14. How many days have you stayed overnight in a hospital for psychiatric problems in the Past 6 months and Past 30 days?
T16. How many times have you visited an Emergency Room in the Past 6 months and Past 30 days?
T20. How many of your children spent the majority of the Past 6 months living with you? Past 30 days living with you?
T24. Have you been enrolled in a vocational, training or educational program in the Past 6 months and Past 30 days?
T25. How many times have you been arrested in the Past 6 months and Past 30 days?
These two time frames are important to understand for the purposes of coding and interviewing. The Past 30 days time frame is a subset of the Past 6 months time frame. Therefore, the Past 6 months time frame will be asked first, so that numbers will not be counted twice. For example, if the client was arrested 5 times in the past 6 months, the interviewer would state the Past 30 days time frame question as, “Of those 5 arrests, how many of them were in the past 30 days?” Thus, the “Past 30 days” response can never be a larger number than the “Past 6 months” response.
An example of the suggested interviewing technique for these time frame questions would be:
“So, John, how many times in the past 6 months have you been arrested?” John responds, “5.” “Of those 5 arrests, how many were in the past 30 days?” John responds, “2.”
In order to code this, the 6 month boxes will be coded as “05” and the 30 days boxes will be coded as “02.”
Distinction Between Time Frames of ASI Items and TOPPS II Items:
For the items in the TOPPS II Core Data Set items, the one time frame is a subset of the other. The Past 30 Days time frame is included in the Past 6 Months time frame and the number coded in the 6 month time frame will always be larger or equal to the number coded in the 30 day time frame. On the other hand, for items in the ASI, the time frames are Lifetime and Past 30 Days. Here, these are two separate and distinct time frames, thus, the Past 30 Days time frame is not included in the Lifetime time frame. The distinction of these two time frames between the ASI and the TOPPS II Core Data Set items is made so that interviewers are aware of these differences and can accurately ask the item so as to elicit responses for the correct time frame. It is especially important to be noted for those TOPPS II States who are incorporating the TOPPS II Core Data Set items into their own admission and/or follow-up instruments so that these time frames are not confused.
General Information
T1.Provider Identifier No.
Intent/Key Points: To record a unique, non-reassigned facility identifier code within the State, for the purpose of matching the client with a place of treatment. Provider ID identifies the provider of the alcohol or drug treatment service and is limited to 15 alphanumeric characters. The responsibility for assigning unique numbers to providers within a given State may reside within the individual State.
Suggested Interviewing Techniques:
This item is not asked of the client. A facility staff member with access to this information will provide the Provider Identifier No.
Coding Issues:
Entry must contain a valid provider ID that matches the State ID in SAMHSA’s National Facility Register. Be sure all boxes are filled.
T2.Client Identifier No.
Intent/Key Points: To record a unique, non-reassigned client identifier number within the facility program so that client confidentiality is protected. The number will also assure that admission, discharge, and follow-up interview data are appropriately and accurately linked. The identifier is limited to 15 alphanumeric characters, and the responsibility for assigning numbers to the clients will reside within the individual State.
Suggested Interviewing Techniques:
This item is not asked of the client. Each facility should have procedures in place to assign a unique identifier number to each newly admitted client; thus, a facility staff member with access to this information will provide the Client Identifier No.
Coding Issues:
Be sure that all boxes are filled.
T3.Date of Admission
Intent/Key Points: To record the date that the client receives his/her first direct treatment/recovery service. This item will be used with the date of last service received (collected at discharge) to calculate the “length of stay.” It will also be used to determine subsequent follow-up points. This date may be different from the date that the baseline interview takes place (Date of Interview).
Suggested Interviewing Techniques:
“When was the date that you were admitted to treatment?”
“When did you first start receiving treatment?”
In some cases, the date of admission will be provided by the program, but the item should still be asked of the client for verification. If there is a discrepancy between the date the program notes and the date the client reports, it will be the responsibility of the program to decide how to resolve this discrepancy.
Coding Issues:
Be sure to fill in the complete 4-digit year.
T4.Date of Interview
Intent/Key Points: To record the actual date that the baseline interview is administered and to determine the amount of time that has passed between admission to treatment and the baseline interview. Date of Interview will be the current date, and may or may not be different from the Date of Admission.
Suggested Interviewing Techniques:
Completed by program staff.
Coding Issues:
Be sure to fill in the complete 4-digit year.
T5.Type of Admission
Intent/Key Points: To determine if the client has had previous treatment (other than detox) in the past 30 days. This item will determine eligibility in the TOPPS II study. If the client has had more comprehensive treatment (e.g., inpatient, outpatient, residential treatment) in the past 30 days, then the client will not be eligible for the study. However, if the client has had detox in the past 30 days, then the client can be considered for the study. Participation only in AA/NA/CA in the past 30 days will not be considered more comprehensive treatment, and the client can be eligible for the study.
Suggested Interviewing Techniques:
“Have you been in any substance abuse treatment in the past 30 days?” If so, “what type of treatment was it? Can you give me more details of the treatment you’ve received?”
It is important to obtain very specific details as to the type of treatment the client has previously received.
Coding Issues:
Code the response with the number “1” or “2”.
1 = No substance abuse treatment services at all OR no substance abuse treatment services other than detox in the past 30 days.
2 = Prior substance abuse treatment services other than detox in the past 30 days.
Cross-check Items With:
Controlled environment items.
T6.Gender
Intent/Key Points: To record the biological gender of each client for purposes of accurate demographic classifications of the clients. Issues and questions of trans-gender among clients may arise, thus, specifically asking this question can clarify the gender of the client.
Suggested Interviewing Techniques:
Gender is typically not asked but based upon appearance. However, if there is some uncertainty, the interviewer is encouraged to gently probe and base gender determination on client’s current biological/legal gender status. Possible questions to ask, “Are you Male or Female?” or “What is your biological gender?”
Coding Issues:
Code “1” for Male and “2” for Female.
Only those who have completed a medical sex change should be coded as a gender different from that at birth.
T8.Date of Birth
Intent/Key Points: To record the age of the client. Age itself is important as a variable, but birthdate is also an important identifier when linking a client’s records across multiple databases. Enter the month, day and year.
Suggested Interviewing Techniques:
“What is your date of birth?”
Some data collectors have reported that an atypical number of clients report the first day of the month as their birthday. Because of the importance of birthdate as an identifying variable across databases, interviewers may want to ask such respondents, “Are you sure the first is actually your birthdate?” Interviewers may want to ask the client for proof of identification that includes a birthdate.
Coding Issues:
Be sure to code the full 4-digit year.
T9.Of what ethnic group do you consider yourself?
Intent/Key Points: To record specific demographic information about the client: those of Hispanic or Latin descent and those not of Hispanic or Latin descent.
Suggested Interviewing Techniques:
“Of what ethnic group do you consider yourself? – Hispanic or Latino or Not Hispanic or Latino.”
Coding Issues:
Code “1” for Hispanic or Latino.
Code “2” for Not Hispanic or Latino.
T10.Of what race do you consider yourself? (Select one or more.)
Intent/Key Points: To record basic demographic information about a client. A client may consider himself of more than one race; therefore, multiple responses are acceptable.
Suggested Interviewing Techniques:
“Of what race do you consider yourself? - American Indian or Alaska Native; Asian; Black or African American; Native Hawaiian or other Pacific Islander; White; or Other.”
Define categories, as necessary, for the client:
American Indian – A person having origins in any of the original people of North America and who maintain cultural identification through tribal affiliation or community recognition.