TREATMENT INTERVENTION INVENTORY

Treatment Intervention Inventory (TII)

The Treatment Intervention Inventory (TII) identifies people with problems that would benefit from counseling, psychotherapy and/or substance (alcohol and other drugs) abuse treatment. Two of the most important clinical decisions are, Does the client have a problem? And if so, what is the most beneficial counseling and/or treatment program available? The TII helps answer both of these questions. We now know that appropriate and timely counseling/treatment intake influences treatment effectiveness. In other words, early problem detection facilitates timely intervention and improves outcome. So what does the TII screen? Areas of inquiry include anxiety, depression, self-esteem, distress, family issues, alcohol abuse, drug abuse and stress handling abilities. This type of information helps in deciding upon the type of treatment needed, appropriate referral options and the level of care needed.

TREATMENT INTERVENTION INVENTORY

The Treatment Intervention Inventory (TII) is designed for treatment referral and treatment intake. The TII consists of 162 items and can be completed in 35 minutes. The TII is an automated (computer-scored) self-report assessment instrument or test. It is administered and scored on-site with reports available within 3 minutes. The TII is a clinical test that assesses anxiety, depression, self-esteem, distress, substance (alcohol and other drugs) use and stress handling abilities while concurrently exploring family issues.

Nine TII Scales (Measures)

1. Truthfulness Scale: Measures how truthful the client was while completing the TII. This scale identifies denial, problem minimization and attempts to fake good.
    
2. Anxiety Scale: Measures nervousness, apprehension and somatic correlates of anxiety. This score varies directly with experienced symptoms.
    
3. Depression Scale: Measures dejected or self-depreciating emotional states that vary from normal to pathological. Melancholy and dysphoria are assessed.
    
4. Self-Esteem Scale: Reflects a person’s explicit valuing and appraisal of self. It incorporates an attitude of acceptance-approval versus rejection-disapproval.
    
5. Distress Scale: Measures experienced pain, worry, sorrow and distress. Distress can involve both mental and physical strain. Distress is a common reason people seek counseling.
    
6. Family Issues Scale: Measures family stability, problems and concerns. The client rates their own family and relationship stability.
    
7. Alcohol Scale: Measures the client’s alcohol proneness and the severity of alcohol-related problems. Alcohol refers to beer, wine and other liquors.
    
8. Drugs Scale: Measures illicit drug proneness and drug-related involvement. Drugs refer to marijuana, crack, cocaine, amphetamines, barbiturates and heroin. This scale measures the severity of drug use and abuse.
    
9. Stress Coping Abilities Scale: Measures experienced stress in comparison to stress coping abilities. The scale measures how well the client copes with stress. Stress exacerbates emotional and mental health symptomatology. A Stress Coping Abilities Scale score at or above the 90^th percentile identifies the presence of an established emotional or mental health problem.

The TII-Juvenile is adapted from the TII. It is appropriate for juvenile screening in HMO’s, EAP’s, juvenile screening, referral agencies and counseling program intake evaluation. Click on the following link to go to the TII-Juvenile webpage.

TII Summary

The TII is a test whose results can be used for program intake and/or referral for treatment. The TII provides an objective assessment of the client’s situation and needs. It can be administered at intake, follow-up intervals and discharge. It’s also appropriate for use in EAP's, HMO's and other screening-and-referral programs, as warranted.

In addition to establishing client truthfulness and substance (alcohol and other drugs) involvement, the TII measures important counseling, treatment, recovery and relapse indicators. The TII provides a sound empirical basis for decision making.

There have been several reviews of the poor performance of the interview and its paradoxical lack of reliability and validity. Interviews are at the mercy of client untruthfulness, denial and problem minimization. In contrast, the TII's Truthfulness Scale measures client truthfulness, identifies denial, quantifies problem minimization and reveals faking. Raw scores reflect what the client wants you to know. Truth-Corrected scores reveal what the client may be trying to hide.

The Treatment Intervention Inventory (TII) was developed specifically for client screening and treatment intake. It is much more than just another alcohol or drug test. It measures important attitudes and behaviors overlooked by other screening tests.

Why Use the TII?

Many mental health professionals, screeners referring clients for help and (treatment intake) staff need meaningful and accurate assessment. The TII is an objective and standardized test with impressive reliability, validity and accuracy. Early detection of emotional, psychological and behavioral problems facilitates quicker intervention and treatment. This type of information helps in deciding upon appropriate referral, the nature of treatment needed and the level of care that is warranted. At one sitting of approximately 35 minutes' duration, staff can acquire a vast amount of treatment and needs information. Early problem identification facilitates timely intervention and improved outcome results.

Advantages of Screening

Screening or assessment instruments filter out individuals with serious problems that may require referral for counseling, substance abuse treatment or psychotherapy. This filtering system works as follows:

Reference to the above table shows that a problem is not identified until a scale score is at the 70^th percentile or higher. These risk range percentiles are calculated on the clients that have completed the TII. This procedure is fair and avoids extremes such as over-identification and under-identification of problems.

A department or agency's policy might refer clients with serious problems for further evaluation or treatment. In this case (Severe Problem), 11% of the people screened would be referred. Or, policy might refer people with identified problems (Problem Risk and Severe Problem, 31%) for additional services. In these examples, either 89% or 69% (contingent upon adopted policy) of the people screened would not be referred for additional (and expensive) services.

Budgetary savings (dollars) would be large with no compromises in clients receiving appropriate evaluation and/or treatment services. Indeed, more offenders would receive help. Without a screening program, there is usually more risk of over or under-utilization of additional professional services.

TII Test Booklets

TII test booklets are provided free. These booklets contain 162 items and are written at a 5^th to 6^th grade reading level. If a person can read the newspaper, they can read the Treatment Intervention Inventory (TII).

Reports

In brief, TII reports summarize the client’s self-report history, explain what attained scale scores mean and offer specific score-related recommendations.

Within 2 minutes of test data entry, automated (computer-scored) three-page reports are printed on-site. These reports summarize a lot of information in an easily understood format. For example, reports include a TII profile (graph), which summarizes scale scores at a glance. Also included are attained scale scores, an explanation of what each score means and specific score-related recommendations. In addition, significant items (direct admissions) are highlighted, and answers to a built-in interview (last sequence of items) are presented. Emphasis is placed on having meaningful reports that are helpful and easily understood.

To go directly to the example TII report, click on the TII Report link. After reviewing the report, you can return to this section by clicking on the "Return to TII Reports Section" link.

Reliability and Validity

The TII has a proprietary built-in database that insures inclusion of all tests administered in a confidential (no names) manner. These reliability and validity statistics are reported in the document titled "TII: An Inventory of Scientific Findings." Annual database analysis further demonstrates the TII scale to have very high reliability and validity coefficients.

For example, the internal consistencies (coefficient alphas) for TII scales are reported in the following table for TII assessed clients in the year 2002. This is one among several studies.

All TII scales are highly reliable. All alpha coefficients are well above the professionally accepted standard of .75. The results clearly demonstrate that the TII is a reliable test.

Early TII validation studies involved other tests that measured the same thing. These criterion group studies are reported in the document titled "TII: An Inventory of Scientific Findings." Subsequent database research further supports the validity of the TII. Moreover, in the 2002 study (N=3,414) reported above, the accuracy of the TII was demonstrated. Of the clients involved who admitted to serious problems, the accuracy of identification is demonstrated in the following table.

A TII research study is presented at the end of this webpage. To go directly to this research, click the TII Research Study link.

The 70^th percentile cutoff for problem identification correctly classifies nearly 100% of clients with problems. The Low Risk level of 39% avoids putting a large number of clients into a "moderate" range.

Undesirable outcomes associated with inappropriate treatment level placement are discussed by Andrews, Bonta and Hoge (1990). Their conclusions emphasize the importance of TII scale accuracy. By most, if not all standards, TII scales are reliable, valid and accurate.

In summary, all 9 TII scales are highly reliable. And, predictive validity analyses demonstrated that the TII correctly identified problem prone clients. Furthermore, obtained risk range percentages on all TII scales very closely approximate predicted percentages. One of the most important decisions regarding counseling clients is which intervention/treatment program is most appropriate for the client. The TII is an empirically based test that can help in client referral.

The 3,414-client study completed in the year 2002 is presented at the end of this TII webpage. To go directly to this study, click on the TII Research Study link.

Software

The TII is available in MS-DOS or Windows. MS-DOS diskettes contain all their own software. Windows diskettes require a one-time computer setup procedure after which TII data (25 or 50 tests) diskettes are used to score and print reports. Training manuals are provided, and new test users can be walked through these procedures by Risk & Needs Assessment, Inc.'s (Risk & Needs') staff.

Proprietary TII data diskettes contain 25 or 50 test applications. These 3½" or 5¼" diskettes score, interpret and print TII reports on-site. Once a TII account is established, ordered diskettes are mailed to users. Approximately 97% of orders are filled and mailed back to users the same day. When all test applications on a diskette are used, that diskette is returned to Risk & Needs where the test data is downloaded into the TII database. The proprietary "delete names" program is activated by the test user with a few keystrokes to delete all client names from diskettes before they are returned to Risk & Needs. Deleting all client names insures client confidentiality and compliance with HIPAA (federal regulation 45 C.F.R. 164.501).

The "TII: Orientation and Training Manual" explains how the TII works and should be read by staff. The "TII: Computer Operating Guide" explains how to score tests, print or store reports and discusses other unique TII computer-related features. These manuals are provided free to TII users.

Database

The TII system contains a proprietary built-in database. Earlier, it was noted that all used TII diskettes are returned to Risk & Needs, and test data is downloaded into the TII database. This expanding database allows ongoing research and testing program summary -- features that were not possible before.

In summary, all returned TII diskettes' test data is centrally filed at Risk & Needs' offices in the TII database. This database has many advantages. Database analysis permits ongoing cost efficient research that includes scale alpha coefficients, ANOVA, frequency distributions, correlations, cross-tab statistics along with reliability, validity and accuracy determinations. Annual testing program summary provides a vehicle for program evaluation. Click on this TII Research Study link to review TII research.

Annual Summary Reports

Risk & Needs can access each of its tests' built-in databases for statistical analysis and summarization of all tests administered in a year. Annual Summary Reports are prepared for state, department, agency and even some individual providers -- at no cost to them. These reports are provided as a professional courtesy to large volume test users. Summary reports include demographics, court-history when relevant, and test statistics (reliability, validity and accuracy). Has anyone offered to summarize your testing program? Annually? At no additional cost to you? Minimum testing volume for annual reports is 350 tests. There is no maximum limit. Risk & Needs' annual reports range in size from 350 tests to over 55,000 tests annually. An example Annual Summary Report can be viewed by clicking on this Annual Summary Reports link.

Staff Member Input

The TII is to be used in conjunction with experienced staff judgment. Experienced staff should interview the client. For these reasons, the following statement is contained in each TII report: "Treatment Intervention Inventory results are confidential and should be considered a working hypothesis. No diagnosis or decision should be based solely upon these results. Use only with experienced staff judgment."

Why Develop the TII?

Appropriate and timely treatment intake is important to treatment effectiveness. Emotional and psychological assessment is complex and requires more than just alcohol and drug screening. Important areas of inquiry include: client truthfulness, anxiety, depression, self-esteem, distress, family problems, substance (alcohol and other drugs) use and abuse along with stress coping abilities. We now know that stress exacerbates emotional and mental health symptomatology. A Stress Coping Abilities Scale score at or above the 90^th percentile indicates the presence of a DSM-IV disorder. In these instances, the client should be referred to a licensed mental health provider for a diagnosis and written treatment plan.

How do you know if the client is lying? The TII contains a Truthfulness Scale that determines how truthful the client was while completing the test. This scale identifies denial, problem minimization, defensiveness and attempts to fake good. And, the TII doesn’t stop there. Error of measurement due to untruthfulness is measured for each scale and reported as Truth-Corrected scores. Truth-Corrected scores reveal what the client is minimizing or trying to hide. Truth-Corrected scores are more accurate than raw scores.

Unique TII Features

TII-Juvenile: The TII has been modified for juvenile (14 to 18 years) assessment. The TII-Juvenile consists of 143 items and can be completed in 25 to 30 minutes. The 9 TII scales (measures) are retained in the juvenile version. These are: Truthfulness Scale, Anxiety Scale, Depression Scale, Self-Esteem Scale, Distress Scale, Alcohol Scale, Drugs Scale, Family Issues Scale, and the Stress Coping Abilities Scale. To go to the TII-Juvenile webpage, click on the TII-Juvenile link.

Truthfulness Scale: Identifies denial, problem minimization and faking. It is now known that many clients attempt to minimize their problems. A Truthfulness Scale is a necessary component in contemporary tests. The TII's Truthfulness Scale has been validated with the Minnesota Multiphasic Personality Inventory (MMPI), polygraph exams, other tests, truthfulness studies and experienced staff judgment. The TII's Truthfulness Scale has been demonstrated to be reliable, valid and accurate. In some respects, the TII's Truthfulness Scale is similar to the MMPI’s L and F-Scales. It consists of a number of items that most people agree or disagree with.

Truth-Corrected Scores: Have proven to be very important for assessment accuracy. This proprietary truth correction process is comparable to the MMPI's K-Scale correction. The TII's Truthfulness Scale has been correlated with the other 5 scales. The Truth Correction equation converts raw scores to Truth-Corrected scores. Truth-Corrected scores are more accurate than raw scores. Raw scores reflect what the client wants you to know. Truth-Corrected scores reveal what the client is attempting to hide.

Stress Coping Abilities Scale: Measures how well the client handles stress, tension and pressure. And, we now know that stress exacerbates emotional and mental health symptomatology. This scale is a non-introversive way to screen for established (diagnosable) mental health problems. A person scoring at or above the 90^th percentile on the Stress Coping Abilities Scale should be referred to a certified mental health professional for a more comprehensive evaluation, diagnosis and treatment plan. This important area of inquiry is missed by many other assessment tests.

More than just another alcohol or drug test. In addition to alcohol and drugs, the TII assesses other important areas of inquiry like truthfulness, denial and faking, family issues, emotional/mental health problems, etc. The TII is specifically designed for client screening.

Three ways to give the TII. The TII can be administered in three different ways: 1. Paper-pencil test booklet format is the most popular testing procedure. TII English and Spanish test booklets and answer sheets are available. 2. Tests can be given directly on the computer screen. Some agencies dedicate computers for TII testing. And, 3. Human Voice Audio in English or Spanish is available. These three test administration modes are discussed in the "TII: Orientation and Training Manual." Each test administration mode has advantages and some limitations. Risk & Needs offers these three test modes so test users can select the administration mode that is optimally suited to their needs.

Reading Impaired Assessment: Reading impaired clients represent 20+ percent of the clients tested. This represents a serious problem to other treatment tests. Risk & Needs has developed an alternative for dealing with this problem: Human Voice Audio.

Human Voice Audio: Presentation of the TII is in English and Spanish. Clients’ passive vocabularies are often greater than their active vocabularies. Hearing items read out loud often helps reduce cultural and communication problems. This administration mode requires earphones and simple instructions to orient the client to the up-down arrow keys on the computer keyboard. Human Voice Audio is an alternative approach for screening reading impaired clients.

Confidentiality: Risk & Needs encourages test users to delete client names from diskettes before they are returned to Risk & Needs. Once client names are deleted, they are gone and cannot be retrieved. Deleting client names does not delete demographics or test data, which is downloaded into the TII database for subsequent analysis. This proprietary name deletion procedure involves a few keystrokes and insures client confidentiality and compliance with HIPAA (federal regulation 45 C.F.R. 164.501).

Test Data Input Verification: Allows the person that inputs test data from the answer sheet into the computer to verify the accuracy of their data input. In brief, test data is input twice, and any inconsistencies between the first and second data entries are highlighted until corrected. When the first and second data entries match or are the same, the staff person can continue. This proprietary Data Input Verification procedure is optional, yet strongly recommended by Risk & Needs.

Inventory of Scientific Findings: Much of the TII research has been gathered together in a document titled "TII: An Inventory of Scientific Findings." This document summarizes TII research chronologically -- as the studies were completed. This chronological reporting format was established largely because of the TII database, which permits annual database analysis of all tests administered.

Orientation and Training Manual: The "TII: Orientation and Training Manual" (O&T Manual) explains how the TII works. It is a must read for staff that will be using the TII. O&T Manual content includes, but is not limited to, the following: instructions for testing, an explanation of how scores are derived, a clarification of how court-related information is used, a description of unique TII features and much more.

Computer Operating Guide: Some computer operators want more information than others. Consequently, Risk & Needs provides a One-Page Quick Start, which includes basic instructions for scoring TII’s, and a more comprehensive "TII: Computer Operating Guide." The Computer Operating Guide contains instructions for using MS-DOS as well as Windows software. This manual discusses hardware, software, scoring, printing reports, unique program features and much more.

Staff Training: Risk & Needs' staff is available to participate in TII training programs conducted by statewide programs, departments and high volume agencies in the United States. Sometimes, smaller volume providers get together for collective (multiple providers) on-site training. Risk & Needs typically participates in 4-hour or 6-hour TII training sessions. This training can include hands-on computer scoring, as desired. Risk & Needs gives attendees certificates attesting to their TII training.

Staff training is also provided on Fridays at Risk & Needs' Phoenix offices from 8:30 a.m. to 11:30 a.m. or from 1:30 p.m. to 4:30 p.m. These training sessions are free. To participate, contact Risk & Needs at least ten days in advance. Participation is on a first call, first scheduled basis.

Automated Criminogenic Structured Interview (ACSI): The ACSI is a structured interview, not a test. The ACSI consists of 65 multiple choice items. It obtains comprehensive background history, pattern of substance (alcohol and other drugs) abuse and criminogenic needs information. Whatever multiple choice item answer that is selected is printed in the ACSI report. Use of the ACSI is voluntary (not required). The ACSI is free. ACSI use is restricted to users of Risk & Needs adult tests. The ACSI is not a test, and it is not to be used as a standalone test. The ACSI is a structured interview. For more information on the ACSI and to see an ACSI report, click on this ACSI link.

Support Services: Risk & Needs provides a full range of support services. These services include e-mail, fax and telephone availability, provision of test-related information, telephone walk-through assistance, staff training and test consultation. Support services and test-related materials are provided free.

Test Unit Fee (Cost): TII cost information can be reviewed by clicking on the Test Unit Fee (Cost) link. There is only the one cost or charge, and that is the test unit fee. Everything else is included at no additional cost to the test user. This includes test booklets, answer sheets, training manuals, upgrades, ongoing database research, annual summary testing reports, staff training, and support services. Do not be misled by some test publishers' à la carte pricing like separate costs for each test administration as well as for each of the test-related items listed above. Instead of asking for the test administration cost, ask for the total cost involved in using a test. We believe Risk & Needs' one test unit fee is very affordable.

Free Examination Kit: A 1-test TII demonstration diskette is available on a 30-day cost free basis. Demo diskettes are in MS-DOS format so that the software is contained on the diskette. This way, the one-time Windows setup program is avoided at the demo level. The examination kit contains a 1-test demo diskette, test booklet (reusable), an answer sheet (can photocopy), a "TII: Orientation and Training Manual," One-Page Quick Start and some descriptive information. Risk & Needs does want the demonstration diskette and test booklet returned within 30 days of receipt. To request a free examination kit, click on the Free Examination Kit Request link.

How to Proceed: To become a Risk & Needs test user, click on the Agreement & Proposals link, click on the Print Client User Agreement button and fax the completed form to (602) 266-8227, or mail your completed form to Risk & Needs. Upon its receipt by Risk & Needs, you become a Risk & Needs test user and can order tests. Risk & Needs test users can reorder tests by mail, telephone, fax or e-mail.

Other related links are listed for reference. They are available as needed.

    Test Unit Fee (Cost) webpage link. Explains Risk & Needs' Test Unit Fees or Costs.
    New Client Order webpage link. Explains steps to become a "new Risk & Needs client."
    How to Order webpage link. Explains how Risk & Needs tests can be ordered.

Additional information can be provided upon request. Contact Risk & Needs Assessment, Inc., P.O. Box 44828, Phoenix, Arizona 85064-4828. Risk & Needs' telephone number is (602) 234-3506, our fax number is (602) 266-8227 and our e-mail address is hhl@riskandneeds.com.

Reference

Andrews, D., Bonta, J. & Hoge, R. (1990). Classification for effective rehabilitation: Rediscovering Psychology. Criminal Justice and Behavior 17, 19 – 52.

Selecting a Screening and Referral or Intake Test

If you are selecting a screening and referral and/or intake screening test, the following Comparison Checklist should prove helpful. It lists important screening test qualities. The "Other" column represents any other test you might want to compare to the TII.

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EXAMPLE TII REPORT

Within 2 minutes of test data entry, automated (computer-scored) three-page reports are printed on-site. These reports summarize a lot of information in an easily understood format. For example, reports include a TII profile (graph), which summarizes scale scores at a glance. Also included are attained scale scores, an explanation of what each score means and specific score-related recommendations. In addition, significant items (direct admissions) are highlighted, and answers to a built-in interview (last sequence of items) are presented. Emphasis is placed on having meaningful reports that are helpful and easily understood.

An example four-page TII report follows.

Page 1 includes some basic demographics, a TII profile (graph of scale scores), and a reproduction of all TII answers. The nine TII scales are presented by name, the client’s percentile scores and a graph of the client’s scores. Page 1 concludes with summary paragraphs for the Truthfulness and Anxiety Scales.

Example report summaries are presented on page 2 of the TII report. These scale summaries include the Depression Scale, Alcohol Scale, Drugs Scale, Stress Coping Abilities Scale, Self-Esteem Scale and the Distress Scale. Each scale paragraph gives the client's attained score, explains what that score means and provides score-related recommendations.

The Distress Scale paragraph is completed on page 3 of the TII report. The Family Issues Scale is presented and explained, and score-related recommendations are presented. Next, the client's significant items (direct admissions) are presented for the Alcohol Scale, Drugs Scale, Distress Scale and Family Issues Scale. Lower on the page are the client's selected "treatment needs." If no treatment needs were selected, the report would state "No treatment options were selected." The "Multiple Choice" consists of multiple choice items. The answer selected by the client is set forth under the Social Stressors (Multiple Choice) section of the report. These multiple choice items include items #147 through #162.

Largely because the Treatment Intervention Inventory (TII) is a clinical test, considerable space has been allocated for the evaluator's recommendations. Sometimes, assessors are influenced by information obtained from the client's record, in interview or from a significant "other." It is recommended that such sources of information be referenced and clarified. In other instances, the assessor may want to note their intuitions, insights or "hunches." And, it often requires space to summarize the clinical situation, client's motivation and recommendations. Page 4 of the TII report provides space for the evaluator's observations, conclusions and recommendations. Page 4 concludes with the assessor's signature, date of the evaluation and a summary of the client's answers.

To go back the TII Reports section, click the Return to TII Reports Section link.

We hoped you found this webpage interesting and helpful. Additional information can be provided upon request by writing Risk & Needs Assessment, Inc., P.O. Box 44828, Phoenix, Arizona 85064-4828. Our telephone number is (602) 234-3506, our fax number is (602) 266-8227 and our e-mail address is hhl@riskandneeds.com. Risk & Needs' offices are open 8:00 a.m. to 4:00 p.m., Monday through Friday, Mountain Standard Time.

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