Determining clinical cutoff scores for the Australian Treatment Outcomes Profile psychological health, physical health and quality of life questions

Abstract

Introduction The Australian Treatment Outcomes Profile (ATOP) is a brief instrument that measures self‐reported substance use, health, and wellbeing in the previous 28 days for people in alcohol and other drug treatment. Previous studies have established the concurrent validity, inter‐rater, and test–retest reliability of the tool. The current study sought to identify recommended cutoff scores for ATOP items for psychological health, physical health and quality of life that identify clients reporting clinically significant problems warranting further assessment and/or intervention, compared to cutoffs used by ‘gold‐standard’ measures for these domains. Methods Clients attending for treatment for problems with opioid (n = 144) or alcohol use (n = 134) completed the ATOP and comparison standardised questionnaires (Kessler‐10, Short Form Survey 12 and the Personal Wellbeing Index) with a researcher. Receiver operating characteristics analysis, along with clinician perspectives, were used to recommend cutoff scores for ATOP items indicative of clinically significant problems. Results A cutoff score of 5 or less out of 10 was identified as an optimal pragmatic cutoff for ATOP items relating to psychological health, physical health and quality of life items with regards to balancing sensitivity, specificity, and application in a treatment setting. Discussion and Conclusions The recommended clinical cutoffs will support clinicians and treatment services to identify clients who require further assessment and follow up for their psychological health, physical health and quality of life. The current study provides further evidence for the utility of the ATOP for individual clinical review, service planning and research.

Health and social characteristics of clients reporting amphetamine type substance use at entry to public alcohol and other drug services in New South Wales, Australia, 2016–2019

“…The ATOP is a 22‐item, validated, client‐reported scale that assesses a range of domains over the preceding 28 days [ 20 , 21 , 22 ], including recent number of days' substance use, injecting behaviour, vocational engagement (days of paid work or study in past 28), housing stress (homeless or at risk of eviction), arrest, whether they are living with children and whether they have experienced violence as victim and/or perpetrator. Clients also rate their physical health, psychological health and quality of life from 0 (poor) to 10 (good), with scores of 5 or below identifying significant concerns in these domains [ 22 ].…”

“…All analyses were conducted using SPSS, Version 26 [ 23 ]. The effect of the above independent variables on two dependent/outcome variables were tested: any ATS use (binary categorical: no ATS use in previous 28 days [reference] vs. >0 days' use) and frequency of ATS use (three‐level categorical: ‘no’ ATS use [0 days in previous 28] vs. ‘low frequency’ ATS use [1–12 days used] vs. ‘high frequency’ ATS use [13–28 days] [see [ 22 ]]). Transformation of frequency of ATS use from a bounded count variable (days of ATS use in the previous 28) to a categorical variable was based on its being bi‐modally distributed, thus violating the normality assumption of linear regression.…”

Substance use, socio‐demographic characteristics, and self‐rated health of people seeking alcohol and other drug treatment in New South Wales: baseline findings from a cohort study

“…We assessed age, work or study frequency (days), substance use frequency (days, by substance: alcohol, amphetamine‐type stimulants, benzodiazepines, cannabis, cocaine, any opioids [heroin or other non‐prescribed opioids]), and self‐rated psychological health, physical health, and quality of life as continuous variables; and sex, Indigenous status, birthplace (Australia, elsewhere), and preferred language (English, other) as binary variables. Housing stress, any violence (as victim or perpetrator), living with a child under five years of age, arrest, any use of alcohol, amphetamine‐type stimulants, benzodiazepines, cannabis, opioids, or cocaine, any injecting drug use, daily tobacco use, and poor psychological health, physical health and quality of life status (scores of 5 or less 16 ) during the past 28 days were also assessed as binary variables.…”

Identifying thresholds for clinically meaningful change among clients of drug and alcohol services using the Australian Treatment Outcomes Profile

“…It builds upon the Treatment Outcomes Profile (TOP) used in Britain [6] and similar scales developed internationally [7–9]. The ATOP has demonstrated reliability and validity across different populations [10–13], and there are published recommended clinical cut‐offs for assessing single‐occasion risk [14]. However, it is also important to know what amount of change is required on the tool for it to be considered clinically meaningful.…”

“…and there are published recommended clinical cut-offs for assessing single-occasion risk [14]. However, it is also important to know what amount of change is required on the tool for it to be considered clinically meaningful.…”