The variables contained in the baseline and follow-up forms of the NORMS are designed to provide a practical basic system to monitor outcomes from addictions treatment to assist in quality improvement and to document benefits of treatment to both the individual and society. The forms are available to use as is or to incorporate the items into any management information system for extraction and analyses. The copyright designation is simply designed to ensure that the forms themselves remain accessible to all who wish to use them. NORMS is not intended to be a comprehensive outcome evaluation system, but rather to provide a basic foundation for outcomes-based treatment delivery. . The following is a discussion of the rationale and purpose of the various items.
National Outcomes Recording & Monitoring System
Baseline measures typically collected at or shortly after intake, are intended to provide for a general description of the population treated by a program and to capture variables of prognostic significance. This includes basic demographics and clinical data that can provide an indication of the case-mix of the population. Case-mix refers to the composition of the treatment population in terms of proportion of cases based on the severity of the conditions, possible complications to treatment, and other prognostic indicators.
The first page of the baseline document documents demographics and the four variables strongly associated with outcomes (age, education, marital status, and employment). The second page provides a means of documenting the nature and extent of dependence/abuse in accordance with the DSM-IV-TR. Adding the compulsion criterion makes the form compatible with the proposed DSM-5, which adds this criterion and drops the one on legal problems. Documenting the specific positive criteria findings is more important and informative than the frequency of use and route of ingestion typical of most forms. Injection is the mode of ingestion that has the most important and consistent prognostic and health implications. The third page covers injection, psychiatric and mental health conditions. The fourth page covers factors with economic implications: healthcare utilization, motor vehicle issues, arrests, and vocational functioning.
The follow-up form can provide three functions. First, it can document strengths and weaknesses from the perspective of the client. Second, it can provide data on the basic clinical outcomes to monitor the clinical results of treatment. Third, it can document benefits of treatment at an individual and societal level. This also includes measures that can be used to estimate the economic benefits of treatment.
The follow-up form provides a means of getting feedback on the strengths and weaknesses of the treatment from the perspective of the clients in terms of helpfulness. This is not the same as what the client liked, but the degree treatment components were perceived to be helpful in attaining recovery. These questions would likely be asked at only one or two of the potential follow-up intervals. A three month window is used because it is likely to present a more stable picture than a 30 day perspective and allows for an early perspective on outcome as well as providing outcome documentation during the treatment continuum. It is widely determined that a minimum of three month (and much better six) continuum is required for reasonable results.
One of the consistent correlates of outcome is whether the individual has regular contact with support systems irrespective of what that support system is. The most compelling data are for AA, but other support systems should also be monitored.
The items on potential quality of life cover negative feelings and experiences that we have found to be related to current status, but may also suggest unresolved issues, such as family of origin or relationship issues. Such unresolved issues as well as any current dissatisfactions may constitute relapse risks.
Substance use and consequences of use tap not only whether a laps or relapse has occurred, but whether the individual is likely to still meet criteria for a continuing substance use disorder or qualifies for early remission. Again, duration of use during consecutive three month intervals plus any prevalent type of consequences compatible with diagnostic criteria are more informative than days of use in the past 30. For example, simply monitoring the past 30 days would underestimate problems prior to that time or would overlook periods of abstinence if use is discontinued after the follow-up contact. The use of a three-month interval is short enough to allow for initial outcomes during the period of optimal aftercare, or maintenance services and long enough so that two follow-up intervals will cover this critical period. Longer follow-up intervals could be used, but maintaining contact between longer contact intervals increases the likelihood of losing contact.
The second page of the follow-up covers the financial and societal outcome implications of treatment. These types of data will be essential to document the benefits of treatment and make the case that paying for treatment is a good societal investment.
Those wishing more information on NORMS or who have general questions about outcomes monitoring or outcomes-based treatment strategies may utilize the following contact information:
Norman G. Hoffmann, Ph.D.
e-mail address: email@example.com
Postal address: 29 Peregrine Place, Waynesville, NC 285786