While there is a general consensus that questions in the ATR are clear, for sure there are questions that emerge. Below are some of them identified by teams, and some answers.
By the way, happy to discuss the ATR directly with teams via phone, OTN, or live.
1. Why the reverse scoring? The questions could have been worded so the 1-4 scale could have stayed consistent rather than reversing things for specific questions (i.e. # 5, 7, 12, 17).
2. Questions 5, 7, 15 could be simply Yes or No answers. People are in hospital or not.
3. what is the cut-off score for a person who may be ready to go into step care? For example, does a score of 50 mean they're ready to give it a try, or not. I interpret this as an opportunity for team discussion based on client history, etc.
Below is Bill's reply
Just to comment overall – on question 17, good point on reverse meaning but the other reverse scoring questions also aim at negative behaviours. The aim is that each question be closely considered and the reverse scoring is meant to counter administrator bias etc.
1) Reverse scoring problems ---below I have provided steps that would counter any scoring problems and have attached this to a file in this email for distribution if wanted.
Recommended approach to scoring: |
Mark at the top the columns (1) = Strongly Disagree, (2) = Disagree, (3) = Agree, (4) = Strongly Agree. |
Highlight the four reverse score questions by putting a circle on questions numbers: 5, 7, 12, 17. |
Use the margin space on the right side of the instrument to indicate the score, while accounting for the four reversed score items |
Total the score at the bottom of the page. |
2) Why not Yes and No answers to: hospitalization, incarceration, hospitalization etc.?
The scale captures subtlety of the person’s situation, if person might be moving close or away from the above items, for example while not in jail, is involved in the court or having trouble with the law but not quite jail, or recently left such a situation.
3) “cut off score of 50 and “opportunity for team discussion”
Cut off scores are “rough guides”, and it is recognized that while approx. 75% of the time it correctly identifies potential for transition, it will misidentify approx. 22% of consumers.
This assessment scale is meant as a guide and support for teams to address the potential of transition from ACTT and not meant to replace clinical judgments of teams.
It would be super useful to know if the ATR/OCAN grid handout I supplied (attached as well to email) helps focus team discussion, even with people who are not scoring 50.
I have found teams in case discussion are often able to identify how the client is doing in each of the 7 ATR theme areas using a few summary statements or phases. This then helps focus next steps to support the individuals recovery plan as well as support transition, even if transition is seen by the team as a few years away from readiness for transition from ACTT.