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As noted by most people who have used the ATR, the 18 questions can be quickly completed and are clear.  It is important that each question be carefully considered and that you keep in mind that the ATR assesses the client for transition at that point in time, it does not predict future capacity of transition.  

 

 ATR_final_scale

 

Thus for example if a person's medications (question 11) were being managed well by them via their living situation such as family support or living in a domiciliary hostel, you might well "fully" agree.  On the other hand if the person is only maintaining use of medication due to ACT daily visits, even if that part of care is being managed, you might disagree --"strongly" or "mildly" to indicate the person's progression.

 

Key to completing the ATR is that you are thinking about the person and their environment/supports without ACT, (for example question 14).  Thus if the only social supports the person has is ACTT, you might indicate disagree, even if the person is doing well within those supports with ACTT. A disagree in this context would indicate at least some ability of the person to engage with social support.  A strongly disagree would indicate the person is refusing all social support activities of ACTT.

 

 

 

 

  

 

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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.

 

 

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Last edited by Registered Member

Some examples of a few of the ATR questions that sometimes need further definition. Really there are just a few questions that somehow get fuzzy, like:

benefits in place (i.e.: housing registry applications, ODSP, yearly federal income tax reporting, GST, ID sorted out to access banks and programs etc.),

structure in life (the routine person wants and aiming for that shapes their day; for some with support from others in their networks of support

gainfully employed (people seeing their activities are beneficial to them- could be volunteering, now fully retired, working 1 hour a week at a bike shop and pleased with this, engaging in school and/or learning activities).

Key is thinking of the client, without the services of ACTT, rather what surrounds them.

Last edited by Registered Member

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