Comparison Study T Comparison Study Tool (6 Month)

Substance Abuse Mental Health Services Administration

Comparison Study Abstraction Tool (6 Month)

OMB No: XXXXX

Expiration Date: XXXX

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB control number for this project is XXXX-XXXX.  Public reporting burden for this collection of information is estimated to average 10 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 2-1057, Rockville, Maryland, 20857.

Community Support Evaluation: BHTCC

Comparison Study Abstraction Tool (6 Month)

Instructions:

The following instrument will be used by the two selected comparison sites; data will be collected for up to 200 individuals per site. Questions 1-7 should be completed by the comparison site staff at 6 month only. Information will be gathered through interviews with offenders at 6 month from into the comparison site court as well as information abstracted from comparison site justice management information systems.

1. Offender ID [Provided by grantee comparison site]

|____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|

2. Grant ID [Provided by ICF]

|____|____|____|____|____|____|____|____|____|____|

3. Interview Type (Select only one type)

• Baseline

• Reassessment: 6 months

4. Interview date

|____|____| / |____|____| / |____|____|____|____|

Month Day Year

5. Are you currently employed?

Instructions: Clarify by focusing on status during most of the previous week, determining whether client worked at all or had a regular job but was off work. If the client is incarcerated, select “unemployed, not looking for work”.

• Employed full time (35+ hours per week, or would have been)

• Employed part time

• Unemployed, looking for work

• Unemployed, disabled

• Unemployed, volunteer work

• Unemployed, retired

• Unemployed, not looking for work

• Other (Specify): __________________________________

• Declined

• Don’t know/ information not available

6. Are you currently on probation or parole?

• Yes

• No

• Declined

• Don’t know/information not available

SERVICES RECEIVED

7. Services Received

Identify the number of days of services or sessions provided to the comparison site offender during the 6 months from court entry. (Days should be rounded to the nearest whole number. Enter zero if no sessions provided)

Modality	Days		Treatment Services	Sessions
Case management			Screening
Day treatment			Brief Intervention
Inpatient/hospital (other than detox)			Brief Treatment
Outpatient			Referral to Treatment
Outreach			Assessment
Intensive Outpatient			Treatment/Recovery Planning
Medication Assisted Treatment			Individual Counseling
For Opioid Addiction			Group Counseling
Methadone			Family/Marriage Counseling
Buprenorphone			Co-occurring treatment/Recovery services
Naltrexone (Oral)			Psycho-pharmacological Interventions
Vivitrol (Injectable)			HIV/AIDS Counseling
Disulfiram			Mental Health services
Acamprosate			Other Specify:
For Alcohol Addiction
Naltrexone (Oral)			Medical Services	Sessions
Vivitrol (Injectable)			Medical Care
Disulfiram			Alcohol/Drug testing
Acamprosate			HIV/AIDS Medical Support and Testing
Residential/Rehabilitation			Other Specify:
Detoxification (Select only one)
Hospital Inpatient			Case Management Services	Sessions
Free Standing Residential			Family Services (marriage education, parenting, child development services)
Ambulatory Detoxification			Child care
After Care			Employment Services
Recovery Support			Pre-employment
Other (specify):			Employment coaching
			Individual Services Coordination
After Care Services	Sessions		Transportation
Continuing Care			HIV/AIDS Service
Relapse Prevention			Supportive Transitional Drug-Free Housing Services
Recovery Coaching			Care Coordination
Self-help and Support Groups			Other Specify:
Spiritual Support
Other After Care Services			Peer-to-Peer Recovery Support Services	Sessions
Other Specify:			Peer Coaching or Mentoring
			Housing Support
Education Services	Sessions		Alcohol-and Drug-Free Social Activities
Substance Abuse Education			Information and Referral
HIV/AIDS Education			Other Specify
Other Specify:

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