•  

Intervention Summary

Back to Results Start New Search

Computer-Assisted System for Patient Assessment and Referral (CASPAR)

The Computer-Assisted System for Patient Assessment and Referral (CASPAR) is a comprehensive assessment and services planning process used by substance abuse clinicians to conduct an initial assessment, generate a treatment plan, and link clients admitted to a substance abuse treatment program to appropriate health and social services available either on site within the program or off site in the community. The intervention relies on the CASPAR software package, downloaded to a personal computer, that consists of two Microsoft Windows-based applications designed to work sequentially.

The first application is an electronic version of the widely used Addiction Severity Index (ASI) called the Drug Evaluation Network System (DENS) ASI. The ASI is a research-derived problem assessment interview that measures the type and severity of difficulty across seven domains: medical, employment, alcohol use, drug use, legal status, family/social relationships, and psychiatric functioning. The computer-assisted DENS ASI provides item-by-item instructions for the interviewing counselor, including coding and probing suggestions. There are 150 automated consistency checks built into the program to ensure accurate coding fidelity to the ASI interview, and all items are range checked. The software also generates narrative reports and client-level treatment plan problem lists on a form that can be used to manually draft a treatment plan.

After the DENS ASI is used to assess the client and generate a treatment plan problem list, the clinician can use the list to prioritize the client's problems as part of the treatment planning process. The clinician then uses the second application, the CASPAR Resource Guide, to identify off-site health and social services to address these problems. These are often specialized or "wrap-around" services outside the scope or resources of the admitting treatment program. Those implementing CASPAR use a Resource Guide "skeleton" to create an extensive guide tailored to their local community. The Resource Guide used in the study reviewed by NREPP contained electronic information on 1,524 agencies in southeastern Pennsylvania, sorted by agency name, services provided, and 131 keywords. The guide was based on the electronic edition of First Call for Help, a local resource directory of free or low-cost health and social service providers published by the United Way of Southeastern Pennsylvania. The Resource Guide skeleton enables users to capture provider-specific information such as services available, fee structure, eligibility criteria, and all necessary contact information.

Descriptive Information

Areas of Interest Substance abuse treatment
Co-occurring disorders
Outcomes Review Date: November 2009
1: Matching of counselor treatment plan to client admission problems
2: Matching of specialized services received to client admission problems
3: Number of services received
4: Treatment retention and completion
Outcome Categories Alcohol
Drugs
Family/relationships
Mental health
Treatment/recovery
Ages 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Black or African American
Hispanic or Latino
White
Settings Outpatient
Other community settings
Geographic Locations Urban
Implementation History Since 1999, 92 counselors in 22 outpatient substance abuse treatment programs in Pennsylvania and New Jersey have been trained on the use of the CASPAR software suite to assess and arrange treatment services, and a total of 351 clients have been assigned to CASPAR-trained counselors in the developer's studies.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations CASPAR has been adapted for use in the behavioral and mental health area of child welfare. Project IMPROVE (Intervention for Multisector Provider Enhancement) uses the CASPAR process with the Child Behavior Checklist rather than the ASI to assess children and adolescents for behavioral and mental health problems and then link them to appropriate local community services.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: November 2009

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Carise, D., Gurel, O., McLellan, A. T., Dugosh, K., & Kendig, C. (2005). Getting patients the services they need using a Computer-Assisted System for Patient Assessment and Referral--CASPAR. Drug and Alcohol Dependence, 80(2), 177-189.  Pub Med icon

Supplementary Materials

Carise, D., Cornely, W., & Gurel, O. (2002). A successful researcher-practitioner collaboration in substance abuse treatment. Journal of Substance Abuse Treatment, 23(2), 157-162.  Pub Med icon

Carise, D., & Gurel, O. (2002). Benefits of integrating assessment technology with treatment: The DENS project. In J. L. Sorensen, R. Rawson, J. Guydish, & J. E. Zweben (Eds.), Drug abuse treatment through collaboration: Practice and research partnerships that work (pp. 181-195). Washington, DC: American Psychological Association.

Gurel, O., Carise, D., Kendig, C., & McLellan, A. T. (2005). Developing CASPAR: A Computer-Assisted System for Patient Assessment and Referral. Journal of Substance Abuse Treatment, 28(3), 281-289.  Pub Med icon

McLellan, A. T., Alterman, A. I., Cacciola, J., Metzger, D., & O'Brien, C. P. (1992). A new measure of substance abuse treatment: Initial studies of the Treatment Services Review. The Journal of Nervous and Mental Disease, 180(2), 101-110.  Pub Med icon

McLellan, A. T., Grissom, G. R., Zanis, D., Randall, M., Brill, P., & O'Brien, C. P. (1997). Problem-service "matching" in addiction treatment: A prospective study in 4 programs. Archives of General Psychiatry, 54(8), 730-735.  Pub Med icon

McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., et al. (1992). The Fifth Edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9(3), 199-213.  Pub Med icon

Outcomes

Outcome 1: Matching of counselor treatment plan to client admission problems
Description of Measures This outcome assessed the match between client problems identified using the Addiction Severity Index (ASI) and the services planned in counselor treatment plans. Problems at admission were assessed using the ASI, a semistructured interview that measures types and severity of problems in seven domains: medical, employment, alcohol use, drug use, legal status, family relations, and psychiatric functioning. For each client, four trained judges blinded to condition assignment individually rated the client's problem status by ASI domain using a 3-point scale from 0 to 2 (0 = no problem, 1 = some problem, and 2 = significant problem).

Counselor-developed treatment plans derived from the ASI were also rated by the four judges. For each client, the judges rated the problems and planned services described in the treatment plan by ASI domain using a similar 3-point scale from 0 to 2 (0 = no mention of a problem; 1 = a mention or comment on the problem but no clear plan, timeframe, or service suggested; and 2 = the problem was clearly identified with a specific plan and/or timeframe for resolution).

For each client, each judge compared the ratings given to the ASI and treatment plan on corresponding domains to determine the level of matching. For an ASI rating of 1, a treatment plan rating of 1 or 2 was a match; for an ASI rating of 2, a treatment plan rating of 2 was a match. ASI domains rated zero were eliminated from the matching calculations since a zero rating meant there was no problem to be addressed.
Key Findings In a randomized clinical trial, nine community-based outpatient substance abuse treatment programs were randomly assigned to one of two conditions, standard assessment (SA) or enhanced assessment (EA). Counselors in programs assigned to the SA condition received 12 hours of training on use of the Drug Evaluation Network System (DENS) ASI. Counselors in programs assigned to the EA condition received the same DENS ASI training plus an additional 2 hours of training on integrating the DENS ASI assessment and treatment plan with an electronic Resource Guide to link clients to off-site community social and health services. Data were adjusted for site differences in counselor characteristics (i.e., race, level of education) and client characteristics (i.e., gender, race, money spent on drugs in the past 30 days). The percentage of clients whose treatment plans matched problems identified at admission was higher in EA than SA treatment programs across all seven domains: alcohol use (p < .01), drug use (p < .01), psychiatric functioning (p < .01), employment (p < .001), medical (p < .0001), family relations (p < .01), and legal status (p < .01). Effect sizes were large for six of the domains (odds ratio = 7.45 for alcohol use, 13.2 for drug use, 8.32 for psychiatric functioning, 10.66 for employment, 35.93 for medical, and 11.79 for family relations). The effect size for the legal status domain was very small (odds ratio = 1.28).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 2: Matching of specialized services received to client admission problems
Description of Measures This outcome assessed the match between client problems identified using the ASI and the services received as measured by the Treatment Services Review (TSR). Problems at admission were assessed using the ASI, a semistructured interview that measures types and severity of problems in seven domains: medical, employment, alcohol use, drug use, legal status, family relations, and psychiatric functioning. For each client, four trained judges blinded to condition assignment individually rated the client's problem status by ASI domain using a 3-point scale from 0 to 2 (0 = no problem, 1 = some problem, and 2 = significant problem).

The TSR, a 10- to 15-minute structured client interview administered in person or over the telephone, was used to measure the number and types of treatment services received by clients either on site or off site (by referrals) while in substance abuse treatment. The TSR interview questions cover the same domains as the ASI. Within each of these domains, the TSR categorizes services as "general" (e.g., advice or peer counseling received during regular group or individual counseling sessions) or "specialized," focused on a single topic or domain (e.g., vocational counseling, case management, family therapy). For each client, the four judges rated the level of specialized services received in each domain using a similar 3-point scale from 0 to 2 (0 = no specialized services were received, 1 = one specialized service was received, and 2 = two specialized services were received). TSR data were collected for services received during the first 4 weeks of treatment. The analyses were restricted to the specialized on- and off-site services received.

For each client, each judge compared the ratings given to the ASI and TSR on corresponding domains to determine the level of matching. For an ASI rating of 1, a TSR rating of 1 or 2 was a match; for an ASI rating of 2, a TSR rating of 2 was a match. ASI domains rated zero were eliminated from the matching calculations since a zero rating meant there was no problem to be addressed.
Key Findings In a randomized clinical trial, nine community-based outpatient substance abuse treatment programs were randomly assigned to one of two conditions, standard assessment (SA) or enhanced assessment (EA). Counselors in programs assigned to the SA condition received 12 hours of training on use of the DENS ASI. Counselors in programs assigned to the EA condition received the same DENS ASI training plus an additional 2 hours of training on integrating the DENS ASI assessment and treatment plan with an electronic Resource Guide to link clients to off-site community social and health services. Data were adjusted for site differences in counselor characteristics (i.e., race, level of education) and client characteristics (i.e., gender, race, money spent on drugs in the past 30 days). The percentage of clients who received specialized treatment services that matched problems identified at admission was higher in EA than SA treatment programs in the alcohol use (p < .001), drug use (p < .01), psychiatric functioning (p < .01), and medical (p < .05) domains. Effect sizes were large for three of the domains (odds ratio = 13.98 for alcohol use, 15.74 for drug use, and 11.23 for psychiatric functioning). The effect size for the medical domain was medium (odds ratio = 5.20).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.1 (0.0-4.0 scale)
Outcome 3: Number of services received
Description of Measures The number of services received was measured by the TSR, a 10- to 15-minute structured client interview administered in person or over the telephone. The TSR collects information on the number and types of services received by clients on site or off site (by referrals) while in substance abuse treatment. TSR interview questions cover services received in seven domains: medical, employment, alcohol use, drug use, legal status, family relations, and psychiatric functioning. Within each of these domains, the TSR categorizes services as "general" (e.g., advice or peer counseling received during group or individual counseling sessions) or "specialized," focused on a single topic or domain (e.g., vocational counseling, case management, family therapy). TSR data were collected for services received during the first 4 weeks of treatment.
Key Findings In a randomized clinical trial, nine community-based outpatient substance abuse treatment programs were randomly assigned to one of two conditions, standard assessment (SA) or enhanced assessment (EA). Counselors in programs assigned to the SA condition received 12 hours of training on use of the DENS ASI. Counselors in programs assigned to the EA condition received the same DENS ASI training plus an additional 2 hours of training on integrating the DENS ASI assessment and treatment plan with an electronic Resource Guide to link clients to off-site community social and health services. Data were adjusted for site differences in counselor characteristics (i.e., race, level of education) and client characteristics (i.e., gender, race, money spent on drugs in the past 30 days). Among the findings from this study are the following:

  • Clients in EA treatment programs averaged more on-site and off-site service sessions (both specialized and general) than clients in SA treatment programs (100 vs. 31, respectively; p < .001); the difference in services received between the two groups was more pronounced for specialized services (p < .001) than general services (p < .01).
  • Clients in EA treatment programs received more on-site and off-site specialized service sessions than clients in SA treatment programs in the domains of drug and alcohol use (19 vs. 5; p < .001), psychiatric functioning (25 vs. 3; p < .001), employment (5 vs. 1; p < .01), and medical (15 vs. 3; p < .05).
  • More off-site service sessions (both specialized and general) were received by clients in EA than SA treatment programs (20 vs. 6, respectively; p < .001); these differences reflected more specialized services received by EA than SA program clients (15 vs. 5, respectively; p < .01).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.0 (0.0-4.0 scale)
Outcome 4: Treatment retention and completion
Description of Measures Treatment retention was measured as the percentage of clients who left treatment against medical advice, and treatment completion was measured as the percentage of clients who completed the planned duration and activities of the treatment program. Client data were gathered from chart records.
Key Findings In a randomized clinical trial, nine community-based outpatient substance abuse treatment programs were randomly assigned to one of two conditions, standard assessment (SA) or enhanced assessment (EA). Counselors in programs assigned to the SA condition received 12 hours of training on use of the DENS ASI. Counselors in programs assigned to the EA condition received the same DENS ASI training plus an additional 2 hours of training on integrating the DENS ASI assessment and treatment plan with an electronic Resource Guide to link clients to off-site community social and health services. Data were adjusted for site differences in counselor characteristics (i.e., race, level of education) and client characteristics (i.e., gender, race, money spent on drugs in the past 30 days). Compared with treatment programs in the SA condition, programs in the EA condition had a lower percentage of clients that left treatment against medical advice (58% vs. 34%, respectively; p < .05) and a higher percentage of clients that completed treatment (24% vs. 53%, respectively; p < .01).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.2 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
63% Male
37% Female
71% Black or African American
19% White
9% Hispanic or Latino
1% American Indian or Alaska Native

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Matching of counselor treatment plan to client admission problems 3.5 3.5 3.5 3.5 2.5 3.5 3.3
2: Matching of specialized services received to client admission problems 3.5 3.0 3.0 3.0 2.5 3.5 3.1
3: Number of services received 3.0 3.0 3.0 3.0 2.5 3.5 3.0
4: Treatment retention and completion 3.5 3.5 3.0 3.0 2.5 3.5 3.2

Study Strengths

The ASI and TSR are widely used instruments in the field and have strong psychometric properties. The study employed excellent use of judges blinded to condition assignment to determine the match between client admission problems and treatment plan and between client admission problems and services received. The algorithm used to determine the match between admission problems and services received appeared reasonable, and the validity of the approach has been thoroughly evaluated. The judges reported nearly 100% agreement on problem and service coding. Counselors in both treatment conditions participated in extensive ASI competency training to ensure the instrument would be administered with fidelity. The statistical approach thoroughly addressed program and staff attrition. The sample size was adequate, randomization at the level of the treatment program was appropriate, and the modeling approach with covariates was comprehensive.

Study Weaknesses

The absence of any convergent measure for the TSR other than medical chart data weakens the instrument's psychometric properties. Minimal description was provided on the process followed by blinded judges to determine the match between client admission problems and treatment plan ratings. Only 10 of 20 programs approached about the study agreed to participate (with 1 dropping out immediately after training), suggesting some self-selection bias. The high staff turnover rate was disruptive to the study. Baseline counselor differences were not measured prior to ASI training.

Readiness for Dissemination
Review Date: November 2009

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Carise, D., Cornely, W., & Gurel, O. (2002). A successful researcher-practitioner collaboration in substance abuse treatment. Journal of Substance Abuse Treatment, 23(2), 157-162.  Pub Med icon

Carise, D., & Gurel, O. (2002). Benefits of integrating assessment technology with treatment: The DENS project. In J. L. Sorensen, R. Rawson, J. Guydish, & J. Zweben (Eds.), Drug abuse treatment through collaboration: Practice and research partnerships that work (pp. 181-195). Washington, DC: American Psychological Association.

Training materials:

  • Building a RG Using the CASPAR Skeleton--Sample Training Agenda
  • CASPAR Training--Computer Assisted System for Patient Assessment and Referral [PowerPoint slides]
  • Creating an Electronic Resource Guide: Linking Services to Client Needs [PowerPoint slides]
  • Sample CASPAR Training Agenda
  • Training Outline for Building a Resource Guide--Using the CASPAR Skeleton Software
  • Training Outline for CASPAR Electronic Resource Guide

Treatment Research Institute. (2006). Sample DENS ASI printout. Philadelphia, PA: Author.

Treatment Research Institute. (2006). Treatment care plan problem list. Philadelphia, PA: Author.

Treatment Research Institute. (2009). CASPAR Resource Guide manual: Computer Assisted System for Patient Assessment and Referral. Philadelphia, PA: Author.

Treatment Research Institute. (n.d.). The CASPAR Resource Guide software. Philadelphia, PA: Author.

Treatment Research Institute. (n.d.). Treatment plan checklist. Philadelphia, PA: Author.

Treatment Research Institute. (n.d.). Updated CASPAR training cost information. Philadelphia, PA: Author.

Treatment Research Institute Web site, http://www.tresearch.org/

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
2.8 3.5 2.8 3.0

Dissemination Strengths

The Resource Guide software is intuitive and easy to use and is supplemented by a useful manual that provides guidance for populating the software with data on local resources. The developer offers several levels of hands-on training, both on site and at the developer organization, to support implementation. Support is also available through fee-based consultation and an ASI assessment tool helpline. Individual tools for supporting the quality assurance of ASI administration, treatment planning, and client follow-up are provided.

Dissemination Weaknesses

Little information is provided explaining how the Resource Guide is linked to the ASI or other assessment tools. It is unclear how potential implementers can access information on training opportunities. The quality assurance materials lack organization, and no protocol is provided. The quality assurance tools do not address all phases of implementation or support outcome evaluation.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
ASI Manual Free Yes
DENS ASI Software Suite $26 Yes
CASPAR-C Resource Guide Software and Resource Guide Manual on CD-ROM $500 Yes
Half-day, off-site training: Using the CASPAR-C Software $2,700-$3,000 depending on the number of participants No
Half-day, on-site training: Using the CASPAR-C Software $3,900-$5,600 depending on the number of participants, plus travel expenses No
Half-day, off-site training: Building a Resource Guide $2,700-$3,000 depending on the number of participants No
Half-day, on-site training: Building a Resource Guide $3,900-$5,600 depending on the number of participants, plus travel expenses No
1-day, off-site Combination Training $3,000-$3,700 depending on the number of participants No
1-day, on-site Combination Training $4,300-$6,200 depending on the number of participants, plus travel expenses No
2-day, off-site ASI Training $3,500-$4,900 depending on the number of participants No
2-day, on-site ASI Training $4,800-$7,400 depending on the number of participants, plus travel expenses No
2-day, off-site ASI/DENS Training $3,600-$5,000 depending on the number of participants No
2-day, on-site ASI/DENS Training $4,900-$7,500 depending on the number of participants, plus travel expenses No
2-day, off-site ASI/DENS/CASPAR Training $3,700-$5,100 depending on the number of participants No
2-day, on-site ASI/DENS/CASPAR Training $5,000-$7,600 depending on the number of participants, plus travel expenses No
Technical assistance and consultation $150 per hour No
ASI Coding Certification $175 No
ASI Interviewing Certification $150 per hour, 2-4 hours to complete per interviewer No
Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

Foster, K. A., & Stiffman, A. R. (2009). Child welfare workers' adoption of decision support technology. Journal of Technology in Human Services, 27, 106-126.

Contact Information

To learn more about implementation, contact:
Meghan Love
(215) 399-0980 ext 184
mlove@tresearch.org

To learn more about research, contact:
Deni Carise, Ph.D.
(646) 505-2165
dcarise@phoenixhouse.org

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

Web Site(s):