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I wouldn’t say that this was a particularly complicated system. If the person has been in services before but ‘closed’ drug free and for drug free read – no heroin or crack use. You do a start TOPS. You review them regularly and, at the very least, six monthly.
Then, once they leave any of the local treatment services, you close them with an exit TOPS. If they leave your service, but are still using drugs, then you review and hand them over to a partner agency and log them as transferred in some way.
Why oh why do people across the country keep getting it wrong? Don’t services talk to each other?
We are so heavily targeted on TOPS that I dread to think what would happen to our manager if we messed up. I fear their head might just explode. It is all checked and double checked.
It is a bit annoying having to chase the client around the treatment service and double check where they have been TOP’d. But then I use it as a networking opportunity and get some contacts in other services. Then, when I have issues that would benefit from the client getting fast-tracked, I use my contacts to help. Everyone’s a winner.
When you sell TOPS to a client they like to measure their success with it. Clients like to see themselves making progress, why wouldn’t they? Most people enjoy success, and people who are recovering don’t tend to get many ways to celebrate their success. I create charts and graphs and even ask clients to plot their own improvements. I get my TOPS complete and they get to see that they are indeed making positive changes.
Services talking to each other? Perish the thought.
I would completely agree that empowering a client to see for them selves the progress that they are making is very powerful and motivating.
On that note – you may be interested to know that the NTA released a client level report called the TOP Progress Tracker last year. This is a very simple graphical summary of each individual clients TOP scores from the start of treatment to when the client exits treatment. It plots progress on each of the 20 items in a simple. Clients have reported that
“ it extremely satisfying to see the improvement captured in visual graph form. All the information is available on TOP forms but seeing it graphically makes more of an impact”
This report currently available to all providers/keyworkers who use the Data Entry Tool (DET). It is also really easy to use – you just select the client, the TOP domains and click a button to generate the report.
This can then provide a very useful summary of changes and is a lot easier than trying to compare the forms in a clients file.
The NTA are also working to make the Progress Tracker more widely available to users of other systems, but in the mean time there is a paper based version (available on the NTA webiste) that can be completed with the client.
For more information on this tool see http://www.nta.nhs.uk/areas/outcomes_monitoring/products_and_guidance.aspx
Here you will find the DET guide which is all about the TOP Progress Tracker and other materials related to the clinical application of the TOP.
… yet there are still CSMT offices that do not regularly produce and agree care and recovery plans with the patient!
