Christo Research Systems

Home of the Christo Inventory for Substance-misuse Services (CISS) George Christo, B.Sc., Ph.D., Psych.D., A.F.B.Ps.S., C.Psychol.

Quick and easy treatment evaluation, assessment, treatment outcome monitoring, clinical audit for: drugs services, drug dependency units, chemical dependency, gambling, drug dependence, alcohol dependence, substance abuse, substance misuse, alcohol abuse, alcohol misuse, drug addiction, drug abuse, alcohol addiction, alcoholism, addictive behaviours, addictive behaviors.

Site created March 2000, updated 12th November 2008 links repaired and contacts updated

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Contents

 Who are Christo Research Systems?

 What is the CISS?

 Links to more detailed information about the CISS

 Contact Information

 CISS Publications

 Biographical Information

 Want to try it out?

 New developments to March 2001

  

Who are Christo Research Systems?

We conduct high quality drug / alcohol / gambling treatment outcome evaluations.

We work for treatment purchasers wishing to evaluate the effectiveness of programmes they purchase, or for treatment providers wishing to demonstrate the effectiveness of their services.

We focus on statistically demonstrating observable changes in patient / client behaviour and well being. The Christo Inventory for Substance-misuse Services (CISS) is the main tool used by us for this type of treatment outcome evaluation work.

Our way of working is similar to that of an accountant processing and reporting end of year accounts. Client organisations complete intake and follow-up CISS forms in a way suited to their programmes. We then process CISS forms and dropout rates at the end of a given time period. We can code up the CISS forms ourselves if they are delivered as hard copy. However, it saves time for clients to code their own CISS forms into a database file that can then be e-mailed to us.

Our expertise is in treatment research, data analysis, and report writing with relevant comparisons to other findings. Click on this link if you want to see an example of our work.

 

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What is the CISS?

Summary

The CISS is a free resource, anyone may use it free of charge as long as they do not change the wording.

The CISS is the main tool used by Christo Research Systems for treatment outcome evaluation work.

The CISS is a simple validated standard measure for outcome monitoring in a practice setting.

The CISS is a 10-item questionnaire producing a single score of 0 to 20 which is a general index of client problems / dysfunction.

It can be used to monitor client dysfunction at intake, improvement over time, or to ensure that keyworkers / counsellors are carrying caseloads of approximately equal difficulty.

As well as the usual outcome measures (e.g., social, health, psychological, drug use, HIV risk, occupational, criminal), it also measures three important areas of client-support interaction: use of structured support, compliance, and working relationships. Research has shown these factors to be relevant to outcome and clinical audit.

It uses only a single page, is easy to photocopy and will not clutter patient/clients' files.

It can be completed face to face or from client assessment notes, it does not necessarily require the presence of the client.

It is user friendly. A familiarised worker can complete it in three to five minutes during their admin time.

A single glance will tell you how the client is performing in 10 areas of outcome.

It works for either drug or alcohol users.

It works for either abstinence based or harm minimisation / prescribing services, comparison and cutoff scores are provided for both.

It appears to be quite popular with treatment commissioners and providers alike.

Research shows the CISS to be easy to use, reliable and sensitive to change.

Click here to see what CISS users think of it themselves.

 

Who is it for?

This is a tool for those of us who work in a busy service with no researchers and limited admin support. It is for services where overworked staff have no time for forms, or already have well tried and tested qualitative assessment interviews. It is for clients who may be uncooperative and stressful to work with. Some may have reading difficulties, may not always turn up for assessments, may discharge themselves without notice for discharge interviews, or may have their own agendas of things they want to talk about.

The CISS has been incorporated into substance misuse prescribing software packages like ‘Advantage’ by Altrix (ex Miriam) Healthcare Ltd. and ‘Modulus / Client Database’ by the Warehouse, Dudley drug project in the UK. It is being used by Lanstat Incorporated for their evaluation work in the USA. It has been translated into portugese by Dr Vilma Aparecida da Silva of Centro Regional Integrado de Atendimento ao Adolescente Universidade Federal Fluminense, Brazil.

 

Why is it necessary?

The Addiction Severity Index, Opiate Treatment Index, and Maudsley Addiction Profile (instrument developed from NTORS) are excellent tools for detailed and well funded research, but they are less appropriate for day to day evaluation work. These existing questionnaires take a while to complete, require the presence of the client in question, and can not combine sub sections to produce a single total score for easy analysis. Something simpler is required.

The usual areas measured in substance misuse outcome questionnaires are social functioning, general health, HIV risk behaviour, psychological well being, occupation, criminal involvement, and drug/alcohol use. As well as these seven outcome variables, the literature indicates that three further variables are relevant to outcome and should not be ignored:

  1. Engagement with support like counselling, supportive groups, AA or NA. (e.g. see Centre for Research on Drugs and Health Behaviour, executive summary No.62 about the use of Narcotics Anonymous as aftercare).
  2. Client reliability / compliance with treatment requirements. This is a clinician observed measure of reliability, the absence of which is one of the first indicators of an addiction problem.  Many clients will have lost jobs through being late or absent.  The ability to turn up on time and co-operate with requirements of others is a critical indicator of recovery and re-integration with society. 
  3. Quality of the working relationships between worker and client. This is a directly observed measure of the client’s ability to interact with others.  While the item pertains to interaction with the clinician, the behaviours usually generalise to all individuals the client may have contact with.  For example, we find that clients with dual-diagnosis (serious depression, personality disorder or psychosis) score particularly highly on 'compliance' and 'working relationships' items.  If they 'get better' those scores reduce as they become easier for everyone to get along with. 

The above items are important subsets of social functioning. However, they are also measures of treatment process as well as outcome. Agencies should be given credit by their commissioners for the extra effort / resources required when working with difficult, chaotic or non-compliant clients.

 

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Links to more detailed information about the CISS

Click on any of the following underlined words or phrases to go to other pages within this website.

 

Demonstration CISS form

Instructions for use with new assessments, prisons, and more generally.

CISS general overview. Unedited version of a brief explanatory article about CISS which appeared in Addiction Today Magazine (Nov/Dec, 1999). Or follow this link out to Addiction Today's website for the real thing, look at Nov/Dec 1999 issue.

CISS comparison scores for harm minimisation oriented methadone prescribing outpatient services

CISS comparison scores for an outpatient alcohol service (item score comparisons with drug users)

CISS comparison scores for abstinence oriented treatment outcomes (cutoffs & discriminant validity)

CISS technical information (reliability, validity, correlations with other scales)

CISS detailed information. Journal paper: Validation of the Christo Inventory for Substance-misuse Services (CISS): a simple outcome evaluation tool (Drug and Alcohol Dependence, 2000). With permission from Elsevier Science http://www.elsevier.com/locate/drugalcdep and ScienceDirectTM http://www.sciencedirect.com.

A CISS based report produced for treatment purchasers. Outcomes of residential and day care placements for people with drug and alcohol problems: the 2000 evaluation for Hammersmith & Fulham Social Services 1.10.98 to 30.9.99.

Detailed intake scores on CISS and drug use measures for injectors and dual diagnosis clients.

A critique of CISS relative to MAP & Europ ASI, and an intake CISS score distribution. Provided by Paul Wells, manager of Coventry Community Drug team.

A CISS score distribution for an alcohol counselling service. Provided by James Kitson, manager of Croydon Alcohol Counselling Service, London.

Comments from CISS users. Feedback from services who have given it a try.

CISS data from an NHS outpatient alcohol team. Provided by Claudia Salazar, manager of Brent, Kensington, Chelsea and Westminster Alcohol Team, Wolverton Gardens, London.

Article describing project workers’ views of the CISS, by Colin Bradbury of ADS, appearing in Addiction Today Nov / Dec 2000, p. 34.

ADS in partnership with Greater Manchester Probation Service, substance misuse treatment outcome report: April – September 2000, by Colin Bradbury, research, outcome monitoring and evaluation manager with ADS, 87 Oldham Street, Manchester M4 1LW

Events:

 

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Contact Information

Electronic mail address: DrGeorgeChristo@tiscali.co.uk

Address:

Barnet Drug and Alcohol Service

Ground Floor, Dennis Scott Unit

Edgware Community Hospital

Burnt Oak Broadway

London HA8 0AD, UK.

Office phone: 020 8937 7770

Fax: 020 8937 7772

 

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CISS Publications

Christo, G (2001) Running numbers: dealing with the data deluge. Druglink (Drugscope journal) Vol.1, issue 3, May/June.

Bradbury, C. (2000) Last Word: Please tick the box if you don’t like filling in monitoring forms… Colin Bradbury has a happy solution to this nasty necessity. Addiction Today Nov / Dec 2000, p. 34.

Bradbury, C. (2000). CISS Conference feedback - a personal view. GLAAS mailing, Issue 115 October 2000, Greater London Association of Alcohol Services.

Christo, G. (2000). What did they get for their money?: When Hammersmith & Fulham Social Services commissioned research on addiction treatments purchased by its managers, what did it discover? Dr George Christo summarises the findings and makes recommendations to help other purchasers. Addiction Today, Vol 11, No 65, pp14-15.

Wells, P. & Christo, G. (2000). Letters to the editor: Outcome monitoring must be made easy. Drug & Alcohol Findings, Issue 3.

Christo, G. (2000). Outcomes of residential and day care placements for people with drug and alcohol problems: the 2000 evaluation for Hammersmith & Fulham Social Services 1.10.98 to 30.9.99. Hammersmith & Fulham Social Services. London, UK.

Christo, G. (2000). The Christo Inventory for Substance-misuse Services. In J. Maltby, C.A. Lewis, and A. Hill (Eds). Commissioned reviews on 300 psychological tests. pp. 33-37. Edwin Mellen Press. Lampeter, Wales, UK.

Christo, G., Spurrell, S. and Alcorn, R. (2000). Validation of the Christo Inventory for Substance-misuse Services (CISS): a simple outcome evaluation tool. Drug and Alcohol Dependence, 59, pp189-197.

Christo, G. (2000). CISS: keeping it sweet and simple (part 2). Addiction Today, Vol 11, No 62, pp14-15.

Christo, G. (2000). Clear classification: simple service evaluation. Druglink (Drugscope journal), 15(1), pp19-21.

Christo, G. (1999). CISS: keeping it sweet and simple. Addiction Today, Vol 11, No 61, Nov / Dec. pp14-15.

Christo, G. (1999). Keep it simple. Drug & Alcohol Findings, June 1999, Issue 1, p27.

Christo, G. (1999). Outcome monitoring: service evaluation made simple. GLAAS mailing, Issue 95 January 1999, Greater London Association of Alcohol Services.

Christo, G. (1988). Outcomes of residential care placements for people with drug and alcohol problems: an evaluation of Hammersmith and Fulham Social Services. Centre for Research on Drugs and Health Behaviour, Hammersmith & Fulham Social Services, Ealing Hammersmith & Hounslow Health Authority. London, UK.

 

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Biographical Information

George Christo is director of Christo Research Systems. He is also an honourary senior lecturer at the Royal Free & University College Medical School, University College London, and a senior practitioner of clinical psychology at the Royal Free Drug Service (an opiate substitute prescribing service), and he periodically takes on freelance academic research, e.g. at the PROMIS 12-step treatment group headed by Dr Robert Lefever.

He has worked in the substance misuse field for 15 years (mostly in London).

He has worked in a research or clinical capacity within 12 step treatment centres, therapeutic communities, community alcohol services, and methadone maintenance services.

He has doctorates in both clinical psychology (University of Surrey, Guilford) and treatment outcomes research (Institute of Psychiatry, King's College London).

He has used these combined experiences to develop an evaluation tool which satisfies psychometric requirements yet meets the limitations imposed in most busy practice settings.

‘Drug and Alcohol Findings’ was the first magazine to feature the CISS back in June 99. Since then the CISS validation study has passed peer review and was published in the international journal ‘Drug and Alcohol Dependence’. The CISS has rapidly grown in popularity in the UK. It has also been featured in the other main UK addiction treatment magazines ‘Addiction Today’ and ‘Druglink’. There have so far been over 200 requests for copies from England, Ireland, Scotland, Wales, the Channel Islands, and the Isle of Man. There are also an increasing number of requests generated by this web site, see Comments from CISS users.

 

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Want to try it out?

You do not have to use us to custom produce an evaluation design for your needs, or to analyse your CISS data. The CISS is a free resource, you can have it anyway. If you have any comments or would like to try the CISS in your service, then e-mail us at DrGeorgeChristo@tiscali.co.uk, we can send you an attached file in Word format. This file will contain the CISS properly formatted on a single page. State if you are using UK (A4) or USA (8.5" x 11") paper size, or if you need the Portuguese version. The questionnaire is on the front of the page and the instructions, comparison scores and references are on the back. The demo version on this site was altered to HTML format and probably will not download in a usable way.

Alternatively, John Chamberlain of the The Alchemy Project Ltd. www.alchemyproject.net has been kind enough to convert a CISS into .PDF format for Acrobat readers, follow this link and scroll to the bottom of their page to find it..... www.alchemyproject.net/special_feature!_-_online_professional_tools_.htm 

WARNING: A condition of use is that you do not modify the wording or title of the CISS. Any such modifications would render reliability, validity and comparison data useless, they would also violate copyright.

Please note, on the basis of feedback from Ross Buitendorp of Grand Rapids, Michigan, the standard USA version of CISS now has five altered words to make sense in American English. They are equivalent words and do not change the scoring or psychometric properties of the tool. (hostel = shelter, NFA = homeless, tick = check, ring = circle, patchy = periodic). It is thus important that you state whether you want the USA or UK version.

Feedback (good or bad) is always welcome, as are comparison scores from other services. We shall endeavour to post as much as possible on this site for world wide reference and comparison.

 

 

New Developments

Added 20.9.2001: Portuguese version now available from DrGeorgeChristo@tiscali.co.uk or from Dr Vilma Aparecida da Silva vilma@nitnet.com.br

Added 10.3.2001: instructions for use in various settings and with various populations.

Added 10.3.2001: Detailed intake scores on CISS and drug use measures for injectors and dual diagnosis clients.

Added 10.3.2001 to this page: American English version available, CISS translated into portugese, and two more conferences held in Warwick and Cheltenham.

Added 17.11.2000: CISS Conference Feedback – a Personal View. Article by Colin Bradbury appearing in issue 115, October 2000 of GLAAS mailing, the newsletter of Greater London Association of Alcohol Services.

Added 6.11.2000: Article describing project workers’ views of the CISS, by Colin Bradbury of ADS, appearing in Addiction Today Nov / Dec 2000, p. 34.

Added 6.11.2000: ADS in partnership with Greater Manchester Probation Service, Substance misuse treatment outcome report: April – September 2000, by Colin Bradbury, research, outcome monitoring and evaluation manager with ADS, 87 Oldham Street, Manchester M4 1LW

Added 14.10.2000: Events: The South West Drug Problem Database present an Outcomes Monitoring Conference fearturing CISS and MAP, Friday, October 27, Social club, Blackberry Hill Hospital, Fishponds, Bristol BS16 2EW.

Added 27.7.2000: Events: The West Midlands Specialist Drug Services Forum present a half-day conference: The Christo Inventory for Substance Misuse Services, Friday 8th September 2000, The Howard Johnson Hotel, West Bromwich.

Added 11.7.2000: CISS data from an NHS outpatient alcohol team. Provided by Claudia Salazar, manager of Brent, Kensington, Chelsea and Westminster Alcohol Team, Wolverton Gardens, London.

Added 15.6.2000: A critique of CISS relative to MAP & Europ ASI, and an intake CISS score distribution. Provided by Paul Wells, manager of Coventry Community Drug team.

Added 15.6.2000: A CISS score distribution for an alcohol counselling service. Provided by James Kitson, manager of Croydon Alcohol Counselling Service, London.

Added 15.6.2000: Comments from CISS users. Other feedback from services who have given it a try.

Added 15.5.2000: A recent CISS based report produced for treatment purchasers. Outcomes of residential and day care placements for people with drug and alcohol problems: the 2000 evaluation for Hammersmith & Fulham Social Services 1.10.98 to 30.9.99.

The CISS now has a self-report version useful for postal follow-ups, validation under way with the assistance of Hammersmith and Fulham Social Services (London).

The CISS format has also been adapted for gambling: the Christo Inventory for Gambling Services (CIGS), validation under way with the assistance of Gamcare (London) and the Gordon House Association (Kent and West Midlands). Gamcare have already used CIGS to good effect in their 2000 report.

 

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Site updated: 12th November 2008