Purchasers increasingly want to know of substance-misuse services "how effective are your interventions - what impact are you having on your client’s drinking and drug use?". Putting aside the many semantic and logical problems of trying to answer this in a simple way, services must provide concrete data.

Put crudely, one of the best ways to do this is to administer a standardised questionnaire, which is proven to be a reliable and valid instrument, to clients at milestones in their treatment - such as assessment, review and closure - and see if the mean scores go down with the number of sessions received.

There are many standardised instruments measuring some element of dependence / problem severity. All have been proved to be reliable and valid to an acceptable degree through peer review and so are good tools to measure outcomes. The SADQ-C, SODQ, OTI, SDS, Map, Audit and IRQ fall in this category.

But in my experience of setting up systems to monitor outcomes, I have had much trouble getting staff to complete questionnaires on a consistent basis.

Recently however, I introduced a new monitoring tool to my organisation, the Christo Inventory for Substance-misuse Services or CISS (see Addiction Today, Nov/Dec 1999). I piloted it with one team in my organisation about six months ago and was quickly struck by how staff seemed to be complying much more readily with my request for them to complete it on a regular basis.

The reasons why academics and researchers like certain outcome tools - such as the Alpha reliability coefficient of internal consistency of items, or the standard deviation of the Spearman’s Rho correlation with one subscale to another test - are not the same reasons as why practitioners like them. So I tried to ascertain via a straw poll of staff what it is about the CISS that they liked, or did not mind as much as other tools. I asked eight staff who between them had completed about 410 CISS forms. Their answers are listed below in order of frequency.

• It is quick and easy: a predictable answer as the CISS was designed to be quick, with 10 questions and a single score at the end.
• It corresponds closely with progress / Is a sensitive instrument: staff said that they could see the CISS score picking up changes in clients as they went through treatment. If the person got better, the score fell commensurately and vice versa. This was reinforcing for staff. Some said that they used it with clients at reviews, to show their progress in a concrete way.
• It is holistic: many tools focus on consumption / withdrawal symptoms whereas the CISS looks at 10 areas such as social functioning, psychological wellbeing and criminal involvement.
• It asks for the staff member’s opinion: the CISS is designed to be filled out by the project worker and asks for their professional judgement and assessment. This protects it from some problems of self-completion forms, such as the client not concentrating or wanting to manipulate their score for perceived benefits of giving the "right" answers.

There were some dislikes and queries about the CISS but no single issue was raised by two workers independently. Moreover, there was a general appreciation among the team of what the CISS was trying to achieve.

It is meant to be a short, simple tool which is applicable to all clients, whether they are alcohol or drug users, abstinent or still using. So there are bound to be some areas not covered as thoroughly as would be ideal.

As a manager, CISS appeals to me not least because it is much easier to achieve a high rate of staff compliance but also because it is a standardised measurement which I can show to purchasers as evidence of service impact.

I have no ulterior or vested interest in the CISS but I would recommend it to anyone in the field who is a manager looking to demonstrate positive outcomes, or who is a practitioner wanting to get their boss to give them less cumbersome monitoring forms to fill in.

• Colin Bradbury is research, outcome monitoring and evaluation manager with ADS, 87 Oldham Street, Manchester M4 1LW (tel: 0161-214 6409, email: colin.bradbury@alcoholanddrugservices.org.uk ).

 Links within CISS site 

CISS home page and index.

CISS form

CISS general overview. Unedited version of an explanatory article about CISS which appeared in Addiction Today Magazine (Nov/Dec, 1999)

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 and cutoffs for abstinence oriented services

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

CISS detailed information. Validation of the Christo Inventory for Substance-misuse Services (CISS): a simple outcome evaluation tool (from Drug and Alcohol Dependence, 2000).

ã 1998 George Christo PhD, PsychD.