Updated 4.11.2000

1.11.00 Dear Dr Christo,

It was good to meet you on Friday last at Bristol, and to hear the detail of your Inventory.   As I indicated to you then, there is a will among all our service providers to begin using the CISS system, and I have called a meeting of them all, together with our primary care colleagues, on 27^th November.   Our non-statutory service GDAS has already begun introducing the Inventory to staff.

Could you kindly forward to me the questionnaire in Word Format file for use on A4 paper (as per your web site).

There continues to be a desire among colleagues to invite you to Gloucestershire to train selected managers of our agencies.  This will be discussed at our forthcoming meeting and I shall keep you informed.

With best wishes,

Colin Hassall, Co-ordinator
Gloucestershire Drug & Alcohol Action Team
Gloucestershire Health Authority
Victoria Warehouse, The Docks
Gloucester GL1 2EL

Telephone 01452 300222 Ext 2630
Fax  01452 318803
Email colin.hassall@glosha.swest.nhs.uk

1.11.00: Dear Dr. Christo,

I work as an information and research officer for Fife Drug and Alcohol action team (in Scotland). We are now in the process of creating some form of common assessment tool and a common data base for all services relating to drugs and
alcohol abuse in Fife. I wonder if it would be possible for me to have a copy of the Christo Inventory. The inventory was highly recommended to me by Stevie Lydon. Hope you do not mind me asking, Many thanks.

25.10.00: Dear Dr Christo

I have recently started work at DASH (Hereford CDT) and am interested in the use of your short questionaire for assessing outcomes. I would be grateful if you could give me further information in this area. Danny Morris who is our co-ordinator has some info (from a recent conference he went to at which you spoke) including the article in drug and alcohol dependence on its validation.

I am not sure from the article (part 3.1.1) how you can be sure that there was a significantly improved outcome associated with a lower CISS score in the abstinense oriented treatment group - although I dont understand the term 6 month timeline follow back. From you introduction it appears this group was very stable with little change over time. At what stages in their treatment was the CISS administered? This could be of particular relevance because you admit that the test retest reliability was performed over an extended timescale of 53 days and so is likely to be less reliable (I believe that timescales of 14 days would be more appropriate).

I very much like the idea of using your questionaire as it seems well suited for use in day to day practice but I am not yet convinced that it will reliably show change over time. I hope that you can clarify these points for me.

If you are aware of other papers dealing with outcomes in drug addiction I would very much appreciate further info.

best wishes Dr Paddy McCarthy

14.10.00: THANKS, I am a Health Lecturer in substance misuse as well as other subjects at The Univerity of Nottingham and am about to embark on a Evaluation of a New Development of Services in Grimsby. It is is going to offer a new opportunity, for small group (about 12-18) people with Dual Diagnosis, hopefully engaging them with a view towards supported and / or competitive employment.  I would be grateful of any other ideas you may have on the subject.    Thanks again for the CISS Inventory.     mike.epling@ntlworld.com   or   mike_epling@yahoo.com

George,  Thanks for the CISS and the report, are any of your articles available in full text on OVId / medline etc? I would really like to see them as we are intending to kick of the evaluation with a possible publication which we are currently working on. If we use the CISS we could then make reference to your work on it or other related stuff which you included in your list of references. If you were able to send any by E / or land mail I would be very grateful.   My land mail address is:  

23.10.00: We understand there is no cost attached to our use of this evaluation tool and would like to try it out across the Addiction Services in Ayrshire & Arran.  We would be grateful if you would send us the relevant file and information.   We were planning to store the data as part of an existing database, please let us know if there would be any objections to this.   Look forward to hearing from you,

Dear Karen   Thank you for your interest, how did you hear about it?   I know I sent copies to Paisley, Glasgow, Edinburgh, Perth, Airdrie and a few other places in Scotland, Did one of them tell you about it? I attach the CISS as WORD format A4 paper size, let me know if you need a different format. (instructions and comparison scores are on the back page).   You have my permission to print as many as you like free on condition that you do not change the wording of CISS, it would render comparisons and validation useless and violate my copyright.    You may use it free on a database, we have one set up on SPSS ourselves, so far it seems to be working ok and the staff tolerate the paperwork.  We are trying to keep it as simple as possible.  I originally coded each of the 10 CISS items separately so could produce pie charts for none, moderate, high problems for health, crime, psychological, etc.... across the clinic.   But these days we just use the CISS total score 0-20 because our throughput of clients is so high.   Further information on CISS is available at the web site, if you intend to use CISS, I recommend you look at the charts and evaluations there......... http://users.breathemail.net/drgeorgechristo/ . Let me know if you need anything else Let me know how you get on with it, all feedback gratefully received.  We could use some stats from Scotland to post on the web site. Best wishes from George Christo  

10.10.00: You may wish to have a look at the various comments we have made in the course of reviewing your product, I enclose a link to the page below.  If you wish to comment or correct any points then please feel free to contact us.  We are also in the business of promoting substance misuse products.   John Chamberlain.

Information about The Alchemy Project Ltd plus chat, information & so much more!
Chemical Dependency Services, Shopping, Chat, Links, Free E-Mail and even more to come!
Visit us at: www.alchemyproject.net and see for yourself!

9.9.00: Hi

Just to say a big 'THANK YOU' for the input into the Conference. I was pleased that it finally turned out so well. I look forward to speaking to you soon... regards..

22.9.00: Hi George, Yes, we are currently going to pilot the collection of CISS scores with Coventry CDT and then follow up the clients at a later date.  Firstly we will collect again a further score and then ask other questions agreed in liaison with Coventry CDT.  It is something we hope we can continue to do locally, but is dependent upon the strategic review that is taking place nationally.  I am meeting with the lead consultants Mike Donmall and Matthew Hickman on 9th October along with other DMD Managers and we hope that this question will be answered.

Jennie Lowdell, RDMD Project Manager, West Midlands, UK.

9.9.00: Dear George,   it likewise very nice for me to meet you on Friday. Thanks for inviting me to speak I enjoyed the afternoon very much and your thoughts on dynamic databases were very helpful and illuminating for me...

17.8.00: Dear Dr Christo,

My name is Val Darroch and I am based in Perth, Scotland, and am setting up an Arrest Referral Scheme. This is the first generic Arrest Referral Scheme in Scotland, the only other scheme targets women only.As there are no other comparable schemes, I have had to devise assessment forms etc, which brings me to you! I had previously worked alongside David Mitchell as part of the Dundee Drug and Alcohol Team, and as the Senior of that team, David encouraged us to use the CISS as part of our assessment tools. I wondered if you would have any objection to this project using the CISS, with full acknowledgement of course.....   Thank You

8.8.00: Dear Dr Christo,

I would just like to say a BIG THANK YOU for devising a simple easy to use (and easy to understand!) outcome measure.  This is what I have been after for years.  Most helpful for DAT's (and Commissioners especially). Having said all that, I have only just managed to persuade all my local agencies to use the CISS.  They have agreed to trial it for 6 months beginning now.  I expect this to give me and the DAT some early indications of service impact in the community. However, as far as the collation and analysis of the data is concerned what would be the best way forward?  Would it be useful for the returns to be sent to you for comparisons or should I be contacting Public Health, St. George's etc. etc.? Any suggestions gratefully received! Yours sincerely,

Krysia Szkot, Sutton DAT Co-ordinator, Chancery House, St Nicholas Way, Sutton, Surrey, SM1 1JB.

30.7.00: Dear Dr. Christo,

I am a psychiatrist , and I am in the direction of a  day hospital aimed to treatment of substance misuse in adolescence.We are very much  concerned about the evaluation of outcome of our treatment and perhaps the CISS could help. I wonder if you have already tryed it in adolescents? If so, could we validate the translation into Portuguese? I am going to London in November and would like to visit treatment centres similar to ours in order to compare problems and outcomes. Would you be so kind as to provide me information about if centres for treatment of adolescent substance misusers are availble in London?       Many thanks for your attention. Sincerely yours,

27.9.00: Dear  Dr. Christo, I finished  a small pilot study of our institution by using the CISS. I used it in English, and applyed it interviewing the psychologists myself. We liked it, it seemed to work well and we intend to validate the translation into Portuguese. Because our patients are in a day hospital there was one item scored zero for everybody,and this will have to be thought about........ 

25.7.00: Dear Dr. George,

I am a supervisor of chemical health programming with Catholic Charities in Minneapolis/St. Paul, MN.  I work with chronics, dually diagnosed (MI/CD), sex workers and women who are living in violent relationships.  MOst of the women I see have been in at least 7-10 traditional (abtstinent based) treatment programs.  I have been implementing harm reduction interventions with clients for over 6 years.  My staff are trained in various models of CD treatement approaches.  Our work is clinically focused and mostly consists of one-on-one sessions (provided in-home, or wherever the client is most comfortable) and small group work.  I come from the land of 10,000 treatment centers (our state motto is 10,000 lakes) and anything besides abstention from drugs/alcohol is often seen as blasphemy.  What I have been looking for is a reliable tool to assess client functioning , which will be especially helpful to funders.  What a godsend it was to find your site.......I am hoping that you are able to send a hard copy, or fax one to me, which is ever easiest for you....

Will you be at the Harm Reduction conference in Miami this year, which is sponsered by the Harm Reduction Coalition.  I would like to be able to talk to you more about the CISS ,as this may be the answer to questions often asked of me as to how one can demonstrate Harm reduction program effectiveness.  Another question I have been asked is why do you give this tool out for free?  People I have told about the CISS are very suprised by this......maybe the new assessment tool for workers in MN.....thank you again....gayle

28.7.00: George,

Thank you for taking time to reformat and send me the hard copy of the CISS.  I also wanted to let you know another way in which this tool will be used....I am sure that you may be aware of the Welfare Reform movement in the U.S. ...my opinion is that it is punitive as hell and will actully cause more harm than good....that is already being demonstrated in states in which
families have had their govt. assistance cut off because of exceeding mandated time limits.  Minnesota has one of the more liberal of the policy, with a five year lifetime time limit for all families to receive government benefits.  I am involved in Catholic Charities Employment and Training Task force and the CISS will be used to "red flag" families and clients who are not work
ready and need other social services (ie:chemical health/mental health or are identified as having muti-barriers that would effect them maintaining competitive employment.  Our job counselor and employment staff will now be able to use the tool to identify sooner those clients and families who are having difficulties in various life areas.  Those that score above six will
be immediately referred onto counselors who will be able to complete more in depth assessments.  I will demonstrate hopefully with more consultation with you how this tool can be used in harm reduction programming throughout the U.S. at the Harm Reduction Conference.....it is estimated that about 1000 people will be in attendance at the Miami conference.

27.7.00: We would like to introduce the CISS into our service & would appreciate your sending us your attached file in Word format. With our thanks..........

Thank you for attachment.   Tried implementing CISS some months ago but failed to press its importance home to counsellors. Source then was EATA and now revitalised by Addictions Today article. Will follow through this time.   NB: our own outcomes much in line with your findings with marginally higher clean figures at 6 months for graduates (90%) but greater fall out rates during treatment of late.   Regards & thanks.

25.7.00: Dear colleague

Please send me details on the above rating scale and how to implement it. We are currently struggling with the MAP, although  it is excellent and collates outcomes it can be time consuming. I would be keen to look at your work and look to how it may be incorporated into our current work.   look forward to hearing from you in due course.

13.7.00:Dear Dr Christo

I am the Manager of the SouthWest Drug Problem Database, my colleague Jenny Lowdell, the Manager of the West Midlands Drug Database has told me about your work.    Since finding out about your inventory I have also spoken to a number of my agencies in the SouthWest and they are using it.  There seems to be great interest in your work in the SouthWest and, therefore, I would like to invite you to a seminar/conference about your system that could be held in Bristol. If you are available in September/October of this year please let me know and we can then discuss details... Yours sincerely

11.7.00: Dear George,

Just to let you know that the first quarter's data for our criminal justice service using the CISS will be with you shortly. I was speaking to Greater Manchester Probation Service's partnership manager about the CISS the other day and she was saying that they may have some money available at the end of the financial year to commission a validation study of the CISS within a criminal justice setting - if you were interested.   I am introducing the CISS to our other services at the moment and I will let you have the data in due course if you would like to see it.   Thanks.

7.7.00: Dear Dr Christo

Thank you for your quick response and your kind wishes. I found your inventory very quickly actually. I used the AOL search engine under the topic "personality assessments". Yours was the only one that came up as an actual inventory or assessment tool (about the 3rd or 4th item) and mentioned specifically that the inventory is used in the realm of substance
abuse (which piqued my interest). The other listings were for web sites where inventories could be purchased, etc.

I was impressed that your inventory is available free of charge. I found your web site very easy to manipulate and I found the articles and addtional information pertinent for my presentation. Thanks again! And good luck with your future endeavors.

Sabine Sell, University of San Francisco

27.6.00: Hello Dr Christo,

I am a colleague of Paul Wells, Coventry Community Drug Team Leader.  Paul heads the west midlands specialist drug services forum.  As you will be aware from discussions with Paul we are looking to set up a half day conference to invite various health professionals from across the west midlands to discuss the 'Christo Inventory for Substance-misuse Services (CISS)'...

19.6.00: Hi George

....... I can see that the CISS has various uses, for example as an outcomes monitoring instrument, but i want to recommend it as primarily as an assessment tool for purchasers, as it is a lot easier to administer than the MAP and ASI. I am interested in developing some treatment choice algorithms eventually. Hope to catch up with you properly some time All the best Tim

6.6.00: Dear George

Thank you for the recent reference regarding the CISS, which I received via Anthony Hewitt. My research is now well underway, and I am a third of the way through the data collection. I am using the CISS for clients at the start of their opiate in-patient detox, and then again at 3 month follow-up. I am anticipating collecting data on 60 clients in total. Of course I will keep you informed.

31.5.00: Dear Dr Christo,

thank you very much for your e-mail regarding my letter expressing interest in the CISS. I was intending to contact you in any event as I have already introduced the instrument for monitoring purposes within my organisation.

I am responsible for evaluation and outcome monitoring for ADS - a medium sized charity which provides a range of services across Greater Manchester, Lancashire & West Yorkshire. I intend to use the CISS eventually in all our service evaluation; we have a wide diversity of services including 9 street level counselling services, 2 residential projects, criminal justice, day-care, primary healthcare outreach, home detox and specialist black and ethnic minority community services.

In the first instance I have introduced the CISS to our partnership work with Greater Manchester Probation Service (we run surgery style services in 23 probation offices and bail hostels across the area). I have asked staff to complete the CISS at the assessment and then every fourth session from then on. I have attached the monitoring form we use for your information (your data is collected under question 6a).

If you wish, I will e-mail the SPSS file with all the data collected at the end of this quarter and then regularly from then on if you find it useful. Last quarter we assessed around 270 new clients in the Gtr Manchester criminal justice service and we did on-going work with hundreds more - so I hope that a database of that size will be of some use to you?

Once again, thanks for making contact.

Colin Bradbury, project manager, Manchester Alcohol and Drug Services, Criminal Justice Service, 87 Oldham Street, Manchester, M4 1LW. UK. Telephone 0161 214 6409. E-mail address: colin.bradbury@alcholanddrugservices.org.uk

Thanks very much for your prompt reply. Please do, by all means, show the form I sent you to your criminal justice contacts in London. It is quite a simple tool, which is tied down by time restraints and also by the data that our purchasers ask me to collect for contractual purposes. Nevertheless, please pass it on if you think it will be of benefit (I also have a sister form that we use to record consultancy/group-work/support services).

I would be delighted to pass our data on and have it posted on the CISS website. I will also keep you informed as to when I phase in the CISS to the other services in my organisation and, again, I would be very happy to make those data available to you.

24.5.00: Dear George

Thank you very much for your prompt reply to my letter of 23 February 2000 and for the information which you forwarded to me.

I found the information you forwarded to be very useful and do feel that CISS has ready applicability to our type of service. I would be very grateful to be updated regarding relevant publications and data from other services about the CISS as you have offered.

It is our intention to implement CISS in the Damascus Unit during the current calendar year and we would appreciate any advice you may wish to give us. I thought that we would complete the CISS on all substantive inpatient admissions in the first instance (both new admissions and re-admissions) towards the end of their inpatient stay. As it is our current practice to follow up by telephone at one week, one month and six months post discharge; it may be appropriate for our follow-up to be undertaken at one month, three months and six months rather than at two months and six months as was the case with the Hammersmith trial…. We had intended that the instrument be completed during a team meeting so that more than one person’s views could be obtained and the views would be multi-disciplinary and minimally biased.

We acknowledge that the individual items in the CISS can not be of any significance by themselves but wonder if you had given any consideration to separating alcohol and drugs into two separate items. I also note the different scoring with respect to anti-depressants which might be prescribed for generalised anxiety disorder and to benzodiazepines which might indeed still be prescribed and utilised for various types of anxiety disorder in accordance with physicians’ recommendations. I wonder if you have any comment on this?

Thank you again for the valuable and interesting information with which you provided me and for your interest in our use of the CISS. I look forward to hearing from you again in the future.

21.5.00: Dear Dr Christo

I have recently taken up post as a CPN to work on a shared care pilot project where I will be attached to 3 GP surgeries. This is initially going to run for a year and hopefully, after evaluation, it will become a permanent and substantive post. I have been looking at different evaluation tools for use within the project and after reading your article in Drug-Link (Jan/Feb 2000) I am interested in using your Christo Inventory for Substance-misuse Services. It appears user-friendly and easy to interpret. I would appreciate it if you could send me some copies of the CISS and also any information surrounding the development of the tool.

24 11.5.00: Dear Dr Christo

Re: use of CISS to monitor and evaluate services funded through the Greater London Drug and Alcohol Purchasers Group.

You are probably aware from speaking to Riccardo Woods at Turning Point that GLDAPG are keen to monitor and evaluate our funded projects over the coming financial year, including Turning Points young persons day programme.

Most local authorities have moved towards the collection of some outcome monitoring data, but few have a tool to coll ect this quickly and easily. Many ask for a 50% improvement in social circumstances for example, but they leave it to the agency to devise a tool to collect this. This does not lead to the collection of consistent or realistic data, services relying on impressionistic information from front line workers.

For this reason, I am keen to see a number of agencies use the CISS. It appears straightforward to use and useable with a range of client groups. It would be useful for me to talk with you about how best the CISS could be used in this way.....

29.3.00: Dear George

Just a note to say, thanks very much for meeting with Rick and I last week. It was very informative and worthwhile. I’ll keep you posted in any progress / hitches re implementing the CISS.

16.3.00: Dear Dr Christo

Many thanks for supplying a copy of the above tool which I found to be very interesting reading. We have in this Service in the past, piloted some very similar tools, which I have enclosed a copy for your information. We have now decided to implement yours in our existing service structure.

I wonder whether we may offer some suggestion for an amendment we would like to include on the form which involves the area of child care? We have numerous problems at the moment with clients in treatment with regard to this area. As you can imagine it does impact quite heavily with regard to a form of weighting that may be applied to a particular case….

21.1.00: Dear George

….The projects plan to introduce a formal system of outcome measurements by April 1^st and in my view the CISS is best suited to our needs. The primary aim of the system will be to report to our stakeholders on overall outcomes on a quarterly or twice yearly basis. At this stage I do not envisage the tool being used for other purposes (e.g. individual progress or workload monitoring)….

5.1.00: Dear Dr Christo

I was interested in the article in Addiction Today on outcome measurement. This is an area which is causing SolCare quite a lot of problems particularly as we use a considerable number of volunteers. It seems the system which you have devised may well be an answer to our prayers.

I would appreciate it if you could arrange to let me have a supply of your CISS forms and comparison scores to see whether we can improve our current systems.

16.11.00: Dear Dr Christo

I heard you speak at the Quality, Effectiveness and Drugs seminar and I was very interested in your CISS, an instrument that I have not previously encountered….

30.6.99: Dear George

Thank you for sending the CISS. We are looking at several possibilities at the moment but yours looks good, comprehensive and user friendly. If we need to, would it be possible to get you to come and explain the CISS in more detail? Do we need to do anything before trying it out?

14.5.99: Re CISS

After researching many outcome and monitoring tools available our organisation has found the CISS the most applicable. We are using this to assess all clients accessing our programme and have found it practical and easy to use. The staff members carrying out the assessments have developed the CISS questions into their interviews with the results being easily comprehended by all members of staff. The form is easy to use within a day care setting and we plan to incorporate our outcomes within a wider monitoring programme. If any further information is required regarding the use of the CISS please contact me at the CORE Trust.

Carolyn McDonald, CORE Trust, Lisson Cottages, 35a Lisson Grove, London, NW1 6UD. UK. Telephone 020 7258 3031, E-mail core_trust@which.net

 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.