The Treatment Intervention
Inventory (TII) identifies people with problems
that would benefit from counseling, psychotherapy and/or substance (alcohol and other drugs) abuse treatment. Two of the most
important clinical decisions are, Does the client have a problem? And if so, what is the most beneficial counseling and/or
treatment program available? The TII helps answer both of these questions. We now know that appropriate and timely counseling/treatment
intake influences treatment effectiveness. In other words, early problem detection facilitates timely intervention and improves
outcome. So what does the TII screen? Areas of inquiry include anxiety, depression, self-esteem, distress, family issues, alcohol
abuse, drug abuse and stress handling abilities. This type of information helps in deciding upon the type of
treatment needed, appropriate referral options and the level of care needed.
The Treatment Intervention Inventory (TII) is designed for treatment referral and treatment intake. The TII consists of 162
items and can be completed in 35 minutes. The TII is an automated (computer-scored) self-report assessment instrument or test. It
is administered and scored on-site with reports available within 3 minutes. The TII is a clinical test that assesses anxiety,
depression, self-esteem, distress, substance (alcohol and other drugs) use and stress handling abilities while concurrently
exploring family issues.
APPLICATIONS
** Treatment Intervention Inventory **
Counseling and psychotherapy intake.
EAP, HMO and agency referral programs.
Program intake screening and evaluation.
Adult evaluation, counseling and treatment agencies.
Nine TII Scales (Measures)
Truthfulness Scale: Measures how truthful the client was while
completing the TII. This scale identifies denial, problem minimization and attempts to fake good.
Anxiety Scale: Measures nervousness, apprehension and somatic
correlates of anxiety. This score varies directly with experienced symptoms.
Depression Scale: Measures dejected or self-depreciating emotional
states that vary from normal to pathological. Melancholy and dysphoria are assessed.
Self-Esteem Scale: Reflects a person's explicit valuing and
appraisal of self. It incorporates an attitude of acceptance-approval versus rejection-disapproval.
Distress Scale: Measures experienced pain, worry, sorrow and
distress. Distress can involve both mental and physical strain. Distress is a common reason people seek counseling.
Family Issues Scale:
Measures family stability, problems and
concerns. The client rates their own family and relationship stability.
Alcohol Scale: Measures the client's alcohol proneness and the
severity of alcohol-related problems. Alcohol refers to beer, wine and other liquors.
Drugs Scale: Measures illicit drug proneness and drug-related
involvement. Drugs refer to marijuana, crack, cocaine, amphetamines, barbiturates and heroin. This scale measures the
severity of drug use and abuse.
Stress Coping Abilities Scale: Measures experienced stress in
comparison to stress coping abilities. The scale measures how well the client copes with stress. Stress exacerbates
emotional and mental health symptomatology. A Stress Coping Abilities Scale score at or above the 90th
percentile identifies the presence of an established emotional or mental health problem.
The TII-Juvenile is adapted from the TII. It is appropriate for juvenile screening in HMO's, EAP's, juvenile screening,
referral agencies and counseling program intake evaluation. Click on the following link to go to the
TII-Juvenile webpage.
TII
Summary
The TII is a test whose results can be used for program intake and/or referral for treatment. The TII provides an
objective assessment of the client's situation and needs. It can be administered at intake, follow-up intervals and discharge.
It's also appropriate for use in EAP's, HMO's and other screening-and-referral programs, as warranted.
In addition to establishing client truthfulness and substance (alcohol and other drugs) involvement, the TII
measures important counseling, treatment, recovery and relapse indicators.
The TII provides a sound empirical basis for decision making.
There have been several reviews of the poor performance of the interview and its paradoxical lack of reliability
and validity. Interviews are at the mercy of client untruthfulness, denial
and problem minimization. In contrast, the TII's Truthfulness Scale measures
client truthfulness, identifies denial, quantifies problem minimization and
reveals faking. Raw scores reflect what the client wants you to know.
Truth-Corrected scores reveal what the client may be trying to hide.
The Treatment Intervention Inventory (TII) was developed specifically for client screening and treatment intake.
It is much more than just another alcohol or drug test. It measures important attitudes and behaviors overlooked by other screening tests.
Why Use the TII?
Many mental health professionals, screeners referring clients for help and (treatment intake) staff need
meaningful and accurate assessment. The TII is an objective and standardized
test with impressive reliability, validity and accuracy. Early detection of
emotional, psychological and behavioral problems facilitates quicker
intervention and treatment. This type of information helps in deciding upon
appropriate referral, the nature of treatment needed and the level of care
that is warranted. At one sitting of approximately 35 minutes' duration, staff
can acquire a vast amount of treatment and needs information. Early problem
identification facilitates timely intervention and improved outcome results.
Advantages of
Screening
Screening or assessment instruments filter out individuals with serious problems that may require referral for
counseling, substance abuse treatment or psychotherapy. This filtering system works as follows:
TII RISK RANGES
Risk Category
Risk Range Percentile
Total Percentage
Low Risk
0 - 39%
39%
Medium Risk
40 - 69%
30%
Problem Risk
70 - 89%
20%
Severe Problem
90 -100%
11%
Reference to the above table shows that a problem is not identified until a scale score is at the 70th
percentile or higher. These risk range percentiles are calculated on the
clients that have completed the TII. This procedure is fair and avoids
extremes such as over-identification and under-identification of problems.
A department or agency's policy might refer clients with serious problems for further evaluation or treatment. In
this case (Severe Problem), 11% of the people screened would be referred. Or,
policy might refer people with identified problems (Problem Risk and Severe
Problem, 31%) for additional services. In these examples, either 89% or 69%
(contingent upon adopted policy) of the people screened would not be referred for additional (and expensive) services.
Budgetary savings (dollars) would be large with no compromises in clients receiving appropriate evaluation and/or
treatment services. Indeed, more offenders would receive help. Without a
screening program, there is usually more risk of over or under-utilization of additional professional services.
TII Test
Booklets
TII test booklets are provided free. These booklets contain 162 items and are written at a 5th to 6th
grade reading level. If a person can read the newspaper, they can read the Treatment Intervention Inventory (TII).
Reports
In brief, TII reports summarize the client's self-report history, explain what attained scale scores mean and
offer specific score-related recommendations.
Within 2 minutes of test data entry, automated (computer-scored) three-page reports are printed on-site. These
reports summarize a lot of information in an easily understood format. For
example, reports include a TII profile (graph), which summarizes scale scores
at a glance. Also included are attained scale scores, an explanation of what
each score means and specific score-related recommendations. In addition,
significant items (direct admissions) are highlighted, and answers to a
built-in interview (last sequence of items) are presented. Emphasis is
placed on having meaningful reports that are helpful and easily understood.
To go directly to the example TII report, click on the
TII Report link. After
reviewing the report, you can return to this section by clicking on the "Return to TII Reports Section" link.
Reliability and Validity
The TII has a proprietary built-in database that insures inclusion of all tests administered in a confidential
(no names) manner. These reliability and validity statistics are reported in
the document titled "TII: An Inventory of Scientific Findings." Annual database analysis
further demonstrates the TII scale to have very high reliability and validity coefficients.
For example, the internal consistencies (coefficient alphas) for TII scales are reported in the
following table for TII assessed clients in the year 2002. This is one among several studies.
TII RELIABILITY COEFFICIENTS (N=3,414, 2002)
TII Scales
Coefficient Alpha
Significance Level
Truthfulness Scale
.88
p<.001
Anxiety Scale
.92
p<.001
Depression Scale
.89
p<.001
Self-Esteem Scale
.91
p<.001
Distress Scale
.90
p<.001
Family Issues Scale
.88
p<.001
Alcohol Scale
.93
p<.001
Drugs Scale
.90
p<.001
Stress Coping Abilities Scale
.94
p<.001
All TII scales are highly reliable. All alpha coefficients are well above the professionally accepted standard
of .75. The results clearly demonstrate that the TII is a reliable test.
Early TII validation studies involved other tests that measured the same thing. These criterion group studies are
reported in the document titled "TII: An Inventory of Scientific Findings." Subsequent
database research further supports the validity of the TII. Moreover, in the 2002 study (N=3,414) reported above, the
accuracy of the TII was demonstrated. Of the clients involved who admitted to serious problems, the
accuracy of identification is demonstrated in the following table.
A TII research study is presented at the end of this webpage. To go directly to this research, click the
TII Research Study link.
TII ACCURACY (N=3,414, 2002)
TII Scales
Correct Problem Identification
Alcohol Scale
100%
Drugs Scale
100%
Anxiety Scale
100%
Depression Scale
98.1%
Distress Scale
93.1%
Family Issues Scale
100%
The 70th percentile cutoff for problem identification correctly classifies nearly 100% of
clients with problems. The Low Risk level of 39% avoids putting a large number of clients into a "moderate" range.
Undesirable outcomes associated with inappropriate treatment level placement are discussed by Andrews, Bonta and
Hoge (1990). Their conclusions emphasize the importance of TII scale accuracy. By most, if not all standards, TII scales are
reliable, valid and accurate.
In summary, all 9 TII scales are highly reliable. And, predictive validity analyses demonstrated that the TII
correctly identified problem prone clients. Furthermore, obtained risk range percentages on all TII scales very closely
approximate predicted percentages. One of the most important decisions regarding counseling clients is which
intervention/treatment program is most appropriate for the client. The TII is an empirically based test that can help in
client referral.
The 3,414-client study completed in the year 2002 is presented at the end of this TII webpage. To go directly to
this study, click on the
TII Research Study link.
Software
The TII is available in Windows. Windows diskettes require a
one-time computer setup procedure after which TII data (25 or 50 tests) diskettes are used to score and print reports.
Training manuals are provided, and new test users can be walked through these procedures by
Risk & Needs Assessment, Inc.'s (Risk & Needs) staff.
Proprietary TII data diskettes contain 25 or 50 test applications. These 3½" diskettes score, interpret
and print TII reports on-site. Once a TII account is established, ordered diskettes are mailed to users. Approximately 97% of
orders are filled and mailed back to users the same day. When all test applications on a diskette are used, that diskette is
returned to Risk & Needs where the test data is downloaded into the TII database. The proprietary "delete names"
program is activated by the test user with a few keystrokes to delete all client names from diskettes before they are returned
to Risk & Needs. Deleting all client names insures client confidentiality
and compliance with HIPAA (federal regulation 45 C.F.R. 164.501).
Database
The TII system contains a proprietary built-in database. Earlier, it was noted that all used TII diskettes are
returned to Risk & Needs, and test data is downloaded into the TII database. This expanding database allows ongoing
research and testing program summary -- features that were not possible before.
No personal information, names, social security numbers, etc. are ever downloaded into any
test database.
In summary, all returned TII diskettes' test data is centrally filed at
Risk & Needs' offices in the TII database. This
database has many advantages. Database analysis permits ongoing cost
efficient research that includes scale alpha coefficients, ANOVA, frequency
distributions, correlations, cross-tab statistics along with reliability,
validity and accuracy determinations. Annual testing program summary
provides a vehicle for program evaluation. Click on this
TII Research Study link to review TII research.
After downloading test data returned diskettes are destroyed.
Annual Summary Reports
Risk & Needs can access each of its tests' built-in databases for statistical analysis and summarization of all
tests administered in a year. Annual Summary Reports are prepared
for state, department, agency and even some individual providers -- at no
cost to them. These reports are provided as a professional courtesy
to large volume test users. Summary reports include demographics,
court-history when relevant, and test statistics (reliability, validity
and accuracy). Has anyone offered to summarize your testing program?
Annually? At no additional cost to you? Minimum testing volume for
annual reports is 350 tests. There is no maximum limit. Risk & Needs'
annual reports range in size from 350 tests to over 55,000 tests annually.
An example Annual Summary Report can be viewed by clicking on this
Annual Summary Report link.
Staff Member Input
The TII is to be used in conjunction with experienced staff judgment. Experienced staff should interview the
client. For these reasons, the following statement is contained in each TII
report: "Treatment Intervention Inventory results are confidential and
should be considered a working hypothesis. No diagnosis or decision should
be based solely upon these results. Use only with experienced staff judgment."
Why Develop the TII?
Appropriate and timely treatment intake is important to treatment effectiveness. Emotional and psychological
assessment is complex and requires more than just alcohol and drug
screening. Important areas of inquiry include: client truthfulness, anxiety,
depression, self-esteem, distress, family problems, substance (alcohol and
other drugs) use and abuse along with stress coping abilities. We now know
that stress exacerbates emotional and mental health symptomatology. A Stress
Coping Abilities Scale score at or above the 90th percentile
indicates the presence of a DSM-IV disorder. In these instances, the client
should be referred to a licensed mental health provider for a diagnosis and written treatment plan.
How do you know if the client is lying? The TII contains a Truthfulness Scale that determines how truthful
the client was while completing the test. This scale identifies denial,
problem minimization, defensiveness and attempts to fake good. And, the TII
doesn't stop there. Error of measurement due to untruthfulness is measured
for each scale and reported as Truth-Corrected scores. Truth-Corrected
scores reveal what the client is minimizing or trying to hide.
Truth-Corrected scores are more accurate than raw scores.
Unique TII Features
TII-Juvenile:
The TII has been modified for juvenile (14 to 18 years) assessment. The
TII-Juvenile consists of 143 items and can be completed in 25 to 30 minutes.
The 9 TII scales (measures) are retained in the juvenile version. These are:
Truthfulness Scale, Anxiety Scale, Depression Scale, Self-Esteem Scale,
Distress Scale, Alcohol Scale, Drugs Scale, Family Issues Scale, and the
Stress Coping Abilities Scale. To go to the TII-Juvenile webpage, click on
the
TII-Juvenile link.
Truthfulness Scale: Identifies denial,
problem minimization and faking. It is now known that many clients attempt
to minimize their problems. A Truthfulness Scale is a necessary component in
contemporary tests. The TII's Truthfulness Scale has been validated with the
Minnesota Multiphasic Personality Inventory (MMPI), polygraph exams, other
tests, truthfulness studies and experienced staff judgment. The TII's
Truthfulness Scale has been demonstrated to be reliable, valid and accurate.
In some respects, the TII's Truthfulness Scale is similar to the MMPI's L and
F-Scales. It consists of a number of items that most people agree or disagree with.
Truth-Corrected Scores: Have proven to
be very important for assessment accuracy. This proprietary truth correction
process is comparable to the MMPI's K-Scale correction. The TII's Truthfulness
Scale has been correlated with the other 5 scales. The Truth Correction
equation converts raw scores to Truth-Corrected scores. Truth-Corrected
scores are more accurate than raw scores. Raw scores reflect what the client
wants you to know. Truth-Corrected scores reveal what the client is attempting to hide.
Stress Coping Abilities Scale:
Measures how well the client handles stress, tension and pressure. And, we
now know that stress exacerbates emotional and mental health symptomatology.
This scale is a non-introversive way to screen for established (diagnosable)
mental health problems. A person scoring at or above the 90th percentile on
the Stress Coping Abilities Scale should be referred to a certified mental
health professional for a more comprehensive evaluation, diagnosis and
treatment plan. This important area of inquiry is missed by many other assessment tests.
More than just another alcohol or drug
test. In addition to alcohol and drugs, the TII assesses other important
areas of inquiry like truthfulness, denial and faking, family issues,
emotional/mental health problems, etc. The TII is specifically designed for client screening.
Three ways to give the TII.
The TII
can be administered in three different ways:
1. Paper-pencil test booklet
format is the most popular testing procedure. TII English and Spanish test
booklets and answer sheets are available.
2. Tests can be given directly on
the computer screen. Some agencies dedicate computers for TII testing. And,
3. Human Voice Audio in English or Spanish is available. These three test
administration modes are discussed in the "TII: Orientation and Training
Manual." Each test administration mode has advantages and some limitations.
Risk & Needs offers these three test modes so test users can select the
administration mode that is optimally suited to their needs.
Reading Impaired
Assessment: Reading impaired clients represent 20+ percent of the clients tested. This
represents a serious problem to other treatment tests. Risk & Needs has developed an
alternative for dealing with this problem: Human Voice Audio.
Human Voice Audio: Presentation of the
TII is in English and Spanish. Clients' passive vocabularies are often
greater than their active vocabularies. Hearing items read out loud often
helps reduce cultural and communication problems. This administration mode
requires earphones and simple instructions to orient the client to the
up-down arrow keys on the computer keyboard. Human Voice Audio is an
alternative approach for screening reading impaired clients.
Confidentiality: Risk
& Needs Assessment,
Inc. encourages test
users to delete client names from diskettes before they are returned to
Risk & Needs. Once client names are deleted, they are gone and cannot be retrieved.
Deleting client names does not delete demographics or test data, which is
downloaded into the TII database for subsequent analysis. This proprietary
name deletion procedure involves a few keystrokes and insures client confidentiality
and compliance with HIPAA (federal regulation 45 C.F.R. 164.501).
Test Data Input Verification: Allows
the person that inputs test data from the answer sheet into the computer to
verify the accuracy of their data input. In brief, test data is input twice,
and any inconsistencies between the first and second data entries are
highlighted until corrected. When the first and second data entries match or
are the same, the staff person can continue. This proprietary Data Input
Verification procedure is optional, yet strongly recommended by Risk
& Needs.
Inventory of Scientific Findings: Much
of the TII research has been gathered together in a document titled "TII: An
Inventory of Scientific Findings." This document summarizes TII research
chronologically -- as the studies were completed. This chronological
reporting format was established largely because of the TII database, which
permits annual database analysis of all tests administered.
Staff Training: Risk &
Needs' staff is available
to participate in TII training programs conducted by statewide programs,
departments and high volume agencies in the United States. Sometimes, smaller
volume providers get together for collective (multiple providers) on-site
training. Risk & Needs typically participates in 4-hour or 6-hour TII training
sessions. This training can include hands-on computer scoring, as desired.
Risk & Needs gives attendees certificates attesting to their TII training.
Staff training is also provided on Fridays at Risk & Needs' Phoenix offices from 8:30 a.m. to 11:30 a.m. or from
1:30 p.m. to 4:30 p.m. These training sessions are free. To participate, contact
Risk & Needs at least ten days in
advance. Participation is on a first call, first scheduled basis.
Support Services:
Risk & Needs provides a full range of support
services. These services include e-mail, fax and telephone availability, provision of test-related information, telephone
walk-through assistance, staff training and test consultation. Support services and test-related materials are provided free.
Test Unit Fee (Cost): TII cost information can be reviewed by clicking on the
Test Unit Fee
(Cost) link. There is only the one cost or charge, and that is the test unit
fee. Everything else is included at no additional cost to the test user. This
includes test booklets, answer sheets, training manuals, upgrades, ongoing
database research, annual summary testing reports, staff training, and support
services. Do not be misled by some test publishers' à la carte pricing like
separate costs for each test administration as well as for each of the
test-related items listed above. Instead of asking for the test administration
cost, ask for the total cost involved in using a test. We believe Risk & Needs' one test
unit fee is very affordable.
Free Examination Kit:
A 1-test TII demonstration diskette is available on a 30-day cost
free basis. Demo diskettes are in MS-DOS format so that
the software is contained on the diskette. This way, the one-time Windows
setup program is avoided at the demo level. The examination
kit contains a 1-test demo diskette, test booklet (reusable), an answer
sheet (can photocopy), Training Manual, and some descriptive information.
Risk & Needs does want the demonstration diskette and test booklet returned
within 30 days of receipt.
Reference
Andrews, D., Bonta, J. & Hoge, R. (1990). Classification for effective rehabilitation: Rediscovering
Psychology. Criminal Justice and Behavior 17, 19 - 52.
Selecting a Screening and Referral or Intake Test
If you are selecting a screening and referral and/or intake screening test, the following Comparison Checklist
should prove helpful. It lists important screening test qualities. The
"Other" column represents any other test you might want to compare to the TII.
TEST COMPARISON CHECKLIST
COMPARISON CATEGORIES
TII
Other
Designed Specifically for Screening and Referral
Yes
A Counseling and Treatment Intake Test
Yes
Test Reliability and Validity Research Provided
Yes
Test Completed in 30 Minutes
Yes
On-Site Reports within 2½ Minutes On-Site
Yes
Truthfulness Scale to Detect Minimization and Faking
Yes
Truth-Corrected Scores for Accuracy
Yes
Three Test Administration Options
Yes
1. Paper-Pencil (English and Spanish)
Yes
2. On Computer Screen (English and Spanish)
Yes
3. Human Voice Audio (English and Spanish)
Yes
Delete Client Names (insures confidentiality) Program
Yes
HIPAA (federal regulation) Compliant
Yes
Available in English and Spanish
Yes
Built-in Database at No Additional Cost
Yes
Alcohol and Drugs Scales
Yes
Anxiety Scale
Yes
Distress Scale
Yes
Self-Esteem Scale
Yes
Family Issues Scale
Yes
Depression Scale
Yes
Stress Coping Abilities Scales
Yes
Easily Understood Reports
Yes
Facilitates Adult (male and female) Referral
Yes
Annual Testing Summary Reports (Free)
Yes
ASAM Compatible Recommendations
Yes
Staff Training (Free)
Yes
Examination Kits (Free)
Yes
Thirty-Day Money Back Guarantee
Yes
Very Affordable Test Unit Fee
Yes
Test Data Input Verification (insures accuracy) Program
Within 2 minutes of test data entry, automated (computer-scored) three-page reports are printed on-site. These
reports summarize a lot of information in an easily understood format. For
example, reports include a TII profile (graph), which summarizes scale
scores at a glance. Also included are attained scale scores, an explanation
of what each score means and specific score-related recommendations. In
addition, significant items (direct admissions) are highlighted, and answers
to a built-in interview (last sequence of items) are presented. Emphasis is
placed on having meaningful reports that are helpful and easily understood.
Largely because the Treatment Intervention Inventory (TII)
is a clinical test, considerable space has been allocated for the evaluator's
recommendations. Sometimes, assessors are influenced by information obtained
from the client's record, in interview or from a significant "other." It is
recommended that such sources of information be referenced and clarified. In
other instances, the assessor may want to note their intuitions, insights or
"hunches." And, it often requires space to summarize the clinical situation,
client's motivation and recommendations.
Additional information can be provided upon request by writing:
Risk & Needs Assessment, Inc. P.O. Box 44828 Phoenix, Arizona 85064-4828.
Our telephone number is (602) 234-3506
Our fax number is (602) 266-8227
and our e-mail address is
sheryl@riskandneeds.com.
