CEST Texas Christian University 

Included FREE with the Kipu EMR.

Consists of 4 self-report assessments for monitoring client needs and progress in four areas: 1) treatment motivation, 2) psychological functioning, 3) social functioning, and 4) clinical engagement scales designed to be administered throughout treatment to help inform planning of services and gauge client changes over time.

The CEST Mission

To evaluate and improve the effectiveness of programs for reducing drug abuse and related mental health as well as social problems. For many years, research staff at the IBR have given special attention to addictions and the evaluation of cognitive and behavioral interventions provided by community-based programs. Emphasis has been on the use of natural designs for studies in real-world settings and the use of advanced multivariate methodologies.

Research interests in recent years have broadened to include related areas of significant public concern, especially addiction treatments for criminal justice populations, and adolescents, as well as the spread of HIV and related infections among drug users. Other major areas of interest include organizational functioning and process research for improving field-based implementation strategies of science-based innovations.

The TCU Short Forms contain a revised and expanded set of assessments for planning and managing addiction treatment services. They are formatted as brief (1-page) forms to measure client needs and functioning, including drug use severity and history (TCUDS II), criminal thinking and cognitive orientation (CTSForm), motivation and readiness for treatment (MOTForm), psychological functioning (PSYForm), social relations and functioning (SOCForm), and therapeutic participation and engagement (ENGForm). These instruments facilitate optically-scanned data entry, computerized scoring, and rapid graphical feedback for clinical decisions. The present study (based on 5,022 inmates from eight residential prison treatment programs) examines evidence on scale reliabilities and measurement structures of these tools. Results confirmed their integrity and usefulness as indicators of individual and group-level therapeutic dynamics.

The CEST Family of Assessments

TCU Treatment Needs and Motivation

(TCU MOTForm) includes 36 items from 5 scales representing Problem Recognition, Desire for Help, Treatment Readiness, Treatment Needs Index, and Pressures for Treatment Index. It is used mainly for intake and early treatment phases.

TCU Psychological Functioning

(TCU PSYForm) includes 33 items from 5 scales representing Depression, Anxiety, Self-Esteem, Decision Making, and Expectancy.

TCU Social Functioning

(TCU SOCForm) includes 36 items from 4 scales representing Hostility, Risk-Taking, Social Support, and Social Desirability.

TCU Treatment Engagement

(TCU ENGForm) includes 36 items from 4 scales representing Treatment Participation, Treatment Satisfaction, Counseling Rapport, and Peer Support.

A national sample of over 1,700 clients from 87 programs located across the U.S. was used initially to study reliability and validity of the CEST (Joe et al., 2002).  Results from confirmatory factor analysis verified the CEST factor structure, coefficient alpha reliabilities established that the scales had satisfactory levels of internal consistency, and relationships of scales with selected client and program functioning indicators documented their predictive validities.  The CEST scales also have been adapted and tested for use in criminal justice populations, using a sample of 3,266 offenders from 26 CJ‐based programs located in 6 different states (Garner et al., 2007).  It likewise has been used internationally as illustrated by a study of over 1,500 clients from 44 treatment agencies located in England (Simpson, Rowan‐Szal, Joe et al., in press).

These studies show consistency in the way client motivation and psychosocial self ratings are associated with indicators of program participation and counseling rapport.   Namely, these measures of therapeutic engagement are related directly to higher treatment motivation and readiness scores as well as to better psychosocial functioning profiles (i.e., higher self esteem, decision making, self efficacy, and social consciousness, along with lower anxiety, hostility, and risk taking).  In turn, stronger therapeutic linkages predict longer treatment retention and better follow‐up outcomes.  Regression analyses indicate these relationships are substantial, with motivation and psychosocial functioning measures accounting for one‐fourth to one‐half of the variance in the client engagement (Simpson et al., in press).  Within a treatment process framework (Simpson, 2004, 2006), therefore, early interventions designed to improve treatment readiness, mental health, and anger‐related problems seem to be highly appropriate.

CEST Abstract

The TCU Short Forms contain a revised and expanded set of assessments for planning and managing addiction treatment services. They are formatted as brief (1-page) forms to measure client needs and functioning, including drug use severity and history (TCUDS II), criminal thinking and cognitive orientation (CTSForm), motivation and readiness for treatment (MOTForm), psychological functioning (PSYForm), social relations and functioning (SOCForm), and therapeutic participation and engagement (ENGForm). These instruments facilitate optically-scanned data entry, computerized scoring, and rapid graphical feedback for clinical decisions. The present study (based on 5,022 inmates from eight residential prison treatment programs) examines evidence on scale reliabilities and measurement structures of these tools. Results confirmed their integrity and usefulness as indicators of individual and group-level therapeutic dynamics.

CEST Credentials

The new formulation of TCU Short Forms matches the favorable psychometric qualities of previous versions. When used to evaluate client problems and progress over time, treatment intake information accounted for a significant amount of variance in treatment engagement measures obtained 3 months later, as predicted in the TCU Treatment Process Model. Effective, brief, and less expensive tools have long been a goal for assessments in community-based drug abuse treatments, and these qualities are even more significant in the growing but financially strapped needs of drug treatment providers for correctional populations. In part, this is because CJ-based programs often must evaluate and process large numbers of court, jail, or prison admissions with limited resources. Intense treatment programs are costly, so it is important to identify inmates who can be best served by referrals to appropriate levels of therapeutic services.

Image Image Image

Evaluating CEST Results

Client Evaluation of Self and Treatment (TCU CEST)

Scales and Item Scoring Guide

Scoring Instructions. Numbers for each item indicate its location in the administration version, in which response categories are 1=Strongly Disagree to 5=Strongly Agree; designates items with reflected scoring. Scores for each scale are obtained by summing responses to its set of items (after reversing scores on reflected items by subtracting the item response from “6”), dividing the sum by number of items included (yielding an average) and multiplying by 10 in order to rescale final scores so they range from 10 to 50 (e.g., an average response of 2.6 for a scale becomes a score of “26”).

 

TREATMENT MOTIVATION SCALES

 

A. Desire For Help (DH)

3. You need help in dealing with your drug use.

32. It is urgent that you find help immediately for your drug use.

39. You will give up your friends and hangouts to solve your drug problems.

65. Your life has gone out of control.

86. You are tired of the problems caused by drugs.

116. You want to get your life straightened out.

 

B. Treatment Readiness (TR)

6. You plan to stay in this treatment program for awhile.

13. This treatment may be your last chance to solve your drug problems.

14. This kind of treatment program will not be very helpful to you.

54. This treatment program can really help you. 56. You want to be in a drug treatment program now. 82. You have too many outside responsibilities now to be in this treatment program.

89. You are in this treatment program because someone else made you come.

125. This treatment program seems too demanding for you.

 

C. Treatment Needs (TN)

24. You need more help with your emotional troubles

47. You need more individual counseling sessions.

55. You need more educational or vocational training services.

68. You need more group counseling sessions.

118. You need more medical care and services.

 

D. Pressures for Treatment Index* (PT – not scored as single scale)

10. You have family members who want you to be in treatment.

25. You are concerned about legal problems.

44. You feel a lot of pressure to be in treatment.

49. You could be sent to jail or prison if you are not in treatment.

94. You have serious drug-related health problems. 124. You have legal problems that require you to be in treatment. * Formerly labeled External Pressures

PSYCHOLOGICAL FUNCTIONING SCALES

E. Self Esteem (SE)

17. You have much to be proud of.

59. You feel like a failure.

71. You wish you had more respect for yourself.

88. You feel you are basically no good.

100. In general, you are satisfied with yourself.

109. You feel you are unimportant to others.

 

F. Depression (DP)

57. You feel interested in life.

74. You feel sad or depressed.

76. You feel extra tired or run down.

90. You worry or brood a lot.

97. You feel hopeless about the future.

123. You feel lonely.

 

G. Anxiety (AX)

16. You have trouble sleeping.

60. You have trouble concentrating or remembering things.

69. You feel afraid of certain things, like elevators, crowds, or going out alone.

70. You feel anxious or nervous.

78. You have trouble sitting still for long.

105. You feel tense or keyed-up.

114. You feel tightness or tension in your muscles.

 

H. Decision Making (DM)

48. You consider how your actions will affect others.

53. You plan ahead.

75. You think about probable results of your actions.

79. You think about what causes your current problems.

87. You think of several different ways to solve a problem.

93. You have trouble making decisions.

98. You make good decisions.

103. You make decisions without thinking about consequences.

126. You analyze problems by looking at all the choices.

 

I. Self-Efficacy (PM)

5. You have little control over the things that happen to you.

23. What happens to you in the future mostly depends on you.

33. There is little you can do to change many of the important things in your life.

45. There is really no way you can solve some of the problems you have.

108. You can do just about anything you really set your mind to do.

117. Sometimes you feel that you are being pushed around in life.

120. You often feel helpless in dealing with the problems of life.

SOCIAL FUNCTIONING SCALES

J. Hostility (HS)

28. You have carried weapons, like knives or guns.

36. You feel a lot of anger inside you. 41. You have a hot temper.

46. You like others to feel afraid of you. 51. You feel mistreated by other people.

92. You get mad at other people easily.

102. You have urges to fight or hurt others.

130. Your temper gets you into fights or other trouble.

K. Risk Taking (RT)

9. You only do things that feel safe.

61. You avoid anything dangerous.

73. You are very careful and cautious.

96. You like to do things that are strange or exciting.

106. You like to take chances.

111. You like the "fast" life.

119. You like friends who are wild.

L. Social Consciousness (SC)

4. Your religious beliefs are very important in your life.

12. You keep the same friends for a long time.

22. You feel people are important to you.

34. You have trouble following rules and laws.

40. Taking care of your family is very important.

101. You feel honesty is required in every situation.

112. You work hard to keep a job.

129. You depend on "things" more than "people".