Adult Outpatient Assessment (AOA)

The Adult Outpatient Assessment (AOA) is an evidence based self-report test that is designed for adult (male and female) outpatient screening or evaluation. The AOA consists of 153 items and takes on average 25 to 30 minutes to complete. There are eight (8) AOA scales (measures or domains).

The Adult Outpatient Assessment (AOA) is available online at www.online-testing.com. It can be administered on a computer or in paper-pencil test booklet format. Regardless of how it is administered, all AOA tests are scored online. Test booklets and answer sheets can be downloaded and photocopied as desired. Paper-pencil testing enables group testing which can save staff time.

The AOA is available in English or Spanish. Language in the AOA is direct, non-offensive and uncomplicated. Tests are available 24/7. AOA is evidence based and has demonstrated reliability and validity. AOA tests are scored online and printed reports are available within 2½ minutes after data (answers) entry.

The Adult Outpatient Assessment (AOA) contains eight (8) scales:

1. TRUTHFULNESS SCALE: Measures how truthful the client was while completing the test. It identifies guarded and defensive people that attempt to "fake good". Assessment results can be impacted by 'socially desirable responding' (Blanchett, Robinson, Alksnis, & Serin, 1997). Most outpatient tests do not incorporate a measure of truthfulness (Bishop, 2011). Truthfulness Scale scores at or below the 89th percentile mean that all other AOA scale scores are accurate. When the AOA Truthfulness Scale score is in the problem (70 to 89th percentile) range, other AOA scale scores are accurate because they have been Truth-Corrected. In contrast, when the Truthfulness Scale score is at or above the 90th percentile this means that all AOA scales are inaccurate (invalid) because the client was overly guarded, read things into test items that aren't there, was minimizing problems, or was caught faking answers. If not consciously deceptive, clients with elevated (70th percentile or higher) Truthfulness Scale scores are uncooperative (likely in a passive-aggressive manner), fail to understand test items or have a need to appear in a good light. One of the first things to check when reviewing an AOA report is the Truthfulness Scale score.

2. ALCOHOL SCALE: Measures alcohol use and the severity of abuse. Alcohol refers to beer, wine and other liquors. An elevated (70 to 89th percentile) Alcohol Scale score is indicative of an emerging drinking problem. An Alcohol Scale score in the severe problem (90 to 100th percentile) range identifies established and serious drinking problems. Elevated Alcohol Scale scores do not occur by chance. Alcohol involvement can range from abstinence (non-drinking) to dependency (Maisto & Saitz, 2003). A history of alcohol problems (e.g., alcohol-related arrests, DUI/DWI convictions, etc.) could result in an abstainer (current non-drinker) attaining a low to medium risk scale score. Consequently, safeguards have been built into the AOA to identify "recovering alcoholics." For example, the client's self-reported court history is summarized on the first page of the AOA report. The AOA client's answer to the "recovering alcoholic" question (item 146) is printed on page 3 of the AOA report. In addition, elevated Alcohol Scale paragraphs caution staff to establish if the client is a recovering alcoholic. If recovering, how long? Severely elevated (90th percentile and higher) Alcohol and Drug Scale scores reflect polysubstance abuse and the highest score usually identifies the client's substance of choice. Scores in the severe problem (90 to 100th percentile) range are a malignant prognostic sign. Elevated Alcohol Scale and Drug Scale scores with an elevated Violence Scale score identifies a particularly dangerous individual. In intervention and treatment settings, the client's AOA Alcohol Scale score can help staff work through client denial. More people accept objective standardized assessment results than someone's subjective opinion. This is especially true when it is explained that the AOA has been standardized and that elevated scores do not occur by chance. The Alcohol Scale can be interpreted independently or in combination with other AOA scales.

3. DRUG SCALE: Measures drug use and severity of drug abuse. Drugs refer to marijuana, ice, crack, cocaine, ecstasy, amphetamines, barbiturates, heroin, etc. An elevated (70 to 89th percentile) Drug Scale score identifies emerging drug problems. A Drug Scale score in the severe problem (90 to 100th percentile) range identifies established drug problems and drug abuse. A history of drug-related problems (e.g., drug-related arrests, prior DUI/DWI convictions, drug treatment, etc.) could result in an abstainer (current non-user) attaining a low to medium risk Drug Scale score. For this reason, precautions have been built into the AOA to insure correct identification of "recovering" drug abusers. Many of these precautions are similar to those discussed in the above Alcohol Scale description. The client's answer to the "recovering drug abuser" question (item 146) is printed on page 3 of the AOA report. Concurrently elevated Drugs and Alcohol Scale scores are indications of polysubstance abuse, and the highest score usually reflects the client's substance of choice. Very dangerous individuals are identified when both the Drug Scale and the Violence Scale are elevated. Any Drug Scale score in the severe problem (90 to 100th percentile) range should be taken seriously. The Drug Scale can be interpreted independently or in combination with other AOA scales. Substance Abuse/Dependency Scal.e

4. & 5. SUBSTANCE ABUSE/DEPENDENCY SCALE: Classifies clients as substance abusers, substance dependent or non-pathological substance users in accordance with Diagnostic and Statistical Manual Disorders, 4th Edition (DSM-IV) criteria. The AOA Substance Abuse/Dependency Scale is based on DSM-IV classification criteria for substance abuse and dependency (Davignon, 2008). When a client admits to one of the four DSM-IV abuse symptoms (criteria), that client is classified in the substance abuse category. When a client admits to three of the seven DSM-IV dependency symptoms (criteria), that client is classified in the substance dependency category. When a client does not meet DSM-IV criteria for abuse or dependency, they are non-pathological substance users (if they use alcohol or drugs). There is an important difference between the AOA Substance Abuse/Dependency Scale and the Alcohol and Drug Scales. The Substance Abuse/Dependency Scale classifies people as abusers, dependent or non-pathological substance users (if they use alcohol or drugs). The Alcohol Scale and Drug Scale measure the severity of alcohol and drug use or abuse.

6. VIOLENCE: Identifies clients that are a danger to themselves and others. Violence is defined as the expression of hostility, anger or rage through emotional or physical force. Violence is aggression in its most extreme and unacceptable form. Elevated Violence Scale scorers can be demanding, overly sensitive to perceived criticism, and insightless about how they express their anger and hostility. Severe problem Violence Scale scores should not be ignored as they are threatening and dangerous. A particularly unstable and perilous situation involves an elevated Violence Scale score with an elevated Alcohol Scale or Drug Scale score. Substance (alcohol and other drugs) abuse could contribute to a person’s dangerousness. Some of the same neurochemical anomalies that increase an individual’s violence risk could also increase the risk of a developing substance disorder (Brady, 2000). The more of these scales that are elevated with an elevated Violence Scale score - the worse the prognosis. An elevated Stress Management Scale score with an elevated Violence Scale score provides insight regarding co-determinates and treatment. A severe problem Violence Scale score is a malignant sign with or without other elevated scale scores and describes a dangerous person. The Violence Scale score can be interpreted independently or in combination with other AOA scales. There is much evidence supporting the use of Cognitive Behavioral Therapy in treating violent clients/offenders and reducing recidivism (Lipsey, Chapman & Landenberger, 2001).

7. SELF-ESTEEM SCALE: Measures the client’s feelings of self-acceptance and self-worth. Self-Esteem reflects a person’s explicit valuing and appraisal of self. Self-esteem incorporates an attitude of acceptance - approval versus rejection - disapproval. Self-esteem refers to a person’s perception of self. The Self-Esteem Scale score represents the person one believes oneself to be. Negative self-esteem has been related to maladjustment. The theory goes “the client sees themselves as bad or worthless and acts accordingly.” An elevated (70 to 89th percentile) score reflects impaired self-esteem. A pattern of self-rejection and disapproval is apparent. The client has a poor self-perception. Sometimes this is associated with guilt, remorse or shame. A severe problem (90 to 100th percentile) Self-Esteem Scale score is often characterized by shame, humiliation, uncertainty and even unbearable worry. The client disapproves of himself or herself. Elevated Violence and Stress Management Scales with the elevated Self-Esteem scale is problematic and could represent suicidal or homicidal ideation. And substance (alcohol and other drugs) abuse can foster even more disapproval of self. The higher these scale scores are, the more perilous and threatening the client’s situation becomes. The Self-Esteem Scale can be interpreted independently or in combination with other AOA scales. Many professionals believe that a person’s behavior is a reflection of their self-esteem. The concept of self-esteem is widely used in clinical settings.

8. STRESS MANAGEMENT SCALE: Measures the client's ability to cope effectively with stress, tension and pressure. How well a person manages stress effects their life situation. A Stress Management Scale score in the elevated (70 to 89th percentile) range provides considerable insight into co-determinants, while suggesting possible intervention programs like participation in a stress management program or class. A client scoring in the severe problem (90 to 100th percentile) range may have issues that require intervention or psychotherapy, augmented with attending a stress management class. We know that stress exacerbates emotional and mental health problems. The Stress Management Scale is a non-introversive way to screen for established (diagnosable) mental health problems. Elevated (90th percentile and higher) stress coping problems indicates that the client need to learn more effective stress management techniques and strategies. In conclusion, it was noted that several levels of AOA interpretation are possible. They range from viewing the AOA as a self-report to interpreting scale elevations and inter-relationships. Staff can then put a client's AOA findings within the context of the client’s life situation.

Confidentiality And Security

The confidentiality and security measures reported herein apply to Behavior Data Systems, Ltd. (BDS) and its subsidiaries Risk & Needs Assessments, Inc. (Risk & Needs) and Professional Online Testing Solutions, Inc. (Online Testing).

Whether you are using diskettes, USB flash drives or testing online, when you are using Behavior Data Systems, Ltd. tests, you can rest assured knowing that your client's privacy and confidentiality are safe. Any identifying information (name, ID numbers, etc.) is encrypted before being stored in our database. A secure algorithm built into each BDS test’s software unencrypts this information before displaying it to you over the web. This ensures that only you can access the data and reports for your clients. This encryption method is HIPAA (federal regulation 45 C.F.R. 164.501) compliant.

Online Test users are encouraged to delete client names when their assessment process is completed. This proprietary name deletion procedure involves a few keystrokes. Once names are deleted they are gone and cannot be retrieved. Deleting names does not delete demographics or test data, which is downloaded into each tests' database for subsequent analysis. This name deletion procedure insures confidentiality and compliance with HIPAA (federal regulation 45 C.F.R. 164.501) requirements.

Windows diskettes and flash drives are sent out with 25 or 50 tests on them. When these tests are used, the customer returns the diskette or flash drive to Behavior Data Systems, Ltd. (BDS). As explained in the test Training Manual, before returning diskettes or flash drives to Behavior Data Systems, Ltd. (BDS) customers are instructed to delete the clients' names from the diskettes/flash drives.

When the diskette or flash drive is received at BDS, it is logged in as returned in our tracking system. The diskette or flash drive then is processed through a File Transfer Program (FTP) that extracts client demographics (age, sex, race, date of birth, education, etc.), history questions (age of first arrest, number of arrests, etc.) and client response data (answers). This data is used for each test's research – no names or identifying numbers are needed and none are collected. After the data is transferred to our database (minus names and/or identifying numbers), physical diskettes and flash drives are destroyed.

References

Bishop, N. (2011). Predicting multiple DUI offenders using the Florida DRI. Substance Use & Misuse (46), 696-703.

Blanchett, K. Robinson, D., Alksnis, C., Serin, R. (1997). Assessing Treatment Outcome Among Family Violence Offenders: Reliability and Validity of a Domestic Violence Treatment Assessment Battery. Correctional Service of Canada.

Brady, K. (2000). Violent behavior and substance use disorders. Program and abstracts from the 153rd Annual American Psychiatric Association Meeting, May 13-18, 2000; Chicago, Illinois. Abstract 26D.

Davignon, D. (2008). Driver Risk Inventory: An Inventory of Scientific Findings, Volume 2. Behavior Data Systems, Ltd.

Lipsey, M., Chapman, G., Landenberger, N. (2001). Cognitive Behavioral Programs for Offenders. Annals of the American Academy of Political and Social Science, 578:144-157.

Maisto, S., Saitz, R. (2003), Alcohol use disorders: screening and diagnosis. The American Journal of Addiction 12:S12-S25.