Purpose: The Needs and Progress Assessment Profile (NPAP) is a brief 3 to 5 minute assessment of client functioning designed for a clinician to ask at the beginning of each counseling session. This counseling framework enables a clinician to assess and prioritize client needs; deliver counseling services in accordance to the severity and type of needs; and to measure change in client functioning across multiple encounter points. The purpose of this study was to evaluate the effectiveness of the NPAP compared to standard counseling.

Methods: A total of 52 clients admitted to methadone treatment voluntarily agreed to be randomly assigned to counselors who provided standard treatment (control condition) (N=26) or to counselors who implemented the NPAP approach (N=26). Other than the brief NPAP assessment conducted at the onset of each counseling session, there were no other modifications in the type, duration, or amount of services provided. A total of 6 counselors were randomly assigned to the conditions (3 per condition). Counseling sessions were randomly audio-taped to document the fidelity of service delivery. All clients completed the Addiction Severity Index (ASI) upon entry into treatment. Overall 50/52 (96%) of the participants completed a 3-month follow-up version of the ASI and provided a urine screen. Client chart reviews were undertaken to document outcomes such as methadone dose, attendance, treatment plan modifications, and drug screens.

Results: A comparison of baseline demographic (e.g., age) and behavioral (e.g., days of drug use) characteristics found no statistically significant differences between conditions. A series of bivariate tests were performed to assess differences between conditions in client functioning at the 3 month follow-up. Although not statistically significant, clients in the experimental condition reported greater likelihood to be enrolled in treatment at the 3 month follow-up (96% vs. 85%, chi-square=1.9, df=1, p=.16). Both days of mental health issues (8 vs. 4.2) and days of drug use (6.4 vs. 3.1) in the past 30 days were lower in the experimental than the control condition (t=1.8, df=48, p=.08; and t=1.7, df=48, p=.10, respectively). Also a greater proportion of clients in the experimental condition tested negative for drugs compared to the control condition (61% vs. 36.4%; chi-sq=2.9, df=1, p=.09).

Two analyses were found to be statistically significant. Overall the majority of clients in the experimental condition had a modified treatment plan during the initial 3 months of treatment compared to the control condition (92.3% vs. 26.9%; chi-sq=23.08, df=1, p<.001). Likewise more clients in the experimental condition had a statistically higher mean methadone dose (84mg vs. 69mg; t=2.02, df=50, p=.05).

Implications: Nearly all of the analyses found that clients whose counselors used the NPAP approach were more likely to have improved outcomes. Although some outcomes did not demonstrate statistical significance, many were of clinically importance (e.g., lower days of drug use). Based on these data, the NPAP is a promising approach for social workers, particularly substance abuse counselors to consider as part of a counseling framework. Qualitative interviews found that counselors believed the system to be feasible and pragmatic to use.