Current motivational assessment instruments measure clients' attributions about their readiness to change problem behaviors. Motivation for change is typically characterized as a uni-dimensional construct, represented either by a single summative score, or by a profile of scores on scales that are believed to measure a progressive sequence of motivational stages. Although yielding important information, these data do not indicate why a particular client may be motivated for treatment, nor do they suggest how the treatment provider might maintain or improve upon the client's motivational state. Presumably, readiness to change is precipitated by specific events or pressures that impinge on a client as a result of substance abuse. These pressures may be characterized along dimensions (i.e., """"""""negative"""""""" vs. """"""""positive,"""""""" """"""""internal"""""""" vs. """"""""external""""""""""""""""), and they emanate from various biopsychosocial domains (e.g., legal, familial, financial, medical). A multi-dimensional assessment of these treatment- entry pressures would yield important information about a client's motivational state, and might suggest specific strategies for engaging and retaining the client in treatment. We defined the content domain of treatment-entry pressures by interviewing over 500 clients in diverse substance abuse treatment programs about their reasons for entering treatment. We performed a systematic content analysis of subjects' interview responses, and used these response to devise items for a standardized instrument, the """"""""Survey of Treatment-Entry Pressures"""""""" (STEP). An expert panel on test construction reviewed the items for clarity and placed them into preliminary scales according to our clearly articulated theory about the important dimensions of treatment-entry pressures. The goals of the proposed studies are to evaluate the test-retest reliability, internal consistency, factor structure, and external validity of this instrument in methadone maintenance, intensive outpatient, standard outpatient, residential, correctional, and welfare samples. The STEP is intended to fill a gap between instruments that measure functional impairment from substance abuse (e.g., the ASI), and those that measure clients' attitudes about the need for change (e.g., the URICA or SOCRATES). By connecting specific conditions in a clients life to his or her desire for change, the STEP will provide important information to clinicians and researchers about the elements and determinants of motivation.
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