WHAT IS THE DENS SOFTWARE?
Drug Evaluation Network System (DENS)
Software Overview
The DENS Suite is a software program built with substance abuse treatment providers in mind. It automates collection of Addiction Severity Index (ASI) data through an intuitive, time-saving interface used by counselors at treatment facilities. The software takes very little time to learn and has a host of benefits unavailable to states and/or programs currently using paper and pencil instruments. Below is a more detailed description of these benefits.
1. Comprehensive intake assessment
The DENS Suite is a vehicle for the collection of the ASI (the most widely used substance abuse assessment instrument in the world). Mandated by several state governments as well as the Veteran’s Administration, it is a standardized, semi-structured, multi-focused screening and assessment tool collecting client information in seven (7) different areas (General Information, Medical, Employment, Alcohol/Drug, Legal, Family/Social, & Psychiatric). Every question on a normal ASI form is included in the software, which uses the same semi-structured format as the original instrument to ensure questions are posed in the order intended. Less personally sensitive questions are asked toward the beginning, with more invasive items and sections appearing toward the end. This allows a counselor to build rapport before posing questions regarding intimate details to their clients.
2. Advanced functionality with little or no learning curve
The software was
designed to be as easy to use as possible, especially for those with little or
no previous experience with computers. All major functions are accessed through
point-and-click button pressing, and all frequently used buttons have graphics
on them as a visual aid. In addition, there are no menus, or “options” screens
to configure. After a brief initial installation and registration process
(completed either by TRI or your staff), every aspect of the DENS Suite is
configured and available for immediate use by counselors, who can perform all
software functions without the need to memorize commands or complex procedures.
On-screen help is present at all times (for both software functions and the ASI
instrument), and there is room within the title bar of the program to enter a
telephone number users may call should they require further assistance.
DENS software training is normally an inherent part of the TRI ASI training
protocol. We have found consistently that even those with the most elementary
level of computer literacy feel comfortable using the DENS Suite once they are
properly trained and have briefly practiced using the software.
3. Coding,
Crosschecks, & Defaults
The DENS Suite contains a significant number of embedded quality assurance
measures to assure the data collected are as accurate as possible. Most visible
among these is a series of Crosschecks and Automatic Defaults within the ASI
portion of the software.
Sample Crosscheck based on codes: Drug & Alcohol section – If a counselor codes
a client with more days “drinking to intoxication” than number of day drinking
at all, a pop-up message will appear warning the counselor that this is not
possible, and prompting them to recode one response or the other. Additionally,
if the clinician enters 30 days of both alcohol and heroin use but enters 0 days
of using more than one substance, the computer will remind the user that the
client used both alcohol and heroin every day and the days of using more than
one substance should be 30.
Sample Crosscheck based on client age: Drug and Alcohol Section – If the
client’s age is 25 (as entered in the demographic section) and the counselor
enters 25 years of drinking regularly, a warning will appear reminding the
counselor of the client’s age and prompting them to code for the number of years
the client drank on a “regular basis” (a few times a week or more). The
counselor will be directed to go back to the question on years of alcohol use
and enter a new code.
Sample Default: Legal Section – If a counselor codes a client as not awaiting
trial or sentencing for any criminal charges, the software will automatically
code the next item (asking for the specific charge for which they are awaiting
trial or sentencing) as “not applicable”.
Crosschecks and Defaults guard against contradictory responses throughout the
course of a client’s intake assessment, and ensure the counselor is coding
consistently according to standardized ASI conventions. In addition to these
safeguards, each text field within the DENS Suite is set to accept only a
particular set of characters as a response (i.e. a “how many days in the past
30” question will only accept a numerical answer between 0-30). This feature
guards against typographical errors, and ensures the counselor is attuned to the
specific information being requested for each question.
4. Hints & Comments
Each ASI item within the DENS software is displayed along with a “hint” at the
bottom of the screen. These hints provide additional information on the intent
of the item, any special coding rules, and recommended additional probes to
provide clinicians with more detailed information. The content of the hints box
changes each time the counselor clicks on a new item within the ASI, assuring
that the display is always relevant to the question being asked.
Also included in the software is a text box for entering comments. This is
available for each item on the ASI, and allows the counselor to enter additional
information to the assessment above and beyond the standard ASI questions. The
content of the comments box refreshes as the counselor moves from item to item
(similar to the hints), and all comments are automatically integrated in logical
sequence within the ASI Print-out and Narrative Summary alongside their related
items.
5. Automated Reports
(client-level & aggregate)
The DENS Suite produces two types of reports, client-level and aggregate level
reports. Client-level reports are summaries of an individual case, and are
available in three formats. These are useful in printing a question and answer
version of the ASI, for treatment planning, and in creating a narrative
biopsychosocial report of the client’s case. Aggregate reports provide a
comparison between 2 groups (criminal justice involved clients vs. those not
involved in the criminal justice system) and summarize all of the cases on a
particular computer. These aggregate reports are typically used for tracking
trends in a client population, performing program evaluation, submitting
responses to data requests, and preparing applications for grant funding.
Client-level Reports
a. ASI Print-out
This report lists all questions in the ASI along with the client's
responses. Each comment entered by the counselor related to a
specific question appears in the text following the response to those
items.b. Narrative Summary
The narrative is a 10-14 page report suitable for use as an intake
summary. It converts the client’s ASI responses into plain English
sentences, in effect “telling the story” of the client’s intake interview. As
with the ASI Print-out, any interviewer comments are automatically
inserted within the narrative following the question item to which they
refer. This allows the report to be customized for each client, allowing
reporting of information observed but not necessarily collected through
the ASI. Many facilities involved in the DENS research study use this
stand-alone report as their biopsychosocial assessment.c. Treatment Care Plan Problem List
This is a list of potential problem statements derived from items on the
ASI to which the client responds above or below a certain threshold.
The statements include such details as “The client reports lifetime,
regular use of heroin,” or “The client is troubled by psychological or
emotional problems and is interested in treatment.” Included with this
report is a blank treatment care plan template, used by counselors to
construct a full treatment plan based on the provided problem list.d. Treatment Care Planning (Coming Soon!)
Currently being tested is a new software programs (also public domain)
that includes a full treatment care planning module. This module will
allow the clinician to select from a list of possible Problem Statements
in each section (drug section, employment section, etc.), some of which
will be que’d by the DENS ASI data entered for that client. There will
also be space for clinicians to enter their own problems statements.
Following selection of a Problem Statement, a list of GOALS matched
to that problem statement will appear. The clinician can either select
from these GOALS or insert their own goal. The procedures are the
same for the next 2 levels of treatment planning – selecting
OBJECTIVES and INTERVENTIONS. All statements are linked based
on the previous coding and in every situation, there is the capacity for
the counselors to enter problem statements, goals, objectives and
interventions of their own. Testing of this software should be completed
by April 2005.Aggregate Reports
These reports summarize the entire database on a particular computer, providing an overall look at the clients. They compare each of the following pairs of groups to each other, listing averages for nearly all items included on the ASI.
a. Male vs. Female
b. Last Year vs. This Year
c. Welfare vs. Non-Welfare
d. Criminal Justice System (CJS) vs. Non-CJS
6. Additional
Questions (For agencies that will be collecting data on their own SQL server
from a group of distinct treatment programs
In addition to providing an electronic means of collecting ASI data, the DENS Suite has the capability of incorporating additional questions of current interest. Up to five additional questions can be inserted into each section of the ASI. With the proper training, adding additional questions to the software is a relatively simple process for IT staff. The questions will be automatically loaded onto each remote site computer the next time those machines connect to the server to transmit ASI data. The result is a system allowing an agency to quickly gather new information from their sites without needing to budget large amounts of time and funding to distribute and collect data from an addendum to a pre-existing instrument.
7. Security
Several security
features are built into the software to guard against client information being
accessed by an unauthorized party. The entire client database is password
protected, making it difficult for someone to simply copy the file from a
facility computer and view it outside the DENS software environment. Within the
software itself, there is a password protected login screen, preventing access
by anyone other than users sanctioned by a treatment program. Further, when
adding usernames to the software a system administrator can decide whether or
not to grant new users “administrative access,” which gives them permission to
add and delete users themselves. This feature helps administrators limit access
(if desired) to only those counselors who have passed the required ASI
competency measures.
Another security feature embedded in the DENS software protects a treatment
facility from transferring identifying information about their clients to TRI
via modem or the internet. When data is exported, the software automatically
strips the database of any and all client identifying information. This feature
qualifies DENS for HIPAA-compliant status, and protects the security of client
information within the specific computer used to collect their ASI.
8. Training & Competency
Although the software is very user-friendly, it is important to ensure that counselors using the ASI and its software are competent and comfortable with its operation before they attempt to utilize it for a client assessment. To this end, there is a “practice” section within the software program that allows counselors to complete mock interviews just as they would if a client were present. The screens in this portion of the software function identically to the normal ASI screens, but the data entered is only stored temporarily, and in a separate database location than real client data. Counselors can do as many practice ASIs as they want, and TRI offers a series of competency measures should an organization wish its staff to become officially certified by the developers of the ASI and DENS.
9. Administrative Functions
In the administrative portion of the software, users will find all the tools necessary to maintain the software and manage their data. Here, counselors can backup their client database so no data is lost in the event of a computer malfunction. They can also use these screens to transmit their non-identifying data, or export it to a floppy disk for manual transmission (e.g. e-mail or the postal service). Aggregate reports (discussed above) are generated from the administrative area of the DENS Suite, and counselors can batch print multiple client narrative summaries from here as well. In addition to being able to print several narratives at once, counselors can use the batch printing feature to customize the order in which ASI sections appear within the narrative report. This feature is useful for facilities that report to a specific agency requesting only certain information about clients (e.g. a court system only interested in Legal & Alcohol/Drug data).
10. DENS Data Software
Available along with the DENS Suite intake software is a program called DENS Data, which allows a facility to export its client database to a statistical analysis package such as SPSS or SAS. The program can also convert a DENS database to Microsoft Excel spreadsheets. DENS Data is a useful utility for performing more advanced analyses on your site’s data than the DENS Suite software is capable of completing on its own. Further, if you have more than one computer at your site running DENS, this data export utility offers a method of merging the data from several machines into one database, allowing you to get an overall picture of your site’s clientele.