Treatment Effectiveness Assessment TEA
Treatment Effectiveness Assessment TEA overview
Creator and Context
The Treatment Effectiveness Assessment (TEA) is a four item, patient centred measure of progress in recovery from addiction.
It was developed by Walter Ling, David Farabee and colleagues and published in 2012. Instead of measuring symptoms, it asks the person how their life has changed since starting treatment, which is a deliberately different question.
Presenting Conditions
The TEA covers four domains, each with a single rating and space for the person to write in what has changed:
Substance use, covering drugs, alcohol and tobacco
Health, both physical and emotional
Lifestyle, covering housing, family, employment and relationships
Community, covering obeying the law and being a responsible member of society
Administration
Self report, on paper or verbally, taking a minute or two. Each domain is rated from 1 (none or not much) to 10 (much better). It requires no training and no software.
The anchor is change since treatment began, rather than a fixed recall window.
Desired Audience
Adults in treatment for substance use disorders, including opioid use disorder. It is designed for repeated administration across a treatment episode.
Recovery is not the absence of a substance. It is housing, health, relationships and a life. The TEA measures those four things in about ninety seconds, in the person's own words, which makes it one of the few instruments that patients themselves find worth completing.
Considerations
The items are worded to measure change for the better, so the instrument cannot capture deterioration. Results from a first visit must be interpreted with that in mind.
Test retest reliability only approached the accepted threshold.
Correlations with health related quality of life and severity measures are low. It measures something different from those instruments, which is the point, but it is not a substitute for them.
There are no severity cut offs. It is a change measure.
The key psychometric study was a secondary analysis inside an industry funded trial.
How to score the Treatment Effectiveness Assessment TEA
Conducting the assessment
The person rates each of the four domains from 1 to 10 and writes in specifics for each.
Interpretation
The four domain ratings are summed to give a total from 4 to 40. Higher scores indicate greater improvement.
There are no severity bands. The TEA is a change measure, and the meaningful figure is the minimal important difference, which was estimated at between 4.8 and 8.0 points in a phase 3 opioid use disorder trial, with an anchor based mean of 6.8.
In that trial, mean total scores rose from 25.4 at baseline to 35.0 by the end of the study.
Clinical Considerations
Use the written responses, not just the numbers. The free text is where the clinically useful material sits.
Track change against the person's own baseline, using the minimal important difference rather than reacting to small movements.
Pair it with a symptom or severity measure. The TEA deliberately does not capture deterioration.
Treatment Effectiveness Assessment TEA use cases
Measuring recovery progress in addiction treatment
Patient centred outcome reporting to funders and commissioners
Structuring a review conversation around the four domains that matter to the person
Research in substance use treatment
Category
Drug & Alcohol
Research Summary
Ling, W., Farabee, D., Liepa, D., & Wu, L. T. (2012). The Treatment Effectiveness Assessment (TEA): An efficient, patient centered instrument for evaluating progress in recovery from addiction. Substance Abuse and Rehabilitation, 3, 129 to 136.
Ling, W., Nadipelli, V. R., Solem, C. T., et al. (2019). Measuring recovery in opioid use disorder: Clinical utility and psychometric properties of the Treatment Effectiveness Assessment. Substance Abuse and Rehabilitation, 10, 13 to 21.
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