What a TOP is for
The Treatment Outcome Profile (TOP) is the standard outcome measure used in England's structured drug and alcohol treatment. It is a short, structured questionnaire completed with the client that captures how they are doing across the areas treatment is meant to improve — substance use, health, crime, and social functioning.
TOP matters for two reasons. Clinically, it gives the keyworker and client a shared, repeatable way to see whether things are getting better or worse over time. For reporting, TOP data flows into NDTMS and is one of the main ways commissioners and OHID, formerly PHE, judge whether services are producing outcomes rather than just activity.
The four domains a TOP measures
A TOP covers four broad domains. The exact wording follows the official form, but in practice keyworkers are recording change across:
- Substance use — the specific substances used and the number of days used over the preceding period.
- Injecting risk — whether the client has injected and whether any equipment was shared.
- Crime — involvement in offending such as shoplifting, selling drugs, or other acquisitive crime over the period.
- Health and social functioning — physical and psychological health, and stability in areas such as housing, work, and relationships.
When a TOP should be completed
TOP is not a one-off assessment. It is designed to be repeated at defined points so that change can be measured against a baseline. The points services work with are:
- Start (baseline) — completed as the client begins a treatment journey, giving the reference point everything else is measured against.
- Review — completed at regular review points during treatment, typically around every six months of continuous treatment.
- Exit (discharge) — completed as the client leaves structured treatment, so the outcome of the episode can be assessed.
Why TOP completion is where services slip
The single most common outcomes problem we see is not bad results — it is missing TOPs. A start TOP that was never recorded, a review TOP that fell due while the keyworker was on leave, or a discharge TOP skipped because the client disengaged all leave gaps in the data.
Incomplete TOP data undermines the service twice over. It weakens the clinical picture for that client, and it depresses the reported outcomes for the whole service because unmatched start and exit TOPs cannot be paired to show change. A service can be doing excellent work and still look weak in the data purely because of TOP completion rates.
Making TOP part of the workflow, not an extra task
TOP completion rates are highest when the form is embedded in the keyworking session rather than treated as separate data entry. If the system prompts the keyworker that a review TOP is due, captures it in the same place as the case note, and links it automatically to the client's episode, completion stops depending on memory.
GreenShoots surfaces due and overdue TOPs against each client, records them alongside case notes, and includes the results in the NDTMS dataset it generates — so an outcome captured in a session is already submission-ready. The clinical judgement stays with your staff; what changes is that nothing quietly falls through the gaps between a session and a submission.
A simple TOP health-check for your service
Run this check with your data lead each quarter:
- What proportion of clients starting treatment have a completed start TOP?
- How many clients in continuous treatment have an overdue review TOP?
- For clients discharged last quarter, how many have a matched start and exit TOP?
- Are any keyworkers or teams consistently below the service average, suggesting a training or workload issue rather than a system one?