Always at your service GAIN Related Project Progress Report Michael L. Dennis, Ph.D., Laine Twanow, & Nora Jones, M.S. Chestnut Health Systems, Normal,

Always at your service

GAIN Related Project Progress ReportMichael L. Dennis, Ph.D.,

Laine Twanow, & Nora Jones, M.S.Chestnut Health Systems, Normal, IL

Created for: King County Mental Health,

Chemical Abuse and Dependency Services Division

Presentation at the Mental Health, Chemical Abuse and Dependency Services Division 1st Annual All

Providers’ Meeting, January 27, 2012

2

Detailed Acknowledgements• This presentation was supported by a contract with King County and

includes data from the following agencies: Auburn Youth Resources; Center for Human Services; Therapeutic Health Services; Community Psychiatric Clinic; Consejo Counseling & Referral Service; Friends of Youth; Kent Youth & Family Services; Navos; Ryther Child Center; Seattle Counseling Services for Sexual Minorities; United Indians of All Tribes Foundation; Valley Cities Counseling & Consultation; Washington Asian Pacific Islander Families Against Substance Abuse (WAPIFASA); Youth Eastside Services; Renton Area Youth & Family Services; Sound Mental Health; Asian Counseling & Referral Services; Pioneer Human Services; Snoqualmie Tribe/Raging River Recovery Center; Muckleshoot Tribe; Northshore Youth & Family Services; Integrative Counseling Services; SeaMar Community Heath Centers; Vashon Youth and Family Services; Seattle King County ROSC PPW; and Reclaiming Futures.

• The authors thank these grantees and their study clients for agreeing to share their data

• Any opinions about this data are those of the authors and do not reflect official positions of the government or individual grantees.

3

Goals

• Summarize the King County Data and its implication for program planning by looking at – Baseline characteristics– Correlates of most common problems– Costs to society– Treatment planning needs– Performance measures

• Examine how well King County is doing in terms – data quality– efficiency in terms of time to complete the

interview– Folloeup rates from the first quarter of FY12

4

2011 King County GAIN Data Set

• GAIN Initial (GI) data collected by 18 agencies from 5,602 clients between 7/2008 and12/2011 – Roughly a third from 2011, 2010 and pre 2010

• GAIN Monitoring 90 days (GM90) data collected by 17 agencies from 710 clients between 5/2009 and12/2011– Roughly 78% in 2011

• Grant data collapsed into the agency that collected it

5

2011 KC Data by Agency

Source: 2011 King County Data Set (n=5,507)

Con

sejo

Ther

apeu

tic

Asi

an C

oun.

Nav

os

Aub

urn

Ken

t

CH

S

Vas

hon

Nor

thsh

ore

WA

PIF

AS

A

Com

. Psy

ch

Ren

ton

Are

a

You

th E

ast.

Frie

nds

Inte

grat

ive

Sou

nd M

H

Val

ley

Citi

es

Pio

neer

0

100

200

300

400

500

600

700

800

900

1,000

156

346

305

131

856

357

883

36

129

888

36 21

612

176

343

104

44

179

G A I N -I I nt er vi e w s

6

2011 KC Data Set by Gender


Males 69.7% (n=3,904)

Females 30.3% (n= 1,694)

Other 0.04%

(n= 2)

7

2011 KC Data Set by Age


18 -25 Years 14.3%

(n=802)

Under 15 Years (<15) 17.3%

(n=967)

15-17 Years 57.6%

(n=3,227)

26+ Years 10.8%

(n=606)

8

2011 KC Data Set by Race


Mixed 18.2% (n=1,005)

African American 14.0% (n=777)

Hispanic 13.6%

(n=750)

White 45.4% (n= 2,514)

Other 8.8%

(n=488)

9

2011 KC Data Set by Risk of Homelessness


At Risk 11.9%

(n=658)

Housed 78.5%

(n=4,356)

Group or Institution

2.3% (n=128)

Currently Homeless

7.4% (n=409)

10

2011 KC Data Set by Co-Occurring Disorders


Internalizing Disorders

Only 10.3%

(n=566)

Externalizing Disorders

Only 20.3%

(n=1,112)

Both 28.4%

(n=1,557)

Neither 41.1%

(n=2,253)

11

2011 KC Data Set by Substance Use Severity


Past Year Dependence

47.9% (n=2,616)

No Past Year Use 1.7%

(n=93)

Past Year Use

19.3% (n=1,056)

Past Year Abuse 31.1%

(n=1,699)

12

Any SUD Diag-nosisMarijuana

Alcohol

Amphetamine*

Cocaine

Opiates

Sed/hyp/anx

Hallucinogens

Other drugs

Inhalants

PCP

Tobacco **

0% 20% 40% 60% 80% 100%

79%

32%18%

6%5%

4%

0%

35%

Abuse

Use

No Use

Series5


Substance Use Disorders in Past Year by Major Substances

*n=9,134**Not counted in Any SUD Diagnosis. No abuse available for Tobacco.

13

Pattern of Weekly Use (13+/90 days)

Anything

Cannabis

Alcohol

Opioid

Amphetamines

Other Drugs

Cocaine

Tobacco

Controlled Environment

Any Needle Use*

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

57%

42%

16%

4%

3%

2%

2%

42%

13%

3%


*Not a weekly measure; any in past 90 days

14

Any Past Year Diagnosis

First Use < Age 15

Weekly Use of AOD

3+ Years Use


Any Withdrawal

Prior SA Treatment

Severe Withdrawal

Substance Use Prob-lems*

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

79%

68%

57%

51%

48%

34%

29%

3%

21% 46% 33%

EAST High (6-8) Mod. (3-5)

Substance Use Problems


*Count of 8 items

15

Substance Problem Recognition

Can Give 1+ Reasons to Quit*

Client Believes Need ANY Treatment

Acknowledges Hav-ing an AOD Prob-

lem

0% 20% 40% 60% 80% 100%

88%

61%

26%


16

HIV Risk Scale: Needle Problems

Use a needle to shoot up drugs

Reuse needle you had used before

Let someone else inject you w/ needle

Skip cleaning needle after done

Reuse needle w/o cleaning first

Let use water/cooker/cotton after you

Reuse water/cooker/cotton after

Let someone else use needle

Use needle someone else used

0% 20% 40% 60% 80% 100%

3.4%

2.3%

2.1%

1.7%

1.4%

1.4%

1.1%

1.1%

1.0%


* Mean of 36 items from the next four slides. Intake only.

17

HIV Risk Scale: Sex Risk

Sex in past year

Sex w/o barrier of any kind

Have sex w/you or partner high on AOD

2 or more sex partners in past year

Use AOD to make sex longer or hurt less

Have sex involving anal intercourse

Pain during sex or after sex

Sex with injection drug user

Trade sex for drugs, gifts, or money

Sex w/man who has sex with other men

Sex with someone HIV positive

Use drugs/gifts/money to purchase sex

0% 20% 40% 60% 80% 100%

68%

38%

36%

36%

5%

5%

3%

3%

2%

1%

1.1%

0.8%


* Mean of 36 items. Intake only.

18

HIV Risk Scale: Victimization

Ever hurt by striking/beating

Abused emotionally

Ever attacked w/ gun, knife, other weapon

Ever forced sex acts against your will/anyone

Age of 1st abuse < 18

Any several times or for long time

Was person family member/trusted one

Any with more than one person involved

Were you afraid for your life/injury

People you told not believe you/help you

Result in oral, vaginal, anal sex

Currently worried someone abuse emotionally

Currently worried someone beat/hurt

Currently worried someone attack

Currently worried someone force sex acts

General Victimization Scale*

0% 20% 40% 60% 80% 100%

35%

33%

32%9%

51%

32%

27%

27%

17%

10%

7%

8%6%

5%1%

42% 17% 42%

EAST

High Severity (4-15)

Moderate Severity (1-3)


*Mean of 15 items

19

HIV Risk Scale


Moderate 47%

(n=2,637)

Low 36%

(n=1,992)

High 17%

(n=939)

20

HIV Risk Scale* by Co-Occurring Disorders


* Available at intake only.

Neither(OR=1.0)


Only(OR=3.5)


Only(OR=10.9)

Both(OR=21.5)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

3% 10%25%

40%

Low (0-2)

Moderate (3-9)

High(10-36)

21

HIV Risk Scale* by Substance Use Severity



No Past Year Use(OR=1.0)

Past Year Use

(OR=5.4)

Past Year Abuse

(OR=8.7)


(OR=35.3)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1% 6% 9%

28%

Low (0-2)

Moderate (3-9)

High(10-36)

22

HIV Risk Scale* by Severity of Victimization



Low Severity(OR=1.0)

ModerateSeverity(OR=3.9)

High Severity(OR=226.6)

0%10%20%30%40%50%60%70%80%90%

100%

1%

39%

Low (0-2)

Moderate (3-9)

High(10-36)

23

Homicidal/Suicidal Thoughts

Thought about committing suicide

Thought about killing/hurting someone

Had a plan to commit suicide

Attempted suicide

Gotten gun etc. to carry out plan

Homicidal Suicidal Thought Scale*

0% 20% 40% 60% 80% 100%

11%

8%

4%

3%

3%

3%13%

84%

EAST

High Severity(4-5)


*Mean of 5 itemsSource: 2011 King County Data Set (n=5,509)

24

Para-Suicidal Behavior

Cut, burned, or hurt self on purpose - PY

Cut, burned, or hurt self on purpose - P90 days

Felt can't stop cut, burn, or hurt self - PY

Needed medical attention after cut, burn, or hurt self

Parasuicidal Index *

0% 20% 40% 60% 80% 100%

9%

7%

3%

2%

6% 91%

Series1


*Sum of 4 itemsSource: 2011 King County Data Set (n=1,566)

25

Any Violence or Illegal Activity

Physical Violence

Any Illegal Activity

Any Property Crimes

Other Drug Related Crimes*

Any Interpersonal/ Violent Crime

Lifetime Justice Involvement

1+/90 days In Controlled Envi-ronment

Current Justice involvement

0% 20% 40% 60% 80% 100%

60%

47%

45%

34%

26%

23%

55%

47%

40%

Past Year Violence & Crime


*Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)

26

Type of Crime


*Other crime includes vandalism, possession of stolen goods, forgery, and theft.

Violent Crime22%

Other Crime*

20%

Drug Use only58%

27

Type of Crime by Co-Occurring Disorders

Neither(OR=1.0)


Only(OR=4.4)


Only(OR=1.4)

Both(OR=5.2)

0%10%20%30%40%50%60%70%80%90%

100%

10%

33%13%

37%

Drug Use only

Other Crime*

Violent Crime


28

Type of Crime by Substance Use Severity

No PY Use(OR=1.0)

PY Use(OR=2.3)

PY Abuse(OR=3.7)

PY De-pendence(OR=7.2)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

6% 12% 18%30%

Drug Use only

Other Crime*

Violent Crime


29

Type of Crime by Severity of Victimization


Moderate Severity(OR=3.4)

High Severity(OR=5.0)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

9%26%

34%

Drug Use only

Other Crime*

Violent Crime


30

Intensity of Justice System Involvement


Past year illegal activity/ SA use

48%

Past arrest/JJ/CJ status10%

Other JJ/CJ status15%

Other prob/parole/ detention

11%

On prob/parole 14+ days w/ 1+ drug screens

9%

Drug Court1%

In detention/ jail 14-29 days3%

In detention/ jail 30+ days4%

31

Male Female0%

10%20%30%40%50%60%70%80%90%

100%Past yr illegal activity/SA usePast arrest/JJ/CJ sta-tusOther JJ/CJ statusOther probation, parole, detentionProb/parole 14+ days w/ 1+ drug screensDrug CourtDetention/jail 14-29 daysDetention/jail 30+ days

Intensity of Justice Involvement by Gender


32

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Past yr illegal activ-ity/SA use

Past arrest/JJ/CJ status

Other JJ/CJ status

Other probation, parole, detention

Prob/parole 14+ days w/ 1+ drug screens

Drug Court

Detention/jail 14-29 days

Detention/jail 30+ days

Intensity of Justice Involvement by Age


33

African Ameri-

can

Hispanic Other White Mixed0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Past yr illegal activity/SA use

Past arrest/JJ/CJ sta-tus

Other JJ/CJ status

Other probation, parole, detention

Prob/parole 14+ days w/ 1+ drug screens

Drug Court

Detention/jail 14-29 days

Detention/jail 30+ days

Intensity of Justice Involvement by Race


34

In S

cho

ol

PH

Tx

MH

Tx

At

Wo

rk

Arr

este

d

SA

Tx0%

10%20%30%40%50%60%70%80%90%

100%

74%

43%23% 21% 15% 12%

Never

More than 90 days ago

Past 90 days

Recency of System Involvement


35

Count of Major Clinical Problems at Intake

Cannabis disorder

Alcohol disorder

Other drug disorder

Conduct Disorder

ADHD

Depression

Trauma

Anxiety

Violence/ illegal activity

Victimization

Suicide

Major Clinical Problems*

0% 20% 40% 60% 80% 100%

34%

33%

21%

38%

33%

31%

26%

13%

60%

58%

11%

40% 11% 12% 14% 12% 10%

East

Five to Twelve

Four

Three

Two

One


36

Count of Major Clinical Problems* at Intake by Gender

Male(OR=1.0)

Female(OR=1.6)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

37%48%

None

One

Two

Three

Four

Five to Twelve


37

Count of Major Clinical Problems* at Intake by Age

<15(OR=1.0)

15-17(OR=1.2)

18-25(OR=1.5)

26+(OR=2.5)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

34% 38% 44%56%

None

One

Two

Three

Four

Five to Twelve


38

Count of Major Clinical Problems* at Intake by Race

African American(OR=1.0)

Hispanic(OR=1.0)

Other(OR=1.3)

White(OR=1.6)

Mixed(OR=1.9)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

32% 32% 38% 43% 47%

None

One

Two

Three

Four

Five to Twelve


39

Count of Major Clinical Problems* at Intake by Risk of Homelessness

Housed(OR=1.0)

Group/Inst(OR=1.5)

At Risk of Homelessness

(OR=1.9)

Currently Homeless(OR=4.1)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

36%45% 52%

69%

None

One

Two

Three

Four

Five to Twelve


40

Count of Major Clinical Problems* at Intake by Co-Occurring Disorders

Neither(OR=1.0)


Only(OR=24.7)


Only(OR=34.0)

Both(OR=369.2)

0%10%20%30%40%50%60%70%80%90%

100%

3%

42% 50%

92%

None

One

Two

Three

Four

Five to Twelve


41

Count of Major Clinical Problems* at Intake by Substance Use Severity

No PY Use(OR=1.0)

PY Use(OR=12.6)

PY Abuse(OR=32.0)

PY De-pendence

(OR=159.5)

0%10%20%30%40%50%60%70%80%90%

100%

1%12%

26%

63%

None

One

Two

Three

Four

Five to Twelve


42

Count of Major Clinical Problems* at Intake by Severity of Victimization


Moderate Severity(OR=4.8)

High Severity

(OR=16.0)

0%10%20%30%40%50%60%70%80%90%

100%

12%

40%

69%

None

One

Two

Three

Four

Five to Twelve


43

Count of Major Clinical Problems* at Intake by King County Agency


Consejo

Therap

eutic

Asian

Coun.

Navos

AuburnKen

tCHS

Vashon

Northsh

ore

WAPIF

ASA

Com. P

sych

Rento

n Are

a

Youth E

ast.

Friends

Inte

grativ

e

Sound MH

Valle

y Citi

es

Pionee

r0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

4%

22% 30%

31%

32%

35%

40%

42%

40%

44%

47%

52%

51%

53%

52% 60%

55%

79%

None

One

Two

Three

Four

Five to Twelve

OR=90.3 for most/ least severe

44

Family History of Physical Health Problems


Problems with alcohol use

Problems with drug use

Heart or blood problems

Diabetes

Psychological problems

Other probs or in Tx a lot

Any Family History of Physical Health Problems

0% 20% 40% 60% 80% 100%

63%

50%

48%

48%

40%

32%

86%

45

Recovery Environment - Peers

Social Peers Getting Drunk Weekly+

School/Work Peers Getting Drunk Weekly+

Others at Home Getting Drunk Weekly+

Social Peers Using Drugs

School/Work Peers Using Drugs

Others at Home Using Drugs

0% 20% 40% 60% 80% 100%

50%

42%

30%

66%

56%

26%


46

Recovery Environment - Home

Source: 2011 King County Data Set (5,448)

Family History of Substance Use

Weekly Alcohol Use at Home

Weekly Family Problems

Weekly Drug Use at Home

0% 20% 40% 60% 80% 100%

69%

23%

19%

9%

47

Sources of Stress: Personal

Death of family member/close friend

Health problem of family/friend

Major change in relationships/divorce

Fights with boss/ teacher/coworkers

Other family changes/problems

Birth/adoption of new family member

0% 20% 40% 60% 80% 100%

32%

30%

22%

21%

11%

8%


48

Sources of Stress: Other

Major change/bad housing

Transportation problems

Interruption or loss of house/job/school

Hard work or school schedule

Threat of losing job/house/school/transportation

New job, position, or school

Something you saw

Discrimination in community/work/etc.

Other environmental demands

Sources of Stress Index*

23%

18%

16%

15%

14%

14%

14%

5%

4%

35% 31% 34%

East

High (3-15)

Moderate (1-2)

Source: 2011 King County Data Set (n=1,519)*Sum of 15 items

49

Treatment Readiness

Can get help you need in Tx program

Need to be in Tx for at least a month

Old friends may try to get you drunk/high

A lot of pressure to be in Tx

Need support from friends/ relatives

Being in Tx program too demanding

Too many responsibilities to be in Tx

Be hard to resist AOD where you live

Will need to come back to Tx 1/more times

Treatment Readiness*

56%

34%

34%

31%

31%

30%

27%

16%

13%

30% 59% 12%

East

Low (0-2)

Moderate (3-5)

Source: 2011 King County Data Set (n=5,478)*Sum of 9 items

50

Treatment Readiness by Age

<15(OR=1.0)

15-17(OR=1.2)

18-25(OR=3.2)

26+(OR=12.6)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

20% 22%

44%

75%

High (6-9)

Moderate (3-5)

Low (0-2)


51

Neither(OR=1.0)

Externaliz-ing

Disorders Only

(OR=1.1)


Only(OR=3.0)

Both(OR=2.7)

0%10%20%30%40%50%60%70%80%90%

100%21% 23%

45% 42%High (6-9)

Moderate (3-5)

Low (0-2)

Treatment Readiness by Co-Occurring Disorders


52

No Past Year Use(OR=1.0)

Past Year Use

(OR=16.5)

Past Year Abuse

(OR=20.5)

Past Year Depen-dence

(OR=73.5)

0%10%20%30%40%50%60%70%80%90%

100% 1%15% 18%

45%High (6-9)

Moderate (3-5)

Low (0-2)

Treatment Readiness by Substance Use Severity


53

Individual Strengths

Doing well with close friends

Listening, caring or communicating with others

Problem solving and figuring things out

Doing well at with your family

Doing well at sports, exercise, physical activity

Working or playing with computers

Doing well at school or training

Doing well at music, dancing, acting, other performing art

Drawing, painting, design or other art activities

Doing well at work

Strength Self-Efficacy Index*

0% 20% 40% 60% 80% 100%

86%

78%

72%

70%

67%

61%

50%

49%

44%

28%

8% 46% 46%

EAST

High Problems(2-0)

Moderate Problems(6-3)

*Sum of 10 items


54

Friends to hang out with

Family members/close partners

Someone to talk to about emotions

Someone to help cope with problems

Legal hobby or activity

People at work/school: get assignments

People at work/school: day to day things

Friends/colleagues from other com-panies/schools

Professional counselor/health provider

General Social Support Index*

0% 20% 40% 60% 80% 100%

83%

79%

78%

76%

73%

57%

57%

49%

48%

8% 15% 77%

EAST

High Problems(1-0)

Moderate Problems (4-2)

General Social Support Strengths

*Sum of 9 items


55

Potential Mentors in the Recovery Environment

None involved in illegal activity

Little shouting, arguing or fighting most weeks

Know anyone in treatment

Know anyone in recovery









Environmental Strengths Index*

0% 20% 40% 60% 80% 100%

83%63%

20%14%

77%58%

27%13%

70%50%

33%16%

9% 38% 54%

WEST High Problems (2-0) Moderate Problems (5-3)

Ho

me

Sch

oo

l or

Wo

rkS

oci

al

Pee

rs

*Sum of 12 items

Critical gap in

connection to recovery community


56

Quarterly Cost to Society

Using the GAIN we are able estimate the cost to society of tangible services (e.g., health care utilization, days in detention, probation, parole, days of missed school) in 2010 dollars for the 90 days before intake

Of the 5,602 clients served in 18 sites in 2011, the average Quarterly Cost to Society per client, in the quarter before they entered treatment, was $1,938 and totaled $8,224,406 across clients.

In the year before they entered treatment, they cost society an average of $7,752 per client and a total of $32,897,624 across clients

57

Quarterly Cost to Society – 2010 Dollars

*Quarterly cost to society 2010 dollars w/ SA TX based on French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates and cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35, 462-469.

Description Unit Cost 2010 dollars

Inpatient hospital day Days $ 1,432.81

Emergency room visit Visits $ 269.88

Outpatient clinic/doctor’s office visit Visits $ 76.83

Nights spent in hospital Nights $ 1,432.81

Times gone to emergency room Times $ 269.88

Times seen MD in office or clinic Times $ 76.83

Days bothered by any health problems Days $ 25.63

Days bothered by psych problems Days $ 9.90

How many days in detox Days $ 258.99

Nights in residential for AOD use Nights $ 151.65

Days in Intensive outpatient program for AOD use Days $ 104.19

Times did you go to regular outpatient program Times $ 280.70

Days missed school or training for any reason Days $ 18.38

How many times arrested Times $ 2,125.81

Days on probation Days $ 5.77

Days on parole Days $ 18.59

Days in jail/prison/detention Days $ 81.06

Days detention/jail Days $ 113.60

58


% of Total Dol-lars

($8,224,406; mean=$1,939)

% of Popula-tion (5,602)

0% 20% 40% 60% 80% 100%

48%

4%

35%

24%

17%

72% $10,000+

$2,000 - $9,999

$0-$1,999


59

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

$993$1,459

$2,912

$4,226

$0-$1,999

$2,000 - $9,999

$10,000+

Mean

Quarterly Cost to Society* by Age

Source: 2011 King County Data Set (n=4,241) *Using 2010 Dollars

$3970 $5,837 $11,648 $16,904 <- Annual Cost

60

Housed Group/Inst

At Risk of

Home-lessness

Currently Homeless

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

$1,554

$7,230

$2,842

$4,192

$0-$1,999

$2,000 - $9,999

$10,000+

Mean

Quarterly Cost to Society* by Risk of Homelessness


*Using 2010 Dollars

61

Neither Externaliz-ing

Disorders Only


Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

$1,017$1,515

$3,022$3,347

$0-$1,999

$2,000 - $9,999

$10,000+

Mean

Quarterly Cost to Society* by Co-Occurring Disorders

Source: 2011 King County Data Set (n=4,190)*Using 2010 Dollars

62

No PY Use

PY Use PY Abuse PY De-pen-

dence

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

$614$1,265

$1,179

$2,857

$0-$1,999

$2,000 - $9,999

$10,000+

Mean

Quarterly Cost to Society* by Substance Use Severity

Source: 2011 King County Data Set (n=4,185)*Using 2010 Dollars

63

Quarterly Cost to Society* by Severity of Victimization


*Using 2010 Dollars

Low Severity

Moderate Severity

High Severity

0%10%20%30%40%50%60%70%80%90%

100%

$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000$9,000$10,000

$1,056

$1,716

$3,032

$0 - $1,999

$2,000 - $9,999

$10,000+

Mean

64

Problem Prevalence

Index


Quality of Life Index

General Sat-isfaction Index*,**

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

11% 4%

0.381322957198444 0.56603773584

9057 High Mod

Low Low

Mod High

Cross Validation of Four Summary Indices


Pro

ble

mat

icB

en

efic

ial

*n=8,973**GSI groups are usually reversed (low satisfaction scores (0-2) are in the high problem group); here low satisfaction scores are in the low group, and high satisfaction scores are in the high group.

65

Quality of Life

This index summarizes quality of life represented by fewer reported problems during the past year in school problems, work problems, health problems, sources of stress, risk behavior, internal disorders, external disorders, substance disorders, and crime/violence.

It is calculated as the sum of 9 screeners from the GAIN-Q version 3 (reversed to Low=2, Moderate=1, and High=0) divided by the range (18), and multiplied by 100 to get a score from 0 to 100.

The Quality of Life Index can be interpreted continuously where higher values represent greater quality of life.

It can also be triaged to low (0-36), moderate (37-69) or high (70-100) groups.

66

General Satisfaction Index

This index summarizes life satisfaction in 6 areas (sexual relationship, living situation, family relationships, school/work, free time, and getting help with problems).

It is calculated as the sum of these 6 items The General Satisfaction Index can be interpreted

continuously where higher values represent greater satisfaction with life situations.

It can also be triaged to low problems (5-6), moderate problems (3-4) or high problems (0-2) groups. High satisfaction corresponds to low problems.– For the purposes of this presentation, the groups are not reversed,

such that low satisfaction scores (0-2) are in the low group, and high satisfaction scores (5-6) are in the high group.

67

General Satisfaction Index* by Problem Prevalence Index

General Satisfaction

Problem Prevalence Index*GSI groups are usually reversed (low satisfaction scores (0-2) are in the high problem group); here low satisfaction scores are in the low group, and high satisfaction scores are in the high group.

Low (0-5)

(OR=1.0)

Moderate (6-24)

(OR=5.6)

High (25-100)

(OR=18.1)

0%10%20%30%40%50%60%70%80%90%

100%

45%

33%22%

High (5-6)

Moderate (3-4)

Low (0-2)

Problems are subjectively

unpleasant and are associated

with lower satisfaction


68

Low ($0-$1,999)(OR=1.0)

Moderate ($2,000-$9,999)

(OR=0.5)

High ($10,000+)(OR=0.3)

0%10%20%30%40%50%60%70%80%90%

100%

63%47%

36%

High (5-6)

Moderate (3-4)

Low (0-2)

General Satisfaction Index* by Quarterly Cost to Society



Higher costs are subjectively

unpleasant and are associated with

lower satisfaction

*GSI groups are usually reversed (low satisfaction scores (0-2) are in the high problem group); here low satisfaction scores are in the low group, and high satisfaction scores are in the high group.


69

Low (0-36)

(OR=1.0)

Moderate (37-69)

(OR=2.4)

High (70-100)(OR=6.3)

0%10%20%30%40%50%60%70%80%90%

100%

31%51%

74% High (5-6)

Moderate (3-4)

Low (0-2)

General Satisfaction Index* by Quality of Life


Quality of Life

Quality of life is subjectively

pleasant and is associated with

higher satisfaction

*GSI groups are usually reversed (low satisfaction scores (0-2) are in the high problem group); here low satisfaction scores are in the low group, and high satisfaction scores are in the high group.


70

Treatment Needs and Performance Measures

71

GAIN Treatment Planning/Placement Grid

Problem Recency/Severity

None Past Current (past 90 days)* Low-Mod | High Severity

Treatment History

None Past Current

1. No problem

2. Past problem Consider monitoring and relapse prevention.

3. Low/Moderate problems; Not in treatmentConsider initial or low invasive treatment.

4. Severe problems;Not in treatment Consider a more intensive treatment or intervention strategies.

0. Not LogicalCheck under- standing of problem or lying and recode.

5. No current problems; Currently in treatmentReview for step down or discharge.

6. Low/Moderate problems; Currently in treatment Review need to continue or step up.

7. Severe problems; Currently in treatmentReview need for more intensive or assertive levels.

* Current for Dimension B1 = Past 7 days

72

GAIN Placement Cells by ASAM Dimension

B1.Intoxication/Withdrawal

B2. Biomedical

B3 Psychological/Behavioral

B4. Tx Acceptance/Resistance

B5. Relapse Potential

B6. Environment

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Inconsistent No problemPast Problem Low/Moderate ProblemsHigh Problems No Problems in TreatmentLow/Moderate Problems in Treatment High Problems in Treatment


73

B1. Intoxication/Withdrawal – Common Treatment Planning Needs

Detox/withdrawal services

Meds for non-opioid withdrawal & relapse

Meds for opiate withdrawal & relapse

Monitoring withdrawal & AOD meds compliance

0% 20% 40% 60% 80% 100%

41%

19%

2%

1%


74

B2. Biomedical – Common Treatment Planning Needs

Risky sexual behavior

Tobacco cessation

Compliance with PH meds

Accommodate medical condition*

Meds for physical health problems

ER/hospitalization history

Current Tx for medical problem

Tetanus shot**

0% 20% 40% 60% 80% 100%

70%

49%

28%

21%

19%

16%

15%

10%


*n = 1,552 ** n = 1,262

75

B3. Psychological – Common Treatment Planning Needs

Behavior controlAnger management

Coordinate with justice systemInterpersonal illegal acts

Drug-related illegal activitiesHomicidal/suicidal risk

Current Tx for psych problemsIllegal activities

Current meds for psych problemsArrest history

Civil court*Problems w/ reading & writing

0% 20% 40% 60% 80% 100%

63%45%

41%22%

21%19%18%

17%16%

12%11%8%


*n = 1,528

76

B4.Readiness – Common Treatment Planning Needs

Case management

Any Tx Pressure

Tx required

Partner to understand Tx process

Review expectations for length of Tx

Dissatisfaction with past 90 day Tx*

0% 20% 40% 60% 80% 100%

70%

64%

39%

36%

18%

8%


*n=227

77

B5. Relapse Potential – Common Treatment Planning Needs


Recovery Coach

CC after controlled environment

Significant time in controlled environment

Discuss substance abuse Tx his-tory

0% 20% 40% 60% 80% 100%

69%

16%

13%

2%

78

B6. Environment – Common Treatment Planning Needs

Any school past 90 daysEnvironmental risk

Coping with stress*Need for change**

Child maltreatmentSchool problems

Family fightingOther vocational help

Substance use in the homeFinancial counseling***Employed past 90 days

Housing situationRecent victimization

0% 20% 40% 60% 80% 100%

74%74%

67%66%

58%51%

37%35%

30%22%21%

19%18%


*n=1,473 **n=1,946 ***n=1,531

79

Exploring Efficiency & Health Disparities

– Clients with Mod/High Need is the percent of all clients who at intake had ASAM cell placement of moderate problems; not in treatment (3), Severe problems; not in treatment (4), moderate problems, currently in treatment (6), or Severe problems; currently in treatment (7); divided by the number of all clients..

– Services going to those in high need is the percent of clients receiving a target service who met the above definition of Mod/High Need.

– Need but no treatment is the percent of clients who met the above definition of need who did NOT get the targeted services within 90 days of the intake.

80

Intoxication (at Intake) vs. Detox Treatment at 3 Months

*Current need on ASAM dimension B1 criteria (past 7 days)** ‘Services’ is self-reported receipt of detox treatment at 3 months

Source: 2011 King County Data Set Subset to has 3m Follow up (n=394)

Clients With Mod/High Need* (n=46/394)

Services** Going to Those in Need (n=2/9)

Need but No Service After 3 Months

(n=44/46)

0%10%20%30%40%50%60%70%80%90%

100%

12%22.2%

97%

81

Physical Health Problem (at Intake) vs. Medical Treatment at 3 Months

*Current Need on ASAM dimension B2 criteria (past 90 days)** ‘Services’ is self-report of any days of physical health treatment at 3 months Source: 2011 King County Data Set Subset to has 3m Follow up (n=390)


Services** Going to Those in Need

(n=59/134)


(n=80/139)

0%10%20%30%40%50%60%70%80%90%

100%

36%44.0%

54%

82

Mental Health Problem (at Intake) vs. MH Treatment at 3 Months

*Current Need on ASAM dimension B3 criteria (past 90 days)** ‘Services’ is self-report of any days of mental health treatment at 3 months Source: 2011 King County Data Set Subset to has 3m Follow up (n=394)



(n=108/127)


(n=168/276)

0%10%20%30%40%50%60%70%80%90%

100%

70%

85.0%

61%

83

Relapse Potential (at Intake) vs. Urine/Breathalyzer at 3 months



(n=300/339)


(n=55/355)

0%10%20%30%40%50%60%70%80%90%

100% 90% 88.5%

16%

*Current Need on ASAM dimension B5 criteria (past 90 days)** ‘Services’ is self-reported receipt of one or more breathalyzer or urine test at 3 monthsSource: 2011 King County Data Set Subset to has 3m Follow up (n=396)

84

Recovery Environment (at Intake) vs. Self Help at 3 Months

*Current Need on ASAM dimension B6 criteria (past 90 days)** ‘Services’ is self-report of any days of self-help attendance at 3 months

Source: 2011 King County Data Set Subset to has 3m Follow up (n=387)



(n=122/124)


(n=257/379)

0%10%20%30%40%50%60%70%80%90%

100%

98% 97%68%

85

GAIN Administration Fidelity Index (GAFI)

Max Breaks

Average Denial/ Misrepresentation

Context Effects

Inconsistencies

Administration Dura-tion

Don't Know's in Change Scale Items

Total GAINEdits**

GAFI*

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

100.0%

64.7%

50.2%

84.2%

84.8%

84.2%

66.7%

66.9%28.0%

Low Fidelity

Mod Fidelity

HighFidelity


*Proportional sum of 7 items (n=3,063) **n=3245

86

GAFI – King CountyCompared to CSAT

CSAT(OR=1.0)

KC(OR=1.7)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

33%45%

High Fidelity (80-100%)

Moderate Fidelity (70-79%)

Low Fidelity(0-69%)

CSAT 2010 Summary Analytic Data Set (n=22,122)Sources: 2011 King County Data Set (n=3,063) and

87

GAFI by King County Agency


*Based on count of self reporting criteria to suggest alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal activity

Consejo

Therap

eutic

Asian

Coun.

Navos

AuburnKen

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Vashon

Northsh

ore

WAPIF

ASA

Com. P

sych

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n Are

a

Youth E

ast.

Friends

Inte

grativ

e

Sound MH

Valle

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es

Pionee

r0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

35% 39%53%

18%

67%

47%61%

41%49% 51% 56%

28% 28%

56%

17%25%

11%

High Fidelity (80-100%)

Moderate Fidelity (70-79%)

Low Fidelity(0-69%)

88

Cumulative Distribution of GAIN-IAdministration Time – KC vs CSAT

0 20 40 60 80 100

120

140

160

180

200

220

240

260

280

300

320

340

360

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CSAT

King Co.

Time in Minutes

Sources: 2011 King County Data Set (n=5,507) and CSAT 2010 Summary Analytic Data Set (n=26,207)

Both Have Medians around 90-100 Minutes

89

GAIN-I Admin. Time by Count of Major Clinical Problems* at Intake


Five to Twelve

Four

Three

Two

One

None

0 30 60 90 120 150 180

116

103

97

97

90

89

Time in Minutes*Based on count of self reporting criteria to suggest alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal activity

90

GAIN-I Administration Timeby King County Agency


0

60

120

180

104113

134

97

127

74

99 95

114 10892 94

124 127

103112

143

89

168

M ed ia n Ti m e in

M in ut es

91

Cumulative Distribution of GAIN-M90Administration Time – KC vs CSAT

0 20 40 60 80 100

120

140

160

180

200

220

240

260

280

300

320

340

360

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CSAT

King Co.

Time in Minutes

Sources: 2011 King County Data Set (n=700) and CSAT 2010 Summary Analytic Data Set (n=21,307)

KC faster than CSAT (Medians of 55 vs 95 Min.)

92

GAIN-M90 Administration Timeby King County Agency

Source: 2011 King County Data Set (n=647)

0

60

120

180

240

300

360

78

183

71 59 6541

78 68

119

59

96

50

165

8862

303

220

T i m e i n M i n u t e s

93

Percent of 1st Quarter 2012 Recruitswith 3 Month Follow-up

Source: 2011 King County Data Set (n=407 Q1 recruits, n=40 3-month follow-ups)

KC Tota

l

Consejo

Therap

eutic

Asian

Coun.

Navos

AuburnKen

tCHS

Vashon

Northsh

ore

WAPIF

ASA

Com. P

sych

Rento

n Are

a

Youth E

ast.

Friends

Inte

grativ

e

Sound MH

Valle

y Citi

es

Pionee

r0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10% 8%0%

17%14%11%18%

6% 7%0% 4% 0%

33%

0%

15%

0% 3%

18%

0%

80% Target

Documents

Always at your service GAIN Related Project Progress Report Michael L. Dennis, Ph.D., Laine Twanow, & Nora Jones, M.S. Chestnut Health Systems, Normal,