Global Appraisal of Individual Needs (GAIN)
Michael L. Dennis, Ph.D.Chestnut Health Systems, Bloomington, IL
The Global Appraisal of Individual Needs or “GAIN”
is actually a series of standardized instruments designed to integrate the assessment for both clinical (e.g.,
diagnosis, bio-psycho-social assessment, placement, and treatment planning) and program evaluation
(needs assessment, clustering, fidelity, outcomes, and benefit cost) purposes.
Objectives
1. Provide an overview of the GAIN’s key features and organization.
2. Highlight some key methodological findings from current adolescent treatment work using the GAIN
3. Briefly demonstrate Capabilities of Computer Applications
Key Features and Organization.
Development and Purpose of the GAIN
• The GAIN family of instruments were developed through a 10 year collaboration of researchers, clinicians, policy makers, and IT specialists
• They provide a standardized approach to measuring: – Eligibility/need (i.e., screening),– DSM/ICD Diagnosis, – ASAM level of care Placement, – Study/State/Federal Reporting, – Treatment Planning, – Severity/Case Mix, – Change in Functioning, Service Utilization, and other
Outcomes, and – Economic Cost and Benefits of treatment.
Methodological Features
• It can be used and has norms available across age groups and level of care,
• It has 103 scales with demonstrated reliability and validity and over 3 dozen scientist doing further research on it,
• It is designed to be modularized so you can use all or parts of it and transfer data (e.g, from screener to full assessment),
• It has a clear training and certification program, has technical assistance/support, and
• It is available at minimal cost.
Administration/Logistical Features• Administration can be done by paper/pencil, by computer, on a
stand alone PC, network, and the web (via other contractors),• HIPPA compliant data base• Data can be transferred to/from multiple MIS systems or other
providers,• Computerized scoring, narrative interpretative reports,
intervention specific reports, validity and re-keying reports are available,
• Has versions (varying in content) that can take from 20 to 120 minutes, and
• It is design for administration by a paraprofessional but so that a range of behavioral, health and other professionals can use/ interpret it with minimal additional questions.
The Progression of Substance Use Problems
• Multiple Problem Clients • Clinical Disorder • Problem Use • Frequent Use• Bingeing • Opportunistic Use • Experimentation • No Use
Severity
Progressive Assessment
• Screening to Identify Who Needs Fully “Assessed”– Focus on brevity, simplicity for administration
• Screening for Targeted Referral – Assessment of who needs crisis or brief intervention (e.g., by SAP,
doctor) vs. more detailed assessment and specialized treatment/referral – Decision rules about where to send may be more complex (e.g.,
substance abuse, mental health, both)• Comprehensive Biopsychosocial
– Used to identify common problems and how they are inter-related– Requires more skill in administration and even more in interpretation
• Specialized Assessment– The bio-psycho-social may identify areas where additional assessment by
a specialist (e.g., psychiatrist, school counselor) may be needed to rule out a diagnosis or develop a treatment plan or individual education plan
• Program Level Assessment– For program management, evaluation and planning
Organization of the core GAIN
A. Administration (including records information, cognitive impairment, calendaring, referral information, general instructions)
B. Background and Treatment Arrangements (demographics, custody, access to care)
S. Substance Use (including treatment readiness, relapse potential, withdrawal, abuse, and dependence, treatment history, content and satisfaction with recent treatment, current medication)
P. Physical Health (including disabilities, current and childhood infectious diseases, allergies, lifetime history, treatment history, current medication)
R. Risk Behaviors and Disease Prevention (including needle and sexual risk behaviors, sexual preference, birth control, tobacco use/dependence, fasting and exercise, testing and prevention classes)
Organization- ContinuedM. Mental Health and Emotions
(including somatic, depressive, suicide risk, anxiety, traumatic distress, ADHD, CD, personality disorder, treatment history, current medication)
E. Environment and Living Situation(including housing, homelessness, public/emergency housing, use in home, controlled environment, children status, living, vocational, and social risk, violence towards others, traumatic victimization, other psycho-social stressors, general social support, spirituality, general satisfaction)
L. Legal (Civil & Criminal) (civil court involvement, illegal activities, status offenses, arrest history, current criminal justice involvement, outstanding warrants and payments)
V. Vocational (School, Work, Financial) (educational attainment/degrees, school problems and involvement, military history, vocational attainment, work problems and involvement, current vocational status, financial problems, pathological gambling, TANF participation, personal and family income, HHS poverty index, drug/alcohol expenses)
Z. End(administrative time, comments, signatures, administrative ratings and methods information, diagnostic impressions, special study information)
Within Section Organization
• Status – Recency (past prevalence)– Breadth (symptom count/covariate)– Current prevalence (days or times)– ASAM or diagnostic check boxes for hand scoring
• Utilization– Lifetime History– Recency– Current utilization
• Cross Item Ratings (substance problems, satisfaction)
• Treatment Planning (urgency, wants)
• Staff Ratings(urgency, denial and misrepresentation)
Alternative Versions
• GAIN-M90 for outcome monitoring interviews• GAIN-CI for collateral initial interview• GAIN-CM for Collateral outcome monitoring interviews• GAIN-Quick for screening, outreach and other areas where
a briefer (10-20 minute) assessment is desired• GAIN-QM for briefer outcome monitoring• Custom specific versions of the above for a given program,
site or study• People currently working on adaptations for Native
Americans, Spanish speakers and American Sign Language
Computer Generated Reports
• Validity reports to identify areas for clarificaiton and potential problems
• Text based Personal Feedback Reports (PFR) to support MET/CBT
• Text based GAIN-Q Referral and Recommendation Summary (GRRS) to support preliminary diagnosis and placement
• Detailed Individual Clinical Profile (ICP) to support more detailed diagnosis, placement, and treatment planning
• Government Performance and Results Act (GPRA) reporting requirements report
• Other site specific reports
GAIN Referral and Recommendation Summary (GRRS)
• General– Computer Generate Text Narrative– Prompts to check or add text– Gives symptoms to support major diagnosis and insurance
claims– Quotes clients
• Presenting Concerns • Five Axis DSM-IV/ICD-9 Diagnoses • Evaluation Procedure • Substance Use Diagnoses and Treatment History • Level of Care and Service Needs by ASAM Placement
Criteria• Summary Recommendations
Detailed Individual Clinical Profile (ICP)
• Five Axis DSM-IV DiagnosisI. Substance use disorders, major depression, generalized anxiety, ADHD, CD,
and pathological gambling to criteria, screening for mood/anxiety disorders, suicide risk, traumatic distress
II. Screening for personality disorders by clusterIII. Lifetime history by ICD-9 area and check for common drug-health interactionsIV. Traumatic victimization, check for major axis IV bio-psycho-social stressors,
and checks for other high-stress eventsV. Past year and Past 90 day staff ratings for GAF, SOFAS, GARF
• ASAM PPC2-R Placement – Text statements on diagnosis– Red flag statements on six dimensions (intoxication/withdrawal, biomedical,
psychological, relapse potential, treatment readiness, environment)– Scale summaries of problems– Current prevalence and utilization summary
Individual Clinical Profile- Continued
• Treatment Planning– Client and staff urgency ratings by section– List of things the client wants– Other things typically required by agency or regulation
• Demographics – Site, staff and client identifiers– Administration information– Demographics– Appearance– Housing situation– Prior treatment – Current involvement in other systems– Staff notes
Training and Quality Assurance Model
• National Training of Trainers and Local Training• Covers administration, scoring, training, quality assurance, data
entry set up• Includes providing feedback on up to four audio tapes• Includes technical assistance installing computer applications• Part of a multi-level certification process with continuing education
credits in substance abuse counseling, social work, probation, and gambling
• Certified trainers are able to train, do quality assurance and certify local staff and have on-going access to technical assistance
• Highest level of trainers certified to help train other agencies/trainers
• Follow-up technical assistance with local MIS person to help set up and administer
Key Methodological Findings
NIAAA/NIDA Other Grantees
CSAT’s Adolescent Treatment Program Grantees and Collaborators
CSATCannabis Youth Treatment (CYT)Adolescent Treatment Model (ATM)Strengthening Communities for Youth (SCY)Adolescent Residential Treatment (ART)Effective Adolescent Treatment (EAT)
Other CSAT Grantees
Other Collaborators
RWJF Reclaiming Futures Program
RWJF Other RWJF Grantees
Test - Retest• We did a test-retest study of the days of use and lifetime marijuana
abuse/dependence symptoms over 48 hours or less with 210 adolescent outpatients in CYT.
• They reported consistent but increasing numbers of– abuse/dependence symptoms (r=.73, 4.6 vs. 5.3 lifetime), – days of marijuana use (r=.74, 31 vs. 34 days) and– days of alcohol use (r=.74, 6 vs. 7 days).
• Lifetime marijuana abuse/dependence symptoms were internally consistent (Cronbach’s alpha=.82).
• Lifetime marijuana dependence diagnosis was consistent though rising in the second interview (Kappa=.55, 40% vs. 44% lifetime dependence).
Validation To Urine Testing
• Higher self reported marijuana use than 573 on-site urine tests (83% vs. 76%), with 5% false negative (kappa=.81)
• Higher self reported marijuana use than 74 quantitative tests (82% vs. 50%), with 3% false negative (kappa=.90)
• Higher self reported rates of other drugs than laboratory urine tests and breathalyzer tests for alcohol
• Currently working on predicting false positives and negatives based on self report, validity checks (creatinine, ph., specific gravity), and time from sample to testing
Validation To Collateral Measures
• Adolescents were more likely than family members or other collaterals to report a greater number of days of any substance use (39 vs. 31 days, t(527)=7.0, p<.001) and cannabis use (37 vs. 30, t(505)=6.0, p<.001) during the past 90 days.
• They reported slightly fewer days of alcohol use (7 vs. 8, t(505)=-2.2, p<.05) and about the same number of abuse/dependence symptoms of abuse/dependence during the past month (2.4 vs. 2.6 of 11 symptoms, t(594)=-1.6, n.s.d.), past year (4.6 vs. 4.6 symptoms, t(594)=0.1 n.s.d.), and lifetime (5.1 vs. 5.2 symptoms, t(594)=-0.9, n.s.d).
• main symptom counts (e.g, internal distress, external distress, conduct disorder, aggression) from the GAIN-CAF and CBCL found that similar scales were correlated around .6
Validation To Blind Psychiatric Diagnosis
• GAIN has also been found to accurately predict diagnoses of co-occurring psychiatric disorders that were made by independent staff blind to GAIN findings including – ADHD (kappa = 1.00), – Mood Disorders (kappa = 0.85), – Conduct Disorder or Oppositional Defiant Disorder
(kappa = 0.82), – Adjustment Disorder (kappa = 0.69), and – No other diagnosis (kappa = 0.91)
Source: Shane, Jasiukaitis, & Green, 2003
55%
67%
84%
29%
12%
48%
34%
50%
65%
38%
16%
51%
35%
66%
30%
31%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
c. Hide Use
d. Complaints
e. Weekly Use
f. Psych Prob.
g. Health Prob.
h. Role Failure
j. Hazardous Use
k. Legal Problems
m. Use Des. L/S Prob
n. Tolerance
p. Withdrawal
q. Loss of Control
r. Unable to Stop
s. Time Consuming
t. Reduced Activities
u. Use Despite PH/MH
Screening Questions (c-e)
Substance Induced Problems (f-g)
Abuse Criteria (h-m)
Dependence Criteria (n-u)(phsyiological, n-p)
Prevalence of Self Reported Past Year Symptoms
84%
67%
66%
65%
55%
51%
50%
48%
38%
35%
34%
31%
30%
29%
16%
12%
0% 20% 40% 60% 80% 100%
e. Weekly Use
d. Complaints
s. Time Consuming
m. Use Des. L/S Prob
c. Hide Use
q. Loss of Control
k. Legal Problems
h. Role Failure
n. Tolerance
r. Unable to Stop
j. Hazardous Use
u. Use Despite PH/MH
t. Reduced Activities
f. Psych Prob.
p. Withdrawal
g. Health Prob.
Additional Screening Questions (c-e)- at low end as expected
Additional Substance Induced Problems (f-g)
- at high end as expected
Abuse Criteria (h-m)- totally overlapswith dependence
Dependence Criteria (n-u)(physiological, n-p)- tolerence only appears in the middle- withdrawal is clearly more severe as expected
Ranked Prevalence of Self Reported Past Year Symptoms
77%
73%
71%
69%
66%
66%
64%
63%
63%
61%
45%
41%
39%
35%
21%
11%
0% 20% 40% 60% 80% 100%
e. Weekly Use
c. Hide Use
m. Use Des. L/S Prob
h. Role Failure
d. Complaints
t. Reduced Activities
f. Psych Prob.
r. Unable to Stop
u. Use Despite PH/MH
s. Time Consuming
k. Legal Problems
j. Hazardous Use
q. Loss of Control
n. Tolerance
p. Withdrawal
g. Health Prob.
Additional Screening Questions (c-e)- at low end as expected
Additional Substance Induced Problems (f-g) - psych problems more common
Abuse Criteria (h-m)- more likely to report role failure
Dependence Criteria (n-u)(physiological, n-p)- tolerence lower in rank, but same prevalence- less likely to report loss of control- twice as likely to reportother dependence symptoms
Ranked Prevalence of Collateral Reported Past Year Symptoms
93%
87%
86%
83%
79%
78%
70%
66%
65%
64%
63%
59%
51%
44%
28%
19%
0% 20% 40% 60% 80% 100%
e. Weekly Use
d. Complaints
m. Use Des. L/S Prob
c. Hide Use
h. Role Failure
s. Time Consuming
t. Reduced Activities
f. Psych Prob.
u. Use Despite PH/MH
r. Unable to Stop
k. Legal Problems
q. Loss of Control
j. Hazardous Use
n. Tolerance
p. Withdrawal
g. Health Prob.
Combining - increases prevalence- averages out order
Additional Substance Induced Problems (f-g) - psych problems more common- health problems rare/severe
Abuse Criteria (h-m)- spread out
Dependence Criteria (n-u)(physiological, n-p)- tolerence/withdrawalARE more severe (but under reported by adolescents)
Ranked Prevalence of Combined Past Year Symptoms
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16Substance Problem Index (Past Year Symptoms)
Cum
ulat
ive
Per
cent
Adolescent (Median 7, IQR 4-10)
Collateral (Median 8, IQR 4-10)
Combined (Median 11, IQR 8-13)
Combining Adolescent and Collateral Symptoms Significantly Increases the Total Number of Symptoms Endorsed
Evaluating the Effects of Treatment
Short Term Outcome Stability Difference between average of
early (3-6) and latter (9-12) follow-up interviews
Treatment OutcomeDifference between intake and average
of all short term follow-ups (3-12)
Long Term Stability Difference between average of short term
follow-ups (3-12) and long term follow-up (30)
Source: Dennis et al, under review, forthcoming
Month
Z-S
core
-0.60
-0.50
-0.40
-0.30
-0.20
-0.10
0.00
0 3 6 9 12
15
18
21
24
27
30
Freq. of Use
Sub. Prob.
Importance of Multiple Measures
Over 98% of CYT treatments completed
Adolescent Recovery Pattern Over 12 Mon.s
Source: Cannabis Youth Treatment (CYT) study
Comparative Clinical Characteristics of 2968 Clients from 61 Treatment Units
Adolescent Inpatient/Therapeutic CommunityAdolescent Outpatient/IOP
Adult Outpatient/IOP/OP Methadone TreatmentAdult Inpatient/Therapeutic Community
Oakland, CA
Shiprock, NMLos Angeles, CAPhoenix/Tempe, AZ
Tucson, AZ
Miami, FLSt. Petersburg, FL
Cantonsville, MDBaltimore, MD
New York, NYChicago, ILPeoria, IL
Maryville, IL
Philadelphia, PABloomington, IL
Farmington, CT
Hypothesized Structure of the GAIN’s Psychopathology Measures
S u b s ta n ce Issu e s In d exS u b s ta n ce A b u se In d exS u b s tan ce D e p e nd e n ce In d ex
S u b s ta nce U se S e ve rity
S o m atic S ym pto m In d exD e p re ss io n S ym p to m In d exH o m ic id a l/S u ic id a l T ho u g h t In d exA n x ie ty S ym p to m In d exT ra u m a tic D is tre ss In d ex
In te rn a l L ife D is tre ss
In a tten tiven e ss In d exH yp e ra c tiv ity -Im p lu s iv ity In d exC o n d u c t D iso rd e r In d ex
E x te rn a l L ife D is tre ss
G e n e ra l C o n flic t T a c tic S ca leP ro p e rty C rim e In d exIn te rp e rso n a l C rim e In d exD ru g C rim e In d ex
V io le n ce , D e lin q u e ncy & C rim e
G e n e ra l P a th o lo g ica l S e ve rity
* Main scales have alpha over .85, subscales over .7
Confirmatory Factor Analysis (CFA)
Comparative Fit Index: .974 Root Mean Square Error of Approximation: 0.079
.60
Internal.27
HSTI
.67
DSI
.77
ASI.47
TSI
.51
External.68
CDI
.83
IAI
.60
HII
.25
Crime/Violence
.55
DCI
.62
ICI
.62
PCI
.39
GCTI
.55
SA Problems.78
SDIY
.51
SAIY
.64
SIIY
.54
SSI
.54
GeneralSeverity
.50
ri
re
rv
rs
.71
.78
.74
.68
.88
.52
.82
.73
.88
.71
.62
.91
.46
.23
.80
.74
.63
.79
.79
Comparative Fit Index: .97 vs .98 Parsimony Ratio: .80 vs .70 CFI x PR: .78 vs .68 Root Mean Square Error of Approximation: .04 vs .04
Invariant vs Variant AcrossAge and Level of Care
Psychometrics
The Hypothesized Psychometric Structure of the
GAIN’s Psychopathology Measures was replicated
across age and level of care subgroups in terms of: • the internal consistency of the measures• convergent and divergent validity of their loading on
the four hypothesized factors• the hypothesized structure plus two additional cross
loadings was confirmed as the best structure• the solution was invariant across age and level of care
General Severity
0%10%20%30%40%50%60%70%80%90%
100%
Low 52% 20% 54% 33%
Medium 33% 34% 26% 30%
High 15% 46% 20% 38%
Adol OP (n=1081)
Adol Resd (n=1127)
Adult OP (n=219)
Adult Resd (n=413)
Substance Problems(abuse, dependence, substance induced problems)
0%10%20%30%40%50%60%70%80%90%
100%
Low 59% 21% 24% 10%
Medium 24% 27% 32% 23%
High 17% 52% 44% 67%
Adol OP Adol Resd Adult OP Adult Resd
Internal Distress (Somatic, Depression, Suicide, Anxiety, Trauma)
0%10%20%30%40%50%60%70%80%90%
100%
Low 55% 28% 40% 19%
Medium 32% 39% 32% 33%
High 13% 33% 28% 48%
Adol OP Adol Resd Adult OP Adult Resd
Behavior Complexity(AD,HD, ADHD, CD)
0%10%20%30%40%50%60%70%80%90%
100%
Low 36% 18% 62% 46%
Medium 38% 31% 20% 19%
High 26% 51% 18% 35%
Adol OP Adol Resd Adult OP Adult Resd
Crime/Violence (property, interpersonal and drug related crime, oral & physical aggression)
0%10%20%30%40%50%60%70%80%90%
100%
Low 40% 22% 70% 56%
Medium 37% 32% 19% 27%
High 23% 46% 11% 17%
Adol OP Adol Resd Adult OP Adult Resd
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Low (n=150) Moderate (n=158) High (n=216)
No Crime
1-2 Crimes3+ Crimes
X2(4)=24.56, p<.001
CVI can predict Criminal Activity 30 Months Latter
Odds of committing 3+ crime 4
times higher
Source: White (2003)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Low (n=150) Moderate (n=158) High (n=216)
No crime
Incarcerated
Substance Use only
Non-violent crime
Violent crimeX2(8)=18.36, p<.05
CVI Predict Type of Crime 30 Months Latter
Odds of committing
violent crime 4.5
times higherSource: White (2003)
Global Appraisal of Individual Needs- Quick (GAIN-Q)
• Designed to identify those in need of referral for a more detailed assessment on substance use and/or mental health problems
• First used in a needs assessment for Macon County (IL) Court Services (Titus & Godley, 2000) -- screening of the adolescent probation population
• Currently being used in SCY, RWJF and several individual projects
Description of the GAIN-QS version 2
• Designed to be a shorter more general assessment for use with indicated populations (e.g., student or employee assistance programs, juvenile or criminal justice) or needs assessment.
• 10 pages in length (9 content, 1 case disposition)• Interviewer- or self-administered in 15 to 20 minutes• Eight sections - Background, General Factors, Sources of Stress,
Physical Health, Emotional Health, Behavioral Health, Substance-Related Issues, End
• First four sections are background and formative indices of factors related to behavioral health problems
• Total score on 99 yes/no items, that are also divided into four scales and 12 subscales
Substance Abuse (SA) and Mental Health (MH) Needs in Adolescent Probation
Neither23%
SA Only3%
MH Only53%
SA+MH21%
Source: Titus & Godley 2001
Quick GAIN IndicesTotal Symptom Severity Index (TSSI – 99 items)General Life Problem Index (GLPI – 50 items)• General Factors Index (GFI- 16 items)• Sources of Stress Index (SOSI - 20 items)• Health Distress Index (HDI – 14 items)Internal Behavior Index (IBI – 17 items)• Depression Symptom Index (DSI-5 items)• Suicide Risk Index (SRI-5 items)• Anxiety Symptom Index (ASI-7 items)External Behavior Index (EBI 16 items)• Attention Deficit/Hyperactivity Disorder Index (ADHDI-6)• Conduct Disorder/Aggression Index (CDAI-6)• General Crime Index (GCI-4)Substance Problems Index (SPI –16 items)• Substance Use & Abuse Index (SUAI-9 items)• Substance Dependence Index (SDI-7 items)
QS Scales by Level of Care
Source: Approximation from ATM data
-0.6
-0.4
-0.2
0.0
0.2
0.4
0.6
QS
dep
ress
ion S
ym
pto
min
dex
QS
Suic
ide R
isk In
dex
QS
Anxie
ty S
ym
pto
m ind
ex
QS
Inte
rnal B
eh
avio
r In
dex
QS
Att
en
tion-H
ypera
ctiv
ity
Dis
ord
er
Ind
ex
QS
Con
duct
Dis
ord
er-
Aggre
ssio
n In
dex
QS
Gen
era
l C
rim
e Ind
ex
QS
Exte
rnal B
eh
avio
r In
dex
QS
Subst
ance
Use
and
Abuse
Su
bst
ance
Depend
en
ce Ind
ex
Su
bst
ance
Pro
ble
m Index
TC (n=288) STR (n=604) OP/IOP (n=513)
QS Scales by Gender
-0.6
-0.4
-0.2
0.0
0.2
0.4
0.6Q
S d
epre
ssio
n S
ym
pto
min
dex
QS S
uic
ide R
isk
Index
QS A
nxie
ty S
ym
pto
m index
QS Inte
rnal B
ehavio
r In
dex
QS A
ttenti
on-H
ypera
ctiv
ity
Dis
ord
er
Index
QS C
onduct
Dis
ord
er-
Aggre
ssio
n Index
QS G
enera
l C
rim
e Index
QS E
xte
rnal B
ehavio
r In
dex
QS S
ubst
ance
Use
and
Abuse
Subst
ance
Dependence
Index
Subst
ance
Pro
ble
m Index
Male (n=935)
Female (n=333)
Source: Approximation from ATM data
Other Features
• HIPAA compliant computer applications for data entry or computer assisted interviewing are in development and testing
• Change be imported into the GAIN for a full assessment
• Has “days” and “times” questions to support analysis of change
• Has service utilization questions Addition of other outcomes, service utilization module, and substance abuse skip out for non users
• Referral and Recommendation Summary Report
• Supplemental “Reasons for Quitting” module and “Personal Feedback Report” to support brief interventions with substance users using MET/CBT5
Key Methodological Work Underway
• ASAM placement recommendations based on expert and statistical models
• Identification of multi-problem clusters or “Code types”• Modeling Change over time in relations to the treatment
hinge and the cycle of relapse, treatment re-entry and recovery
• Propensity score models to predict outcomes and serve as a synthetic “average treatment” comparison group
• Clusters or “Code Type” labels based on above• Economic analysis of costs, cost-effectiveness and benefit
costs
Can be used to Measure Changes in Cost to Society
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
0 3 6 9 12 15 18 21 24 27 30
Months from Intake
UCHC, Farmington, CT (-24%, -44%)
PAR, St. Petersburg, FL (-22%, -49%)
CHS, Madison Co., IL (-8%, -51%)
CHOP, Philadelphia, PA (+18%, -34%)
Source: French et al, 2003
Measuring Improved Adherence to Continuing Care after Residential Treatment
Source: Godley et al 2002ACC * p<.05
0% 10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Weekly Tx Weekly 12 step meetings
Regular urine tests
Contact w/ probation/school
Follow up on referrals*
0% 10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Relapse prevention*
Communication skills training*
Problem solving component*
Meet with parents 1-2x month*
Weekly telephone contact*
Referrals to other services*
Discuss probation/school compliance*
Adherence: Meets 8/12 criteria*
UCC
270180900
1.0
.9
.8
.7
.6
.5
.4
.3
.2
.10.0
Reducing Relapse: Marijuana
Source: Godley et al 2002Days to First Alcohol Use (p<.05)
Per
cent
Rem
aini
ng A
bstin
ent
UCC
ACC
Other Major Methods Studies Underway
• Internal consistency and norms by age and level of care on website already
• Reliability comparisons being done in CYT and ERI• Validation of self reported use to on-site urine and saliva, Emit and
quantitative urine tests, as well as collaterals• Exploratory and confirmatory factor analyses done across studies,
populations and levels of care• Multiple case mix adjustments being tested for comparing programs• Prediction of blind psychiatric diagnosis• Comparison with records in AAP, CYT, ATM• Comparisons with other existing measures (e.g., ARCQ, BAC,
Barclay ADHD scale, CBCL, DIS, DOTS-R, FES, FFS, Form 90, Jessor’s religiosity scale, MMPI, PDQ, RFQ, PPS, Reasons for Quitting, SCIDII, SCL, SM, TLFB, Tolan’s Parenting Practices measure,Tower of Hanoi, TTS, WAI, WISC-R Digit Span) and protocol or study specific measures (e.g., adherence, discharge, follow-up log, service contact logs)
Validity Checks
Currently Available• Staff ratings of understanding, misrepresentation,
appearance/behaviors during assessment, and context• Consistency Reports• Counts of missing/refused items• Out of normative responses on time, key itemsAdditional Scales in the Works• Inconsistency scale• Endorsing rare items (faking bad/general severity)• Not endorsing common items (faking good/a typical
profile)
GAIN/ABS just part of aTrans-Enterprise MIS
Host MIS
MgmtReports
ServiceLogsAppt
Tracking
HostAcctSys
HostLab
SchoolMIS
Welfare
MIS
JJSMIS
Evaluator or Data Manager
GRL, Other Data
AssessmentBuildingSystem:
GAIN, ScreenerAnd Other Measures Cross Site
Evaluation
Contact Information
Michael L. Dennis, Ph.D.
Lighthouse Institute, Chestnut Health Systems
720 West Chestnut, Bloomington, IL 61701
Phone: (309) 827-6026, Fax: (309) 829-4661
E-Mail: [email protected] Website: www.chestnut.org/li/GAIN
GAIN Training Coordinator:
Michelle White at 309-827-6026 or mwhite@chestnut