Evidence-Based Practices for Adolescents

Report
GLOBAL APPRAISAL OF INDIVIDUAL NEEDS
(GAIN): AN INTRODUCTION AND OPPORTUNITY
TO ASK QUESTIONS
Kate R. Moritz, M.A. & Michael L. Dennis, Ph.D.
Chestnut Health Systems, Normal, IL
Presentation at the Reclaiming Futures Leadership Institute, Asheville, NC, May 8, 2013. Supported by the
Reclaiming Futures/Juvenile Drug Court Evaluation under Library of Congress contract no. LCFRD11C0007 to
University of Arizona Southwest Institute for Research on Women, Chestnut Health Systems & Carnevale
Associates The development of this presentation is funded by the Office of Juvenile Justice and Delinquency
Prevention (OJJDP) through an interagency agreement with the Library of Congress – contract number
LCFRD11C0007. The views expressed here are the authors and do not necessarily represent the official policies
of OJJDP or the Library of Congress; nor does mention of trade names, commercial practices, or organizations
imply endorsement by the U.S. Government. Available from www.gaincc.org/presentations.
Goals
1. Give an overview of the different GAIN measures,
why/when they would be each be used and what
the value added would be.
2. Illustrate with real data the diversity in the type and
severity of problems, as well as how they vary by
juvenile justice system involvement.
3. provide an opportunity to ask questions.
GAIN Overview
The Global Appraisal of Individual Needs
(GAIN) is…


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A family of instruments ranging from screening to
quick assessment to full biopsychosocial and
monitoring tools
Designed to integrate clinical and research
assessment
Designed to support clinical decision making at the
individual client level
Designed to support evaluation and planning at the
program level
Designed to support secondary analyses and
comparisons across individuals and programs
Use of the GAIN in the U.S.: 1997-2012
Use of the GAIN in the Canada: 1997-2012
Chestnut’s GAIN Coordinating Center (GCC)
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7
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Chestnut Health Systems is a non-profit behavioral
health care organization in Illinois
Chestnut’s GCC provides the following core services
related to the GAIN family of instruments
 Training,
Quality Assurance , & Certification on the
Instruments, Clinical Interpretation, and using the data for
Program Management and Evaluation
 Web applications and technical support for administration,
clinical decision support, and data transfer to other
electronic medical records or analytic files
 Data cleaning, management, analytic support, technical
reports, and articles
Designed to Provide a Continuum of Measurement
(Common Measures)
8
Quick
Comprehensive Special
More Extensive / Longer/ Expensive
Screener
8

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Screening to Identify Who Needs to be “Assessed” (5-10 min)
 Focus on brevity, simplicity for administration & scoring
 Needs to be adequate for triage and referral


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
GAIN Short Screener for SUD, MH & Crime
ASSIST, AUDIT, CAGE, CRAFT, DAST, MAST for SUD
SCL, HSCL, BSI, CANS for Mental Health
LSI, MAYSI, YLS for Crime


GAIN Quick
ADI, ASI, SASSI, T-ASI, MINI


GAIN Initial (Clinical Core and Full)
CASI, A-CASI, MATE

CIDI, DISC, KSADS, PDI, SCAN
Quick Assessment for Targeted Referral (20-30 min)
 Assessment of who needs a feedback, brief intervention or referral
for more specialized assessment or treatment
 Needs to be adequate for brief intervention
Comprehensive Biopsychosocial (1-2 hours)
 Used to identify common problems and how they are interrelated
 Needs to be adequate for diagnosis, treatment planning and
placement of common problems
Specialized Assessment (additional time per area)
 Additional assessment by a specialist (e.g., psychiatrist, MD, nurse,
spec ed) may be needed to rule out a diagnosis or
develop a treatment plan
The More you Measure, the More you Find
9
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
12
0
10
10.36
8
6
4.5
4
2.8
36%
GAIN-SS
4-6 mins
(OR=1.0)
70%
GAIN-Q3
25-35 mins
(OR=4.1)
87%
GAIN-I
60-120 mins.
(OR=11.7)
Source: CSAT 2010 AT Summary Analytic Data Set (n = 17,356)
2
0
Mean of 0-12 problems
% with 0-4+ problems
9
1
2
3
4+
Mean
Across Instruments the GAIN we have
10
10
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Set up shorter versions use subsets of items from longer measures
and that predict them well
Established a common web-based platform for computer assisted
interviewing, clinical decision support, data entry, and data
management
Cleaned and pooled data to support local evaluation and provide
practice based evidence for norms by age (under 18, 18-25,
26+), gender, and race, and to support secondary analysis by over
4 dozen independent researchers (see
http://www.gaincc.org/psychometrics-publications/)
Published power points for policy makers showing distributions and
cross tabs related to key target populations, clinical outcomes and
costs to society (see http://www.gaincc.org/slides )
GAIN ABS Web Application
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HIPAA-compliant, web-based system hosted by Chestnut
records are accessible from anywhere with an internet connection
 Chestnut handles all maintenance and regularly updates and adds
new functionality

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Allows for electronic administration of the GAIN
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Includes automated item skips and calculations to reduce
administration time
Includes detailed clinical reports that can be generated
immediately after an assessment is completed
GAIN Short Screener (GAIN-SS)
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12
Designed for use in general populations or where there is less control to identify
who has a disorder warranting further assessment or behavioral intervention,
measuring change in the same, and comparing programs
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Administration Time: 5 minutes

Mode: Self or staff administered

Scales: Four screeners used to generate symptom counts for the past month to
measure change, past year to identify current disorders and lifetime to serve as
covariates/validity checks

Internalizing Disorders (somatic, depression, suicide, anxiety, trauma, behavioral disorders)

Externalizing Disorders (ADHD, CD)

Substance Disorders (abuse, dependence)

Crime/Violence Disorders, and

Total Disorder Screener
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Reports: Full Report and Summary Report
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Language: Available in English and Spanish
The 2 Page GAIN-SS
13
13
GAIN SS Problem Profile
14
14
Substance Disorder Screener
47%
External Disorder Screener
43%
Internal Disorder Screener
28%
Crime/Violence Screener
27%
Total Disorder Screener*
Mod/High Problem Count* 7%
0%
* The first summary row is based on
the sum of symptoms (0-20); The
second is based on the areas with 1 or
more symptoms (0-9)
79%
34%
20%
59%
40%
Low (0)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,660)
60%
Mod. (1-2)
80%
100%
High (3+)
Validation of Adolescent Co-Occurring from GAIN SS v. Records
15
Substance Abuse
Treatment (n=8,213)
Juvenile Justice
(n=2,024)
GAIN Short Screener
Mental Health
Treatment (10,937)
Children's
Administration
(n=239)
Clinical Indicators
Source: Lucenko et al. (2009). Report to the Legislature: Co-Occurring Disorders
Among DSHS Clients. Olympia, WA: Department of Social and Health
Services. Retrieved from http://publications.rda.dshs.wa.gov/1392/
9%
11%
15%
12%
34%
35%
56%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
In 5 min, the 2 page GAIN SS predicted a similar rate to
everything found in the clinical record over 2 years and was
the best single source
47%
15
GAIN SS Total Screener Score Predicts Adolescent Level of Care
Total Disorder Screener for Adolescents
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% within Level of Care
16
11%
Lo Mod. High ->
10%
w
9%
8%
7%
6%
5%
4%
3%
2%
1%
0%
0 1 2 3 4 5
Few missed
(1/2-3%)
Outpatient
Median=6.0
Residential (n=1,965)
OP/IOP (n=2,499)
Residential
Median= 10.5
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7
8
9 10 11 12 13 14 15 16 17 18 19 20
Total Disorder Sceener (TDScr) Score
About 41% of Residential are below 10
(more likely typical OP)
Source: SAPISP 2009 Data and Dennis et al 2006
About 30% of OP are in the high severity
range more typical of residential
16
The GAIN SS Predicts Recidivism in the Next 12 months
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17
Any Illegal Activity
(months1-12)
61%
60%
55%
42%
40%
30%
35%
41%
29%
30%
20%
17%
High
Mod
0%
High
Mod
Low
Crime/Violence Screener
(past year at Intake)
Low
Substance
Disorder Screener
(past year at Intake)
Source: CSAT 2010 Summary Analytic Dataset (n=20,982)
GAIN-Q3
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Designed for use in targeted populations for more detailed
screening, for screening in correctional settings or controlled
environment, to support brief intervention, or for referral to
further assessment or behavioral intervention, and for followup
Mode: Generally staff-administered on computer (can be
done on paper or self-administered with proctor)
Response Set: Recency (“the last time” scale), breadth
(lifetime, past year, past 90 days, past month for symptoms
and utilization), and prevalence (past 90 days for behavior
and utilization)
Reports: Individual Clinical Profile, Personalized Feedback
Report, Q3 Recommendation Referral Summary, Validity
Report
GAIN-Q3 Versions
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19
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GAIN-Q3-Lite (19 pages, 20 minutes) –
screeners & quality of life measure
9
GAIN-Q3-Standard (26 pages, 35 minutes) – Q3-Lite
plus days of behavior, utilization/cost and life
satisfaction
GAIN-Q3-MI (34 pages, 45 minutes) –
Q3Standard plus reasons & readiness for change to
support motivational interviewing/problem solving for
each area
GAIN Q3 Problem Profile (Adolescents)
20
20
Risk Behavior Problems Screener
52%
Substance Disorder Screener
47%
External Disorder Screener
43%
School Problems Screener
36%
Internal Disorder Screener
28%
Crime/Violence Screener
27%
Stress Problems Screener
26%
Physical Health Problems Screener
14%
2%
Work Problems Screener
Total Disorder Screener Sx Count*
93%
High or Moderate Problem Count* 2% 16%
0%
* The first summary row is based on the sum of
symptoms (0-20); The second is based on the areas
with 1 or more symptoms (0-9)
20%
Low (0)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,650)
82%
40%
60%
Mod. (1-2)
80%
100%
High (3+)
GAIN Q3 Summary Indices
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8%
12%
12%
Low
Beneficial
37%
Mod
High
High
Problem
Prevalence
Index
Quarterly
Cost to
Society
Quality of
Life Index
General
Satisfaction
Index*
Problematic
100%
21
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Mod
Low
*GSI groups are usually reversed (low satisfaction scores
the high
Based (0-2)
on theare inRatings
of satisfaction
Based mostly on
Functional
problem group); here low satisfaction scores are in the low group, and high
absence of
with several areas of
Service
Impairment
satisfaction scores
are in the high group.
Utilization
problems
Source: CSAT 2011 AT Summary Analytic Data Set (n=14,291)
life
GAIN-Initial (GAIN-I)
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Designed: to provide a standardized biopsychosocial for people
presenting to substance abuse treatment using DSM-IV for diagnostic
impressions and ASAM for placement and needing to meet common
requirements (CARF, JCAHO, insurance,TEDS, Medicaid) for
assessment, diagnosis, placement, treatment planning, accreditation,
performance/outcome monitoring, economic analysis, program
planning,
Mode: Generally staff-administered on computer (can be done on
paper or self-administered with proctor)
Response Set: Breadth (past-year symptom counts for behavior and
lifetime for utilization), recency (48 hours, 3-7 days, 1-4 weeks, 2-3
months, 4-12 months, 1+ years, never), and prevalence (past 90
days); patient and staff ratings
GAIN-I Versions
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GAIN-I Full (113 pages, 1.5 to 2.5 hours) – includes information on
a wide range of life areas including background, substance use,
physical health, risk behaviors and disease prevention, mental and
emotional health, environment and living situation, legal, and
vocational
GAIN-I Core (77 pages, 1 to 2 hours) – covers the same life areas
as the GAIN-I Full, but does not collect information on such topics as
substance use treatment history, peak use of substances other than
alcohol and cannabis in the past 90 days, specific lifetime health
problems, or sources of treatment pressure
GAIN-I Lite (56 pages, 1 hour) – covers the same life areas as the
GAIN-I Core, but does not collect information on such topics as
peak use in the past 90 days for any substances, lifetime arrest
history, some risk behaviors, some victimization, and spirituality
GAIN-I (continued)
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Scales: The GAIN-I has 9 sections (access to care, substance use,
physical health, risk and protective behaviors, mental health,
recovery environment, legal, vocational, and staff ratings) that
include 103 long (alpha over .9) and short (alpha over .7) scales,
summative indices, and over 3,000 created variables to support
clinical decision-making and evaluation.
Interpretation:
 Items can be used individually or to create specific diagnostic or
treatment planning statements
 Items can be summed into scales or indices for each behavior
problem or type of service utilization
 All scales, indices, and selected individual items have
interpretative cut points to facilitate clinical interpretation and
decision making
Examples: Will come back with data in a moment
GAIN ABS Reports for GAIN-I
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Reports:
GAIN Recommendation and Referral Summary: a narrative report
with editing capabilities for clinician to use for initial assessment
summary, diagnosis, placement, and treatment planning
 Individual Clinical Profile: Shows the severity of the client (low,
moderate, high) on key indicators
 Personal Feedback Report: Based on reasons for quitting and
substance use items; used to support Motivational Interviewing and
Motivational Enhancement Therapy
 Validity Report: Identifies potential inconsistencies in a
participant’s responses

GAIN Data Management Services
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26
We also offer data management services to make the
most of your GAIN data
Review your GAIN records for anomalies and return
feedback to help you maintain accuracy of your data
Create and distribute analytic SPSS data files
Create and distribute a Characteristics and Outcomes
Site Profiles report – which includes tables and charts
displaying demographics, substance use patterns,
lifetime severity, crime, risk behaviors, etc.
GAIN Trainings
GAIN Training Model
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Includes training, coaching, monitoring and certifying
staff on the GAIN family of instruments
Provide training on standardized administration
guidelines
Provide advanced training on the assessment to support
diagnosis, treatment planning, and program evaluation
To promote sustainability, provide training on
techniques for training others at the local agency
GAIN Administration Trainings
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GAIN Short Screener Training is generally provided via
self-paced online course available 24 hours/ 7 days a
week*.
GAIN-Q3 Training is generally provided via distance
learning* that includes online coursework, conference calls
and webinars, and one-on-one coaching
GAIN-I training is generally provided via distance
learning or in person that include presentations, smallgroup work, workshops, discussions, and practice and are
followed by the same one-on-one coaching
* Also available in person
GAIN Advanced Trainings
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
GAIN Clinical Interpretation Training is generally provided via
distance or in-person and is designed to learn how to better
clinically interpret and more efficiently edit the results at the
individual levels to support diagnosis, treatment planning and
placement; it includes coursework, discussion, and iterative
feedback on actual clinical reports.
GAIN Program Management and Evaluation Training is
generally provided via distance or in-person and is designed to
learn how to better use data across clients and time to manage
and evaluate programs in a more rigorous and efficient manner;
it includes coursework, review of support materials, discussion,
development and iterative feedback on a management and
evaluation plan
Cultural Considerations with Assessments
Cultural Considerations
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Any assessment can only be as culturally sensitive as the
treatment professionals who uses the tool.
This places the responsibility of cultural sensitivity in
assessment and treatment planning upon the interviewers
and clinicians conducting the assessment and interpreting the
information.
It is important that the individual be assessed in his/or her
primary language (for accuracy and ethical reasons).
Need to consider local dialect and slang terminology that
does not necessarily correspond with the version of the
language used in the assessment
Cultural Considerations (continued)
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33
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

Individuals may not know what comprises assessment or
how it will be used or it may bring up old fears like school
achievement testing anxieties.
Need to establish norms, validity, and real differences in
how people respond to questions by gender, race, age
and/or by clinical groups
The level of acculturation can impact a wide variety of
areas such as choices of social networks, particular
lifestyle and decisions on how to seek help..
Training Staff About Cultural Considerations
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


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
Recognize the power of historical perspective (e.g.,
historical trauma, aculturation)
Appreciate the impact of cultural explanations and
stigmas
Respect cultural variations, expectations, and
communication
Create an atmosphere of cultural safety and
familiarity with pictures, sounds, colors, food and
awareness of customs
Show adaptability, flexibility, and respect
Cultural Considerations in Interviewing
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35
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Adapting location
Providing flexible scheduling
Adjusting for language barriers
Assigning appropriate interviewers
Showing respect
Making culturally sensitive adaptations to questions
Acknowledging historical trauma if it comes up (but
not assuming it applies to everyone in the group)
In Practice
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

If you work with a population with strong cultural
traditions, ask the client about their level of
engagement in traditional culture as this could have a
profound effect on their responses.
The interviewer should make reasonable adaptations
and accommodations while administering the GAIN as
a semi-structured assessment in an effort to optimize
respect, validity, reliability and efficiency with clients of
any cultural background.
Bottom line
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37

Whether you use the GAIN or another assessment, you
owe it to your clients to understand not only their
symptomology/severity, but the cultural context of the
symptoms associated with the individual. Look for
common occurrences, but NEVER assume. You must
continually span for cultural variability.
GAIN-I Results by
Juvenile Justice System Involvement
GAIN Data Collected from 1997 to 2011 on
22,967 Adolescents from 202 Sites
NH
WA
MT
ND
ME
VT
MN
OR
ID
WY
SD
MI
NV
UT
RI
PA
IA
NE
CA
MA
NY
WI
CT
OH
IL
CO
KS
NJ
IN
WV
MO
VA
DE
KY
NC
AZ
OK
NM
AR
GU
SC
MS
TX
AK
MD
TN
AL
GA
LA
FL
HI
PR
VI
Juvenile Justice System Involvement
40
40
No current
Juvenile
Justice
Involvement
23%
Other justice
29%
14 or more
days in
detention
16% On probation
or parole 14
or days with
urine screens
24%
Juvenile
Treatment
Drug Courts
8%
40
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
Demographic Characteristics
41
41
Female
26%
Predominately male,
Not-white, age 15 to
17 and from single
parent households
4%
GLBTQ
37%
Caucasian
29%
Hispanic*
Mixed/Other
19%
African American
16%
15 to 17 Years Old
82%
12 to 14 Years Old
18%
With Parents
43%
Single Parent
44%
Other Custody
13%
0%
20%
40%
60%
80%
*Any Hispanic ethnicity separate from race group
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
100%
Custody by Justice System Involvement
42
100%
42
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
17%
11%
12%
13%
Other out of
home*
52%
58%
25%
13%
37%
54%
49%
33%
39%
44%
Single
parent
43%
With
parents**
14+ days in Prob/parole Drug Courts Other justice No current JJ
detention 14+ days w/ (N=1,808)
(n=6,723) involvement
(n=3,567) 1+ screens
(n=5,239)
(5,496)
*Other family, foster care, institution, emancipated, runaway
**Includes shared custody, step parents and adopted
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
42
Substance Use Problems
43
43
First Use < Age 15
85%
Any Past Year Diagnosis
80%
Weekly Use of AOD
55%
3+ Years Use
54%
Past Year Dependence
47%
Any Lifetime Withdrawal
38%
Prior SA Treatment
32%
Severe Past Week Withdrawal
3%
28%
Count of Problems
0%
Low SU (0-2)
20%
50%
40%
21%
60%
Moderate SU (3-5)
80%
100%
High SU (6-8)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
Past Year Substance Severity by Justice Involvement
44
44
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
59%
48%
50%
41%
Dependence
45%
Abuse
25%
36%
36%
34%
31%
Use
No Use
14+ days in Prob/parole Juvenile Other justice No current JJ
detention 14+ days w/ Treatment (n=6,723) involvement
(n=3,567) 1+ screens Drug Courts
(n=5,239)
(5,496)
(N=1,808)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
44
Victimization Severity
45
Ever attacked w/weapon
Ever hurt by beating
Ever abused emotionally
Ever forced sex acts
Age of 1st abuse < 18
By multiple people
Happened several times
By family/ trusted one
Victim afraid for life/injury
People you told not believe you
Result in oral, vaginal, anal sex
Currently worried someone might attack
Currently worried someone might beat
Currently worried re emotionally abuse
Currently worried someone force sex acts
Count of Victimization Symptoms
39%
33%
27%
45
7%
58%
30%
30%
24%
17%
10%
10%
8%
8%
5%
1%
38%
0%
Low Severity (0)
20%
43%
19%
40%
Moderate Severity (1-3)
60%
80%
100%
High Severity (4-15)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
Severity of Victimization by Justice Involvement
46
100%
46
90%
80%
70%
55%
46%
38%
37%
42%
60%
High
Severity
(4-15)
Moderate
Severity
(1-3)
50%
40%
30%
Low
Severity
(0)
20%
10%
0%
14+ days in Prob/parole
Juvenile
detention 14+ days w/ Treatment
(n=3,567)
1+ screens Drug Courts
(5,496)
(N=1,808)
Other
Juvenile
Justice
(n=6,723)
No current JJ
involvement
(n=5,239)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
Co-Occurring Psychiatric Problems
47
47
Any Co-Occurring Psychiatric…
Conduct Disorder
Attention Deficit/Hyperactivity…
Mood Disorder NOS
Traumatic Stress Disorder
General Anxiety Disorder
Ever Victimized -physical/ sexual/…
High Severity Victimization
Ever Homeless or Runaway
Homicidal/Suicidal Thoughts
Any Self Mutilation
Prior Mental Health Treatment
No. of Psychiatric Diagnoses
64%
49%
41%
33%
23%
12%
61%
43%
33%
20%
12%
38%
0%
None
13%
47%
20%
One
40%
Two
13%
60%
Three
12%
80%
Four
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
9% 6%
100%
Five
Past Year Mental Health Disorders
48
Internalizing
and
Externalizing
Disorders
32.8%
(n=9,727)
48
Internalizing
Disorders
Only
9.3%
(n=2,770)
Neither
37.3%
(n=11,059)
Externalizing
Disorders
Only
20.6%
(n=6,128)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
Mental Health Disorders by Justice Involvement
49
100%
49
90%
80%
40%
33%
31%
29%
38%
70%
Internalizing &
Externalizing
Disorders
Internalizing
Disorders
Only
60%
50%
40%
Externalizing
Disorders
Only
30%
20%
10%
Neither
0%
14+ days in Prob/parole Juvenile
Other
No cur. JJ
detention 14+ days w/ Treatment Juvenile involvement
(n=3,567) 1+ screens Drug Courts
Justice
(n=5,239)
(5,496)
(N=1,808) (n=6,723)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
HIV Risk Behaviors in Past 90 Days
50
50
Sexually active
63%
Mulitple Sex partners
30%
Any unprotected Sex
26%
Victimized
19%
Current worries about being
victimized
17%
Any needle use
2%
Shared needles
0%
No. of HIV Risk Behaviors
52%
0%
Low Risk (0-1)
20%
39%
40%
Moderate Risk (2-3)
60%
8%
80%
High Risk (4-7)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
100%
HIV Risk Change by Justice Involvement
51
100%
51
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
10%
10%
10%
8%
9%
High
Risk
(4-7)
Moderate
Risk
(2-3)
Low
Risk
(0-1)
14+ days in Prob/parole
Juvenile Other Juvenile No cur. JJ
detention 14+ days w/ Treatment
Justice
involvement
(n=3,567) 1+ screens Drug Courts (n=6,723)
(n=5,239)
(5,496)
(N=1,808)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
Current Risk of Homelessness
52
52
Currently
Homeless
4.3%
(n=1,261)
At Risk
10.4%
(n=3,073)
Group or
Institution
10.7%
(n=3,174)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
Housed
74.7%
(n=22,138)
Risk of Homelessness by Justice System Involvement
53
53
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
4%
2%
83%
3%
83%
3%
82%
3%
86%
Currently
Homeless
At Risk of
Homelessness
Group/Inst
59%
Housed
14+ days in Prob/parole Juvenile
detention 14+ days w/ Treatment
(n=3,567) 1+ screens Drug Courts
(5,496)
(N=1,808)
Other
No current JJ
Juvenile involvement
Justice
(n=5,239)
(n=6,723)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
53
Tobacco Diagnosis
54
Dependence or
Daily Use
39%
n=10,547
54
Current PY Use
36%
(n=9,745)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
Never Used
20%
(n=5,354)
Past Use
6%
(n=1,738)
Tobacco Diagnosis by Justice System Involvement
55
100%
55
90%
80%
27%
42%
30%
35%
34%
70%
Dependence/
Daily Use
Current PY
Use
60%
50%
Past Use
40%
30%
20%
Never Used
10%
0%
14+ days in Prob/parole Juvenile
Other
No cur. JJ
detention 14+ days w/ Treatment
Juvenile involvement
(n=3,567) 1+ screens Drug Courts
Justice
(n=5,239)
(5,496)
(N=1,808) (n=6,723)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
55
Health Care Utilization Cost to Society
56
56
Description
Unit
Cost 2011 dollars
Inpatient hospital day
Days
$
2,202.87
Emergency room visit
Visits
$
6,477.04
Outpatient clinic/doctor’s office visit
Visits
$
68.58
Nights spent in hospital
Nights
$
2,202.87
Times gone to emergency room
Times
$
6,477.04
Times seen MD in office or clinic
Times
$
79.77
How many days in detox
Days
$
234.86
Times in ER for AOD use
Times
$
270.51
Nights in residential for AOD use
Nights
$
121.62
Days in Intensive outpatient program for AOD use
Days
$
94.36
Times did you go to regular outpatient program
Times
$
32.50
*Quarterly Health Care Utilization 2011 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.
Health Care Utilization Cost
57
57
$0
% of Population
(21,883)
18%
73%
10%
$1 - $7,599
% of Total Dollars
($53,808,204;
mean=$2,459)
0%
38%
62%
$7,600+
20%
40%
60%
80%
100%
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
Health Care Utilization Cost* by Justice System
58
58
100%
$7,600+ 90%
80%
70%
$1 60%
$7,599
50%
40%
$0
30%
20%
Mean 10%
0%
$3,910
$2,729
$1,968
$2,152
$2,149
14+ days in Prob/parole Juvenile
Other
No cur. JJ
detention 14+ days w/ Treatment Juvenile involvement
(n=3,567) 1+ screens Drug Courts Justice
(n=5,239)
(5,496)
(N=1,808) (n=6,723)
*Using 2011 Dollars
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
$5,500
$5,000
$4,500
$4,000
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
Past Year Crime & Justice Involvement
59
59
Any Violence or Illegal Activity
81%
Physical Violence
68%
Any Illegal Activity
65%
Any Property Crimes
49%
Other Drug Related Crimes*
45%
Any Interpersonal/ Violent Crime
44%
Lifetime Justice Involvement
86%
Current Justice involvement
74%
1+/90 days In Controlled Environment
50%
0%
20%
40%
60%
*Dealing, manufacturing, prostitution, gambling (does not include simple
possession or use)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
80%
100%
Type of Crime by Justice System Involvement
60
100%
60
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
48%
45%
40%
30%
Violent
Crime*
62%
Other
Crime**
Drug Use
only
14+ days in Prob/parole Drug Courts Other justice No current JJ
detention 14+ days w/ (N=1,808)
(n=6,723) involvement
(n=3,567) 1+ screens
(n=5,239)
(5,496)
* Violent crime includes assault, rape, murder, and arson.
**Other crime includes vandalism, possessing stolen goods, forgery and theft.
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
Cost of Crime to Society*
61
Description
Unit
Cost 2011
dollars
Purposely damaged or destroyed property
Passed bad checks/forged a prescription/took money from
employer
Times
$5,095.64
Times
$5,745.70
Taken money/property (not from a store)
Times
$8,360.63
Broken into a house/building to steal
Times
$6,775.32
Taken a car that didn't belong to you
Used a weapon, force, or strong-arm methods to get money or
things from a person
Times
$11,294.29
Times
$44,361.43
Hurt someone badly enough they needed bandages or a doctor
Times
$112,208.95
Made someone have sex with you by force
Been involved in the death or murder of another person
(including accidents)
Times
$252,450.22
Times
$9,418,450.51
Intentionally set a building, car, or other property on fire
Times
$22,126.20
61
*Cost of Crime 2011 dollars w/ SA TX based on McCollister, K. E., French, M. T., & Fang, H. (2010). The
cost of crime to society: New crime-specific estimates for policy and program evaluation. Drug and Alcohol
Dependence, 108(2)(1-2), 98-109.
Cost of Crime
62
62
% of Population
(20,838)
55%
22%
% of Total Dollars
($6,690,936,987;
mean=$321,093)
0%
23%
97%
20%
40%
60%
$0
$1 - $119,00
80%
$120,000+
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
100%
Cost of Crime by Justice System Involvement
63
100%
63
$120,000
+
$1$119,000
90%
$711,445
$700,000
80%
$600,000
70%
$500,000
60%
50%
$0
$800,000
40%
30%
$400,000
$338,771
$268,744
$300,000
$232,637
$181,117
20%
Mean
$100,000
10%
0%
$200,000
14+ days in Prob/parole Juvenile
Other
No cur. JJ
detention 14+ days w/ Treatment Juvenile involvement
(n=3,567) 1+ screens Drug Courts Justice
(n=5,239)
(5,496)
(N=1,808) (n=6,723)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
$0
Major Clinical Problems at Intake
64
64
Other drug disorder
41%
Cannabis disorder
37%
Alcohol disorder
24%
CD
43%
ADHD
38%
Depression
35%
Trauma
25%
Anxiety
15%
Violence/ illegal activity
78%
Victimization
Suicide
64%
11%
No. of Clinical Problems* 5% 9% 12%
0%
None
One
20%
Two
14%
47%
13%
40%
60%
80%
Three
Four
Five to Twelve
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
100%
No. of Clinical Problems by Justice System Involvement
65
65
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
60%
50%
44%
42%
45%
Five to
Twelve
Four
Three
Two
One
None
14+ days in Prob/parole
Juvenile Other Juvenile No cur. JJ
detention 14+ days w/ Treatment
Justice
involvement
(n=3,567)
1+ screens Drug Courts
(n=6,723)
(n=5,239)
(5,496)
(N=1,808)
*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
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)
Outcomes: Days of substance use at the Last Wave
66
66
14+ days in detention
(n=3,567)
35%
16%
50%
Prob/parole 14+ days w/
1+screens (5,496)
34%
17%
49%
Juvenile Treatment Drug
Courts (N=1,808)
44%
26%
30%
Other Justice (n=6,723)
33%
21%
46%
No current JJ involvement
(n=5,239)
31%
22%
46%
0%
0 in the past 90 days
20%
40%
Reduced 50%+ from intake
60%
80%
100%
No change or worse
SAMHSA 2011 GAIN SA Data Set-Adolescents 12-17 subset to 1+ Follow ups
Days of Mental Health Problems at Last Wave
67
67
14+ days in detention
(n=3,567)
Prob/parole 14+ days w/
1+screens (5,496)
9%
27%
14%
64%
29%
57%
Juvenile Treatment Drug
Courts (N=1,808)
21%
24%
55%
Other Justice (n=6,723)
18%
28%
54%
No current JJ involvement
(n=5,239)
17%
27%
55%
0%
0 in the past 90 days
20%
40%
Reduced 50%+ from intake
60%
80%
100%
No change or worse
SAMHSA 2011 GAIN SA Data Set-Adolescents 12-17 subset to 1+ Follow ups
Days of Illegal Activity at Last Wave
68
68
14+ days in detention
(n=3,567)
65%
8%
28%
Prob/parole 14+ days w/
1+screens (5,496)
71%
6%
23%
Juvenile Treatment Drug
Courts (N=1,808)
72%
5%
23%
Other Justice
(n=6,723)
72%
7%
21%
No current JJ involvement
(n=5,239)
76%
0%
0 in the past 90 days
20%
40%
Reduced 50%+ from intake
5%
60%
80%
19%
100%
No change or worse
SAMHSA 2011 GAIN SA Data Set-Adolescents 12-17 subset to 1+ Follow ups
Cost of Crime at 3 months
69
6914+
days in detention (n=2,872;
Mean change= -$648,046)
68%
Prob/parole 14+ dys/1+DrScrn
(n=4,567; M change -$320,668)
18%
72%
Juvenile Treatment Drug Courts
(n=1,337; M change= -$214,020)
13%
14% 14%
69%
16%
15%
Other Justice
(n=5,530; M change = -$199,451)
75%
12% 13%
No current JJ involvement
(n=4,303; M change = -$286,469)
77%
11% 12%
0%
0 in the past 90 days
20%
40%
Reduced 50%+ from intake
60%
80%
100%
No change or worse
SAMHSA 2011 GAIN SA Data Set-Adolescents 12-17 subset to 1+ Follow ups
Mental Health Problem at Intake (need) vs.
Mental Health Treatment by 3 Months
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
High rate of co-occurring mental health
problems; large unmet need
70%
70%
24%
Need
Unmet
Need
Any
Service
*Current Need on ASAM dimension B3 criteria (past 90 days)
** ‘Services’ is self-report of any days of mental health treatment at 3 months
SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=20,433)
13%
Untargeted
Service
Unmet Need for
Mental Health Treatment by 3 Months
Race*
Higher for African
Americans &
Hispanics
100%
Gender*
Significantly
higher for males
90%
80%
70%
80%
60%
84%
66%
72%
30%
Multi-racial
White
Other
Hispanic
50%
40%
61%
African
American
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
74%
62%
20%
10%
0%
* p<.05
SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=14,358)
Male
Female
Unmet Need for
Mental Health Treatment by 3 Months
Age*
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Higher for adolescents
and young adults
72%
71%
74%
53%
<15
15-17
18-26
* p<.05
SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=14,358)
26+
Questions?
73
73
• Poster available from www.chestnut.org\li\posters
• For questions about this presentation, please contact us at Kate
Moritz at 309-451-7831 / [email protected] or Michael
Dennis at 309-451-7801 / [email protected]
• For questions on the National Cross-Site Evaluation, contact
Monica Davis, Evaluation Coordinator at 520-295-9339 x211 or
[email protected]
73

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