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: mdennis@chestnut.org Website: www.chestnut.org/li/GAIN

GAIN Training Coordinator:

Michelle White at 309-827-6026 or mwhite@chestnut