Chapter 7 Subset of Overview by Race

Chapter 7Subset of Overview by

Race

GAIN Coordinating Center (11/21/2012).Normal, IL: Chestnut Health Systems. November 2012.

Available from www.gaincc.org/slides

Created for: Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for

Substance Abuse Treatment (CSAT) under contract number 270-2012-00001

http://www.gaincc.org/slides

2

SAMHSA/CSAT Full GAIN Outcome Data Set

Sample: The 2011 SAMHSA/CSAT data set includes data on 29,782 clients from 230 local evaluations, recruited between 1997-2011 who were due for at least one follow-up and available in the last quarterly data set of 2011.

Levels of Care: Outpatient, Intensive Outpatient, Short-term & Moderate/Long-term Residential, Corrections-Based Treatment and Post-Treatment Continuing Care

Instrument: Global Appraisal of Individual Needs (GAIN) (see www.gaincc.org/gaini) Versions 3 (CYT & ATM) and 5.1 through 5.6

Follow-up: 89% with one or more follow-ups at 3, 6, 9 & 12 months post intake, and 66% with two or more

Funding: SAMHSA/CSAT contracts 270-07-0191 and 270-2012-00001 and 230 individual grants

(see Detailed Acknowledgement)

http://www.gaincc.org/gaini

3

Race

Multi-racial 13.4% (n=4,003)

African American 15.8% (n=4,702)

Hispanic 28.7%

(n=8,555)

White 38.1% (n=11,355)

Other 3.9%

(n=1,152)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,767)

4

Risk and Protective Factors by Race The following slides present information on

demographics, and risk and protective factors by different age groups for clients at intake, including: Demographics Substance use Risk behaviors Victimization Mental health disorders Physical health problems Crime and violence Sources of stress and strengths Costs Summary indices (problem prevalence, quality of life, general

satisfaction) Non-client characteristics (program, level of care,

and type of treatment)

5

Age by Race

African Ameri-

can

Hispanic Other White Multi-Racial

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10% 9% 7% 11% 5%

14% 14%12%

13%11%

63% 61% 67%64%

67%

13% 16% 14% 12% 16%

<15

15-17

18-25

26+


6

Gender by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18% 23%32% 33% 32%

82% 77%68% 67% 68% Male

Female


7

7

Risk of Homelessness by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

73% 76% 73% 76% 70%

4% 3% 3% 5% 6%

Currently Homeless

At Risk of Homeless-ness

Group/Inst

Housed


8

Past Year Substance Severity by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

30%

49% 51% 53% 51%

PY De-pendence

PY Abuse

PY Use

No PY Use


9

Primary Substance by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

21% 27%37%

28% 27%

68% 54%46%

49% 56%

Other Drug

Opioids

Amphetamines

Cocaine

Marijuana

Alcohol


10

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%11%

24% 21% 27% 27%High SU (6-8)

Moderate SU (3-5)

Low SU (0-2)

Number of Substance Problems by Race


11

11

Tobacco Diagnosis by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

33%25% 32%

51%41%

Dependence/Daily Use

Current PY Use

Past Use

Never Used


12

HIV Risk Scale* by Race

* Available at intake only.

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%13% 18% 23% 23% 25% High

Risk(10-36)

Moderate Risk(3-9)

Low Risk(0-2)


13

HIV Risk Change Index* by Race

*Can be used to measure change.

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 7% 10% 9% 9% 11%HighRisk(4-7)

ModerateRisk(2-3)

LowRisk(0-1)


14

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

25%16% 10% 12% 16%

3+ Sex Partners

1-2 Sex Partners

No Sex Partners

Number of Sex Partners* by Race

*In the past 90 days


15

Severity of Victimization by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

36%44%

52% 48%55%

High Severity (4-15)

Moderate Severity (1-3)

Low Severity (0)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29486)

16

Mental Health Disorders by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

20%30% 36% 37% 40%

Both

Internalizing Disorders Only

Externalizing Disorders Only

Neither


17

17

Homicidal/Suicidal Thoughts by Race

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 1% 3% 4% 3% 4%

#REF!

#REF!

#REF!


18

Health Problems by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 6% 7% 8% 11% 11%

High Prob-lems(33-100)

Moderate Problems (10-32)

Low Prob-lems(0-9)


19

Health Care Utilization Cost* by Race

African Ameri-

can

His-panic

Other White Multi-Racial

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$1,911

$1,800$1,995

$3,074

$3,402$7,600+

$1 - $7,599

$0

Mean


*Using 2011 Dollars

20

Crime & Violence by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

32% 36% 33% 33%43%

High Crime(7-29)

Moderate Crime (3-6)

Low Crime(0-2)


21

Type of Crime by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

36% 40% 37% 35%45%

Violent Crime*

Other Crime**

Drug Use only


* Violent crime includes assault, rape, murder, and arson.** Other crime includes vandalism, possession of stolen goods, forgery, and theft.

22

Cost of Crime* by Race

*Using 2011 Dollars


African Ameri-

can

His-panic


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000

$800,000

$900,000

$418,864

$852,574

$559,968

$250,470

$665,960 $120,000+

$1-$119,000

$0

Mean

23

African Ameri-

can

His-panic


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Detention/jail 30+ days

Detention/jail 14-29 days

Drug Court

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

Other probation, parole, detention

Other JJ/CJ status

Past arrest/JJ/CJ sta-tus

Past yr illegal activity/SA use

Intensity of Justice System Involvement by Race


24

Count of Major Clinical Problems* at Intake by Race

African American


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

100%

32%43% 51% 52% 55%

Five to Twelve

Four

Three

Two

One

None

*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


25

25

Sources of Stress Index by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

26% 28%38% 44% 46%

High Stress(3-15)

Moderate Stress(1-2)

Low Stress(0)


26

26

Treatment Readiness by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 6% 4% 5% 5% 5%

Low Readiness (0-2)

ModerateReadiness (3-5)

High Readiness (6-9)


27

Self-Help Activities by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

79%86%

72%60%

74%

Low Activity (0)

Moderate Activity (1-11)

High Activ-ity (12-19)


28

28

Strength Self-Efficacy Index by Race

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%10% 11% 6% 6% 5%

Low Strength(0-2)

Moderate Strength (3-6)

High Strength (7-10)


29

29

General Social Support Index by Race

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%10% 10% 5% 4% 4%

Low Support(0-1)

Moderate Support (2-4)

High Support(5-9)


30

Spiritual Social Support by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

41%51% 49%

56% 50%

Low Support (0-2)

Moderate Support (3-5)

High Support (6-7)


31

Environmental Strengths Index by Race

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%7% 6% 10% 9% 8%

Low Strength(0-2)

Moderate Strength (3-5)

High Strength(12-16)


32

AfricanAmeri-

can

His-panic


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

$11,000

$4,298 $4,334 $4,434$5,292

$6,034

$10,000+

$2,000 - $9,999

$0-$1,999

Mean

Quarterly Cost to Society* by Race

*Using 2011 Dollars


33

33

Problem Prevalence Index by Race

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 5% 7% 5% 8% 9%

High Preva-lence(25-100)

Moderate Prevalence (6-24)

Low Preva-lence(0-5)


34

34

Quality of Life by Race

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

19%35% 31% 35%

42%Low Qual-ity (0-36)

Moderate Quality (37-69)

High Quality(70-100)


35

35

General Satisfaction by Race

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%16% 14% 14% 14% 14%

Low Satis-faction(0-2)

Moderate Satisfaction(3-4)

High Satis-faction(5-6)


36

Program by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%ATM

ART

CYT

YORP

ORP

ATDC

SCY

AAFT

DC

EAT

TCE

Other


37

Level of Care by Race

African Ameri-

can


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

67% 72%60%

73% 67%

16%13%

10%

13%10%

7% 6%

5%

7%9%

9% 8%

22%

6% 13%1% 1% 2% 1% 1%

STR

M-LTR

CC-OP

IOP

OP


38

Type of Treatment by Race

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

32% 29% 28%

46%36%

18%13%

7%

8%

8%

30%35%

32%

21%30%

17% 20%

12%

16% 20%

4% 4%

22%9% 5%

Tx Man

Other

ACRA/ACC

Other EBTx

MET/CBT


39

Outcomes The following slides present information on the outcomes of

substance abuse treatment by race, including: Abstinence Recovery GPRA outcomes (vocationally engaged, housed, no justice

system involvement, social consequences, abstinence, and social connectedness) and

NOMS outcomes (treatment initiation, engagement and continuing care; no problems with: health, mental health, family, illegal activity; abstinent, vocationally engaged and housed).

Data on follow up rates, months to last follow up, and number of follow ups per client are provided in the Methods Appendix.

http://gaincc.org/_data/files/Posting_Publications/19._Methods_Appendix_2011.pptx

http://gaincc.org/_data/files/Posting_Publications/19._Methods_Appendix_2011.pptx

40

Percent Change in 6 Month Abstinence by Race

African American

Hispanic Other White Multi-Racial0%

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

100%

23%20% 16% 19% 18%

SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=20,172)

41

Relative Percent Change in 6 Month Abstinence by Race

African American

Hispanic Other White Multi-Racial0%

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

100%

53% 48%

35%

46%39%

SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=20,172)

42

Past Month AOD Abstinence by Race

Intake 3 Month 6 Month 9 Month* 12 Month0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

African American

Hispanic

Other

White

Multi-Racial

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups *Interpolated

43

Recovery* by Race

Intake 3 Month 6 Month 9 Month** 12 Month0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

African American

Hispanic

Other

White

Multi-Racial

* Recovery defined as no past month use, abuse, or dependence symptoms while living in the community. SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups **Interpolated

44

Change in GPRA Outcomes by Race (Intake to Last Wave*)In

take

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

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

100%

Vocationally Engaged

Housing

No Justice Sys-tem Involvement

No Social Consequences

Abstinence

Socially ConnectedAfrican

AmericanHispanic Other White Multi-

Racial*Last wave is the last follow-up

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

45

NOMS Outcome: Number of Treatment Received Outcomes Met* by Race

African American


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

100%

28% 34% 31% 27% 32%

41%39%

36% 41%42%

None

One

Two

Three

Four

*Based on a count of initiation within 14 days, evidence based practice, engagement for at least 6 weeks, and any continuing care.

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=24,611)

46

SAMHSA Outcome: Treatment Cost Bands by Race

African American


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

42% 47% 45%52%

44%

Above

Within

Below


47

Change in Selected NOMS Outcomes by Race (Intake to Last Wave)

African American Hispanic Other White Multi-

Racial*Past month

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%No Health Problems

No Mental Health Prob-lems

No Family Problems

Abstinence

No Illegal Ac-tivity

Vocationally Engaged*

Housed

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

48

NOMS Outcomes: Count of Positive Outcomes (Last FU–Intake) by Race

African American

(74% w/ 1+)

Hispanic(78% w/ 1+)

Other(72% w/ 1+)

White(78% w/ 1+)

Multi-Racial

(77% w/ 1+)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

24% 30% 25% 28% 28%

Less than negative one

Negative one

None

One

Two

Three

Four

Five +


Documents

Chapter 7 Subset of Overview by Race