GLOBAL APPRAISAL OF INDIVIDUAL NEEDS (GAIN): AN INTRODUCTION AND OPPORTUNITY TO ASK QUESTIONS Kate R. Moritz, M.A. & Michael L. Dennis, Ph.D. Chestnut

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…

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

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Chestnut’s GAIN Coordinating Center (GCC)

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

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Designed to Provide a Continuum of Measurement (Common Measures)

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 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

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 GAIN Quick ADI, ASI, SASSI, T-ASI, MINI

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 GAIN Initial (Clinical Core and Full) CASI, A-CASI, MATE

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 CIDI, DISC, KSADS, PDI, SCAN

Scre

ener Q

uick C

om

pre

hensiv

e

Specia

l

More

Exte

nsiv

e / Lo

ng

er/ E

xp

en

sive

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GAIN-SS4-6 mins (OR=1.0)

GAIN-Q325-35 mins (OR=4.1)

GAIN-I 60-120 mins.

(OR=11.7)

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

100%

0

2

4

6

8

10

12

36%70% 87%

2.8

4.5

10.36

0

1

2

3

4+

Mean

% w

ith

0-4

+ p

rob

lem

s

Mea

n o

f 0-

12 p

rob

lem

s

The More you Measure, the More you Find

Source: CSAT 2010 AT Summary Analytic Data Set (n = 17,356)

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Across Instruments the GAIN we have

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 )

http://www.gaincc.org/psychometrics-publications/

http://www.gaincc.org/psychometrics-publications/

http://www.gaincc.org/slides

http://www.gaincc.org/slides

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GAIN ABS Web Application

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 Allows for electronic administration of the GAIN

Includes automated item skips and calculations to reduce administration time

Includes detailed clinical reports that can be generated immediately after an assessment is completed

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GAIN Short Screener (GAIN-SS)

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

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

Reports: Full Report and Summary Report Language: Available in English and Spanish

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The 2 Page GAIN-SS

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GAIN SS Problem Profile

Substance Disorder Screener

External Disorder Screener

Internal Disorder Screener

Crime/Violence Screener

Total Disorder Screener*

Mod/High Problem Count*

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

47%

43%

28%

27%

79%

59%7% 34%

Series4 Mod. (1-2) High (3+)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,660)

* 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)

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Validation of Adolescent Co-Occurring from GAIN SS v. Records

35%

12%

11%

56%

34%

15%

9%

47%

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

100%

Substance AbuseTreatment (n=8,213)

Juvenile Justice(n=2,024)

Mental HealthTreatment (10,937)

Children'sAdministration

(n=239)

GAIN Short Screener Clinical Indicators

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

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/

http://publications.rda.dshs.wa.gov/1392/

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Total Disorder Screener for Adolescents

0%1%2%3%4%5%6%7%8%9%

10%11%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Total Disorder Sceener (TDScr) Score

% w

ith

in L

ev

el

of

Care

Residential (n=1,965)

OP/IOP (n=2,499)

Low

Mod. High ->

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GAIN SS Total Screener Score Predicts Adolescent Level of Care

Source: SAPISP 2009 Data and Dennis et al 2006

Residential Median= 10.5

Outpatient Median=6.0

Few missed (1/2-3%)

About 30% of OP are in the high severity range more typical of residential

About 41% of Residential are below 10 (more likely typical OP)

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The GAIN SS Predicts Recidivism in the Next 12 months

High Mod Low0%

20%

40%

60%

LowMod

High

41%

30%

17%

55%

35%

29%

61%

42%

30%

Crime/Violence Screener (past year at Intake)

An

y Ill

egal

Act

ivit

y(m

on

ths1

-12)

Substance Disorder Screener (past year at Intake)

Source: CSAT 2010 Summary Analytic Dataset (n=20,982)

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GAIN-Q3

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 follow-up

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

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GAIN-Q3 Versions

GAIN-Q3-Lite (19 pages, 20 minutes) – 9 screeners & quality of life measure

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) – Q3-Standard plus reasons & readiness for change to support motivational interviewing/problem solving for each area

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GAIN Q3 Problem Profile (Adolescents)

Risk Behavior Problems Screener

Substance Disorder Screener

External Disorder Screener

School Problems Screener

Internal Disorder Screener

Crime/Violence Screener

Stress Problems Screener

Physical Health Problems Screener

Work Problems Screener

Total Disorder Screener Sx Count*

High or Moderate Problem Count*

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

52%

47%

43%

36%

28%

27%

26%

14%

2%

93%

82%2%16%

Series4 Mod. (1-2) High (3+)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,650)

* 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)

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GAIN Q3 Summary Indices

Problem Prevalence

Index

Quarterly Cost to Society

Quality of Life Index

General Sat-isfaction In-

dex*

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

100% 8% 12%

0.366

0.115Low

Mod

High

High

Mod

Low

Pro

ble

mat

icB

en

efic

ial

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

Source: CSAT 2011 AT Summary Analytic Data Set (n=14,291)

Functional Impairment

Based mostly on Service

Utilization

Based on the

absence of problems

Ratings of satisfaction with several areas of

life

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GAIN-Initial (GAIN-I)

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

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GAIN-I Versions

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

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GAIN-I (continued)

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

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GAIN ABS Reports for GAIN-I

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

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GAIN Data Management Services

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

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GAIN Training Model

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

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GAIN Administration Trainings

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, small-group work, workshops, discussions, and practice and are followed by the same one-on-one coaching

* Also available in person

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GAIN Advanced Trainings

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

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Cultural Considerations

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

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Cultural Considerations (continued)

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..

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Training Staff About Cultural Considerations

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

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Cultural Considerations in Interviewing

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)

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In Practice

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.

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Bottom line

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

AK

AL

ARAZ

CA CO

CT

DE

FL

GA

HI

IA

ID

IL IN

KSKY

LA

MA

MD

ME

MI

MN

MO

MS

MT

NC

ND

NE

NH

NJ

NM

NV

NY

OH

OK

OR

PARI

SC

SD

TN

TX

UTVA

VT

WA

WI

WV

WY

PRVI

GU

40

40

40

40

40

Juvenile Justice System Involvement

14 or more days in detention

16%

On probation or parole 14 or days

with urine screens24%

Juvenile TreatmentDrug Courts

8%

Other justice29%

No current Ju-venile Justice Involvement

23%

Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)

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Other Custody

Single Parent

With Parents

12 to 14 Years Old

15 to 17 Years Old

African American

Mixed/Other

Hispanic*

Caucasian

GLBTQ

Female

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

13%

44%

43%

18%

82%

16%

19%

28%

37%

4%

26%

Demographic Characteristics

*Any Hispanic ethnicity separate from race group

Predominately male, Not-white, age 15 to 17 and from single parent households


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Custody by Justice System Involvement

14+ days in detention (n=3,567)

Prob/parole14+ days w/ 1+ screens

(5,496)

Drug Courts (N=1,808)

Other jus-tice

(n=6,723)

No current JJ

involvement (n=5,239)

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

100%

25%37% 33% 39% 43%

58%52% 54% 49% 44%

17% 11% 13% 12% 13%

Other out of home*

Single parent

With parents**


*Other family, foster care, institution, emancipated, runaway **Includes shared custody, step parents and adopted

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First Use < Age 15

Any Past Year Diagnosis

Weekly Use of AOD

3+ Years Use

Past Year Dependence

Any Lifetime Withdrawal

Prior SA Treatment

Severe Past Week Withdrawal

Count of Problems

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

85%

80%

55%

54%

47%

38%

32%

3%

28% 50% 21%

EAST Low SU (0-2) Moderate SU (3-5)

Substance Use Problems


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Past Year Substance Severity by Justice Involvement



(5,496)

Juvenile Treatment


Other jus-tice

(n=6,723)

No current JJ


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

100%

25%36% 34%

36% 31%

59%48% 50%

41% 45%Dependence

Abuse

Use

No Use


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Victimization Severity

Ever attacked w/weaponEver hurt by beating

Ever abused emotionallyEver forced sex acts

Age of 1st abuse < 18By multiple people

Happened several timesBy family/ trusted one

Victim afraid for life/injuryPeople you told not believe you

Result in oral, vaginal, anal sex Currently worried someone might attack

Currently worried someone might beatCurrently worried re emotionally abuse

Currently worried someone force sex actsCount of Victimization Symptoms

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

39%33%

27%7%

58%30%30%

24%17%

10%10%

8%8%

5%1%

38% 19% 43%

EAST Low Severity (0) Moderate Severity (1-3)


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Severity of Victimization by Justice Involvement



(5,496)

Juvenile Treatment


Other Ju-venile Jus-

tice (n=6,723)

No current JJ involvement

(n=5,239)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

55%46%

38% 37% 42%High Severity (4-15)

Moderate Severity (1-3)

Low Sever-ity (0)


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Co-Occurring Psychiatric Problems

Any Co-Occurring Psychiatric ProblemConduct Disorder

Attention Deficit/Hyperactivity Dis-orderMood Disorder NOS

Traumatic Stress DisorderGeneral Anxiety Disorder

Ever Victimized -physical/ sexual/ emotional

High Severity VictimizationEver Homeless or Runaway

Homicidal/Suicidal Thoughts Any Self Mutilation

Prior Mental Health TreatmentNo. of Psychiatric Diagnoses

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

64%

49%

41%

33%

23%

12%

61%

43%

33%

20%

12%

38%

47% 13% 13% 12% 9% 6%

bar None One Two Three Four


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Past Year Mental Health Disorders

Internalizing Disorders

Only 9.3%

(n=2,770)

Externalizing Disorders

Only 20.6%

(n=6,128)

Internalizing and

ExternalizingDisorders

32.8% (n=9,727)

Neither 37.3%

(n=11,059)


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Mental Health Disorders by Justice Involvement


Prob/pa-role

14+ days w/ 1+ screens

(5,496)

Juvenile Treatment



tice (n=6,723)

No cur. JJ involve-ment

(n=5,239)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

40% 33% 31% 29%38%

Internalizing & Externalizing Disorders

Internalizing Disorders Only

Externalizing Disorders Only

Neither


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50

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50

HIV Risk Behaviors in Past 90 Days

Sexually active

Mulitple Sex partners

Any unprotected Sex

Victimized

Current worries about be-ing victimized

Any needle use

Shared needles

No. of HIV Risk Behaviors

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

63%

30%

26%

19%

17%

2%

0%

52% 39% 8%

East Low Risk (0-1) Moderate Risk (2-3)


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HIV Risk Change by Justice Involvement

14+ days in

detention (n=3,567)

Prob/pa-role

14+ days w/ 1+

screens (5,496)

Juvenile Treatment

Drug Courts

(N=1,808)


tice (n=6,723)


(n=5,239)

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

100%10% 10% 10% 8% 9%

HighRisk(4-7)

Mod-erateRisk(2-3)

LowRisk(0-1)


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Current Risk of Homelessness

At Risk 10.4%

(n=3,073)

Housed 74.7%

(n=22,138)

Group or Institution

10.7% (n=3,174)

Currently Homeless

4.3% (n=1,261)


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Risk of Homelessness by Justice System Involvement



(5,496)

Juvenile Treatment



tice (n=6,723)

No current JJ


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

100%

59%

83% 83% 82% 86%

4% 2% 3% 3% 3%

Currently Homeless

At Risk of Homeless-ness

Group/Inst

Housed


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Tobacco Diagnosis

Past Use 6% (n=1,738)

Current PY Use 36%

(n=9,745)

Dependence or Daily

Use 39%

n=10,547

Never Used 20% (n=5,354)


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Tobacco Diagnosis by Justice System Involvement



(5,496)

Juvenile Treatment



tice (n=6,723)

No cur. JJ involve-

ment (n=5,239)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

27%42%

30% 35% 34% Dependence/Daily Use

Current PY Use

Past Use

Never Used


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Health Care Utilization Cost to Society

Description UnitCost 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.

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Health Care Utilization Cost

% of Total Dollars ($53,808,204; mean=$2,459)

% of Population (21,883)

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

38%

73%

62%

10%18% $0

$1 - $7,599

$7,600+


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Health Care Utilization Cost* by Justice System



(5,496)

Juvenile Treatment



tice (n=6,723)

No cur. JJ involve-

ment (n=5,239)

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$4,500$5,000$5,500

$3,910

$2,729

$1,968 $2,152 $2,149

$7,600+

$1 - $7,599

$0

Mean

*Using 2011 DollarsSource: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents 12-17 (n=22,976)

59

59

59

59

Past Year Crime & Justice Involvement

Any Violence or Illegal Activity

Physical Violence

Any Illegal Activity

Any Property Crimes

Other Drug Related Crimes*

Any Interpersonal/ Violent Crime

Lifetime Justice Involvement

Current Justice involvement

1+/90 days In Controlled Environment

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

81%

68%

65%

49%

45%

44%

86%

74%

50%

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


60

60

60

60

Type of Crime by Justice System Involvement



(5,496)


Other justice (n=6,723)

No current JJ involvement

(n=5,239)

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

100%

62%48% 45% 40%

30% Violent Crime*

Other Crime**

Drug Use only

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


61

61

61

61

Cost of Crime to Society*

Description UnitCost 2011

dollars

Purposely damaged or destroyed property Times $5,095.64

Passed bad checks/forged a prescription/took money from employer 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 Times $11,294.29

Used a weapon, force, or strong-arm methods to get money or things from a person 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 Times $252,450.22

Been involved in the death or murder of another person (including accidents) Times $9,418,450.51

Intentionally set a building, car, or other property on fire Times $22,126.20

*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.

62

62

62

62

Cost of Crime

% of Total Dollars ($6,690,936,987; mean=$321,093)

% of Population (20,838)

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

97%

23%55% 22%

$0 $1 - $119,00 $120,000+


63

63

63

63

Cost of Crime by Justice System Involvement


Prob/pa-role

14+ days w/

1+ screens (5,496)

Juvenile Treatment Drug Courts (N=1,808)


tice (n=6,723)

No cur. JJ involve-

ment (n=5,239)

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$711,445

$338,771$268,744

$232,637$181,117

$120,000+

$1-$119,000

$0

Mean


64

64

64

64

Major Clinical Problems at Intake

Other drug disorder

Cannabis disorder

Alcohol disorder

CD

ADHD

Depression

Trauma

Anxiety

Violence/ illegal activity

Victimization

Suicide

No. of Clinical Problems*

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

41%

37%

24%

43%

38%

35%

25%

15%

78%

64%

11%

5% 9% 12% 14% 13% 47%

East None One Two Three Four


65

65

65

65

No. of Clinical Problems by Justice System Involvement

14+ days in

detention (n=3,567)

Prob/pa-role

14+ days w/ 1+

screens (5,496)

Juvenile Treatment

Drug Courts

(N=1,808)


tice (n=6,723)


(n=5,239)

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

100%

60%50% 44% 42% 45%

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


66

66

66

66

Outcomes: Days of substance use at the Last Wave


Prob/parole 14+ days w/ 1+screens (5,496)


Other Justice (n=6,723)

No current JJ involvement (n=5,239)

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

35%

34%

44%

33%

31%

16%

17%

26%

21%

22%

50%

49%

30%

46%

46%

0 in the past 90 days Reduced 50%+ from intake No change or worse

SAMHSA 2011 GAIN SA Data Set-Adolescents 12-17 subset to 1+ Follow ups

67

67

67

67

Days of Mental Health Problems at Last Wave






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

9%

14%

21%

18%

17%

27%

29%

24%

28%

27%

64%

57%

55%

54%

55%



68

68

68

68

Days of Illegal Activity at Last Wave






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

65%

71%

72%

72%

76%

8%

6%

5%

7%

5%

28%

23%

23%

21%

19%

0 in the past 90 days Reduced 50%+ from intakeNo change or worse


69

69

69

69

Cost of Crime at 3 months

14+ days in detention (n=2,872; Mean change= -$648,046)

Prob/parole 14+ dys/1+DrScrn (n=4,567; M change -$320,668)

Juvenile Treatment Drug Courts (n=1,337; M change= -$214,020)

Other Justice (n=5,530; M change = -$199,451)

No current JJ involvement (n=4,303; M change = -$286,469)

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

68%

72%

69%

75%

77%

18%

14%

16%

12%

11%

13%

14%

15%

13%

12%



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

Need UnmetNeed

AnyService

Untargeted Service

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

100%

70% 70%

0.240.13

High rate of co-occurring mental health problems; large unmet need

*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)

Unmet Need for Mental Health Treatment by 3 Months

Male Female0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

74% 62%

Afr

ican

Am

eric

an

His

pan

ic

Oth

er

Wh

ite

Mu

lti-

raci

al

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

100%

80%84%

72%61%

66%

* p<.05

Gender*Race*

Significantly higher for males


Higher for African Americans &

Hispanics

Unmet Need for Mental Health Treatment by 3 Months

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

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

100%

72% 71%74%

53%

* p<.05

Age*


Higher for adolescents and young adults

73

73

73

73

73

Questions?

• 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]

http://www.chestnut.org/li/posters

mailto:[email protected]



Documents

GLOBAL APPRAISAL OF INDIVIDUAL NEEDS (GAIN): AN INTRODUCTION AND OPPORTUNITY TO ASK QUESTIONS Kate R. Moritz, M.A. & Michael L. Dennis, Ph.D. Chestnut