GAIN Related Project Progress Report
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GAIN Related Project Progress Report Michael L. Dennis, Ph.D., Laine Twanow, & Nora Jones, M.S. Chestnut Health Systems, Normal, IL. Created for : King County Mental Health, Chemical Abuse and Dependency Services Division.

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Created for king county mental health chemical abuse and dependency services division

GAIN Related Project Progress ReportMichael L. Dennis, Ph.D., Laine Twanow, & Nora Jones, M.S.Chestnut Health Systems, Normal, IL

Created for: King County Mental Health,

Chemical Abuse and Dependency Services Division

Presentation at the Mental Health, Chemical Abuse and Dependency Services Division 1st Annual All Providers’ Meeting, January 27, 2012


Detailed acknowledgements

Detailed Acknowledgements

This presentation was supported by a contract with King County and includes data from the following agencies: Auburn Youth Resources; Center for Human Services; Therapeutic Health Services; Community Psychiatric Clinic; ConsejoCounseling & Referral Service; Friends of Youth; Kent Youth & Family Services; Navos; RytherChild Center; Seattle Counseling Services for Sexual Minorities; United Indians of All Tribes Foundation; Valley Cities Counseling & Consultation; Washington Asian Pacific Islander Families Against Substance Abuse (WAPIFASA); Youth Eastside Services; Renton Area Youth & Family Services; Sound Mental Health; Asian Counseling & Referral Services; Pioneer Human Services; Snoqualmie Tribe/Raging River Recovery Center; Muckleshoot Tribe; NorthshoreYouth & Family Services; Integrative Counseling Services; SeaMarCommunity Heath Centers; Vashon Youth and Family Services; Seattle King County ROSC PPW; and Reclaiming Futures.

The authors thank these grantees and their study clients for agreeing to share their data

Any opinions about this data are those of the authors and do not reflect official positions of the government or individual grantees.


Goals

Goals

Summarize the King County Data and its implication for program planning by looking at

Baseline characteristics

Correlates of most common problems

Costs to society

Treatment planning needs

Performance measures

Examine how well King County is doing in terms

data quality

efficiency in terms of time to complete the interview

Folloeup rates from the first quarter of FY12


2011 king county gain data set

2011 King County GAIN Data Set

GAIN Initial (GI) data collected by 18 agencies from 5,602 clients between 7/2008 and12/2011

Roughly a third from 2011, 2010 and pre 2010

GAIN Monitoring 90 days (GM90) data collected by 17 agencies from 710 clients between 5/2009 and12/2011

Roughly 78% in 2011

Grant data collapsed into the agency that collected it


2011 kc data by agency

2011 KC Data by Agency

Source: 2011 King County Data Set (n=5,507)


2011 kc data set by gender

2011 KC Data Set by Gender

Other 0.04% (n= 2)

Females 30.3% (n= 1,694)

Males69.7% (n=3,904)

Source: 2011 King County Data Set (n=5,600)


2011 kc data set by age

2011 KC Data Set by Age

26+ Years10.8% (n=606)

Under 15 Years (<15)

17.3%

(n=967)

18 -25 Years14.3% (n=802)

15-17 Years57.6% (n=3,227)

Source: 2011 King County Data Set (n=5,602)


2011 kc data set by race

2011 KC Data Set by Race

Mixed18.2% (n=1,005)

African American

14.0% (n=777)

Hispanic13.6% (n=750)

Other8.8% (n=488)

White45.4% (n= 2,514)

Source: 2011 King County Data Set (n=5,534)


2011 kc data set by risk of homelessness

2011 KC Data Set by Risk of Homelessness

At Risk 11.9% (n=658)

Currently Homeless 7.4% (n=409)

Group or Institution 2.3% (n=128)

Housed 78.5% (n=4,356)

Source: 2011 King County Data Set (n=5,551)


2011 kc data set by co occurring disorders

2011 KC Data Set by Co-Occurring Disorders

Both 28.4% (n=1,557)

Neither 41.1% (n=2,253)

Externalizing Disorders Only

20.3% (n=1,112)

Internalizing Disorders Only

10.3% (n=566)

Source: 2011 King County Data Set (n=5,488)


2011 kc data set by substance use severity

2011 KC Data Set by Substance Use Severity

No Past Year Use 1.7% (n=93)

Past Year Use

19.3% (n=1,056)

Past Year Abuse

31.1% (n=1,699)

Past Year Dependence 47.9% (n=2,616)

Source: 2011 King County Data Set (n=5,464)


Substance use disorders in past year by major substances

Substance Use Disorders in Past Year by Major Substances

*n=9,134

**Not counted in Any SUDDiagnosis. No abuse available for Tobacco.

Source: 2011 King County Data Set (n=4,802)


Pattern of weekly use 13 90 days

Pattern of Weekly Use (13+/90 days)

*Not a weekly measure; any in past 90 days

Source: 2011 King County Data Set (n=5,578)


Substance use problems

Substance Use Problems

*Count of 8 items

Source: 2011 King County Data Set (n=5,496)


Substance problem recognition

Substance Problem Recognition

Source: 2011 King County Data Set (n=5,579)


Hiv risk scale needle problems

HIV Risk Scale: Needle Problems

* Mean of 36 items from the next four slides. Intake only.

Source: 2011 King County Data Set (n=5,553)


Hiv risk scale sex risk

HIV Risk Scale: Sex Risk

* Mean of 36 items. Intake only.

Source: 2011 King County Data Set (n=5,424)


Hiv risk scale victimization

HIV Risk Scale: Victimization

*Mean of 15 items

Source: 2011 King County Data Set (n=5,468)


Hiv risk scale

HIV Risk Scale

Moderate 47% (n=2,637)

High 17% (n=939)

Low 36% (n=1,992)

Source: 2011 King County Data Set (n=5,568)


Hiv risk scale by co occurring disorders

HIV Risk Scale* by Co-Occurring Disorders

* Available at intake only.

Source: 2011 King County Data Set (n=5,487)


Hiv risk scale by substance use severity

HIV Risk Scale* by Substance Use Severity

* Available at intake only.

Source: 2011 King County Data Set (n=5,436)


Hiv risk scale by severity of victimization

HIV Risk Scale* by Severity of Victimization

* Available at intake only.

Source: 2011 King County Data Set (n=5,516)


Homicidal suicidal thoughts

Homicidal/Suicidal Thoughts

*Mean of 5 items

Source: 2011 King County Data Set (n=5,509)


Para suicidal behavior

Para-Suicidal Behavior

*Sum of 4 items

Source: 2011 King County Data Set (n=1,566)


Past year violence crime

Past Year Violence & Crime

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

Source: 2011 King County Data Set (n=4,907)


Type of crime

Type of Crime

*Other crime includes vandalism, possession of stolen goods, forgery, and theft.

Source: 2011 King County Data Set (n=4,645)


Type of crime by co occurring disorders

Type of Crime by Co-Occurring Disorders

Source: 2011 King County Data Set (n=4,580)


Type of crime by substance use severity

Type of Crime by Substance Use Severity

Source: 2011 King County Data Set (n=4,583)


Type of crime by severity of victimization

Type of Crime by Severity of Victimization

Source: 2011 King County Data Set (n=4,626)


Intensity of justice system involvement

Intensity of Justice System Involvement

Source: 2011 King County Data Set (n=4,676)


Intensity of justice involvement by gender

Intensity of Justice Involvement by Gender

Source: 2011 King County Data Set (n=4,673)


Intensity of justice involvement by age

Intensity of Justice Involvement by Age

Source: 2011 King County Data Set (n=4,676)


Intensity of justice involvement by race

Intensity of Justice Involvement by Race

Source: 2011 King County Data Set (n=4,612)


Recency of system involvement

Recency of System Involvement

Source: 2011 King County Data Set (n=5,386)


Count of major clinical problems at intake

Count of Major Clinical Problems at Intake

Source: 2011 King County Data Set (n=5,522)


Count of major clinical problems at intake by gender

Count of Major Clinical Problems* at Intake by Gender

Source: 2011 King County Data Set (n=5,598)


Count of major clinical problems at intake by age

Count of Major Clinical Problems* at Intake by Age

Source: 2011 King County Data Set (n=5,602)


Count of major clinical problems at intake by race

Count of Major Clinical Problems* at Intake by Race

Source: 2011 King County Data Set (n=5,534)


Count of major clinical problems at intake by risk of homelessness

Count of Major Clinical Problems* at Intake by Risk of Homelessness

Source: 2011 King County Data Set (n=5,602)


Count of major clinical problems at intake by co occurring disorders

Count of Major Clinical Problems* at Intake by Co-Occurring Disorders

Source: 2011 King County Data Set (n=5,488)


Count of major clinical problems at intake by substance use severity

Count of Major Clinical Problems* at Intake by Substance Use Severity

Source: 2011 King County Data Set (n=5,464)


Count of major clinical problems at intake by severity of victimization

Count of Major Clinical Problems* at Intake by Severity of Victimization

Source: 2011 King County Data Set (n=5,464)


Count of major clinical problems at intake by king county agency

Count of Major Clinical Problems* at Intake by King County Agency

OR=90.3 for most/ least severe

Source: 2011 King County Data Set (n=5,516)


Family history of physical health problems

Family History of Physical Health Problems

Source: 2011 King County Data Set (n=5,335)


Recovery environment peers

Recovery Environment - Peers

Source: 2011 King County Data Set (n=5,403)


Recovery environment home

Recovery Environment - Home

Source: 2011 King County Data Set (5,448)


Sources of stress personal

Sources of Stress: Personal

Source: 2011 King County Data Set (n=1,523)


Sources of stress other

Sources of Stress: Other

*Sum of 15 items

Source: 2011 King County Data Set (n=1,519)


Treatment readiness

Treatment Readiness

*Sum of 9items

Source: 2011 King County Data Set (n=5,478)


Treatment readiness by age

Treatment Readiness by Age

Source: 2011 King County Data Set (n=5,123)


Treatment readiness by co occurring disorders

Treatment Readiness by Co-Occurring Disorders

Source: 2011 King County Data Set (n=5,022)


Treatment readiness by substance use severity

Treatment Readiness by Substance Use Severity

Source: 2011 King County Data Set (n=5,027)


Individual strengths

Individual Strengths

*Sum of 10 items

Source: 2011 King County Data Set (n=1,520)


General social support strengths

General Social Support Strengths

*Sum of 9items

Source: 2011 King County Data Set (n=1,522)


Potential mentors in the recovery environment

Potential Mentors in the Recovery Environment

Home

Critical

gap in connection to recovery community

School or Work

Social Peers

*Sum of 12 items

Source: 2011 King County Data Set (n=5,398)


Quarterly cost to society

Quarterly Cost to Society

  • Using the GAIN we are able estimate the cost to society of tangible services (e.g., health care utilization, days in detention, probation, parole, days of missed school) in 2010 dollars for the 90 days before intake

  • Of the 5,602 clients served in 18 sites in 2011, the average Quarterly Cost to Society per client, in the quarter before they entered treatment, was $1,938 and totaled $8,224,406 across clients.

  • In the year before they entered treatment, they cost society an average of $7,752 per client and a total of $32,897,624 across clients


Quarterly cost to society 2010 dollars

Quarterly Cost to Society – 2010 Dollars

*Quarterly cost to society 2010 dollars w/ SA TX based onFrench, 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.


Quarterly cost to society1

Quarterly Cost to Society

Source: 2011 King County Data Set (n=5,602)


Quarterly cost to society by age

Quarterly Cost to Society* by Age

$3970 $5,837 $11,648 $16,904 <- Annual Cost

*Using 2010 Dollars

Source: 2011 King County Data Set (n=4,241)


Quarterly cost to society by risk of homelessness

Quarterly Cost to Society* by Risk of Homelessness

*Using 2010 Dollars

Source: 2011 King County Data Set (n=4,202)


Quarterly cost to society by co occurring disorders

Quarterly Cost to Society* by Co-Occurring Disorders

*Using 2010 Dollars

Source: 2011 King County Data Set (n=4,190)


Quarterly cost to society by substance use severity

Quarterly Cost to Society* by Substance Use Severity

*Using 2010 Dollars

Source: 2011 King County Data Set (n=4,185)


Quarterly cost to society by severity of victimization

Quarterly Cost to Society* by Severity of Victimization

*Using 2010 Dollars

Source: 2011 King County Data Set (n=4,232)


Cross validation of four summary indices

Cross Validation of Four Summary Indices

Beneficial

Problematic

*n=8,973

**GSIgroups 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: 2011 King County Data Set (n=3,192)


Quality of life

Quality of Life

  • This index summarizes quality of life represented by fewer reported problems during the past year in school problems, work problems, health problems, sources of stress, risk behavior, internal disorders, external disorders, substance disorders, and crime/violence.

  • It is calculated as the sum of 9 screeners from the GAIN-Q version 3 (reversed to Low=2, Moderate=1, and High=0) divided by the range (18), and multiplied by 100 to get a score from 0 to 100.

  • The Quality of Life Index can be interpreted continuously where higher values represent greater quality of life.

  • It can also be triaged to low (0-36), moderate (37-69) or high (70-100) groups.


General satisfaction index

General Satisfaction Index

  • This index summarizes life satisfaction in 6 areas (sexual relationship, living situation, family relationships, school/work, free time, and getting help with problems).

  • It is calculated as the sum of these 6 items

  • The General Satisfaction Index can be interpreted continuously where higher values represent greater satisfaction with life situations.

  • It can also be triaged to low problems (5-6), moderate problems (3-4) or high problems (0-2) groups.High satisfaction corresponds to low problems.

    • For the purposes of this presentation, the groups are not reversed, such that low satisfaction scores (0-2) are in the low group, and high satisfaction scores (5-6) are in the high group.


General satisfaction index by problem prevalence index

General Satisfaction Index* by Problem Prevalence Index

General Satisfaction

Problems are subjectively unpleasant and are associated with lower satisfaction

Problem Prevalence Index

*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: 2011 King County Data Set (n=1,477)


General satisfaction index by quarterly cost to society

General Satisfaction Index* by Quarterly Cost to Society

General Satisfaction

Higher costs are subjectively unpleasant and are associated with lower satisfaction

Quarterly Cost to Society

*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: 2011 King County Data Set (n=1,335)


General satisfaction index by quality of life

General Satisfaction Index* by Quality of Life

General Satisfaction

Quality of life is subjectively pleasant and is associated with higher satisfaction

Quality of Life

*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: 2011 King County Data Set (n=1,482)


Treatment needs and performance measures

Treatment Needs and Performance Measures


Gain treatment planning placement grid

GAIN Treatment Planning/Placement Grid

* Current for Dimension B1 = Past 7 days


Gain placement cells by asam dimension

GAIN Placement Cells by ASAM Dimension

Source: 2011 King County Data Set (n=5,437)


B1 intoxication withdrawal common treatment planning needs

B1. Intoxication/Withdrawal –Common Treatment Planning Needs

Source: 2011 King County Data Set (n=5,587)


B2 biomedical common treatment planning needs

B2. Biomedical – Common Treatment Planning Needs

*n = 1,552 ** n = 1,262

Source: 2011 King County Data Set (n=5,529)


B3 psychological common treatment planning needs

B3. Psychological – Common Treatment Planning Needs

*n = 1,528

Source: 2011 King County Data Set (n=5,103)


B4 readiness common treatment planning needs

B4.Readiness –Common Treatment Planning Needs

*n=227

Source: 2011 King County Data Set (n=3,318)


B5 relapse potential common treatment planning needs

B5. Relapse Potential –Common Treatment Planning Needs

Source: 2011 King County Data Set (n=5,304)


B6 environment common treatment planning needs

B6. Environment – Common Treatment Planning Needs

*n=1,473 **n=1,946 ***n=1,531

Source: 2011 King County Data Set (n=5,036)


Exploring efficiency health disparities

Exploring Efficiency & Health Disparities

  • Clients with Mod/High Need is the percent of all clients who at intake had ASAM cell placement of moderate problems; not in treatment (3), Severe problems; not in treatment (4), moderate problems, currently in treatment (6), or Severe problems; currently in treatment (7); divided by the number of all clients..

  • Services going to those in high need is the percent of clients receiving a target service who met the above definition of Mod/High Need.

  • Need but no treatment is the percent of clients who met the above definition of need who did NOT get the targeted services within 90 days of the intake.


Intoxication at intake vs detox treatment at 3 months

Intoxication (at Intake) vs. Detox Treatment at 3 Months

*Current need on ASAM dimension B1criteria (past 7 days)

** ‘Services’ is self-reported receipt of detox treatment at 3 months

Source: 2011 King County Data Set Subset to has 3m Follow up (n=394)


Physical health problem at intake vs medical treatment at 3 months

Physical Health Problem (at Intake) vs. Medical Treatment at 3 Months

*Current Need on ASAM dimension B2criteria (past 90 days)

** ‘Services’ is self-report of any days of physical health treatment at 3 months

Source: 2011 King County Data Set Subset to has 3m Follow up (n=390)


Mental health problem at intake vs mh treatment at 3 months

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

*Current Need on ASAM dimension B3criteria (past 90 days)

** ‘Services’ is self-report of any days of mental health treatment at 3 months

Source: 2011 King County Data Set Subset to has 3m Follow up (n=394)


Relapse potential at intake vs urine breathalyzer at 3 months

Relapse Potential (at Intake) vs. Urine/Breathalyzer at 3 months

*Current Need on ASAM dimension B5criteria (past 90 days)

** ‘Services’ is self-reported receipt of one or more breathalyzer or urine test at 3 months

Source: 2011 King County Data Set Subset to has 3m Follow up (n=396)


Recovery environment at intake vs self help at 3 months

Recovery Environment (at Intake) vs. Self Help at 3 Months

*Current Need on ASAM dimension B6criteria (past 90 days)

** ‘Services’ is self-report of any days of self-help attendance at 3 months

Source: 2011 King County Data Set Subset to has 3m Follow up (n=387)


Gain administration fidelity index gafi

GAIN Administration Fidelity Index (GAFI)

*Proportional sum of 7 items (n=3,063) **n=3245

Source: 2011 King County Data Set (n=5,538)


Gafi king county compared to csat

GAFI – King CountyCompared to CSAT

Sources: 2011 King County Data Set (n=3,063) and

CSAT 2010 Summary Analytic Data Set (n=22,122)


Gafi by king county agency

GAFI by King County Agency

*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: 2011 King County Data Set (n=3,063)


Cumulative distribution of gain i administration time kc vs csat

Cumulative Distribution of GAIN-IAdministration Time – KC vs CSAT

Both Have Medians around 90-100 Minutes

Time in Minutes

Sources: 2011 King County Data Set (n=5,507) and

CSAT 2010 Summary Analytic Data Set (n=26,207)


Gain i admin time by count of major clinical problems at intake

GAIN-I Admin. Time by Count of Major Clinical Problems* at Intake

*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: 2011 King County Data Set (n=5,507)


Gain i administration time by king county agency

GAIN-I Administration Timeby King County Agency

Source: 2011 King County Data Set (n=5,507)


Cumulative distribution of gain m90 administration time kc vs csat

Cumulative Distribution of GAIN-M90Administration Time – KC vs CSAT

KC faster than CSAT (Medians of 55 vs 95 Min.)

Time in Minutes

Sources: 2011 King County Data Set (n=700) and

CSAT 2010 Summary Analytic Data Set (n=21,307)


Gain m90 administration time by king county agency

GAIN-M90 Administration Timeby King County Agency

Source: 2011 King County Data Set (n=647)


Percent of 1 st quarter 2012 recruits with 3 month follow up

Percent of 1st Quarter 2012 Recruitswith 3 Month Follow-up

80% Target

Source: 2011 King County Data Set (n=407 Q1 recruits, n=40 3-month follow-ups)


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