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Chapter 3 Overview of Adolescent Treatment Sites

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  1. Chapter 3Overview of Adolescent Treatment Sites 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

  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)

  3. Risk and Protective Factors • The following slides present information on demographics, and risk and protective factors 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)

  4. Age 18+ Years 9.5% (n=1,919) Under 15 Years (<15) 17.0% (n=3,427) 15-17 Years73.4% (n=14,777) Source: CSAT 2011 AT Summary Analytic Data Set (n=20,123)

  5. Gender Other0.04% (n=9) Females 27.2% (n= 5,479) Males 72.7% (n=14,635) Source: CSAT 2011 AT Summary Analytic Data Set (n=20,123)

  6. Race Multi-racial 14.3% (n=2,866) African American 16.1% (n=3,233) Hispanic23.9% (n=4,807) Other4.4% (n=890) White41.3% (n=8,314) Source: CSAT 2011 AT Summary Analytic Data Set (n=20,110)

  7. Demographic Characteristics CSAT data dominated by male, minority, age 15 to 17 *Any Hispanic ethnicity separate from race group Source: CSAT 2011 AT Summary Analytic Data Set (n=19,890)

  8. Environment *n = 8,286 Source: CSAT 2011 AT Summary Analytic Data Set (n=19,700)

  9. Current Risk of Homelessness At Risk 8.9% (n=1,785) Currently Homeless 3.4% (n=691) Group or Institution 7.9% (n=1,577) Housed 79.8% (n=16,028)

  10. Substance Problem Recognition * n=10,899 Source: CSAT 2011 AT Summary Analytic Data Set (n=20,077)

  11. Substance Severity by Time Period Source: CSAT 2011 AT Summary Analytic Data Set (n=19,781)

  12. Past 90 Day Primary Substance Opioids 2.5% (n=459) Other Drugs 2.4% (n=434) Amphetamines 5.1% (n=920) Alcohol 25.6% (n=4,624) Cocaine 2.4% (n=433) Source: CSAT 2011 AT Summary Analytic Data Set (n=18,059)

  13. Substance Use Problems *Count of 8 items Source: CSAT 2011 AT Summary Analytic Data Set (n=19,614)

  14. Pattern of Weekly Use (13+/90 days) *Not a weekly measure; any in past 90 days Source: CSAT 2011 AT Summary Analytic Data Set (n=19,981)

  15. Substance Use Disorders in Past Year by Major Substances *n=6,364 **Not counted in Any SUD Diagnosis. Abuse is not an option for Tobacco. Source: CSAT 2011 AT Summary Analytic Data Set (n=16,583)

  16. Tobacco Diagnosis Source: CSAT 2011 AT Summary Analytic Data Set (n=17,839)

  17. Recovery Environment - Peers Source: CSAT 2011 AT Summary Analytic Data Set (n=19,656)

  18. Recovery Environment - Home *Past 90 days Source: CSAT 2011 AT Summary Analytic Data Set (n=19,640)

  19. HIV Risk Scale* Past Year at Intake: Needle Use * Mean of 36 items from the next four slides. Intake only. Source: CSAT 2011 AT Summary Analytic Data Set (n=19,257)

  20. HIV Risk Scale* Past Year at Intake: Sex * Mean of 36 items. Intake only. **n=3,424 Source: CSAT 2011 AT Summary Analytic Data Set (n=18,712)

  21. HIV Risk Scale* Past Year at Intake: Victimization * Mean of 36 items. Intake only. **n=12,065 Source: CSAT 2011 AT Summary Analytic Data Set (n=19,770)

  22. HIV Risk Scale* Past Year at Intake: Trauma *Mean of 36 items. Available at intake only. Source: CSAT 2011 AT Summary Analytic Data Set (n=19,866)

  23. HIV Risk Change Index* in Past 90 Days at Intake *Count of 7 items listed. Can be used to measure change. Source: CSAT 2011 AT Summary Analytic Data Set (n=19,413)

  24. Number of Sex Partners* *In the past 90 days Source: CSAT 2011 AT Summary Analytic Data Set (n=19,508)

  25. Severity of Victimization Scale *n=12,065 **Mean of 15 items Source: CSAT 2011 AT Summary Analytic Data Set (n=19,787)

  26. Past YearMental Health Disorders Both 35.5% (n=7,114) Neither 34.0% (n=6,818) Externalizing Disorders Only 23.2% (n=4,657) Internalizing Disorders Only 7.3% (n=1,471) Source: CSAT 2011 AT Summary Analytic Data Set (n=20,060)

  27. Co-Occurring Psychiatric Problems *n=12,661 ** Count of Conduct Disorder, ADHD/ADD Major Depressive Disorder, Traumatic Stress Disorder, and Generalized Anxiety Disorder Source: CSAT 2011 AT Summary Analytic Data Set (n=18,308)

  28. Homicidal/Suicidal Thoughts *Mean of 5 items Source: CSAT 2011 AT Summary Analytic Data Set (n=19,898)

  29. Para-suicidal Index *Sum of 4 items Source: CSAT 2011 AT Summary Analytic Data Set (n=12,661)

  30. Family History of Health Problems Source: CSAT 2011 AT Summary Analytic Data Set (n=18,935)

  31. Past 90 Day Health Problems Low Problems 52.9% (n=10,541) High Problems 8.4% (n=1,674) Moderate Problems 38.7% (n=7,703) Source: CSAT 2011 AT Summary Analytic Data Set (n=19,918)

  32. Quarterly Cost of Health Care Utilization • Using the GAIN, we are able estimate the quarterly cost to society of tangible services (e.g., hospital visits, emergency room visits, etc.) in 2011 dollars for the 90 days before intake. • For the 20,123 clients served in 161 sites between 1998-2011, the average Quarterly Cost of Health Care Utilization (HCU) per client: • in the quarter before they entered treatment, was $2,681 and totaled $51,337,594 across clients. • in the year before they entered treatment, was $10,724 per client and totaled $205,350,376 across clients.

  33. HCU Cost to Society – 2011 Dollars *Quarterly Health Care Utilization 2011 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.

  34. Health Care Utilization Cost Source: CSAT 2011 AT Summary Analytic Data Set (n=19,148)

  35. Past Year Crime and Violence Low 36.7% (n=7,357) High 38.0% (n=7,620) Moderate 25.4% (n=5,087) Source: CSAT 2011 AT Summary Analytic Data Set (n=20,064)

  36. Past Year Crime & Justice Involvement *Dealing, manufacturing, prostitution, gambling (does not include simple possession or use) Source: CSAT 2011 AT Summary Analytic Data Set (n=20,093)

  37. Type of Crime * Violent crime includes assault, rape, murder, and arson. ** Other crime includes vandalism, possession of stolen goods, forgery, and theft. Source: CSAT 2011 AT Summary Analytic Data Set (n=19,875)

  38. Cost of Crime in the Past Year • Using the GAIN we are able estimate the cost to society associated with economic losses due to criminal activity (e.g., vandalism, forgery, theft, assault, arson, rape, murder) in 2011 dollars for the year prior to intake • Of the 20,123 clients served in 161 sites between 1998-2011, the average Cost of crime per client, in the year before they entered treatment, was $293,376 and totaled $5,244,973,817 across clients.

  39. Cost of Crime – 2011 Dollars* *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.

  40. Cost of Crime Source: CSAT 2011 AT Summary Analytic Data Set (n=17,878)

  41. Intensity of Justice System Involvement Source: CSAT 2011 AT Summary Analytic Data Set (n=19,979)

  42. Recency of System Involvement Source: CSAT 2011 AT Summary Analytic Data Set (n=19,978)

  43. 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: CSAT 2011 AT Summary Analytic Data Set (n=19,654)

  44. GAIN-Initial Profile:Behavior Change Scales at Intake * n=6,801 Source: CSAT 2011 AT Summary Analytic Data Set (n=19,655)

  45. Sources of Stress: Personal Source: CSAT 2011 AT Summary Analytic Data Set (n=9,150)

  46. Sources of Stress: Other *Sum of 15 items Source: CSAT 2011 AT Summary Analytic Data Set (n=8,616)

  47. Treatment Readiness *Sum of 9items Source: CSAT 2011 AT Summary Analytic Data Set (n=18,024)

  48. Self-Help Activities Scale *Mean of 19 items Source: CSAT 2011 AT Summary Analytic Data Set (n=3,441)

  49. Individual Strengths *Sum of 10 items Source: CSAT 2011 AT Summary Analytic Data Set (n=7,355)

  50. General Social Support Strengths *Sum of 9items Source: CSAT 2011 AT Summary Analytic Data Set (n=7,371)