Using the GAIN to Support Adolescent Treatment and Interventions

1
Using the GAIN to Support Adolescent Treatment
and Interventions

• Michael L. Dennis, Ph.D.
• Michelle White, M.S.
• David Smith, B.G.S.
• Chestnut Health Systems, Bloomington, IL

2
Objectives

• Review the need for an integrated and
  standardized assessment
• Provide an overview the GAINs organization, key
  features, and methodological strengths
• Describe how the GAIN is used to support clinical
  decision making and reporting.
• Review system implementation plans and address
  questions about flexibility of instrumentation,
  training, quality assurance and software.

3
Materials

• We are combining 3 hours of presentations into 1
  hour but 1 page summaries, full slides, and
  sample reports are being distributed.
• We are passing around copies of the GAIN,
  GAIN-Quick and ABS software manuals that will be
  talked about later in this presentation and
  covered in the 3.5 day training.
• CDs are also available (1 per agency/site) that
  have electronic copies 15 evidence based
  adolescent substance abuse treatment manuals.

4
Need for Integrated andStandardized Assessment
5
Problems with the Existing System

• Data is often collected in a redundant process,
  with long instruments that had multiple
  overlapping measures and did not necessarily map
  onto the most common needs of the population
• There are often problems getting data back to use
  for individual clinical work and program
  planning.
• Measures did not often translate directly to
  common clinical standards for diagnosis,
  placement, treatment planning or existing
  epidemiological or economic data for
  comparison/evaluation.
• Workforce lacked tools, training, supervision and
  support to collect the breadth of required
  information in an efficient, reliable and valid
  approach
• Assessment system was inefficient and consumer
  unfriendly, with patients having to answer the
  same questions 3 to 5 times in order to access
  care and then link linkage between there answers
  and what they received.

6
Adolescent Treatment Program GAIN Clinical
Collaborators
Source www.chestnut.org/li/apss
7
Multiple Co-occurring Problems Are the Norm and
Increase with Level of Care
Source CSATs Cannabis Youth Treatment (CYT),
Adolescent Treatment Model (ATM), and Persistent
Effects of Treatment Study of Adolescents
(PETS-A) studies
8
Change in Substance Frequency Indexby Level of
Care\a
\a Source Adolescent Treatment Model (ATM)
data Level of cares coded as Long Term
Residential (LTR, n390), Short Term Residential
(STR, n594), Outpatient/Intensive and Outpatient
(OP/IOP, n560). T scores are normalized on the
ATM outpatient intake mean and standard
deviation. Significance (plt.05) marked as \t
for time effect, \s for site effect, and \ts for
time x site effect.
9
Change in Substance Problem Indexby Level of
Care\a
\a Source Adolescent Treatment Model (ATM)
data Level of cares coded as Long Term
Residential (LTR, n390), Short Term Residential
(STR, n594), Outpatient/Intensive and Outpatient
(OP/IOP, n560). T scores are normalized on the
ATM outpatient intake mean and standard
deviation. Significance (plt.05) marked as \t
for time effect, \s for site effect, and \ts for
time x site effect.
10
Change in Emotional Problem Indexby Level of
Care\a
\a Source Adolescent Treatment Model (ATM)
data Level of cares coded as Long Term
Residential (LTR, n390), Short Term Residential
(STR, n594), Outpatient/Intensive and Outpatient
(OP/IOP, n560). T scores are normalized on the
ATM outpatient intake mean and standard
deviation. Significance (plt.05) marked as \t
for time effect, \s for site effect, and \ts for
time x site effect.
11
High Rates of Victimization
Source Dennis, 2004, Adolescent Treatment Model
(ATM) data
12
Victimization is Related to Severity
Source Titus, Dennis, et al., 2003
13
Interaction of Victimization and Treatment
Setting on Days of Marijuana Use
40
35
30
25
20
15
10
5
0
Pre
Post
OP - No/Low Victimization
OP - Acute Victimization
Resid - No/Low
Resid- Acute Victimization
Source Funk, et al., 2003, Adolescent Treatment
Model (ATM), Assertive Continuing Care (ACC)
14
JJ is the Most Common Sources of Adolescent
Referrals
Other
Juvenile
16
Justice
Other
System 44
Health Care
Provider 5
Other
Substance
Abuse
Treatment
School/
Agency 5
Community
Agency 22
Self/Family
17
Source Dennis, Dawud-Noursi, Muck McDermeit,
2003 and 1998 Treatment Episode Data Set (TEDS)
15
Illegal Activity (not just possession)
Source Adolescent Treatment Model (ATM) data
16
Change in Illegal Activity Indexby Level of
Care\a
\a Source Adolescent Treatment Model (ATM)
data Level of cares coded as Long Term
Residential (LTR, n390), Short Term Residential
(STR, n594), Outpatient/Intensive and Outpatient
(OP/IOP, n560). T scores are normalized on the
ATM outpatient intake mean and standard
deviation. Significance (plt.05) marked as \t
for time effect, \s for site effect, and \ts for
time x site effect.
17
Cost of Treatment offset by Reductions in the
Average Cost to Society in 12 to 30 months
6,000
5,000
4,000
3,000
2,000
1,000
0
0
3
6
9
12
15
18
21
24
27
30
Months from Intake
Source French et al, 2003 forthcoming, CYT
18
Substance Use is a Chronic Condition

• While 3 of 4 have a period of early recovery for
  at least one month), relapse is common,
  particularly in the first 90 days
• From first use to a year of sobriety averages 27
  years
• From first treatment to a year of sobriety
  averages 8 years with 3 to 4 admissions to care
• The majority of adults and adolescents in higher
  levels of care have been in treatment before
• Even in adolescent outpatient, over 1 in 4 have
  been in treatment before
• Yet the treatment and finance system has
  traditionally be set up with an acute care
  model.
• Need for more assertive models of public health
  and chronic care particularly after residential
  treatment.

Source Dennis et al in press
19
Measuring Improved Adherence to Continuing Care
after Residential Treatment
100
100
20
20
30
30
10
40
50
60
70
80
90
10
40
50
60
70
80
90
0
0
Weekly
Tx
Weekly 12 step meetings
Relapse prevention
Communication skills training
Problem solving component
Regular urine tests
Meet with parents 1-2x month
Weekly telephone contact
Contact w/ probation/school
Referrals to other services
Follow up on referrals
Discuss probation/school compliance
Adherence Meets 8/12 criteria
UCC
Source Godley et al 2002, ACC
20
Assertive Continuing Care Can Reduce Relapse
Percent Remaining Abstinent
Usual Continuing Care
Days to First Marijuana Use (plt.05)
Source Godley et al 2002, ACC
21
Key Features and Organization of the GAIN
22
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.

23
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.

24
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 designed for administration by a
  paraprofessional but so that a range of
  behavioral, health and other professionals can
  use/ interpret it with minimal additional
  questions.

25
Progressive Assessment Approach

• 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

26
Organization of the Core GAIN

• Administration
• (including records information, cognitive
  impairment, calendaring, referral information,
  general instructions)
• B. Background and Treatment Arrangements
  (demographics, custody, access to care)
• Substance Use
• (including treatment readiness, relapse
  potential, withdrawal, abuse, and dependence,
  treatment history, content and satisfaction with
  recent treatment, current medication)
• 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)

27
Organization- Continued

• M. 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)

28
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)

29
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

30
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 (Cronbachs alpha.82).
• Lifetime marijuana dependence diagnosis was
  consistent though rising in the second interview
  (Kappa.55, 40 vs. 44 lifetime dependence).
• Source Dennis et al., 2002, CYT

31
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.
• Source Dennis et al 2002 Buchan et al, 2002 CYT

32
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, plt.001) and cannabis use (37 vs. 30,
  t(505)6.0, plt.001) during the past 90 days.
• They reported slightly fewer days of alcohol use
  (7 vs. 8, t(505)-2.2, plt.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
• Source Dennis et al., 2002 Diamond et al., in
  press

33
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, ATM

34
Validated Scales and Structural Model of
Psychopathology

• Source Dennis et al, 2003 under review. ATM,
  CYT, ERI

35
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
• Typically use by juvenile and criminal justice
  and SAP/EAP programs for screening, brief
  intervention, and referral for more detailed
  assessment/further treatment.
• Where applicable it can be imported into the full
  GAIN, saving time on questions that have already
  been answered

36
GAIN-Quick Indices by Level of Care
0.6
0.4
0.2
0.0
-0.2
-0.4
-0.6
index
Disorder Index
Aggression Index
Suicide Risk Index
Conduct Disorder-
depression Symptom
General Crime Index
Anxiety Symptom index
Internal Behavior Index
Attention-Hyperactivity
External Behavior Index
Substance Use and Abuse
Substance Problem Index
Substance Dependence Index
TC (n288)
STR (n604)
OP/IOP (n513)
Source Titus et al, 2003 ATM data
37
Other Methodological Work Underway

• Super short (15 questions) screener for substance
  use, internal, behavior and crime/violence
  disorders that can identify over 95 of people
  with diagnoses and correctly rule out over 70.
• ASAM placement recommendations based on expert
  and statistical models
• Identification of multi-problem clusters or Code
  types
• Evaluating therapeutic alliance and treatment
  process
• 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
• Economic analysis of costs, cost-effectiveness
  and benefit costs
• Construct validity checks on measures and
  comparisons to urine, collateral reports, records
  and over 3 dozen other measures.

38
Assessment Building System (ABS) software

• Will be provided by State/Chestnut
• Needs to be set up to comply with your corporate
  HIPAA privacy and security policies and installed
  by some with permission to install on given
  equipment Administrator training take a half a
  day.
• Simple to use, with user training taking ½ day
• Clinical and individual level reports available
  immediately after an on-line interview or after
  data has been keyed.
• Data can be pooled over a server/network/internet,
  uploaded from a remote/laptop on demand, or
  exported and sent via e-mail, FTP or HTP (in a
  password protected file).
• Has features for data entry, editing and note
  making, rekeying resolution, read only, report
  generation, and administrative activities.
• Has the ability to set permission to use each
  feature at the individual or group level.

39
Benefits to the Clinician

• Interactive administration of the GAIN
• ABS manages the assessment process
• Skips and calculations are automated
• Full attention can be paid to the client and
  reduces administration time
• Online access for review or editing
• Easily navigate to specific parts of the GAIN
• The full GAIN or any major segment can be printed
  with client responses
• Immediate feedback to clients
• A validity report can help identify complex
  inconsistencies to follow-up on before the client
  leaves
• An individualized Personal Feedback Report (PFR)
  can be generated immediately upon completing the
  initial assessment to support motivational
  interviewing
• Detailed Clinical Profiles and Summaries
• GAIN Referral and Recommendation Summary (GRRS)
  and Individual Clinical Profile (ICP) are
  immediately available upon completing the initial
  GAIN assessment on line (or after data entry).

40
Benefits to the Local Site

• Supports multiple studies and/or populations
• ABS can manage multiple databases, multiple
  versions of instruments, and multiple set ups
• Supports Privacy and Security
• Security settings can be configured to comply
  with local HIPAA policies
• Assessments are readily available
• Easily viewed online or printed in full or part
• Aggregate data are easily obtained
• Output to SAS, SPSS or Excel for analysis,
  reporting
• Centralized maintenance and updating
• ABS Administrators can conduct most maintenance
  tasks over the network

41
Hardware Requirements

• Client Installation
• 350 MHz or faster processor (500 MHz preferred)
• 64 Mb RAM (128 Mb preferred)
• 50 Mb free hard disk space for client
  installation
• Network access to server database(s)
• Server Installation
• 200 Mb hard disk space
• Data backup availability
• Stand-alone (Laptop) Installation
• 350 MHz or faster processor (500 MHz preferred)
• 64 Mb RAM (128 Mb preferred)
• 250 Mb free hard disk space
• Network access to server database for upload

42
Supporting Individual Level Clinical Decision
Making and Reporting
43
Main Interpretative Reports to Support
Diagnosis, Placement, and Treatment Planning

• GAIN Referral and Recommendation Summary (G-RRS)
  - Text based narrative in MS Word designed to be
  edited and shared with specialist, clinical staff
  from other agencies, insurers and lay people.
• Individual Clinical Profile (ICP) more detailed
  report in MS Access designed to help triage
  problems and help the clinician go back to the
  GAIN for more details if necessary (generally not
  edited or shared)

44
G-RRS Organization

• Presenting Concerns and Identifying Information
• DSM-IV/ICD-9 Diagnoses 
• Evaluation Procedure
• Substance Use Diagnoses and Treatment History
  (ASAM criteria A)
• Level of Care and Service Needs (ASAM Six
  Dimensional Criteria B)
• Summary Recommendation

45
General

• Can use the client name, initials or another term
  supplied by the person running the report
• Can use the sites organizational name or another
  term supplied by the person running the report
• The G-RRS comes out in a MS Word Document file
  (.doc) that can be read, edited and saved by
  most word processing programs.
• The report include three types of prompts
  identifying areas where counselors
• Often add additional information or comments from
  other sources of information
• Have to reconcile and finalize potentially
  conflicting diagnoses
• Have to make preliminary treatment planning
  recommendations
• The ICP report parallels the G-RRS and provides
  more detailed information to supplement it and/or
  to cross reference back to the GAIN for more
  information.

46
General - Continued

• The G-RRS summarizes data collected and follows
  existing rules it is a tool to feed into and
  support clinical judgment not to replace it.
• The G-RRS can only generate reports using the
  data collected.
• A G-RRS based on the full (90-120 minute) version
  of the GAIN contains more details (e.g., name of
  school, employer, probation officer) than a G-RRS
  based on the core (60-90 minute) version of the
  GAIN.
• Sites can add in questions that are not in their
  core but that they want to have for the G-RRS.
• Sites can also remove sections of the report that
  they do not want and/or modify some of the labels
  (e.g., signature lines).

47
Using the ICP to help with the G-RRS

• Identify the criteria on which the diagnosis or
  statement is made
• Examining scale scores in a given area to better
  understand the severity or what is going on
• Complete breakout of demographics, behaviors,
  service utilization
• More detailed information for treatment planning

48
Individual Clinical Profile (ICP) Organization

• Identifiers
• DSM-IV/ICD-9 Diagnoses 
• Demographics (including appearance, housing
  situation, prior treatment, involvement in other
  systems, potential validity concerns, staff
  notes)
• ASAM placement flags
• ASAM placement profile worksheet
• Behaviors and Service Utilization
• Treatment Planning Worksheet (including client
  and staff rating or urgency, what the client has
  asked for help with, and things that most
  agencies/accrediting agencies would expect to be
  in the treatment plans)
• Note this is a MS Access report, not intended
  for general distribution and only reports on data
  that was collected

49
Notes on why the statements were printed

• Notice the addition of the conditions why
  statement was printed.
• Key
• Tx-treatment
• Sx-Symptom
• 3 3 or more
• gt - greater
• than
• lt - less than
• CAPS quote
• from staff
• or client

From Phillip ICP page 1
50
ICP Demographics sectionlists out code and all
values
Example of Code-Response label
Gives status even if none or negative
Cannot give page numbers as it varies by version
but can jump directly there in ABS with
variable name
From Phillip ICP page 3
51
ICP ASAM Flags bulleted out
Minimal Criteria for level of care and basis for
printing the statement
Red flags indicating the need for more services
in the area or a higher level of care and the
basis for printing the statement
Manual has a list of all statements evaluated
From Phillip ICP page 5
52
ICP ASAM Profile
ASAM Criteria Scale Name basis

• Score or
• Skipped
• Bad Data

Scale triaged into Low, Medium, or High Severity
Scales file as more on purpose, interpretation,
source, and psychometrics
From Phillip ICP page 6
53
Simple Behavior/Utilization Measures
Left side gives behaviors in the past 90 days
Right side gives utilization in the past 90 days
Organized by Section of the GAIN Gives page
number, item number -- skipped, RF refused DK
dont know
From Phillip ICP page 9
54
Help with Treatment Planning
Compares Client and Staff Urgency Ratings
Specific things the client has asked for
Other Actions or Things Typically Expected by
Agencies or Accrediting Agencies
From Phillip ICP page 10
55
GI Scales and Variable File

• 1000 page electronic encyclopedia in MS Excel
  with documentation for each GAIN scale, subscale,
  index, created variable/text statements used in
  the G-RRS, ICP and our research to date
• For each variable, documentation includes
• Scale/variable name (and any related/earlier
  versions)
• Time Period(s) covered
• Section of the GAIN
• Question (items, page in full version)
• Scale measurement type (Cut-points for triage)
• Purpose (s)
• Short Description
• Interpretation
• Supplemental References on source, norms,
  psychometrics
• Comments
• GAIN V5 SPSS Syntax
• Prior SPSS Syntax (if different)
• Actual questions (from version 5)

56
Other Computer Generated Clinical Reports

• GAIN-Q Referral and Recommendation Summary (GRRS)
  text based summary to support preliminary
  diagnosis and placement based on the GAIN-Quick
• Personal Feedback Reports (PFR) text based
  summary to support the motivational interviewing
  component of MET/CBT based on the GAIN-I or
  GAIN-Q
• Validity reports to identify areas for
  clarification and potential problems
• Other site specific clinical reports (e.g.,
  pre-filling existing paperwork like a health
  assessment, TEDS report etc)
• Data elements can be transferred into existing
  MIS and used in other reports/systems as well.

57
Overview of theGAIN Coordinating Center
58
GAIN Coordinating Center (GCC) Team Organization
Chart
59
GAIN Training

• Training 1 May 25-28, Casper FULL
• Training 2 Aug. 3-6, Lander
• Training 3 Sept. 7-10, Rock Springs
• To Register or for more information, contact
• Elizabeth Henn
• Phone [phone]
• E-mail ehenn_at_state.wy.us

60
More on Training

• Dept. of Health Substance Abuse Division covers
  costs for training, material, lodging, and meals.
  Agencies are responsible for cost of travel.
• All three trainings are 3 and a half days in
  length.
• WHO SHOULD ATTEND?
• Day-to-day person(s) who will be training others
  to administer the GAIN
• Person who will be administering most GAINs and
  will become trainer/back-up for day-to-day person

61
Agenda Walk-Through

• DAY 1 (TUESDAY)
• Introduction to GAIN and manual
• Conducting a semi-structured assessment
• General Administration
• Live Demonstration of GAIN administration
• Small group Round Robins sessions section S
• GAIN-Quick Administration and Scoring
• DAY 2 (WEDNESDAY)
• Small group Round Robins
• Large group Discussions
• Quality Assurance Model
• Specifics on QA process
• Reviewing a QA taped example
• Question/Answer Review thus far

62
Agenda Walk-Through (cont.)

• DAY 3 (THURSDAY) Track 1
• Scoring and Interpreting the GAIN
• Practice Scoring and Interpreting the GAIN
• Other Instruments in the GAIN family
• Set up and Implementation Decisions and Issues
• Paired Practice
• Most trainees will be in Track 1
• DAY 3 (THURSDAY) Track 2
• ABS Administrator Training
• This is for IT/MIS people that will be installing
  and setting up the software (they can come to
  just this session)
• Laptops brought to training will have software
  installed during this time

63
Agenda Walk-Through (cont.)

• DAY 4 (FRIDAY) Track 1 (a.m. only)
• Software User Training
• Conducting a computer-assisted interview
• Training Wrap-up
• Software Consultation
• DAY 4 (FRIDAY) Track 2 (a.m. only)
• Advanced Issues in Quality Assurance
• Administration Practice Session/Taping
• Training Wrap-up and Site-Specific Consultation

64
Certification Levels

• Coursework Certification
• Requires participation in over 90 of 3.5 days of
  training
• Typically counts for 24 hours towards continuing
  education
• Administration Certification
• Requires course certification
• Submission of 2 or more taped interviews and
  participation in a written and oral review
  process.
• Requires quality assurance to demonstrate mastery
  of materials (can take 6 or more in rare
  instances)
• First tape must be submitted within 2 weeks and
  process must be completed within 3 months of
  coursework.
• Local Trainer
• Requires course work and administration
  certification
• Requires review of ability to train and certify
  others
• Allows certification of site interviewers
• Must be completed within 6 months of coursework

65
Certification - Responsibilities

• Department is covering
• All licensing requirements
• 73 coursework certifications
• 24 administration certifications
• Providing technical assistance with
  implementation, data management, individual and
  program level reporting (i.e., what you get back)
• Providers..
• Will be required to use the GAIN in the proposed
  standards
• Recommended to send 2 or more people to training
  from each agency/site
• Encouraged to apply for assistance with
  administration certification or to purchase
  directly
• Encouraged to purchase local trainer
  certification so that they can train and certify
  their own workforce in the future

66
Certification Additional Costs

• Cost for each additional trainee to get
  administration certification only 750 for
  process or 250 for first submission, 150 for
  each tape thereafter
• Cost for each trainee going on for optional
  certified local trainer certification 400 for
  process or 200 per submission
• Cost for entire process (both administration and
  local trainer certification) 1150
• Advantage to pay in advance method versus pay as
  you go method

67
Key Roles You Need to Designate

• Local Trainer/Lead GAIN person
• Primary person training and supervising people
  doing GAIN assessment.
• In smaller agencies/sites, this may be the
  primary person doing assessments.
• ABS Administrator
• Manages ABS user accounts, passcodes, lookup
  tables
• Installs and updates software and instruments in
  software
• Data Manager
• Each agency will send data to an assigned data
  manager
• The DM assigns groups for HIPAA access to cases
• Liaison with Chestnut the DM sends combined
  data files to Chestnut for compilation and data
  cleaning
• Can be same or different people

68
Contact and Support Information

• Chestnut Health Systems, (309)-827-6026
• 720 W. Chestnut St., Bloomington, IL 61701
• www.chestnut.org/li/gain or www.chestnut.org/li/A
  PSS
• Scientific or Scale Related Questions
• Michael Dennis, Ph.D., Sr. Research
  Psychologist, Mdennis_at_chestnut.org, (309)
  820-3543, ext 83409.
• GAIN training and quality assurance issues
• Michelle White, M. S., GAIN Research Projects
  Manager, Mwhite_at_chestnut.org, [phone], ext
  83439.
• ABS software and MIS integration issues
• David Smith, B.G.S, Software Product Manager,
  Dsmith_at_chestnut.org, [phone]