Global Appraisal of Individual Needs-Short Screener

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GAIN SS Training
Global Appraisal of Individual Needs-Short
Screener
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Global Appraisal of Individual Needs

• The Global Appraisal of Individual Needs (GAIN)
  is a progressive and integrated family of
  instruments for
• initial screenings, brief interventions and
  referrals
• standardized biopsychosocial clinical assessments
  for diagnosis, placement and treatment planning
• monitoring of changes in clinical status, service
  utilization, and costs to society
• subgroup and program level needs assessment and
  evaluation
• The GAIN has been used with both adolescents and
  adults and in outpatient, intensive outpatient,
  partial hospitalization, methadone, short-term
  residential, long-term residential, therapeutic
  communities, and correctional programs.

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The GAIN Family of Instruments

• GAIN-SS (Short Screener)
• GAIN-Q (Quick)
• GAIN-I (Initial)
• GAIN-M (Monitoring)

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GAIN-SS

• Purpose Designed as a Screener for use in
  general populations to quickly and accurately
  identify a clients risk of having a disorder
  that warrants further assessment
• Administration Time 5 minutes
• Mode Staff administered on paper copy (can be
  self-administered, but
• not recommended for screening
  individuals)
• Scales There are 4 subscales, each measuring 5
  symptoms (Total/20).
• ID Scr - Internal disorders (i.e.
  somatic, depression, suicide, anxiety),
• EDScr - External disorders (behavioral
  disorders i.e. ADHD, conduct
• disorders),
• SDScr - Substance use disorders (abuse,
  dependence), and
• CVScr - Crime/violence (interpersonal
  violence, property crime,
• drug-related crime)

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Determining the Risk

• GAIN-SS responses are given in terms of the
  recency of the problem described in the
  questions
• 3 past month
• 2 2 to 12 months ago
• 1 1 years ago
• 0 never.
• The number of past-month symptoms number of 3s
  
• The number of past-year symptoms number of 2s
  or 3s
• We will only be concerned with the number of 3s
  and 2s
• Note Other practitioners who want to consider
  the number of lifetime symptoms, would also
  include the number 1s.

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Instructions for GAIN-SS items

• This instrument is designed to find out how you
  are doing in terms of your health and behavior.
• The information is _______ (privacy statement).
• It will only be used to _________ (choose)
• (Help me know who you should talk to.)
• (Make a good referral for you.)
• It takes about 5 minutes to answer and you can
  say that you do not know or that you do not want
  to answer any question.
• If you are not sure about an answer, please give
  us your best guess.

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Several questions will ask you about things that
have happened during the past month, 2-12 months
ago, more than 12 months ago, or never. To help
you remember these time periods, please look at
this calendar.

• Do you recall anything that was going on about
  (DATE 30 DAYS AGO)? (PROBE FOR SPECIFIC EVENT,
  SEE BELOW IF PROBLEMS.) When the last time
  something happened was since (NAME OF EVENT THAT
  WAS 30 DAYS AGO), please answer, Past month.
• Do you recall anything that was going on about
  (DATE 12 MONTHS AGO)? (PROBE FOR SPECIFIC EVENT,
  SEE BELOW IF PROBLEMS.) When the last time
  something happened was between (30 DAY AGO EVENT)
  and (12 MONTH AGO EVENT), please answer, 2-12
  months ago.
• When the last time something happened was before
  (12 MONTH AGO EVENT), please answer, 1 years
  ago.
• If something has never happened, please answer,
  Never.
• IF PARTICIPANT IS UNABLE TO RECALL ANY EVENTS Do
  you remember any birthdays, holidays, sporting or
  other special events that happened around (DATE
  90 DAYS/12 MONTHS AGO)? Did anything change in
  terms of where you were living, who you were
  with, whether you were in school or someplace
  else? Where were you living then? Were you in
  treatment, working, in school, or involved with
  the law then?

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Instructions, continued

• The following questions are about common
  psychological, behavioral or personal problems.
  These problems are considered significant when
  you have them two or more weeks, when they keep
  coming back, when they keep you from meeting your
  responsibilities, or when they make you feel like
  you cant go on.
• After each of the following statements, please
  tell us the last time you had this problem, if
  ever, by responding
• In the past month 2-12 months ago
• 1 or more years ago or, never.
• NOTE It is very important for the client to
  fully understand the meaning of significant.

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Examples of items

• 1. When was the last time you had significant
  problems
• a. with feeling very trapped, lonely, sad, blue,
  depressed, or hopeless about the future?
• b. with sleeping, such as bad dreams, sleeping
  restlessly or falling asleep during the day?
• c. with feeling very anxious, nervous, tense,
  fearful, scared, panicked or like something bad
  was going to happen?
• d. when something reminded you of the past, and
  you became very distressed and upset?
• e. with thinking about ending your life or
  committing suicide?

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SCORING THE GAIN-SS

• We are scoring past-year symptoms. Count the
  number of 3s (past month) or 2s (2-12 months ago)
  to get the number of symptoms occurring in the
  past year
• 1a to 1e for the Internalizing Disorder Screener
  
• 2a to 2e for the Externalizing Disorder Screener
• 3a to 3e for the Substance Disorder Screener
• 4a to 4e for the Crime/Violence Screener
• 1a to 4e or sum of above for the Total Disorder
  Screener

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SCORING THE GAIN-SS

• COUNT the number of responses that are 3s and
  2s for each section (dont Sum). For example of
  responses to Section 1(InternalizingDisorders)
• 1a 3 (past month)
  1
• 1b 2 (2-12 months ago) 1
• 1c 3 (past month)
  1
• 1d 1 (more than 12 months ago) 0
• 1e 0 (never)
  0
• 
  3
• The score for the IDScr section is 3

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SCORING THE GAIN-SS

• Example SDScr (Substance Disorder Screener)
• 3a 2 (2 12 mo. ago) 1
• 3b 1 (1 years ago) 0
• 3c 0 (never) 0
• 3d 0 (never) 0
• 3e 0 (never) 0
• 
  1
• The total for the SCScr is 1

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Scoring TemplateScoring Count (do not sum) the
number of 3s 2s
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Record the Scoring

• On the Screener, you will record the total number
  of 3 and 2 responses for each section.
• For the first four sections (ID, ED, SD, C/V) you
  should have a 0 5 as a section total.
• 0 20 will be written in the space marked
  TDScr (Total Disorder Screener) .

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A demonstration
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Interpretation

• Does the student need to be referred for further
  assessment? Look at the past-year totals (3s and
  2s) in the four sub-sections, and then in the
  Total Disorder section (TDScr)
• Low (0) unlikely to have a diagnosis
• Moderate (1-2) a possible diagnosis and are
  likely to benefit from a brief intervention.
  Referral indicated
• High (3-5 on a sub-screen 3-20 on the total
  screener) high probability of a diagnosis and
  need for more formal intervention. Referral
  strongly recommended

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Internal Disorder Screener(IDScr)

• Moderate or High on the Internalizing Disorder
  Screener suggests the need for mental health
  assessment related to somatic complaints,
  depression, anxiety, trauma, suicide, and at
  extreme levels more serious mental illness
  (bipolar, etc.)

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Externalizing Disorder Screener (EDScr)

• Moderate or High on the Externalizing Disorder
  Screener suggests the need for further assessment
  for mental health treatment related to attention
  deficits, hyperactivity, impulsivity, conduct
  problems, or other impulse control disorders.

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Substance Disorder Screener (SDScr)

• Moderate or High on the Substance Disorder
  Screener suggests the need for further assessment
  for substance related treatment services and in
  more extreme cases for detoxification or
  maintenance services.

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Crime/Violence Screener (CVScr)

• Moderate or High on the Crime/
• Violence Screener suggests the need for
  assessment for help with interpersonal violence,
  drug-related crime, property violations, and, in
  more extreme cases, interpersonal, violent crime.

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Total Disorder Screener (TDScr)

• Dr. Dennis and colleagues found that persons with
  a high score (3 or more) on the TDScr were very
  likely to have one or more diagnoses (90
  sensitivity) conversely those who scored below
  this point were very unlikely to have any
  diagnosis (90 specificity).
• The individual screeners had 90 sensitivity and
  70 specificity.

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Are you ready to practice?

• Pair up with a partner
• Have a copy of the GAIN-SS, a calendar, and the
  response card
• Interview your partner and score the tool (please
  feel free to role play a typical clientthis does
  not mean a combination of the worst traits from
  every client you have ever seen)
• Switch the interviewer and client roles and repeat

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For More Info on the GAIN
www.chestnut.org/LI/gain/index.html
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Its just a screening tool!

• Remember
• You are not assessing the behaviors
• You are not making a diagnosis
• You are screening for risk
• You are screening to determine the need for
  further assessment ---
• to which you will
• REFER!
• Questions?