Title: Planning for the Next Generation of the Global Appraisal of Individual Needs GAIN
1Planning for the Next Generation of the Global
Appraisal of Individual Needs (GAIN)
- Michael Dennis, Ph.D., David Smith, B.G.S.,
Michelle White, Ph.D. - Chestnut Health Systems, Bloomington, IL
- Think Tank Presentation for the Joint Meeting on
Adolescent Treatment Effectiveness, Baltimore,
MD, March 28, 2006, Federal Hill Room.
Preparation of this manuscript was supported by
funding from the Center for Substance Abuse
Treatment (CSAT Contract no. 270-2003-00006). The
content of this poster are the opinions of the
author and do not reflect the views or policies
of the government. Available on line at
www.chestnut.org/LI/Posters or by contacting Joan
Unsicker at 720 West Chestnut, Bloomington, IL
61701, phone (309) 827-6026, fax(309) 829-4661,
e-Mail junsicker_at_Chestnut.Org
2Global Appraisal of Individual Needs (GAIN)
- The GAIN was developed through over a decade of
collaboration - between clinical researchers, practitioners,
information - technology specialists, funders, and regulators
and is today in - over 300 programs around the United States and
Canada. Based - on a progressive approach to assessment, the GAIN
is a series of - instruments that include
- A 5 minute GAIN-Short Screener (GSS) that can be
used in general populations, for triage services,
or as a denominator/measure of change in program
evaluation - A 20-30 minute GAIN-Quick (GQ) that can be used
with targeted populations (e.g. SAP/EAP, JJ/CJ
settings) to support a basic assessment, brief
intervention, and/or referral to specialty
treatment systems - A 90-120 minute GAIN-Initial (GI) designed to
serve as a standardized biopsychosocial and
integrated clinical research assessment tool - A 30-60 minute GAIN-Monitoring 90 days (GM90) for
tracking change over time and program
evaluation/clinical research.
3This think tank will..
- Summarize the evolution of the GAIN to date, the
growth of the community using it, what it does
well, and summarize where it is currently going - Seek your input on three key challenges for the
next generation of the GAIN - Integrating Treatment Planning and Placement
Recommendation - Software Interface, Modules, Customization
- Workforce Training, Turnover, Sustainability
4Evolution of the GAIN
- 1993 GAIN 1.x created for NIDA Training and
Employment Program (TEP) with adult methadone
clients as an integrated clinical and research
instrument based on ASI, IAP, DATOS, several
existing scales - 1996 GAIN 2.x revised for Drug Outcome Monitoring
Study (DOMS) of all Chestnut Interventions
adult and adolescent levels of care to focus more
specifically on DSM, ASAM, JACHO/CARF and map
onto epidemiological data based - 1998 GAIN 3.x revised for Cannabis Youth
Treatment (CYT) and Adolescent Treatment Model
(ATM) in 18 sites to address problems in DOMS and
incorporate GPRA versions 1 2 - 2000 GAIN 4.x revised to include several new
modules to address specific NIDA and NIAAA
research studies (not widely used) - 2002 GAIN 5.x revised for Strengthening
Communities for Youth (SCY) and CSAT adolescent
treatment program to incorporate changes from
version 4.x, reasons for quitting, treatment
history process measures, GPRA versions 3 4,
several state reporting requirements.
5Location of CSAT Adolescent Treatment Grantees
Using the GAIN Since 1997
NH
WA
VT
ME
MT
ND
MN
OR
MA
NY
ID
WI
SD
MI
WY
RI
IA
PA
CT
NE
OH
NJ
NV
DC
IN
UT
IL
CA
CO
WV
VA
DE
DC
KS
MO
KY
MD
NC
TN
AR
AZ
OK
Program
NM
SC
ART
ATM
GA
AL
MS
CYT
Drug Court
TX
LA
Earmark
AK
EAT
SCY
FL
TCE
YORP
SAC Grant States
PR
HI
3/06
6All Adolescent and Adult, Clinical and Research
Sites Using the GAIN since 1993
New Hampshire
Washington
Maine
Minnesota
Montana
Vermont
North Dakota
Oregon
Massachusetts
Wisconsin
Idaho
New York
South Dakota
Michigan
Rhode Island
Wyoming
Iowa
Pennsylvania
Connecticut
Nebraska
Nevada
Indiana
Ohio
New Jersey
Illinois
West Virginia
Utah
Colorado
Delaware
Virginia
Kansas
Missouri
District Of Columbia
Kentucky
California
North Carolina
Maryland
Tennessee
Oklahoma
Arkansas
South Carolina
Arizona
New Mexico
Mississippi
Alabama
Georgia
Number of Sites
Texas
Louisiana
None (yet)
1 to 14
Alaska
15 to 30
Florida
31 to 88
Hawaii
3/06
Puerto Rico
7Collaboration to create an common infrastructure
to help move the field towards evidenced based
practice
CSAT, NIH, Other Federal, State Local Agencies
Researchers, Local National Evaluators
Sites/Clinics Their IT providers
Chestnut, Optimos, Consultants (often from
sites)
8Common Values
- Want to improve the quality, effectiveness, and
cost effectiveness of substance abuse treatment
by providing an infrastructure to facilitate
evidence based practice and applied research. - Take advantage of growing knowledge base and
shared resources to guide individual level
clinical decisions and effectiveness. - Collect data in a reliable, valid and efficient
manner so that it can be used to support clinical
decision making, administration, accreditation,
program planning, evaluation and research. - Use open software that is flexible enough to use
from situations with no/low IT support to a more
complex agency mapping it onto detailed polices. - Maintain consistency of items, business rules,
and data bases required to share clinical
decision making tools and reports (which save
money), and to pool the data in a reliable and
valid way to facilitate the expansion of the
knowledge base and - To attracting additional sites, policy makers,
evaluators, and researchers interested in using
the system or improving our knowledge.
9Where is the GAIN Going?
- The number of programs using the GAIN has doubled
every year for five years and is projected to
continue to do so for the next five years as
increasingly more regional/state systems strongly
recommend, offer incentives for, and/or codify
requirements to use the GAIN. - Incorporation of computer adaptive testing to
shorten the administration time and other complex
statistical modules to improve validity and
provide clinical guidance. - Better integration of information across records
from multiple sources (e.g., participant,
collateral, urine) and/or over time. - Better integration into existing clinical
information systems related to diagnosis,
placement, treatment planning, monitoring, and
billing.
10Where is the GAIN Going? (continued)
- Demands for more specialized versions, different
languages, self administration, and better
modularization/set up for local customization
(subsets, new items). - Demands for easier ways to generate both canned
and locally created reports to Word, Excel,
Access and other languages. - Demands for use in a range of platforms (laptop,
LAN/WAN, Internet) including minimal/no set up
accounts for sites with minimal IT
infrastructure. - Demands for tools to help local IT staff manage
and update the applications in complex systems. - Need for more robust and flexible software to
meet these demands.
11Where is the GAIN Going? (continued)
- Development of work force development/quality
control model, public domain manuals, other
shared clinical resources, open syntax, data
sharing with multiple applied researchers and
evaluators. - Secondary analysis of existing data to improve
knowledge about what works for whom and to guide
clinicians. - Meta analysis of Adolescent Treatment
Effectiveness Studies and Synthesis to related
them to non-experimental outcome studies. - Development of case mix and propensity score
adjustments for non-experimental studies. - Becoming a key piece of infrastructure in the
move toward evidence based practice.
12Integrating Treatment Planning and Placement
Recommendation
- Challenge Staff have a difficult time
consistently implementing approach to treatment
planning and ASAM placement when they edit the
diagnoses/reports in Word, the changes are not in
the data set. - Potential Strategies
- Expand the GRRS clinical narrative to provide a
summary of what the client wants, general
treatment planning recommendations, and specific
recommendation based on their self reports, and
preliminary level of care recommendations based
on what their peers would do - Create a tool in the new software for partially
editing the diagnosis, treatment planning and
placement recommendation in the system so that
answers are save and available - Produce simple cross tabs of what the computer
recommended vs. what staff did that can be run
overall, by site, staff person or type of client
to identify training issues and for program
planning
13Software Interface, Modules, Customization
- Challenge In the new GAIN Software we plan to
provide instrument templates that will parallel
current grant cores plus others that are
optimized for assessment time, clinical
reporting, mental health, criminal justice, etc.
Adding additional customizability will also add
complexity, cost and development time. - Potential Strategies
- Develop an online tool to fine-tune these
templates further and create new ones - Include knowledge about the composition of
scales and indices in this tool to protect the
user from breaking important relationships - Add the ability to add modules with additional
questions at the end of a GAIN assessment in
essence additional instruments
14Workforce Training, Turnover, Sustainability
- Challenge Many programs enjoy using the GAIN
once it is in use, but when grant funding ends or
trained and certified local trainers resign, they
have a difficult time sustaining its use. They
also have problems with planning issues related
to which instruments to continue using, when, and
why. - Potential Strategies
- Offer packets or consultations on addressing
sustainability based on the experiences of
programs who have been successful in doing it - Reduce barriers to initial implementation to
retain staff longer, thus reducing turnover
problems - Addition of state or regional level
certification/shared local trainers across
programs to address turnover and training issues - Proactive introductions between local programs
using GAIN to encourage cross-program
collaboration to improve sustainability - Improve software tools to better identify which
staff most need ongoing QA reviews