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Chapter 18 Other Special Topics

Chapter 18 Other Special Topics. GAIN Coordinating Center (11/21/2012). Normal , IL: Chestnut Health Systems. November 2012 . Available from www.gaincc.org/slides.

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Chapter 18 Other Special Topics

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  1. Chapter 18 Other Special Topics 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. Other Special Topics • This section presents various other topics including: • GLBTQ status, • ASAM placement, • ASAM treatment planning statements, • Individual Clinical Profile items, • Unmet need and health disparities, • Summary profiles by instrument, • Problem count by instrument, • Treatment Episode Data Set comparisons.

  3. GLBTQ • Gay, Lesbian, Bisexual, Transgendered, or Questioning (GLBTQ) is based on sexual pattern and reported gender for all GAIN versions, with the addition of sexual preference for GAIN version 5.4 and earlier, and also with the addition of sexual attraction and orientation for GAIN version 5.5 and later. • Sexual Pattern is defined by the gender of the sexual partner(s) a participant has had in the past year (all versions). • Sexual Preference is defined as the gender of a preferred sex partner (version 5.4 and earlier). • Sexual Attraction is defined by the gender of one’s current significant sexual or romantic attraction (version 5.5 and later). • Sexual Orientation is defined as the label that the participant most identifies with to describe his/her sexual orientation identity (version 5.5 and later).

  4. Sexual Pattern by GLBTQ SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,440)

  5. GLBTQ GLBTQ 4.9% (n= 1,428) Hetero 95.1% (n=27,529) SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,957)

  6. GLBTQ by Age SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,957)

  7. GLBTQ by Gender Females may be more likely to report GLBTQ preferences, attraction, and behaviors than males SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,949)

  8. GLBTQ by Race SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,943)

  9. GLBTQ by Substance Use Severity SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,568)

  10. GLBTQ by Risk of Homelessness SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,842)

  11. GLBTQ by Severity of Victimization Also of interest is the finding that, of those who identify as GLBTQ, 67% fall in the high severity category SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,877)

  12. GLBTQ by Mental Health Disorders SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,902)

  13. GLBTQ by Health Problems SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,698)

  14. GLBTQ by Crime and Violence SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,919)

  15. GLBTQ by Intensity of Justice System Involvement SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,838)

  16. GLBTQ by Program SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,957)

  17. GLBTQ by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,938)

  18. GLBTQ by Type of Treatment SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,068)

  19. Treatment Needs and Performance Measures

  20. GAIN Treatment Planning/Placement Grid The problem recency/severity axis allows you to classify the client’s problem according to whether it is a current problem, a past problem, or there is no problem “Current problem” is further broken down into low to moderate severity or high severity problem The treatment history axis allows you to classify whether the client is currently receiving treatment for a problem, received treatment in the past, or never received treatment Problem severity and treatment history are determined using responses to GAIN questions For more information on defining problem severity, see Chapter 6 of the GAIN manual, available free for download at http://www.gaincc.org/_data/files/Instruments%20and%20Reports/Instruments%20Manuals/GAIN-I%20manual_combined_0512.pdf or email GAINclinical@chestnut.org Together, the two axes allow for categorization of the client’s problem according to whether they have a problem and whether they are receiving treatment for it already. In general: More severe problems indicate the need for a higher level of care, particularly if current or prior interventions have been unsuccessful Lower severity problems may be addressed with a lower-intensity interventions, unless there is a prior history of intervention This applies to problems on any ASAM treatment planning dimension.

  21. GAIN Treatment Planning/Placement Grid * Current for Dimension B1 = Past 7 days

  22. GAIN Placement Cells by ASAM Dimension SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,382)

  23. GAIN Placement Cells by ASAM Dimension - Interpretation • Some ASAM dimensions are of relatively low concern in this predominantly adolescent population (Intoxication/Withdrawal and Biomedical concerns) • The most severe problems appear in the Environment (B6), Relapse potential (B5), Treatment acceptance/resistance (B4), and Psychological/behavioral dimensions • Of these, Relapse potential shows a high level of current treatment for these problems (treatment or medication in the past 90 days; NOTE: this includes receiving a breathalyzer) • Relapse potential also has the highest percentage of those with no problem receiving treatment • The highest rate of no problems is for intoxication/withdrawal, however, current problems are measured in the past 7 days for this dimension, rather than the past 90 days used for the other dimensions • The high number of untreated past problems on the Biomedical dimension compared to the low number receiving treatment for these problems suggests this may be an area of concern for this population

  24. ASAM Dimension Treatment Planning Needs • For each ASAM dimension, there is a large number of possible treatment planning recommendations • These statements can be generated based on responses to GAIN questions and are included as recommendations in the GAIN Recommendation and Referral Summary Report (atext-based narrative designed to be edited and shared with specialists, clinical staff from other agencies, insurers, and lay people) • The following slides provide data on the most commonly produced treatment planning needs generated from responses to the GAIN by ASAM dimension

  25. B1. Intoxication/Withdrawal –Common Treatment Planning Needs Few clients with dimension B1 needs; most common is need for detox (high withdrawal or substance use in the past two days or daily use) SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,665)

  26. B2. Biomedical – Common Treatment Planning Needs Most common are reduction of risky sexual behavior and tobacco cessation *n = 12,684 ** n = 10,812 SAMHSA 2011 GAIN Summary Analytic Data Set (n=24,349)

  27. B3. Psychological – Common Treatment Planning Needs More than 75% of clients need to coordinate services with the justice system and more then 50% have problems with anger management and behavior control *n = 13,868 SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,436)

  28. B4. Readiness –Common Treatment Planning Needs Most (>60%) are required and/or under pressure to attend treatment *n=28,901 SAMHSA 2011 GAIN Summary Analytic Data Set (n=14,774)

  29. B5. Relapse Potential –Common Treatment Planning Needs More than 60% are not close to anyone in recovery SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,923)

  30. B6. Environment – Common Treatment Planning Needs Environmental risk considers people the client spends time with who are involved in school, training, illegal activities, arguing/fighting, using substances or treatment, or are in recovery *n=14,592 **n=12,229 ***n=7,316 SAMHSA 2011 GAIN Summary Analytic Data Set (n=25,254)

  31. GAIN Individual Clinical Profile Individual Clinical Profile (ICP) is a report generated from GAIN data which provides detailed information on diagnosis, placement, and treatment planning. It includes the core scale scores, detailed tables, and notes about the questions and conditions that met the various criteria. Designed to help triage problems and help the clinician go back to the GAIN for more details if necessary The following slides focus on the ASAM Placement Profile and Service Utilization in the past 90 days sections of the ICP The Placement Profile section provides a numeric and graphical summary of the participant’s responses. particularly useful for seeing patterns and prioritizing problems across sections. Within each section are rows to identify the recency, breadth, and prevalence of problems. Past 90 day service utilization should be used to distinguish between a lack of problems and a lack of problems while the corresponding treatment and services are being provided. While most of this information is presented elsewhere in this presentation, the ICP organizes it so that problems and services can be examined simultaneously by ASAM Dimension.

  32. ICP: ASAM A. Diagnosis SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,342)

  33. ICP: ASAM B1. Acute Intoxication/ Withdrawal – Problems (Past 90 days) * Past week **Lifetime SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,649)

  34. ICP: ASAM B1. Acute Intoxication/ Withdrawal – Services (Past 90 Days) SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,651)

  35. ICP: ASAM B2. Biomedical – HIV Risk Problems (Past 90 Days) * Past Year SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,591)

  36. ICP: ASAM B2. Biomedical – Health Problems (Past 90 Days) * Past Year **Lifetime SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,197)

  37. ICP: ASAM B2. Biomedical – Services (Past 90 Days) SAMHSA 2011 GAIN Summary Analytic Data Set (n=20,639)

  38. ICP: ASAM B3. Internalizing Disorders (Past Year) SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,595)

  39. ICP: ASAM B3. Externalizing Disorders (Past year) SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,582)

  40. ICP: ASAM B3. Crime & Violence (Past Year) SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,361)

  41. ICP: ASAM B3. Emotional, Behavioral, or Cognitive – Services (Past 90 Days) SAMHSA 2011 GAIN Summary Analytic Data Set (n=20,639)

  42. ICP: ASAM B4. Readiness to Change – Current Problems * Scores are reversed to reflect that low scores are of high clinical severity. + n=13,429 ++ n=12,802 # n=16,475 ## n=4,294 SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,394)

  43. ICP: ASAM B4. Readiness to Change and Relapse Potential – Services (Past 90 Days) SAMHSA 2011 GAIN Summary Analytic Data Set (n=20,639)

  44. ICP: ASAM B5. Relapse Potential – Current Problems * Past 90 days **Lifetime ** Scores are reversed to reflect that low scores are of high clinical severity. SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,563)

  45. ICP: ASAM B6. Recovery Environment – Environmental Risk Problems (Past Year) * Lifetime SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,401)

  46. ICP: ASAM B6. Recovery Environment – School and Work Problems (Past 90 Days) SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,134)

  47. ICP: ASAM B6. Recovery Environment – Support Problems (Past 90 Days) * Past Year **Current *** Scores are reversed to reflect that low scores are of high clinical severity. SAMHSA 2011 GAIN Summary Analytic Data Set (n=11,845)

  48. ICP: ASAM B6. Recovery Environment – Services (Past 90 Days) SAMHSA 2011 GAIN Summary Analytic Data Set (n=25,800)

  49. Need Based Performance Measures Clients with Mod/High Needis calculated as an ASAM cell placement of (3) low or moderate problems and not in treatment, (4) severe problems and not in treatment, (6) low or moderate problems and currently in treatment, or (7) severe problems and currently in treatment. It is reported as the extent of the need for treatment. Higher numbers are bad. Percent with no treatment of those with need is the number of people with mod/high need for treatmentwho did NOT receive treatment after 3 months divided by the total number who needed treatment. It is reported as the degree of unmet need for treatment. Higher numbers are bad. Clients receiving services is calculated as any days of treatment received in the past 90 days where treatment is defined appropriately by dimension (see footnotes on each slide). Higher numbers are good. Percent with no/low need of those served is the number of people with low or no need for treatment who received services divided by the total number of those who received treatment after 3 months. Higher numbers are bad. Need/Unmet Need Services/Un-targeted Services

  50. Any AOD Use, Abuse, or Dependence at Intake vs. SA Treatment at 3 Months Services for drug use are well targeted with those in need receiving services and services not being spread to those without need *Any past year AOD problems, use, abuse, or dependence ** ‘Services’ is self-report of any days of SA treatment at 3 months SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=18,899)

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