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Global Assessment of Individual Needs—Short Screener (GAIN-SS)

Global Assessment of Individual Needs—Short Screener (GAIN-SS). Presented By: Ritchie Tidwell Tidwell & Associates, Inc. | (803) 772-8985 tidwell@grantmaster.org http://www.grantmaster.org. Purpose of GAIN-SS.

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Global Assessment of Individual Needs—Short Screener (GAIN-SS)

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  1. Global Assessment of Individual Needs—Short Screener(GAIN-SS) Presented By: Ritchie TidwellTidwell & Associates, Inc. | (803) 772-8985tidwell@grantmaster.orghttp://www.grantmaster.org

  2. Purpose of GAIN-SS • The GAIN-SS is a screening tool used to quickly identify behavioral health conditions (i.e., internalizing or externalizing psychiatric disorders, crime/violence, substance abuse) amongst adolescents upon initial entry into an integrated behavioral health system.

  3. GAIN-SS Items and Scoring • Four subscales, each with five items for indicating 1) internalizing disorder, 2) externalizing disorder, 3) substance abuse, and 4) crime/violence problems. • The GAIN-SS indicates that a referral is needed for an adolescent if he/she scores a 2 or higher on at least one item.

  4. GAIN-SS Subscales • Internalizing (“within the self”)—e.g., somatic complaints, depression, suicidal ideation • Externalizing (behaviors directed outward)—e.g., hyperactivity, impulsivity • Crime/Violence—e.g., interpersonal violence, property violations, drug-related crimes • Substance Abuse / dependence

  5. GAIN-SS Process • 4 pilot counties began using the tool in June 2008; expansion to other counties was initiated in March 2009 • Screening agencies include AOD, MH, DJJ, and DSS • Agencies that can receive referral via the GAIN-SS: AOD and MH

  6. GAIN-SS Process • Responsibility of referring entity: • Client completes the GAIN Informed Consent( parental/guardian signature required for youth’s under the age of 16) • Administer the GAIN-SS and enter electronically • Counselor shares the results of screening information with youth and parent/guardian. • Counselor calls treatment provider to set up an appointment and /or emergency assessment within the required 72 hours • Counselor sends the GAIN to receiving agency, which will include the appointment time • An e-mail will be sent (electronically) to the receiving agency, informing them of the appointment • Counselor then prints the GAIN and maintains information in client’s records

  7. GAIN-SS Process (cont.) • Responsibility of receiving entity: • Acknowledge receipt of the referral and screening information • Obtain informed consent from client and parent/guardian in order to share information • Complete disposition in the GAIN system as to client status ( show, no show, reschedule, cancelled, etc) *NOTE: Essential component to gain permission to share screening information with service providers. Also essential that youth and parent/guardian are given the information needed to making informed choice.

  8. Implementation Challenges • Interviews with clinicians during Summer 2009 indicated: • GAIN-SS may indicate a referral when a referral is not perceived as necessary or appropriate by clinicians. • It is likely that there have been false-positives due to adolescent attention- seeking behavior, and false-negatives due to adolescent uneasiness in reporting issues such as substance abuse.  • Clinicians have reported not receiving as many referrals as expected from partners. • Smaller South Carolina counties generally have had less opportunities for screenings and referrals. • Clinicians have reported not using the GAIN during the summer when school was out.

  9. Implementation Challenges (cont.) • Interviews with clinicians during Summer 2009 indicated (continued): • There have been various computer glitches (e.g., if an adolescent screens positive but refuses to let the referral take place, there is not an easy way to indicate this in the computer) • Adolescents may participate but refuse to allow certain agencies (viz. MH and DSS) to receive their information. • On occasion, adolescent and their families will grant initial consent yet still refuse a referral. • Clinicians have reported that some 12-14 yr olds do not initially understand the purpose of the GAIN

  10. Implementation Challenges (cont.) • There have been difficulties in scheduling appointments within the required time frame. • Clinicians have reported that various GAIN questions are not helpful (e.g., questions about AOD and suicidal ideation are already in the intake). • Clinicians have reported being unclear about age cutoffs for administering the GAIN. • Clinicians have reported initial reluctance in using the GAIN because they had too many other things to do. • Clinicians in some sites did not initially understand that they had to fill out the disposition section

  11. Screened clients: Percentage contributions by age

  12. Clients with at least one positive indicator: Percentage contributions by race

  13. Sensitivity Analysis • Only 25% of clients with internalizing indicator received referral to MH services • To help determine possible causes for low referral rate, sub-analyses were conducted that distinguished between moderate (past year) and severe (past month) indicators • No marked differences were observed between moderate and severe frequencies for internalizing indicators • Hence, low referral rate is most likely a function of insufficient standardization in agencies’ clinical decision-making and referral practices

  14. Clients with at least one positive indicator: Percentage contributions by race

  15. Clients with at least one positive indicator: Percentage contributions by sex

  16. Statewide Screening and Referral Patterns Clients Screened: 3774 Clients with Positive Indicators: 3361/3774 (89%) Clients Referred: 1518/3774 (40%) Referred to AOD: 853/1518 (56%) Referred to MH: 675/1518 (44%) Seen by AOD: 672/853 (88%) Ave Days to Appt: 5 # Seen by MH: 391/675 (59%) Ave Days to Appt: 4

  17. Statewide Screening and Referral Patterns for Clients with Suicide Indicators # Screened: 3774 # with Positive Suicide Indicator: 415/3774 (11%) # Referrals for Suicide Indicator: 186/415 (45%) Moderate: 50 Severe: 63 Moderate: 42 Severe: 31 # Referred to AOD: 73/186 (39%) # Referred to MH: 113/186 (61%) Moderate: 32 (ave=2 days) Severe: 28 (ave=1 day) Moderate: 32 (ave=1 day) Severe: 45 (ave=2 days) # Seen by AOD: 60/73 (82%) Ave Days to Appt: 2 # Seen by MH: 77/113 (68%) Ave Days to Appt: 2

  18. Conclusions • GAIN-SS is a useful, time-efficient tool for catalyzing referral and treatment • Once referrals are generated, agencies have been successful in getting clients into treatment in a timely manner • Additional evaluation is necessary to: • Understand and address low referral rates • Address entry of disposition data • Analyze reported lack of referrals on clients with suicide ideation

  19. Recommendations for Future • Agency Director letters to local sites to reinforce strategies • Develop “Benefits” sheet for staff and families to stress value of screening and other initiatives • Build on successes of Flagship Counties • Schedule regional meetings with child-serving agencies to assure consistency in implementation • Assure frequency of committee meetings to not lose momentum

  20. Questions ? Ritchie Tidwell Tidwell & Associates, Inc. (803) 772-8985 tidwell@grantmaster.org http://www.grantmaster.org

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