1. 1 Next-Generation GAIN Software David Smith, B.G.S. and Michael L. Dennis, Ph.D. Chestnut Health Systems, Bloomington, IL Workshop Presentation for the Joint Meeting on Adolescent Treatment Effectiveness Baltimore, Maryland March 29, 2006, Maryland A Room Preparation of this presentation was supported by funding from the Center for Substance Abuse Treatment (CSAT Contract no. 270-2003-00006). The contents of this presentation are the opinions of the authors 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@chestnut.org

2. 2 This think tank will… Emphasize our commitment to making the GAIN Software widely available, adaptable and compatible with existing and new systems; Provide a brief overview of the GAIN with some of the implications for the GAIN Software; Review the history of GAIN Software; Discuss features and capabilities that we would like to add to the next-generation of GAIN Software; Solicit your input on what would make the GAIN Software more useful to clinicians, clinical researchers, and software developers.

3. 3 GAIN Overview The Global Assessment of Individual Needs (GAIN) is a family of assessment instruments that is widely used in research and clinical settings throughout the United States and Canada. The GAIN has played a significant part in the renaissance of adolescent treatment research and is on the leading edge of the innovative use of assessment data in both research and clinical practice for adolescents and adults.

4. 4 The GAIN is a Family of Instruments There are seven primary instruments: GAIN-I – a 100-page comprehensive biopsychosocial instrument; GAIN-M90 – the follow-up version of the GAIN-I GAIN-SS – a 2-page screener for general populations; GAIN-Q – a 10-page quick assessment; GAIN-QM – the follow-up version of the GAIN-Q; GAIN-CI – a 58-page collateral instrument; GAIN-CM – the follow-up version of the GAIN-CI.

5. 5 The GAIN-I is Comprehensive The current GAIN-I has: A total of 1936 possible questions; Hundreds of related instructions, transition statements and other text items; 156 skips or conditional branches; 314 internal consistency checks; Hundreds of calculated variables per case to support clinical diagnosis and placement decision- making

6. 6 The GAIN Instruments are Customizable Most GAIN instruments are customized: Each is available as a Core with a set of required questions, and a Full with optional questions added. In addition, the makeup of the Core can vary by: Individual Studies Regional Systems Individual Agencies or sites Populations within sites And Special Study questions can be added to the end of most instruments.

7. 7 The GAIN is Constantly Evolving 1993 GAIN 1.x created for NIDA Training and Employment Program (TEP) 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) to focus more specifically on DSM, ASAM, JACHO/CARF and map onto epidemiological data based. 1998 GAIN 3.x revised for CYT and ATM 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 SCY and other CSAT adolescent treatment studies to incorporate reasons for quitting, treatment history & process measures, GPRA versions 3 & 4, several state reporting requirements. Currently on its fourth major revision (version 5.4.0).

8. 8 The GAIN is Widely Used in Research 1995-1997 Drug Abuse Treatment Outcome Study (DOMS) 1997-2000 CSATs Cannabis Youth Treatment (CYT) experiments 1998-2003 CSATs 10 Adolescent Treatment Models (ATM) 2000-2003 CSATs Persistent Effects of Treatment Study (PETS-A) 2002-2007 CSATs 12 Strengthening Communities for Youth (SCY) 2002-2007 CSATs 12+ Targeted Capacity Expansion TCE/HIV 2003-2009 NIDAs 14 individual research grants and CTN studies 2003-2006 CSATs 17 Adolescent Residential Treatment (ART) 2003-2007 CSATs 38 Effective Adolescent Treatment (EAT) 2004-2007 NIAAA/CSATs study of diffusion of innovation 2004-2009 CSAT 22 Young Offender Re-entry Programs (YORP) 2005-2008 CSAT 20 Juvenile Drug Court (JDC) 2005-2008 CSAT 16 State Adolescent Coordinator (SAC) grants

9. 9 The GAIN is Widely Implemented The GAIN has played a role in: Most of the studies that have supported the current Renaissance of Adolescent Treatment Research; The development of clinical expert systems and statistical models to improve diagnosis, placement, treatment planning, program evaluation, and economic evaluations; and Creating the infrastructure supporting the move toward evidence based practice.

10. 10 All Adolescent and Adult, Clinical and Research Sites Using the GAIN since 1993 Indiana Kansas Mississippi Montana Nebraska Nevada North Dakota Arkansas Maine Oklahoma South Dakota Tennessee Alabama Idaho Minnesota New Mexico North Carolina West Virginia Georgia Iowa Louisiana South Carolina Utah Kentucky Alaska Virginia Pennsylvania Michigan Ohio Oregon Colorado New York Arizona Texas Florida Wisconsin Missouri Illinois California Washington Wyoming Number of Sites 1 to 14 15 to 30 31 to 88 Puerto Rico New Hampshire Delaware Hawaii Rhode Island New Jersey District Of Columbia Maryland Connecticut Vermont Massachusetts None (yet) 1+ Statewide syst. 1+ Statewide syst considering it 3/06

11. 11 Where is the GAIN Going? Growth: - The number of sites has doubled every year for five years and is projected to continue to do so for the next five years. Better Integration: - Across records from multiple sources (e.g., participant, collateral, urine) and/or over time. - Into existing and new information systems supporting diagnosis, placement, treatment planning, monitoring, and billing. Decision Support: - Clinical, including how to better use assessment information in diagnosis, placement, and treatment planning. - Supervisory, including monitoring of and technical assistance to staff, grantee or clinic sites to support supervisors, administrators, and funders.

12. 12 Where is the GAIN Going? Flexibility: - More specialized versions, different languages, self administration, and better modularization/set up for local customization (subsets, new items). Technical Innovation: - Incorporation of computer adaptive testing (CAT) to shorten the administration time and other complex statistical modules to improve validity and provide clinical guidance.

13. 13 The Evolution of GAIN Software GAIN Software has been evolving for over a decade: 1993 – Version 1 (FICS) was written in Fortran on DOS for the PC-AT, math-coprocessor emulators, 24-page narrative report that nobody read. 1997 – Version 2 (DOMS) written in Microsoft Access95 with direct synchronization and a statistical summary. 1998 – Version 3 (ABSLite) written in Access97 for data-entry only with direct synchronization and data exports, limited reports. 2000 – Version 4 (ABS) written in Visual Basic with Jet database engine with data export and statistical summaries (ICP). 2003 – Version 5 (ABS) Update of software to address HIPAA requirements, allow interactive interviews and add clinical narrative report (GRRS), GPRA tool and GRL.

14. 14 Current GAIN Software Working in hundreds of agencies around the country. Easy to use – user training takes less than half a day. Clinical reports available immediately after an online interview or after data has been keyed. Data can be pooled over 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). Features for interactive administration, data entry, editing, note making, rekeying and resolution, read-only, report generation. Privacy/security features to aid in complying with HIPAA, 42 CFR and other privacy and security policies. Deployable over LAN/WAN and Internet using Terminal Server or Citrix.

15. 15 Moving to the Next-Generation GAIN Software Up to now weve talked about the context in which were working on the new GAIN Software. Now wed like to talk about how we are envisioning that new software and begin what we hope will be an ongoing conversation about how it will look and work.

16. 16 Initial Decisions The GAIN is too complex for the GAIN Coordinating Center to be able to define and test for multiple developers of GAIN software. The GCCs core competency is the GAIN content – we dont want to become a big software developer. We want to create new GAIN software, not a new case management system.

17. 17 What We Want From a New System Anyone designing a new system these days wants many of the same things: Open Scalable Secure Flexible Maintainable Internet-capable

18. 18 What We Want From a New System In our environment there are several other things that are important to us: Maximum Clinical utility Maximum Research utility Easy interaction with statistical/software/CAT modules Easy interface with other systems

19. 19 Next-Generation We want to build on our existing software strengths: - End-user ease of use - Support for Data Submission process While we add: - Ease of Startup/Implementation - Ease of Local Support - Ease of Tailoring Instruments - Ease of integration with other systems - Robust, modern, standard platforms - Enhanced remote access - Enhanced research and clinical utility - Flexibility and extensibility

20. 20 Next-Generation Overview of typical system Implementation Options (CHS Hosted, Other Hosted (Datacenter), Local Installation, Laptop) Focus on features – - Customization (Templates) - Clinical Reporting (GRRS) - Integration Discussion

21. 21 Next-Generation GAIN Software Overview Based on: Web browser interface SQL database.NET codebase

22. 22 GAIN Software System Architecture

23. 23 Implementation Options Internet Hosted – Cross-system Internet Hosted – System-based Locally Hosted Stand-alone

24. 24 Hosting Options

25. 25 Publicly Hosted

26. 26 Agency Hosted

27. 27 3 rd Party Interaction

28. 28 GRRS Process