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The GAIN-Q (GQ): Development and Validation of a Substance Abuse and Mental Health Brief Assessment Janet C. Titus, Ph.D. Michael L. Dennis, Ph.D. Lighthouse.

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Presentation on theme: "The GAIN-Q (GQ): Development and Validation of a Substance Abuse and Mental Health Brief Assessment Janet C. Titus, Ph.D. Michael L. Dennis, Ph.D. Lighthouse."— Presentation transcript:

1 The GAIN-Q (GQ): Development and Validation of a Substance Abuse and Mental Health Brief Assessment Janet C. Titus, Ph.D. Michael L. Dennis, Ph.D. Lighthouse Institute Chestnut Health Systems Titus, J. C., & Dennis, M. L. (2003). The GAIN-Quick (GQ): Development and Validation of a Substance Abuse and Mental Health Brief Assessment. Poster (#83) presented at the 65th Annual Scientific Meeting of the College for Problems on Drug Dependence (CPDD), Miami, Florida.

2 Abstract The Global Appraisal of Individual Needs-Quick (GAIN-Q) is a brief assessment designed for use in diverse settings to a) identify those in need of a longer, more detailed assessment; b) identify those who may benefit from a brief intervention; and c) guide staff to make effective referral and placement decisions. Scales include those for general life problems (general risk factors, sources of stress, health distress), internal behavior (depression, suicide risk, anxiety), external behavior (activity and inattention, conduct disorder/aggression, illegal activities), and substance-related difficulties (substance use and abuse, substance dependence). The GAIN-Q scales were developed using data from two large treatment outcome studies, one involving adolescents (Cannabis Youth Treatment or CYT, N=600, 82% boys, 48% meeting criteria for dependence and 50% for abuse, most with multiple emotional or behavioral problems) and the other on adults (Early Re-Intervention or ERI, N=448, 59% female, 94% lifetime dependence). Subsets of items from the longer GAIN-I (Dennis, 2002) were selected for the shorter GAIN-Q through the application of classical and summative measurement theories. Coefficient alpha on the total score is.91 for adolescents and.94 for adults, with scale and subscale alphas in the moderate to high range. Evaluation of the summative scales’ reliability and utility is achieved by the indices’ relationships with a number of logically related variables. The GAIN-Q is in use by over 20 research and clinical sites across the United States, allowing for further analysis of the instrument’s psychometric properties and the creation of norms.

3 In this presentation, we aim to… Introduce the GAIN-Q instrument and its scales and subscales. Explain the development of the instrument using adolescent and adult samples. Present initial evidence of validation for the instrument using adolescent and adult samples.

4 The GAIN-Q is part of the GAIN Family of Instruments GAIN-I – Comprehensive biopsychosocial intake assessment for diagnosis and placement of individuals coming into substance abuse treatment (Dennis et al., 2002) GAIN-M90 – 90 day follow-up version of the GAIN-I GAIN-CI – Intake assessment for collaterals (e.g., family, friends) of individuals going into treatment GAIN-CM – 90 day follow-up version of the GAIN-CI GAIN-Q – Brief assessment used to identify various life problems among adolescents and adults in the general population; designed for use by personnel in diverse settings (e.g., EAP, SAP, health clinics, JJ, CJ); created from a subset of items on the GAIN-I

5 How is the GAIN-Q used? Identify those in need of a longer, more detailed assessment Identify those who may benefit from a brief intervention Guide staff to make effective referral and placement decisions Although it does not provide diagnostic information per se, it does identify areas in need of further exploration.

6 Features of the GAIN-Q Arranged in 10 sections (Background, General Factors, Sources of Stress, Physical Health, Emotional Health, Behavioral Health, Substance-Related Issues, Service Utilization, End, Case Disposition) Ten pages in length Hard copy assessment or computer administration Interviewer- or self-administered in minutes Most items written in a “yes/no” format Scoring profiles and narrative reports to facilitate interpretation Can be combined with other information to produce Personal Feedback Reports and other intervention- specific reports.

7 Development of the GAIN-Q Data from adolescent and adult samples were used. Scales were created on assumptions of classical and summative measurement models. Classical measurement model includes internally consistent indicators that are combined to estimate an underlying latent trait; predictive variance is manifest in the common variance of indicators. Summative model assumes scores are linear combinations of variety of behaviors which define the domain and are evaluated on whether they exhibit relationships with logically related variables; predictive variance is manifest in the total variance.

8 Development Sample Characteristics Adolescent sample (N=600) was predominantly male (83%), Caucasian (62%), ages (55%), had one or more emotional or behavioral problems (95%), used marijuana weekly (71%), & met criteria for abuse (50%; 48% dependence). Adult sample (N=448) was predominantly female (59%), African-American (79%), 21+ years, & met criteria for lifetime dependence at intake (94%).

9 General Life Problems Index (a measure of general risk factors associated with substance use and mental health problems)  Subscales are General Factors, Sources of Stress, & Health Distress Index.  Items were drawn from multiple sources, including the National Household Survey of Drug Abuse (NHSDA), National Health Interview Survey (NHIS), Illinois Youth Survey (IYS), and DSM-4.  Items are empirically associated with drug abuse and mental health problems.

10 Internal Behavior Index (a measure of past year signs & symptoms of depression & anxiety) Subscales are Depression Symptom Index, Suicide Risk Index, & Anxiety Symptom Index.

11 External Behavior Index (a measure of past year signs & symptoms of activity & inattention, conduct disorder, & criminal behavior) Subscales are Activity-Inattention Index, Conduct Disorder-Aggression Index, & General Crime Index.

12 Substance Problem Index (a measure of problems associated with use, abuse, & dependence on drugs & alcohol) Subscales are Substance Use and Abuse Index & Substance Dependence Index.

13 Validation Analyses Examine the level and pattern of co-occurring disorders (Internal, External, Neither, Both -- as defined by GAIN-I clinical scales’ items) using the abbreviated set of GAIN-Q clinical scales’ items. Using GAIN-Q data, predict membership in each of the four co-occurring disorders groups (as defined by the GAIN-I data).

14 Adolescents Internal Distress External Behaviors Substance Problems

15 Adults Internal Distress External Behaviors Substance Problems

16 Evidence for Predictive Validity Adult group – 83% of cases were correctly classified; Cohen’s kappa between original group membership and predicted group membership was.75 (p<.001; st. error =.027, N=425) Adolescent group – 75% of cases were correctly classified; Cohen’s kappa between original group membership and predicted group membership was.64 (p<.001; st. error =.026; N=588)

17 Conclusions The GAIN-Q is a short assessment currently used to identify those in need of more indepth evaluation or those who may benefit from a brief intervention. Analyses of the GAIN-Q’s classical scales and subscales reveal moderate to high internal consistency; summative scales show strong associations with logically related variables. Evidence for predictive validity includes strong associations between GAIN-I categories of co- occurring disorders and shorter GAIN-Q scale scores; classification analyses significantly predicted membership in co-occurring disorder groups.

18 Next Steps for the GAIN-Q Collect and analyze data across a wide variety of factors (i.e., setting, placement, developmental level, culture, gender, race, etc.) to create meaningful norms. Translate the GAIN-Q into the 2 nd and 3 rd most widely used languages in the United States: Spanish and American Sign Language. Continue with the further development of the GAIN- Q and its resources in response to user need and input. (The GAIN-Q is currently in use in approximately 20 research and clinical sites around the country, including recently introduced profiles, narrative reports, and intervention-specific reports.)

19 Further Information & Acknowledgement For further information, contact Dr. Janet C. Titus, Chestnut Health Systems, 720 W. Chestnut St., Bloomington, IL GAIN-Q materials are available at LI/GAIN/GAIN-Q. This poster is at LI/GAIN/GAIN-Q The initial development of the GAIN-Q and its manual was supported by the Center for Substance Abuse Treatment (grant no. TI 11320, contract no , contract no ), the National Institute on Alcohol Abuse and Alcoholism (grant no. R01 AA10368), the National Institute on Drug Abuse (grant no. R01 DA 11323), and the Macon County Office of Probation in Decatur, IL.


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