Global Appraisal of Individual Needs The Global Appraisal of Individual Needs (GAIN) is a progressive and integrated family of instruments for:  initial screenings, brief interventions and referrals  standardized biopsychosocial clinical assessments for diagnosis, placement and treatment planning  monitoring of changes in clinical status, service utilization, and costs to society  subgroup and program level needs assessment and evaluation The GAIN has been used with both adolescents and adults and in outpatient, intensive outpatient, partial hospitalization, methadone, short-term residential, long-term residential, therapeutic communities, and correctional programs.

The GAIN Family of Instruments  GAIN-SS (Short Screener)  GAIN-Q (Quick)  GAIN-I (Initial)  GAIN-M (Monitoring)

GAIN-SS  Purpose: Designed as a Screener for use in general populations to quickly and accurately identify a client’s risk of having a disorder that warrants further assessment  Administration Time : 5 minutes  Mode : Staff* administered on paper copy (can be self-administered, but not recommended for screening individuals) not recommended for screening individuals)  Scales: There are 4 subscales, each measuring 5 symptoms (Total/20). ID Scr - Internal disorders (i.e. somatic, depression, suicide, anxiety), ID Scr - Internal disorders (i.e. somatic, depression, suicide, anxiety), EDScr - External disorders (behavioral disorders i.e. ADHD, conduct EDScr - External disorders (behavioral disorders i.e. ADHD, conduct disorders), disorders), SDScr - Substance use disorders (abuse, dependence), and SDScr - Substance use disorders (abuse, dependence), and CVScr - Crime/violence (interpersonal violence, property crime, CVScr - Crime/violence (interpersonal violence, property crime, drug-related crime) drug-related crime)

Determining the Risk  GAIN-SS responses are given in terms of the recency of the problem described in the questions: 3 = past month 2 = 2 to 12 months ago 1 = 1+ years ago 0 = never.  The number of past-month symptoms = number of 3s  The number of past-year symptoms = number of 2s or 3s  We will only be concerned with the number of 3s and 2s *Note: Other practitioners who want to consider the number of lifetime symptoms, would also include the number 1s.

Instructions for GAIN-SS items   This instrument is designed to find out how you are doing in terms of your health and behavior.   The information is _______ * (privacy statement).   It will only be used to _________ * (choose) (Help me know who you should talk to.) (Make a good referral for you.)   It takes about 5 minutes to answer and you can say that you do not know or that you do not want to answer any question.   If you are not sure about an answer, please give us your best guess.

Several questions will ask you about things that have happened during the past month, 2-12 months ago, more than 12 months ago, or never. To help you remember these time periods, please look at this calendar. Do you recall anything that was going on about (DATE 30 DAYS AGO)? (PROBE FOR SPECIFIC EVENT, SEE BELOW IF PROBLEMS.) When the last time something happened was since (NAME OF EVENT THAT WAS 30 DAYS AGO), please answer, “Past month.” Do you recall anything that was going on about (DATE 30 DAYS AGO)? (PROBE FOR SPECIFIC EVENT, SEE BELOW IF PROBLEMS.) When the last time something happened was since (NAME OF EVENT THAT WAS 30 DAYS AGO), please answer, “Past month.” Do you recall anything that was going on about (DATE 12 MONTHS AGO)? (PROBE FOR SPECIFIC EVENT, SEE BELOW IF PROBLEMS.) When the last time something happened was between (30 DAY AGO EVENT) and (12 MONTH AGO EVENT), please answer, “2-12 months ago.” Do you recall anything that was going on about (DATE 12 MONTHS AGO)? (PROBE FOR SPECIFIC EVENT, SEE BELOW IF PROBLEMS.) When the last time something happened was between (30 DAY AGO EVENT) and (12 MONTH AGO EVENT), please answer, “2-12 months ago.” When the last time something happened was before (12 MONTH AGO EVENT), please answer, “1+ years ago.” When the last time something happened was before (12 MONTH AGO EVENT), please answer, “1+ years ago.” If something has never happened, please answer, “Never.” If something has never happened, please answer, “Never.” IF PARTICIPANT IS UNABLE TO RECALL ANY EVENTS: Do you remember any birthdays, holidays, sporting or other special events that happened around (DATE 90 DAYS/12 MONTHS AGO)? Did anything change in terms of where you were living, who you were with, whether you were in school or someplace else? Where were you living then? Were you in treatment, working, in school, or involved with the law then? IF PARTICIPANT IS UNABLE TO RECALL ANY EVENTS: Do you remember any birthdays, holidays, sporting or other special events that happened around (DATE 90 DAYS/12 MONTHS AGO)? Did anything change in terms of where you were living, who you were with, whether you were in school or someplace else? Where were you living then? Were you in treatment, working, in school, or involved with the law then?

Instructions, continued   The following questions are about common psychological, behavioral or personal problems. These problems are considered significant when you have them two or more weeks, when they keep coming back, when they keep you from meeting your responsibilities, or when they make you feel like you can’t go on.   After each of the following statements, please tell us the last time you had this problem, if ever, by responding: “In the past month”; “2-12 months ago”; “1 or more years ago”; or, never. **NOTE: It is very important for the client to fully understand the meaning of “significant”.

Examples of items 1. When was the last time you had significant problems… a. with feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future? b. with sleeping, such as bad dreams, sleeping restlessly or falling asleep during the day? c. with feeling very anxious, nervous, tense, fearful, scared, panicked or like something bad was going to happen? d. when something reminded you of the past, and you became very distressed and upset? e. with thinking about ending your life or committing suicide?

SCORING THE GAIN-SS  We are scoring past-year symptoms. Count the number of 3s (past month) or 2s (2-12 months ago) to get the number of symptoms occurring in the past year:  1a to 1e for the Internalizing Disorder Screener  2a to 2e for the Externalizing Disorder Screener  3a to 3e for the Substance Disorder Screener  4a to 4e for the Crime/Violence Screener  1a to 4e or sum of above for the Total Disorder Screener

SCORING THE GAIN-SS  “COUNT” the number of responses that are 3s and 2s for each section (don’t “Sum”). For example of responses to Section 1 (InternalizingDisorders) : 1a = 3 (past month) 1 1b = 2 (2-12 months ago) 1 1c = 3 (past month) 1 1d = 1 (more than 12 months ago) 0 1e = 0 (never) + 0 = 3 = 3 The score for the IDScr section is “3” The score for the IDScr section is “3”

SCORING THE GAIN-SS  Example SDScr (Substance Disorder Screener) : 3a = 2 (2 – 12 mo. ago) 1 3a = 2 (2 – 12 mo. ago) 1 3b = 1 (1+ years ago) 0 3b = 1 (1+ years ago) 0 3c = 0 (never) 0 3c = 0 (never) 0 3d = 0 (never) 0 3d = 0 (never) 0 3e = 0 (never) + 0 3e = 0 (never) + 0 = 1 = 1 The total for the SCScr is “1” The total for the SCScr is “1”

Scoring Template Scoring: Count (do not sum) the number of 3’s & 2’s … ScreenerItems Past Year (3,2) 1. IDScr 1a-1e 2. EDScr 2a-2e 3. SDScr 3a-3e 4. CVScr 4a-4e Total1a-4e

Record the Scoring  On the Screener, you will record the total number of 3 and 2 responses for each section.  For the first four sections (ID, ED, SD, C/V) you should have a 0 – 5 as a section total.  0 – 20 will be written in the space marked “TDScr” (Total Disorder Screener).

A demonstration…

Interpretation  Does the student need to be referred for further assessment? Look at the past-year totals (3s and 2s) in the four sub-sections, and then in the Total Disorder section (TDScr): Low (0) : unlikely to have a diagnosis Low (0) : unlikely to have a diagnosis Moderate (1-2): a possible diagnosis and are likely to benefit from a brief intervention. *Referral indicated Moderate (1-2): a possible diagnosis and are likely to benefit from a brief intervention. *Referral indicated High (3-5 on a sub-screen; 3-20 on the total screener): high probability of a diagnosis and need for more formal intervention. *Referral strongly recommended High (3-5 on a sub-screen; 3-20 on the total screener): high probability of a diagnosis and need for more formal intervention. *Referral strongly recommended

Internal Disorder Screener (IDScr)  Moderate or High on the Internalizing Disorder Screener suggests the need for mental health assessment related to somatic complaints, depression, anxiety, trauma, suicide, and at extreme levels more serious mental illness (bipolar, etc.)

Externalizing Disorder Screener (EDScr)  Moderate or High on the Externalizing Disorder Screener suggests the need for further assessment for mental health treatment related to attention deficits, hyperactivity, impulsivity, conduct problems, or other impulse control disorders.

Substance Disorder Screener (SDScr)  Moderate or High on the Substance Disorder Screener suggests the need for further assessment for substance related treatment services and in more extreme cases for detoxification or maintenance services.

Crime/Violence Screener (CVScr)  Moderate or High on the Crime/ Violence Screener suggests the need for assessment for help with interpersonal violence, drug-related crime, property violations, and, in more extreme cases, interpersonal, violent crime. Violence Screener suggests the need for assessment for help with interpersonal violence, drug-related crime, property violations, and, in more extreme cases, interpersonal, violent crime.

Total Disorder Screener (TDScr)  Dr. Dennis and colleagues found that persons with a high score (3 or more) on the TDScr were very likely to have one or more diagnoses (90% sensitivity); conversely those who scored below this point were very unlikely to have any diagnosis (90% specificity).  The individual screeners had 90% sensitivity and 70% specificity.

Are you ready to practice?  Pair up with a partner  Have a copy of the GAIN-SS, a calendar, and the response card  Interview your partner and score the tool (please feel free to role play a typical client—this does not mean a combination of the worst traits from every client you have ever seen)  Switch the interviewer and client roles and repeat

For More Info on the GAIN

It’s just a screening tool! Remember…  You are not assessing the behaviors  You are not making a diagnosis  You are screening for risk  You are screening to determine the need for further assessment --- to which you will…  REFER!  Questions?