1. Global Appraisal of Individual Needs (GAIN): An introduction and Opportunity to Ask Questions
Kate R. Moritz, M.A. & Michael L. Dennis, Ph.D.
Chestnut Health Systems, Normal, IL
Presentation at the Reclaiming Futures Leadership Institute, Asheville, NC, May 8, Supported by the Reclaiming Futures/Juvenile Drug Court Evaluation under Library of Congress contract no. LCFRD11C0007 to University of Arizona Southwest Institute for Research on Women, Chestnut Health Systems & Carnevale Associates The development of this presentation is funded by the Office of Juvenile Justice and Delinquency Prevention (OJJDP) through an interagency agreement with the Library of Congress – contract number LCFRD11C0007. The views expressed here are the authors and do not necessarily represent the official policies of OJJDP or the Library of Congress; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. Available from

2. Goals
Give an overview of the different GAIN measures, why/when they would be each be used and what the value added would be.
Illustrate with real data the diversity in the type and severity of problems, as well as how they vary by juvenile justice system involvement.
provide an opportunity to ask questions.

3. GAIN Overview
As defined by the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices (NREPP), EBPs “...generally refer to approaches to prevention or treatment that are validated by some form of documented scientific evidence.”
1 This simply means that several clinical research studies showed the treatment was effective. EBP promotes high quality care and better outcomes for adolescents with substance use disorders.
2 Practice-Based Evidence (PBE) is the flip side of EBP, but is proving to be just as important. Communities, agencies and families create PBE when they attempt to adapt treatment practices to their unique needs.
3 Treatment methods based on the intuition and experience of practitioners and families often are tough to measure with traditional research methods. Practitioners of PBE merge culturally and traditionally defined methods of treating substance abuse to insure a comprehensive, or wellness, approach to treatment. PBE informs selected interventions with the history and culture of the community in which it is practiced. PBE accepts that treatment should be grounded by scientific evidence, but also recognizes that treatment is most successful when informed by community experience.
2 The involvement of an adolescent and his or her family is a strong component of PBE, with the adolescent and his or her caregivers collaborating with the provider on goals, success measures, and the best ways to achieve success.
In adolescent substance abuse treatment, EBPs range widely in their design and application, from individual forms of counseling to family therapy. The expected outcomes for EBPs often are not the same, though all seek a measurable reduction in the negative consequences of substance abuse. EBPs used without regard for a person’s cultural, family, or community values will likely lower long term, positive outcomes.
3 Similarly, PBE by itself is a subjective collection of judgments about what might work. Therefore, achieving the best outcomes for adolescents requires some combination of EBP and PBE. 3

4. The Global Appraisal of Individual Needs (GAIN) is…
A family of instruments ranging from screening to quick assessment to full biopsychosocial and monitoring tools
Designed to integrate clinical and research assessment
Designed to support clinical decision making at the individual client level
Designed to support evaluation and planning at the program level
Designed to support secondary analyses and comparisons across individuals and programs

5. Use of the GAIN in the U.S.: 1997-2012

6. Use of the GAIN in the Canada: 1997-2012
We are now officially International! The GAIN has spread to numerous provinces in Canada. The GAIN-SS being the most popular tool of choice. Over the past few years a major provider by the name of Pavilion Foster in Canada which is part of a larger Association under the Ministry of Health has begun piloting the use of the GAIN-I in Montreal and would like it to eventually become their main assessment among all providers in the Association.
They are currently working on a full French instrument (GAIN-I) translation and GAIN ABS to French translation and hope to have it completed in the next few years. Those products would be available to anyone interested after they are completed. It has been very interesting working with the Canadians as their system of care is very different than ours. Nationalized Health Care is a whole different ball game compared to managed care/PPO and privatized insurance which we deal with her in the US.

7. Chestnut’s GAIN Coordinating Center (GCC)
Chestnut Health Systems is a non-profit behavioral health care organization in Illinois
Chestnut’s GCC provides the following core services related to the GAIN family of instruments
Training, Quality Assurance , & Certification on the Instruments, Clinical Interpretation, and using the data for Program Management and Evaluation
Web applications and technical support for administration, clinical decision support, and data transfer to other electronic medical records or analytic files
Data cleaning, management, analytic support, technical reports, and articles
Sarah will do.

8. Designed to Provide a Continuum of Measurement (Common Measures)
Screening to Identify Who Needs to be “Assessed” (5-10 min)
Focus on brevity, simplicity for administration & scoring
Needs to be adequate for triage and referral
GAIN Short Screener for SUD, MH & Crime
ASSIST, AUDIT, CAGE, CRAFT, DAST, MAST for SUD
SCL, HSCL, BSI, CANS for Mental Health
LSI, MAYSI, YLS for Crime
Quick Assessment for Targeted Referral (20-30 min)
Assessment of who needs a feedback, brief intervention or referral for more specialized assessment or treatment
Needs to be adequate for brief intervention
GAIN Quick
ADI, ASI, SASSI, T-ASI, MINI
Comprehensive Biopsychosocial (1-2 hours)
Used to identify common problems and how they are interrelated
Needs to be adequate for diagnosis, treatment planning and placement of common problems
GAIN Initial (Clinical Core and Full)
CASI, A-CASI, MATE
Specialized Assessment (additional time per area)
Additional assessment by a specialist (e.g., psychiatrist, MD, nurse, spec ed) may be needed to rule out a diagnosis or
develop a treatment plan
CIDI, DISC, KSADS, PDI, SCAN
Screener Quick Comprehensive Special
More Extensive / Longer/ Expensive
Skim

9. The More you Measure, the More you Find
Dennis
4/15/2017
The More you Measure, the More you Find
Mean represents the average number of moderate/high problems per instrument.
Odds Ratios use the GSS 4+ problem group as the reference group.
Source: CSAT 2010 AT Summary Analytic Data Set (n = 17,356)
Chestnut Health Systems 9

10. Across Instruments the GAIN we have
Set up shorter versions use subsets of items from longer measures and that predict them well
Established a common web-based platform for computer assisted interviewing, clinical decision support, data entry, and data management
Cleaned and pooled data to support local evaluation and provide practice based evidence for norms by age (under 18, 18-25, 26+), gender, and race, and to support secondary analysis by over 4 dozen independent researchers (see
Published power points for policy makers showing distributions and cross tabs related to key target populations, clinical outcomes and costs to society (see )
Matt will do.

11. GAIN ABS Web Application
HIPAA-compliant, web-based system hosted by Chestnut
records are accessible from anywhere with an internet connection
Chestnut handles all maintenance and regularly updates and adds new functionality
Allows for electronic administration of the GAIN
Includes automated item skips and calculations to reduce administration time
Includes detailed clinical reports that can be generated immediately after an assessment is completed

12. GAIN Short Screener (GAIN-SS)
Designed for use in general populations or where there is less control to identify who has a disorder warranting further assessment or behavioral intervention, measuring change in the same, and comparing programs
Administration Time: 5 minutes
Mode: Self or staff administered
Scales: Four screeners used to generate symptom counts for the past month to measure change, past year to identify current disorders and lifetime to serve as covariates/validity checks
Internalizing Disorders (somatic, depression, suicide, anxiety, trauma, behavioral disorders)
Externalizing Disorders (ADHD, CD)
Substance Disorders (abuse, dependence)
Crime/Violence Disorders, and
Total Disorder Screener
Reports: Full Report and Summary Report
Language: Available in English and Spanish
The 5-minute GAIN-Short Screener (GAIN-SS) is designed primarily for 3 things: First, it serves as a screener in general populations to quickly and accurately identify clients (also known as patients, respondents, or research participants) whom the full 1.5 to 2-hour GAIN-Initial would identify as having 1 or more behavioral health disorders (e.g., internalizing or externalizing psychiatric disorders, substance use disorders, or crime/violence problems), which would suggest the need for referral to some part of the behavioral health treatment system. It also rules out those who would not be identified as having behavioral health disorders. Second, it serves as an easy-to-use quality assurance tool across diverse field-assessment systems for staff with minimal training or direct supervision. Third, it serves as a periodic measure of change over time in behavioral health.
Dennis, Chan, and Funk (2006) found that for both adolescents and adults the 20-item Total Disorder Screener (TDScr) and its four 5-item subscreeners (internalizing disorders,
externalizing disorders, substance disorders, and crime/violence) have good internal consistency (alpha of .96 on the total screener), were highly correlated (r = .84 to .94) with the 123-item
GAIN Individual Severity Scale (GISS) and its four respective main scales (Internal Mental Distress Scale, Behavior Complexity Scale, Substance Problem Scale, Crime and Violence
Scale) in the full GAIN-I.
The total scale (20-symptoms) and its 4 subscales (5-symptoms each) for internal disorders (somatic, depression, suicide, anxiety, trauma, behavioral disorders (ADHD, CD), substance use disorders (abuse, dependence), and crime/violence can be used to generate symptom counts for the past month to measure change, past year to identify current disorders and lifetime to serve as covariates/validity checks.
Response Set: Recency of 20 problems rated past month (3), 2-12 months ago (2), more than a year ago (1), never (0)
Interpretation: Combined by cumulative time period as:
Past-month count (3s) to measure change
Past-year count (2s or 3s) to predict diagnosis
Lifetime count (1s, 2s, or 3s) as a measure of peak severity
Can be classified within time period as low (0), moderate (1-2), or high (3)
Can also be used to classify remission as
Early (lifetime but not past month)
Sustained (lifetime but not past year)

13. The 2 Page GAIN-SS

14. GAIN SS Problem Profile
Dennis
GAIN SS Problem Profile
4/15/2017
This stacked bar chart shows the distribution of the grouped version of items that were used to calculate the GSS moderate-high problem count. Only moderate or high scores on these items were included in the calculation of the problem count item. The distribution of the grouped version of the GSS moderate-high problem count is shown at the bottom. These are calculations of the GSS Screeners based on GI items. The GSS Mod/High Problem Count is a count of moderate or high responses to the 4 screeners (excluding the Total Disorder Screener). Across the 4 screeners on the SS 59% of respondents have 3 or more that rate as moderate to high problems. N of cases used in this slide was 29,660.
Total Disorder Screener (not used in the calculation of GSS moderate-high problem count): 7% Low (0), 14% Moderate (1-2), 79% High (3 or more)
Substance Disorder Screener: 21% Low (0), 31% Moderate (1-2), 47% High (3 or more)
External Disorder Screener: 35% Low (0), 23% Moderate (1-2), 43% High (3 or more)
Internal Disorder Screener: 39% Low (0), 33% Moderate (1-2), 28% High (3 or more)
Crime/Violence Screener: 38% Low (0), 35% Moderate (1-2), 27% High (3 or more)
GAIN Short Screener Moderate/High Problem Count: 7% Low (0), 34% Moderate (1-2), 59% High (3 or more)
Mean = 2.63; standard deviation = 1.255; scale range: 0-4
* The first summary row is based on the sum of symptoms (0-20); The second is based on the areas with 1 or more symptoms (0-9)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,660)
Chestnut Health Systems 14

15. Validation of Adolescent Co-Occurring from GAIN SS v. Records
In 5 min, the 2 page GAIN SS predicted a similar rate to everything found in the clinical record over 2 years and was the best single source
Source: Lucenko et al (2009). Report to the Legislature: Co-Occurring Disorders Among DSHS Clients. Olympia, WA: Department of Social and Health Services. Retrieved from
Source: Lucenko et al. (2009). Report to the Legislature: Co-Occurring Disorders Among DSHS Clients. Olympia, WA: Department of Social and Health Services. Retrieved from

16. GAIN SS Total Screener Score Predicts Adolescent Level of Care
Dennis
GAIN SS Total Screener Score Predicts Adolescent Level of Care
4/15/2017
Outpatient
Median=6.0
Residential
Median= 10.5
About 30% of OP are in the high severity range more typical of residential
About 41% of Residential are below 10 (more likely typical OP)
Few missed (1/2-3%) 16
Source: SAPISP 2009 Data and Dennis et al 2006
Chestnut Health Systems 16

17. The GAIN SS Predicts Recidivism in the Next 12 months
This version uses any illegal act reported in the past 90 days (anyilacq) between 3 and 12 months post intake.
Using GAIN-M90 data from the CSAT 2010 dataset. This slide examines how crime and violence interacts with substance problems to predict recidivism. The chart shows responses of low, moderate and high on the GAIN-Q3 Substance Disorder Screener and the same on the Crime and Violence Screener as calculated using data from the full GAIN-I.
As you can see the CVScr does a really good job on it’s own of predicting recidivism (or the probability of committing another crime at 6 months post intake). However, we wanted to look and see how the addition of the SDScr helps to predict recidivism.
As you can see here, the higher someone scores on the Substance Disorder Screener (SDScr) the higher the probability of committing another crime 6 months out.
However, while there are people in each group that commit a crime-in all but one case over half do commit additional crimes in the next 6-months.
Source: CSAT 2010 Summary Analytic Dataset (n=20,982) 17

18. GAIN-Q3
Designed for use in targeted populations for more detailed screening, for screening in correctional settings or controlled environment, to support brief intervention, or for referral to further assessment or behavioral intervention, and for follow- up
Mode: Generally staff-administered on computer (can be done on paper or self-administered with proctor)
Response Set: Recency (“the last time” scale), breadth (lifetime, past year, past 90 days, past month for symptoms and utilization), and prevalence (past 90 days for behavior and utilization)
Reports: Individual Clinical Profile, Personalized Feedback Report, Q3 Recommendation Referral Summary, Validity Report

19. GAIN-Q3 Versions
GAIN-Q3-Lite (19 pages, 20 minutes) – screeners & quality of life measure
GAIN-Q3-Standard (26 pages, 35 minutes) – Q3-Lite plus days of behavior, utilization/cost and life satisfaction
GAIN-Q3-MI (34 pages, 45 minutes) – Q3- Standard plus reasons & readiness for change to support motivational interviewing/problem solving for each area

20. GAIN Q3 Problem Profile (Adolescents)
Dennis
GAIN Q3 Problem Profile (Adolescents)
4/15/2017
This stacked bar chart shows the distribution of the grouped version of items that were used to calculate the GQ moderate-high problem count. Only moderate or high scores on these items were included in the calculation of the problem count item. The distribution of the grouped version of the GQ moderate-high problem count is shown at the bottom. These are calculations of the GQ Screeners based on GI items. The GQ Mod/High Problem Count is a count of moderate or high responses to the 4 screeners (excluding the Total Disorder Screener). Across the 9 screeners on the Q3 82% of respondents have 3 or more that rate as moderate to high problems. N of cases used in this slide was 29,650.
Total Disorder Screener (not used in the calculation of GSS moderate-high problem count): 2% Low (0), 4% Moderate (1-2), 93% High (3 or more)
Substance Disorder Screener: 20% Low (0), 28% Moderate (1-2), 52% High (3 or more)
External Disorder Screener: 35% Low (0), 23% Moderate (1-2), 43% High (3 or more)
School Problems Screener: 41% Low (0), 23% Moderate (1-2), 36% High (3 or more) (n= 15,721)
Internal Disorder Screener: 39% Low (0), 33% Moderate (1-2), 28% High (3 or more)
Crime/Violence Screener: 38% Low (0), 35% Moderate (1-2),27% High (3 or more)
Stress Problems Screener: 38% Low (0), 36% Moderate (1-2), 26% High (3 or more) (n= 14,825)
Physical Health Problem Screener: 45% Low (0), 41% Moderate (1-2), 14% High (3 or more) (n= 13,540)
Work Problems Screener: 88% Low (0), 10% Moderate (1-2), 2% High (3 or more) (n= 21,578)
GAIN-Q Moderate/High Problem Count: 2% Low (0), 16% Moderate (1-2), 82% High (3 or more)
Mean = 4.40; standard deviation = 2.027; scale range: 0-9
* The first summary row is based on the sum of symptoms (0-20); The second is based on the areas with 1 or more symptoms (0-9)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,650)
Chestnut Health Systems 20

21. GAIN Q3 Summary Indices Beneficial Problematic
Dennis
GAIN Q3 Summary Indices
4/15/2017
Beneficial
Problematic
This slide compares the 4 summary measures of the Problem Prevalence Index, Quarterly Cost to Society, Quality of Life Index, and General Satisfaction Index in a stacked column chart. N of cases used in this slide was 14,291.
On the Problem Prevalence Index, higher scores indicate a greater occurrence of problems across substance use, mental health, crime, and violence problem areas in the past 90 days.
Overall mean = 10.2, standard deviation = 9.157
The cut points for this item are 0-5 low, 6-24 moderate, high
Problem Prevalence Index: 38% low; 54% moderate; 8% high
Quarterly Cost to Society reflects cost based on the number of times in the past 90 days the client has had to see a medical professional for physical or mental health problems and days spent in detox, rehab, or jail, etc.
Overall mean = $4,460, standard deviation = $8,524
The cut points for this item are $0-$1,999 low, $2,000-$9,999 moderate, $10,000+ high
Quarterly Cost to Society: 12% low; 38% moderate; 50% high
On the Quality of Life Index, higher scores suggests a participant's experience of a greater quality of life, as reflected in fewer reported problems on the GQ (version 3) during the past year in areas associated with psychopathology, problematic substance use, life stress, criminal, and at-risk behavior.
Overall mean = .46, standard deviation = .220
The cut points for this item are 0-36 low, moderate, high
Quality of Life Index: 37% low; 47% moderate; 16% high
General Satisfaction Index reflects self-reported satisfaction with housing, relationships, activities, and help. General Satisfaction Index groups are usually reversed (low satisfaction scores (0-2) are in the high problem group); here low satisfaction scores are in the low group, and high satisfaction scores are in the high group. Thus, scores in the high group of general satisfaction indicate more satisfaction.
Mean = 4.72, standard deviation = 1.564
The cut points for this item are 5-6 high quality of life, 3-4 moderate, 0-2 low
General Satisfaction Index: 12% low; 22% moderate; 67% high
*GSI groups are usually reversed (low satisfaction scores (0-2) are in the high problem group); here low satisfaction scores are in the low group, and high satisfaction scores are in the high group.
Functional Impairment
Based mostly on Service Utilization
Based on the absence of problems
Ratings of satisfaction with several areas of life
Source: CSAT 2011 AT Summary Analytic Data Set (n=14,291)
Chestnut Health Systems 21

22. GAIN-Initial (GAIN-I)
Designed: to provide a standardized biopsychosocial for people presenting to substance abuse treatment using DSM-IV for diagnostic impressions and ASAM for placement and needing to meet common requirements (CARF, JCAHO, insurance,TEDS, Medicaid) for assessment, diagnosis, placement, treatment planning, accreditation, performance/outcome monitoring, economic analysis, program planning,
Mode: Generally staff-administered on computer (can be done on paper or self-administered with proctor)
Response Set: Breadth (past-year symptom counts for behavior and lifetime for utilization), recency (48 hours, 3-7 days, 1-4 weeks, 2-3 months, 4-12 months, 1+ years, never), and prevalence (past 90 days); patient and staff ratings
Supporting diagnosis, placement, and treatment planning
Monitoring of changes in clinical status, service utilization, and costs to society
Communications and referrals to other systems
Subgroup- and program-level needs assessment and evaluation

23. GAIN-I Versions
GAIN-I Full (113 pages, 1.5 to 2.5 hours) – includes information on a wide range of life areas including background, substance use, physical health, risk behaviors and disease prevention, mental and emotional health, environment and living situation, legal, and vocational
GAIN-I Core (77 pages, 1 to 2 hours) – covers the same life areas as the GAIN-I Full, but does not collect information on such topics as substance use treatment history, peak use of substances other than alcohol and cannabis in the past 90 days, specific lifetime health problems, or sources of treatment pressure
GAIN-I Lite (56 pages, 1 hour) – covers the same life areas as the GAIN-I Core, but does not collect information on such topics as peak use in the past 90 days for any substances, lifetime arrest history, some risk behaviors, some victimization, and spirituality

24. GAIN-I (continued) Examples: Will come back with data in a moment
Scales: The GAIN-I has 9 sections (access to care, substance use, physical health, risk and protective behaviors, mental health, recovery environment, legal, vocational, and staff ratings) that include 103 long (alpha over .9) and short (alpha over .7) scales, summative indices, and over 3,000 created variables to support clinical decision-making and evaluation.
Interpretation:
Items can be used individually or to create specific diagnostic or treatment planning statements
Items can be summed into scales or indices for each behavior problem or type of service utilization
All scales, indices, and selected individual items have interpretative cut points to facilitate clinical interpretation and decision making
Examples: Will come back with data in a moment

25. GAIN ABS Reports for GAIN-I
GAIN Recommendation and Referral Summary: a narrative report with editing capabilities for clinician to use for initial assessment summary, diagnosis, placement, and treatment planning
Individual Clinical Profile: Shows the severity of the client (low, moderate, high) on key indicators
Personal Feedback Report: Based on reasons for quitting and substance use items; used to support Motivational Interviewing and Motivational Enhancement Therapy
Validity Report: Identifies potential inconsistencies in a participant’s responses

26. GAIN Data Management Services
We also offer data management services to make the most of your GAIN data
Review your GAIN records for anomalies and return feedback to help you maintain accuracy of your data
Create and distribute analytic SPSS data files
Create and distribute a Characteristics and Outcomes Site Profiles report – which includes tables and charts displaying demographics, substance use patterns, lifetime severity, crime, risk behaviors, etc.

27. GAIN Trainings

28. GAIN Training Model
Includes training, coaching, monitoring and certifying staff on the GAIN family of instruments
Provide training on standardized administration guidelines
Provide advanced training on the assessment to support diagnosis, treatment planning, and program evaluation
To promote sustainability, provide training on techniques for training others at the local agency

29. GAIN Administration Trainings
GAIN Short Screener Training is generally provided via self-paced online course available 24 hours/ 7 days a week*.
GAIN-Q3 Training is generally provided via distance learning* that includes online coursework, conference calls and webinars, and one-on-one coaching
GAIN-I training is generally provided via distance learning or in person that include presentations, small- group work, workshops, discussions, and practice and are followed by the same one-on-one coaching
* Also available in person
GAIN Distance Training for the GAIN-I and GAIN-Q3 takes a distance-learning approach that makes training more affordable and individualized. Trainees complete self-paced online coursework, participate in conference calls and webinars, and receive one-on-one coaching and practice with our GAIN Administration Quality Assurance Team.
This 3.5-day training is held in Normal, IL and includes presentations, small-group work with hands-on practice administering the GAIN Initial (GAIN-I), a workshop to practice identifying and clarifying inconsistent responses, information about the Administration Quality Assurance (A-QA) process, an overview of the GAIN-generated clinical reports, discussions regarding using the GAIN to guide diagnosis and treatment planning, a demonstration of the GAIN ABS online version of the instrument, data management information, optional sessions for conducting follow-up interviews and improving follow-up and recruitment rates, and an opportunity for trainees to make their first submissions toward GAIN Administration Certification.

30. GAIN Advanced Trainings
GAIN Clinical Interpretation Training is generally provided via distance or in-person and is designed to learn how to better clinically interpret and more efficiently edit the results at the individual levels to support diagnosis, treatment planning and placement; it includes coursework, discussion, and iterative feedback on actual clinical reports.
GAIN Program Management and Evaluation Training is generally provided via distance or in-person and is designed to learn how to better use data across clients and time to manage and evaluate programs in a more rigorous and efficient manner; it includes coursework, review of support materials, discussion, development and iterative feedback on a management and evaluation plan

31. Cultural Considerations with Assessments

32. Cultural Considerations
Any assessment can only be as culturally sensitive as the treatment professionals who uses the tool.
This places the responsibility of cultural sensitivity in assessment and treatment planning upon the interviewers and clinicians conducting the assessment and interpreting the information.
It is important that the individual be assessed in his/or her primary language (for accuracy and ethical reasons).
Need to consider local dialect and slang terminology that does not necessarily correspond with the version of the language used in the assessment
Evidence-based assessments like the GAIN have often been criticized for their lack of cultural sensitivity. In this lesson we will examine the concept that any assessment can only be as culturally sensitive as the treatment professionals who use the tool. This places the responsibility of cultural sensitivity in assessment and treatment planning upon the interviewers and clinicians conducting the assessment and interpreting the information. In this module we will explore general concepts of cultural sensitivity, cultural sensitivity in assessment, and cultural sensitivity in treatment planning using the GAIN.

33. Cultural Considerations (continued)
Individuals may not know what comprises assessment or how it will be used or it may bring up old fears like school achievement testing anxieties.
Need to establish norms, validity, and real differences in how people respond to questions by gender, race, age and/or by clinical groups
The level of acculturation can impact a wide variety of areas such as choices of social networks, particular lifestyle and decisions on how to seek help..
Culture: “The attitudes, habits, norms, beliefs, customs, rituals, styles and artifacts that express a group’s adaptation to its environment—that is, ways that are shared by group members and passed on over time” (McAuliffe, p. 8).
Cultural Diversity: “The existence of variety in human expression, especially the multiplicity of mores and customs that are manifested in social and cultural life” (McAuliffe, p. 14).
Cultural Awareness: Understanding of the ideas, influences, and significance of diverse cultures.
Cultural Competence: A skill involving the “translation of this [cultural] awareness into behaviors that result in effective assessment and treatment” (Paniagua, p. 8).
As an interviewer, you will come into contact with many people from diverse cultures. It is important to be aware of the cultural differences that exist between people and competently adapt your assessment tool and protocol to best meet the needs of your client.
Fundamental concepts of Cultural Sensitivity – should be manifest in all levels of a service delivery system and should be reflected in attitudes, structures, policies, and services.
Value diversity
Have the capacity for cultural self-assessment
Be conscious of the dynamics when cultures interact
Institutionalize cultural knowledge
Develop programs and services that demonstrate an understanding of the diversity between and within cultures
By employing all of these concepts, an agency will ensure that its clients feel comfortable receiving their services and taking an active role in the treatment process.
Traits necessary to achieve the upmost cultural sensitivity and competence on a personal level can be broken down into 3 categories: knowledge, professional skills, and personal attributes.
Knowledge
Working knowledge of clients culture - history, traditions, values, familial systems
Impact of racism, discrimination, marginalization, and poverty on behavior, attitudes, and disabilities
Help-seeking behaviors of ethnic and cultural minority clients
Role of language, speech, and patterns and styles of communication
Impact of social service policies on ethnic and cultural minority clients
Available resources for ethnic and cultural minority clients
Professional values conflict or accommodate needs of clients
Professional Skills
Techniques to learn culture from ethnic and cultural minority groups
Communicate effectively and accurately on behalf of ethnic and cultural minority groups and their communities
Openly discuss racial, ethnic, and cultural differences and issues and respond appropriately to culturally based cues
Discern between intra-physic stress and stress arising from the social structure
Practice and implement interviewing techniques that accommodate the role of language in a clients culture
Ability to identify and utilize concepts of empowerment on behalf of ethnic and cultural minority groups and communities
Ability to identify and utilize resources on behalf of ethnic and cultural minority groups and communities
Personal Attributes
Personal qualities the reflect genuineness and empathy and the capacity to respond flexibly to range of solutions
Acceptance of ethnic and cultural difference between people
Willingness to work with clients from different cultural background
Articulation and clarification of personal values, stereotypes, and biases and how these may support or conflict with the needs of clients from different cultures

34. Training Staff About Cultural Considerations
Recognize the power of historical perspective (e.g., historical trauma, aculturation)
Appreciate the impact of cultural explanations and stigmas
Respect cultural variations, expectations, and communication
Create an atmosphere of cultural safety and familiarity with pictures, sounds, colors, food and awareness of customs
Show adaptability, flexibility, and respect
Once you can answer those questions for each of the populations you will most chiefly be working with, all key cultural considerations should be translated into staff behavior towards the clients. There are several steps you can take as an interviewer or a clinician to put your knowledge of a culture into action.
Recognize the power of historical perspective
Appreciate the impact of cultural explanations and stigmas
Respect cultural variations, expectations, and communication
Create an atmosphere of cultural safety
Show adaptability and flexibility.
Each of these items will be addressed in greater detail in the next lesson.

35. Cultural Considerations in Interviewing
Adapting location
Providing flexible scheduling
Adjusting for language barriers
Assigning appropriate interviewers
Showing respect
Making culturally sensitive adaptations to questions
Acknowledging historical trauma if it comes up (but not assuming it applies to everyone in the group)
Making small changes to your interviewing protocol and procedure based on a client’s culture can have a huge impact on how comfortable they will feel during the assessment and the quality of the information that you are able to collect.
Acknowledging historical trauma
Historical trauma suffered by a specific culture can play a large role in their actions and perceptions today.
Historical trauma can manifest itself in many ways. Some common examples include:
May be distrustful or suspicious of provider systems due to recent or historical discrimination or mistreatment by government systems.
Mistrust of anyone representing the system (especially with low income/limited opportunity clients) is to be expected.
Examples include:
Examples:
Slavery and Jim Crow laws, while repealed, have left unequal access to schools, work, housing and health care.
Immigration laws and illegal immigration have led to unequal treatment, constant fear, separation of families, and differences in acculturation.
Intergenerational trauma from the government have taken American Native children away from their families to boarding schools and trying to remove their culture.
Misuse of mental diagnoses to suppress slaves through the 1800s, women through mid 1900s and GLBT through the 1970s.
In order to work past historical trauma, one must build trust and rapport. Engagement is of prime importance in cases where historical trauma is present.
Adapting location
Many cultures may prefer to complete an assessment in the home rather than a treatment unit or research setting. Many cultures place a high value on privacy and there is less stigma attached to having someone come to your home as opposed to someone seeing you at a treatment facility. Because of this, it is often best to ask for the client’s preference of interview locations. You can give them a simple choice of would you like to come in to the office to complete the assessment or would you like me to come to you? Completing assessments at a park, restaurant, or other public place may also be option depending on where the client feels most comfortable and what is allowable based on your agency protocols.
Providing flexible scheduling
Determine what times of year, week, or day are important to your client. You will want to avoid scheduling assessments during religious or cultural holidays or during preparation times. A calendar of traditional religious holidays can be found at Times of regular religious observation or worship should also be avoided. In addition, appointments should not be scheduled during times of family commitment including birthdays, family dinner, etc.). By avoiding important days and times for the client, you are helping to ensure that he or she is able to attend their appointment and avoid lots of missed appointments and rescheduling.
Some cultures do not strictly adhere to the concept of time. You should be flexible if a client comes in at a time other than their scheduled appointment or if they arrive late.
Adjusting for language barriers
It is always best to conduct an assessment in the client’s primary language. However, when that is not possible, a translator may be used to help collect the information. When conducting the assessment in the client’s primary language is not an option, a translator can be used. Translators should be used sparingly as they can sometimes distort a client’s self report or add to the complexity of an interview session.
When translators must be used, translating on the fly should be avoiding. This occurs when a translator uses the English version of an assessment and translates in their had and reads the items to the client on the spot. This is problematic because often times the meaning and concepts are not adequately conveyed in the translation. Research shows that those clients who are not interviewed in their own language tend to receive more severe diagnoses (Paniagua). It is much better to use a translated version of the assessment whenever possible. The most accurate translations have gone through both a forward and a back translation to maintain the validity and reliability of the assessments. The Spanish version of the GAIN, the VGNI has been thoroughly tested in this area.
Allow clients to use non-standard English if it helps them to better express themselves.
Assigning appropriate interviewers
Assigning an appropriate interviewer to complete an assessment can also have an impact on how comfortable the client feels during the interview and the quality of the information they provide. Often clients feel more comfortable when working with someone from the same culture or gender. In these situations, they tend to be more trusting and feel that they are better understood. However, it is important to remember that just because someone is of the race or ethnicity does not mean they are of the same culture.
In some religions and cultures, unmarried or non-family members of different genders are not allowed to interact.
It will not always be possible in real world situations to have all clients be interviewed by someone who is of the same culture or gender. In cases where this is not feasible, it is best to make sure the client feels comfortable before beginning the interview.
Showing respect
If you are working with adolescents, if is also important to show respect to their parents by including them in the process without breaking the client’s confidentiality.
This can be done by thoroughly explaining the program and the process their adolescent will go through during the intake, checking with the them before doing an in-home appointment or visit, exhibiting culturally acceptable behavior while in the home, and getting their input on the treatment plan. As an example, in some cultures it is considered grossly insulting to refuse an offer of food.
Making culturally sensitive adaptations to questions
It is often necessary to make adaptations to questions during an interview to ensure that the client understands each item and that they are accurately responding to the question the interviewer is meaning to ask. This can also show the client that the interviewer understands their culture, he or she is listening to the information being provided. Some examples of this are providing culturally relevant examples, being aware of cultural interpretations of specific concepts, and clarifying when necessary to ensure that responses are valid. To give an example, in some cultures, family definitions and terms may be applied to those who are not related by blood. If the interviewer suspects that this might be occurring, they can clarify by asking if it was their biological cousin, aunt, etc.?

36. In Practice
If you work with a population with strong cultural traditions, ask the client about their level of engagement in traditional culture as this could have a profound effect on their responses.
The interviewer should make reasonable adaptations and accommodations while administering the GAIN as a semi-structured assessment in an effort to optimize respect, validity, reliability and efficiency with clients of any cultural background.
Now that you have a strong background on what it means to culturally competent and how you can apply cultural competency. It is important to note that information about a single culture should not be overly generalized to apply to the entire group. If you work with a population with strong culturally traditions, ask the client about their level of engagement in traditional culture as this could have a profound effect on their responses. Note that those with increased engagement in tradition could have an increased resistance to treatment and intervention. The interviewer should use this information to determine the level of cultural adaptation that is necessary.
All in all, the interviewer should make reasonable adaptations and accommodations while administering the GAIN as a semi-structured assessment in an effort to optimize respect, validity, reliability and efficiency with clients of any cultural background.

37. Bottom line
Whether you use the GAIN or another assessment, you owe it to your clients to understand not only their symptomology/severity, but the cultural context of the symptoms associated with the individual. Look for common occurrences, but NEVER assume. You must continually span for cultural variability.

38. GAIN-I Results by Juvenile Justice System Involvement

39. GAIN Data Collected from 1997 to 2011 on 22,967 Adolescents from 202 SitesAK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY PR VI GU

40. Juvenile Justice System Involvement
The Drug Court category represents all cases included in the Juvenile Treatment Drug Court (JTDC/DC) and Adult Treatment Drug Courts (ATDC) cohorts only.
This pie chart shows the Justice System Involvement item to be used in later breakouts. The variable used here is ijjsi7. N of cases used in this slide was 29,617.
Past year illegal activity/ substance or alcohol use: 15%
Past arrest/ juvenile justice/criminal justice status: 6%
Other juvenile justice/criminal justice status: 12%
Other probation, parole, detention: 15%
On probation or parole 14 or more days with 1 or more drug screens: 22%
Drug Courts: 11%
In detention or jail for days: 5%
In detention or jail for 30+ days: 14%
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)

41. Demographic Characteristics
Dennis
Demographic Characteristics
4/15/2017
Predominately male, Not-white, age 15 to 17 and from single parent households
Consistent with the U.S. public treatment system, the sample is predominately male; the sample size is large enough now that we have a 1000 or more in each of the race and age subgroups shown here, as well as 300 or more in subgroups like Asians, Mexicans, Employed, 12 to 14 year olds, 18 to 25 year olds, and adults over 26 years old.
This bar chart shows some of the personal demographic characteristics of the data set. The average age is SAMHSA/CSAT data dominated by male, minority, age 15 to 17. N of cases used in this slide 29,782.
27% Female
4% Married
4% Gay, Lesbian, Bi-sexual, Transgender, Questioning
38% Caucasian
34% Any Hispanic ethnicity separate from race group
17% Mixed/Other
16% African American
23% 18 Years Old and Older
63% 15 to 17 Years Old
14% 12 to 14 Years Old
*Any Hispanic ethnicity separate from race group
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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42. Custody by Justice System Involvement
Dennis
Custody by Justice System Involvement
4/15/2017
This stacked column chart shows the current risk of homelessness by race. N of cases used in this slide 29,631.
African American: 73% Housed, 13% Group Home or Institution, 10% At Risk of Becoming Homeless, 4% Currently Homeless
Hispanic: 76% Housed, 11% Group Home or Institution, 10% At Risk of Becoming Homeless, 3% Currently Homeless
Other: 73% Housed, 14% Group Home or Institution, 10% At Risk of Becoming Homeless, 3% Currently Homeless
White: 76% Housed, 9% Group Home or Institution, 10% At Risk of Becoming Homeless, 5% Currently Homeless
Multi-Racial: 70% Housed, 11% Group Home or Institution, 13% At Risk of Becoming Homeless, 6% Currently Homeless
*Other family, foster care, institution, emancipated, runaway
**Includes shared custody, step parents and adopted
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976) 42
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43. Substance Use Problems
Dennis
Substance Use Problems
4/15/2017
Substance use problems is a count of these eight problems at intake.
This bar chart shows the eight items that are used to calculate substance abuse problems. The distribution of scores on the grouped version of the substance abuse problem count is presented at the bottom in a stacked bar format. Severe withdrawal is defined as any acute substance withdrawal symptoms. N of cases used in this slide 29,362.
79% First Use Under Age 15
77% Any Past Year Diagnosis
63% 3 or More Years Use
52% Weekly Use of Alcohol or Drugs
48% Past Year Dependence
42% Any Lifetime Withdrawal
37% Prior Substance Abuse Treatment
3% Severe Past Week Withdrawal
Substance Use Problems grouped: 26% Low (0-2), 51% Moderate (3-5), 23% High (6-8)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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44. Past Year Substance Severity by Justice Involvement
Dennis
Past Year Substance Severity by Justice Involvement
4/15/2017
This stacked column chart shows the current risk of homelessness by race. N of cases used in this slide 29,631.
African American: 73% Housed, 13% Group Home or Institution, 10% At Risk of Becoming Homeless, 4% Currently Homeless
Hispanic: 76% Housed, 11% Group Home or Institution, 10% At Risk of Becoming Homeless, 3% Currently Homeless
Other: 73% Housed, 14% Group Home or Institution, 10% At Risk of Becoming Homeless, 3% Currently Homeless
White: 76% Housed, 9% Group Home or Institution, 10% At Risk of Becoming Homeless, 5% Currently Homeless
Multi-Racial: 70% Housed, 11% Group Home or Institution, 13% At Risk of Becoming Homeless, 6% Currently Homeless
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976) 44
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45. Victimization Severity
Dennis
Victimization Severity
4/15/2017
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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46. Severity of Victimization by Justice Involvement
Dennis
Severity of Victimization by Justice Involvement
4/15/2017
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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47. Co-Occurring Psychiatric Problems
Dennis
Co-Occurring Psychiatric Problems
4/15/2017
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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48. Past Year Mental Health Disorders
Dennis
Past Year Mental Health Disorders
4/15/2017
Internalizing and Externalizing
Disorders
32.8% (n=9,727)
Neither 37.3% (n=11,059)
Externalizing Disorders Only
20.6% (n=6,128)
Internalizing Disorders Only
9.3% (n=2,770)
This pie chart shows the breakdown of the pattern of mental health disorders in the past year to be used in later breakouts. The variable used here is Codis4. Externalizing disorders are ADHD and conduct disorder. Internalizing disorders are mood disorders, generalized anxiety disorder, traumatic stress disorders, and any suicide problems.
Neither: 37.3% (n= 11,059)
Externalizing Disorders Only: 20.6% (n= 6,128)
Internalizing Disorders Only: 9.3% (n= 2,770)
Both: 32.8% (n= 9,727)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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49. Mental Health Disorders by Justice Involvement
Dennis
Mental Health Disorders by Justice Involvement
4/15/2017
This stacked column chart shows pattern of mental health disorders in the past year by race. N of cases used in this slide 29,669.
African American: 51% Neither, 20% Externalizing Disorders Only, 9% Internalizing Disorders Only, 20% Both
Hispanic: 40% Neither, 20% Externalizing Disorders Only, 10% Internalizing Disorders Only, 30% Both
Other: 36% Neither, 18% Externalizing Disorders Only, 11% Internalizing Disorders Only, 36% Both
White: 32% Neither, 22% Externalizing Disorders Only, 9% Internalizing Disorders Only, 37% Both
Multi-Racial: 29% Neither, 21% Externalizing Disorders Only, 9% Internalizing Disorders Only, 40% Both
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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50. HIV Risk Behaviors in Past 90 Days
Dennis
HIV Risk Behaviors in Past 90 Days
4/15/2017
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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51. HIV Risk Change by Justice Involvement
Dennis
HIV Risk Change by Justice Involvement
4/15/2017
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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52. Current Risk of Homelessness
Dennis
Current Risk of Homelessness
4/15/2017
Currently Homeless 4.3% (n=1,261)
Housed 74.7% (n=22,138)
At Risk 10.4% (n=3,073)
Group or Institution 10.7% (n=3,174)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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53. Risk of Homelessness by Justice System Involvement
Dennis
4/15/2017
Risk of Homelessness by Justice System Involvement
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976) 53
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54. Tobacco Diagnosis Never Used 20% (n=5,354)
Dennis
Tobacco Diagnosis
4/15/2017
Never Used
20%
(n=5,354)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
Chestnut Health Systems 54

55. Tobacco Diagnosis by Justice System Involvement
Dennis
Tobacco Diagnosis by Justice System Involvement
4/15/2017
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976) 55
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56. Health Care Utilization Cost to Society
Dennis
Health Care Utilization Cost to Society
4/15/2017
Description
Unit
Cost 2011 dollars
Inpatient hospital day
Days
$ ,202.87
Emergency room visit
Visits
$ ,477.04
Outpatient clinic/doctor’s office visit $
Nights spent in hospital
Nights
Times gone to emergency room
Times
Times seen MD in office or clinic $
How many days in detox $
Times in ER for AOD use $
Nights in residential for AOD use $
Days in Intensive outpatient program for AOD use $
Times did you go to regular outpatient program $
*Quarterly Health Care Utilization 2011 dollars w/ SA TX based on French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates and cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35,
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57. Health Care Utilization Cost
Dennis
Health Care Utilization Cost
4/15/2017
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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58. Health Care Utilization Cost* by Justice System
Dennis
4/15/2017
*Using 2011 Dollars
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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59. Past Year Crime & Justice Involvement
Dennis
Past Year Crime & Justice Involvement
4/15/2017
*Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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60. Type of Crime by Justice System Involvement
Dennis
Type of Crime by Justice System Involvement
4/15/2017
* Violent crime includes assault, rape, murder, and arson.
**Other crime includes vandalism, possessing stolen goods, forgery and theft.
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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61. Cost of Crime to Society*
Dennis
Cost of Crime to Society*
4/15/2017
Description
Unit
Cost 2011 dollars
Purposely damaged or destroyed property
Times
$5,095.64
Passed bad checks/forged a prescription/took money from employer
$5,745.70
Taken money/property (not from a store)
$8,360.63
Broken into a house/building to steal
$6,775.32
Taken a car that didn't belong to you
$11,294.29
Used a weapon, force, or strong-arm methods to get money or things from a person
$44,361.43
Hurt someone badly enough they needed bandages or a doctor
$112,208.95
Made someone have sex with you by force
$252,450.22
Been involved in the death or murder of another person (including accidents)
$9,418,450.51
Intentionally set a building, car, or other property on fire
$22,126.20
These are the GAIN items added to calculate cost of crime.
*Cost of Crime 2011 dollars w/ SA TX based on McCollister, K. E., French, M. T., & Fang, H. (2010). The
cost of crime to society: New crime-specific estimates for policy and program evaluation. Drug and Alcohol Dependence, 108(2)(1-2),
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62. Dennis
Cost of Crime
4/15/2017
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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63. Cost of Crime by Justice System Involvement
Dennis
Cost of Crime by Justice System Involvement
4/15/2017
Using 2011 dollars
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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64. Major Clinical Problems at Intake
Dennis
Major Clinical Problems at Intake
4/15/2017
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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65. No. of Clinical Problems by Justice System Involvement
Dennis
4/15/2017
No. of Clinical Problems by Justice System Involvement
*Based on count of self reporting criteria to suggest alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal activity
Source: SAMHSA 2011 GAIN Summary Analytic Data Set: Adolescents (n=22,976)
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66. Outcomes: Days of substance use at the Last Wave
Dennis
Outcomes: Days of substance use at the Last Wave
4/15/2017
Uses SFS_L and SFSred_l
SAMHSA 2011 GAIN SA Data Set-Adolescents subset to 1+ Follow ups
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67. Days of Mental Health Problems at Last Wave
Dennis
Days of Mental Health Problems at Last Wave
4/15/2017
USES EPS_l and EPSred_L
SAMHSA 2011 GAIN SA Data Set-Adolescents subset to 1+ Follow ups
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68. Days of Illegal Activity at Last Wave
Dennis
Days of Illegal Activity at Last Wave
4/15/2017
Uses anyilact_l and ilactred_l
SAMHSA 2011 GAIN SA Data Set-Adolescents subset to 1+ Follow ups
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69. Dennis
Cost of Crime at 3 months
4/15/2017
*Reduction from intake uses year after intake (mean of follow-ups*4).
SAMHSA 2011 GAIN SA Data Set-Adolescents subset to 1+ Follow ups
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70. High rate of co-occurring mental health problems; large unmet need
Dennis
4/15/2017
Mental Health Problem at Intake (need) vs. Mental Health Treatment by 3 Months
High rate of co-occurring mental health problems; large unmet need
This column chart depicts the relationship between mental health treatment need at intake and services received at 3 month follow-up. There is a high rate of co-occurring mental health problems and large unmet need.
70% Clients have moderate to high need for treatment (n=14,358/20,433)
70% Need but did not receive service at 3 months (n= 10,104/14,358)
37% Clients receiving services (n= 4,908/20,433)
50% Services going to those with no or low need (n= 654/4,908)
*Current Need on ASAM dimension B3 criteria (past 90 days)
** ‘Services’ is self-report of any days of mental health treatment at 3 months
SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=20,433)
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71. Unmet Need for Mental Health Treatment by 3 Months
Dennis
4/15/2017
Unmet Need for Mental Health Treatment by 3 Months
Race*
Gender*
Higher for African Americans & Hispanics
Significantly higher for males
Gender: Chi-square= (p=.000)
Race: Chi-Square= (p=.000)
This column chart shows mental health treatment need but no medical health service at 3 months by race and gender.
Race (Higher for African Americans & Hispanics)
80% African American (n=1,447/1,807)
84% Hispanic (n=3,164/3,775)
72% Other (n=355/467)
61% White (n=3,671/6,050)
66% Multi-Racial (n=1,484/2,252)
Gender (Significantly higher for Males)
74% Male (n=7,235/9,733)
62% Female (n=2,864/4,618)
* p<.05
SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=14,358)
Chestnut Health Systems

72. Unmet Need for Mental Health Treatment by 3 Months
Dennis
4/15/2017
Unmet Need for Mental Health Treatment by 3 Months
Age*
Higher for adolescents and young adults
Gender: Chi-square= (p=.000)
Race: Chi-Square= (p=.000)
This column chart shows mental health treatment need but no medical health service at 3 months by race and gender.
Race (Higher for African Americans & Hispanics)
80% African American (n=1,447/1,807)
84% Hispanic (n=3,164/3,775)
72% Other (n=355/467)
61% White (n=3,671/6,050)
66% Multi-Racial (n=1,484/2,252)
Gender (Significantly higher for Males)
74% Male (n=7,235/9,733)
62% Female (n=2,864/4,618)
* p<.05
SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=14,358)
Chestnut Health Systems

73. Questions? Poster available from www.chestnut.org\li\posters
For questions about this presentation, please contact us at Kate Moritz at / or Michael Dennis at /
For questions on the National Cross-Site Evaluation, contact Monica Davis, Evaluation Coordinator at x211 or