1. Always at your service GAIN Related Project Progress Report Michael L. Dennis, Ph.D., Laine Twanow, & Nora Jones, M.S. Chestnut Health Systems, Normal, IL Created for: King County Mental Health, Chemical Abuse and Dependency Services Division Presentation at the Mental Health, Chemical Abuse and Dependency Services Division 1st Annual All Providers’ Meeting, January 27, 2012

2. 2 Detailed Acknowledgements This presentation was supported by a contract with King County and includes data from the following agencies: Auburn Youth Resources; Center for Human Services; Therapeutic Health Services; Community Psychiatric Clinic; Consejo Counseling & Referral Service; Friends of Youth; Kent Youth & Family Services; Navos; Ryther Child Center; Seattle Counseling Services for Sexual Minorities; United Indians of All Tribes Foundation; Valley Cities Counseling & Consultation; Washington Asian Pacific Islander Families Against Substance Abuse (WAPIFASA); Youth Eastside Services; Renton Area Youth & Family Services; Sound Mental Health; Asian Counseling & Referral Services; Pioneer Human Services; Snoqualmie Tribe/Raging River Recovery Center; Muckleshoot Tribe; Northshore Youth & Family Services; Integrative Counseling Services; SeaMar Community Heath Centers; Vashon Youth and Family Services; Seattle King County ROSC PPW; and Reclaiming Futures. The authors thank these grantees and their study clients for agreeing to share their data Any opinions about this data are those of the authors and do not reflect official positions of the government or individual grantees.

3. 3 Goals Summarize the King County Data and its implication for program planning by looking at –Baseline characteristics –Correlates of most common problems –Costs to society –Treatment planning needs –Performance measures Examine how well King County is doing in terms –data quality –efficiency in terms of time to complete the interview –Folloeup rates from the first quarter of FY12

4. 4 2011 King County GAIN Data Set GAIN Initial (GI) data collected by 18 agencies from 5,602 clients between 7/2008 and12/2011 –Roughly a third from 2011, 2010 and pre 2010 GAIN Monitoring 90 days (GM90) data collected by 17 agencies from 710 clients between 5/2009 and12/2011 – Roughly 78% in 2011 Grant data collapsed into the agency that collected it

5. 5 2011 KC Data by Agency Source: 2011 King County Data Set (n=5,507)

6. 6 2011 KC Data Set by Gender Source: 2011 King County Data Set (n=5,600) Males 69.7% (n=3,904) Females 30.3% (n= 1,694) Other 0.04% (n= 2)

7. 7 2011 KC Data Set by Age Source: 2011 King County Data Set (n=5,602) 18 -25 Years 14.3% (n=802) Under 15 Years (<15) 17.3% (n=967) 15-17 Years 57.6% (n=3,227) 26+ Years 10.8% (n=606)

8. 8 2011 KC Data Set by Race Source: 2011 King County Data Set (n=5,534) Mixed 18.2% (n=1,005) African American 14.0% (n=777) Hispanic 13.6% (n=750) White 45.4% (n= 2,514) Other 8.8% (n=488)

9. 9 2011 KC Data Set by Risk of Homelessness Source: 2011 King County Data Set (n=5,551) At Risk 11.9% (n=658) Housed 78.5% (n=4,356) Group or Institution 2.3% (n=128) Currently Homeless 7.4% (n=409)

10. 10 2011 KC Data Set by Co-Occurring Disorders Source: 2011 King County Data Set (n=5,488) Internalizing Disorders Only 10.3% (n=566) Externalizing Disorders Only 20.3% (n=1,112) Both 28.4% (n=1,557) Neither 41.1% (n=2,253)

11. 11 2011 KC Data Set by Substance Use Severity Source: 2011 King County Data Set (n=5,464) Past Year Dependence 47.9% (n=2,616) No Past Year Use 1.7% (n=93) Past Year Use 19.3% (n=1,056) Past Year Abuse 31.1% (n=1,699)

12. 12 Source: 2011 King County Data Set (n=4,802) Substance Use Disorders in Past Year by Major Substances *n=9,134 **Not counted in Any SUD Diagnosis. No abuse available for Tobacco.

13. 13 Pattern of Weekly Use (13+/90 days) Source: 2011 King County Data Set (n=5,578) *Not a weekly measure; any in past 90 days

14. 14 Substance Use Problems Source: 2011 King County Data Set (n=5,496) *Count of 8 items

15. 15 Substance Problem Recognition Source: 2011 King County Data Set (n=5,579)

16. 16 HIV Risk Scale: Needle Problems Source: 2011 King County Data Set (n=5,553) * Mean of 36 items from the next four slides. Intake only.

17. 17 HIV Risk Scale: Sex Risk Source: 2011 King County Data Set (n=5,424) * Mean of 36 items. Intake only.

18. 18 HIV Risk Scale: Victimization Source: 2011 King County Data Set (n=5,468) *Mean of 15 items

19. 19 HIV Risk Scale Source: 2011 King County Data Set (n=5,568) Moderate 47% (n=2,637) Low 36% (n=1,992) High 17% (n=939)

20. 20 HIV Risk Scale* by Co-Occurring Disorders Source: 2011 King County Data Set (n=5,487) * Available at intake only.

21. 21 HIV Risk Scale* by Substance Use Severity Source: 2011 King County Data Set (n=5,436) * Available at intake only.

22. 22 HIV Risk Scale* by Severity of Victimization Source: 2011 King County Data Set (n=5,516) * Available at intake only.

23. 23 Homicidal/Suicidal Thoughts *Mean of 5 items Source: 2011 King County Data Set (n=5,509)

24. 24 Para-Suicidal Behavior *Sum of 4 items Source: 2011 King County Data Set (n=1,566)

25. 25 Past Year Violence & Crime Source: 2011 King County Data Set (n=4,907) *Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)

26. 26 Type of Crime Source: 2011 King County Data Set (n=4,645) *Other crime includes vandalism, possession of stolen goods, forgery, and theft.

27. 27 Type of Crime by Co-Occurring Disorders Source: 2011 King County Data Set (n=4,580)

28. 28 Type of Crime by Substance Use Severity Source: 2011 King County Data Set (n=4,583)

29. 29 Type of Crime by Severity of Victimization Source: 2011 King County Data Set (n=4,626)

30. 30 Intensity of Justice System Involvement Source: 2011 King County Data Set (n=4,676)

31. 31 Intensity of Justice Involvement by Gender Source: 2011 King County Data Set (n=4,673)

32. 32 Intensity of Justice Involvement by Age Source: 2011 King County Data Set (n=4,676)

33. 33 Intensity of Justice Involvement by Race Source: 2011 King County Data Set (n=4,612)

34. 34 Recency of System Involvement Source: 2011 King County Data Set (n=5,386)

35. 35 Count of Major Clinical Problems at Intake Source: 2011 King County Data Set (n=5,522)

36. 36 Count of Major Clinical Problems* at Intake by Gender Source: 2011 King County Data Set (n=5,598)

37. 37 Count of Major Clinical Problems* at Intake by Age Source: 2011 King County Data Set (n=5,602)

38. 38 Count of Major Clinical Problems* at Intake by Race Source: 2011 King County Data Set (n=5,534)

39. 39 Count of Major Clinical Problems* at Intake by Risk of Homelessness Source: 2011 King County Data Set (n=5,602)

40. 40 Count of Major Clinical Problems* at Intake by Co-Occurring Disorders Source: 2011 King County Data Set (n=5,488)

41. 41 Count of Major Clinical Problems* at Intake by Substance Use Severity Source: 2011 King County Data Set (n=5,464)

42. 42 Count of Major Clinical Problems* at Intake by Severity of Victimization Source: 2011 King County Data Set (n=5,464)

43. 43 Count of Major Clinical Problems* at Intake by King County Agency Source: 2011 King County Data Set (n=5,516) OR=90.3 for most/ least severe

44. 44 Family History of Physical Health Problems Source: 2011 King County Data Set (n=5,335)

45. 45 Recovery Environment - Peers Source: 2011 King County Data Set (n=5,403)

46. 46 Recovery Environment - Home Source: 2011 King County Data Set (5,448)

47. 47 Sources of Stress: Personal Source: 2011 King County Data Set (n=1,523)

48. 48 Sources of Stress: Other Source: 2011 King County Data Set (n=1,519) *Sum of 15 items

49. 49 Treatment Readiness Source: 2011 King County Data Set (n=5,478) *Sum of 9 items

50. 50 Treatment Readiness by Age Source: 2011 King County Data Set (n=5,123)

51. 51 Treatment Readiness by Co-Occurring Disorders Source: 2011 King County Data Set (n=5,022)

52. 52 Treatment Readiness by Substance Use Severity Source: 2011 King County Data Set (n=5,027)

53. 53 Individual Strengths *Sum of 10 items Source: 2011 King County Data Set (n=1,520)

54. 54 General Social Support Strengths *Sum of 9 items Source: 2011 King County Data Set (n=1,522)

55. 55 Potential Mentors in the Recovery Environment Home School or Work Social Peers *Sum of 12 items Critical gap in connection to recovery community Source: 2011 King County Data Set (n=5,398)

56. 56 Quarterly Cost to Society  Using the GAIN we are able estimate the cost to society of tangible services (e.g., health care utilization, days in detention, probation, parole, days of missed school) in 2010 dollars for the 90 days before intake  Of the 5,602 clients served in 18 sites in 2011, the average Quarterly Cost to Society per client, in the quarter before they entered treatment, was $1,938 and totaled $8,224,406 across clients.  In the year before they entered treatment, they cost society an average of $7,752 per client and a total of $32,897,624 across clients

57. 57 Quarterly Cost to Society – 2010 Dollars * Quarterly cost to society 2010 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, 462-469. DescriptionUnitCost 2010 dollars Inpatient hospital dayDays $ 1,432.81 Emergency room visitVisits $ 269.88 Outpatient clinic/doctor’s office visitVisits $ 76.83 Nights spent in hospitalNights $ 1,432.81 Times gone to emergency roomTimes $ 269.88 Times seen MD in office or clinicTimes $ 76.83 Days bothered by any health problemsDays $ 25.63 Days bothered by psych problemsDays $ 9.90 How many days in detoxDays $ 258.99 Nights in residential for AOD useNights $ 151.65 Days in Intensive outpatient program for AOD useDays $ 104.19 Times did you go to regular outpatient programTimes $ 280.70 Days missed school or training for any reasonDays $ 18.38 How many times arrestedTimes $ 2,125.81 Days on probationDays $ 5.77 Days on paroleDays $ 18.59 Days in jail/prison/detentionDays $ 81.06 Days detention/jailDays $ 113.60

58. 58 Quarterly Cost to Society Source: 2011 King County Data Set (n=5,602)

59. 59 Quarterly Cost to Society* by Age Source: 2011 King County Data Set (n=4,241) *Using 2010 Dollars $3970 $5,837 $11,648 $16,904 <- Annual Cost

60. 60 Quarterly Cost to Society* by Risk of Homelessness Source: 2011 King County Data Set (n=4,202) *Using 2010 Dollars

61. 61 Quarterly Cost to Society* by Co-Occurring Disorders Source: 2011 King County Data Set (n=4,190) *Using 2010 Dollars

62. 62 Quarterly Cost to Society* by Substance Use Severity Source: 2011 King County Data Set (n=4,185) *Using 2010 Dollars

63. 63 Quarterly Cost to Society* by Severity of Victimization Source: 2011 King County Data Set (n=4,232) *Using 2010 Dollars

64. 64 Cross Validation of Four Summary Indices Source: 2011 King County Data Set (n=3,192) Problematic Beneficial *n=8,973 **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.

65. 65 Quality of Life  This index summarizes quality of life represented by fewer reported problems during the past year in school problems, work problems, health problems, sources of stress, risk behavior, internal disorders, external disorders, substance disorders, and crime/violence.  It is calculated as the sum of 9 screeners from the GAIN-Q version 3 (reversed to Low=2, Moderate=1, and High=0) divided by the range (18), and multiplied by 100 to get a score from 0 to 100.  The Quality of Life Index can be interpreted continuously where higher values represent greater quality of life.  It can also be triaged to low (0-36), moderate (37-69) or high (70-100) groups.

66. 66 General Satisfaction Index  This index summarizes life satisfaction in 6 areas (sexual relationship, living situation, family relationships, school/work, free time, and getting help with problems).  It is calculated as the sum of these 6 items  The General Satisfaction Index can be interpreted continuously where higher values represent greater satisfaction with life situations.  It can also be triaged to low problems (5-6), moderate problems (3-4) or high problems (0-2) groups. High satisfaction corresponds to low problems. –For the purposes of this presentation, the groups are not reversed, such that low satisfaction scores (0-2) are in the low group, and high satisfaction scores (5-6) are in the high group.

67. 67 General Satisfaction Index* by Problem Prevalence Index General Satisfaction Problem Prevalence Index *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. Problems are subjectively unpleasant and are associated with lower satisfaction Source: 2011 King County Data Set (n=1,477)

68. 68 General Satisfaction Index* by Quarterly Cost to Society General Satisfaction Quarterly Cost to Society Higher costs are subjectively unpleasant and are associated with lower satisfaction *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. Source: 2011 King County Data Set (n=1,335)

69. 69 General Satisfaction Index* by Quality of Life General Satisfaction Quality of Life Quality of life is subjectively pleasant and is associated with higher satisfaction *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. Source: 2011 King County Data Set (n=1,482)

70. 70 Treatment Needs and Performance Measures

71. 71 GAIN Treatment Planning/Placement Grid Problem Recency/Severity NonePast Current (past 90 days)* Low-Mod | High Severity Treatment History None Past Current 1. No problem 2. Past problem Consider monitoring and relapse prevention. 3. Low/Moderate problems; Not in treatment Consider initial or low invasive treatment. 4. Severe problems; Not in treatment Consider a more intensive treatment or intervention strategies. 0. Not Logical Check under- standing of problem or lying and recode. 5. No current problems; Currently in treatment Review for step down or discharge. 6. Low/Moderate problems; Currently in treatment Review need to continue or step up. 7. Severe problems; Currently in treatment Review need for more intensive or assertive levels. * Current for Dimension B1 = Past 7 days

72. 72 GAIN Placement Cells by ASAM Dimension Source: 2011 King County Data Set (n=5,437)

73. 73 B1. Intoxication/Withdrawal – Common Treatment Planning Needs Source: 2011 King County Data Set (n=5,587)

74. 74 B2. Biomedical – Common Treatment Planning Needs Source: 2011 King County Data Set (n=5,529) *n = 1,552 ** n = 1,262

75. 75 B3. Psychological – Common Treatment Planning Needs Source: 2011 King County Data Set (n=5,103) *n = 1,528

76. 76 B4.Readiness – Common Treatment Planning Needs Source: 2011 King County Data Set (n=3,318) *n=227

77. 77 B5. Relapse Potential – Common Treatment Planning Needs Source: 2011 King County Data Set (n=5,304)

78. 78 B6. Environment – Common Treatment Planning Needs Source: 2011 King County Data Set (n=5,036) *n=1,473 **n=1,946 ***n=1,531

79. 79 Exploring Efficiency & Health Disparities –Clients with Mod/High Need is the percent of all clients who at intake had ASAM cell placement of moderate problems; not in treatment (3), Severe problems; not in treatment (4), moderate problems, currently in treatment (6), or Severe problems; currently in treatment (7); divided by the number of all clients.. –Services going to those in high need is the percent of clients receiving a target service who met the above definition of Mod/High Need. –Need but no treatment is the percent of clients who met the above definition of need who did NOT get the targeted services within 90 days of the intake.

80. 80 Intoxication (at Intake) vs. Detox Treatment at 3 Months *Current need on ASAM dimension B1 criteria (past 7 days) ** ‘Services’ is self-reported receipt of detox treatment at 3 months Source: 2011 King County Data Set Subset to has 3m Follow up (n=394)

81. 81 Physical Health Problem (at Intake) vs. Medical Treatment at 3 Months *Current Need on ASAM dimension B2 criteria (past 90 days) ** ‘Services’ is self-report of any days of physical health treatment at 3 months Source: 2011 King County Data Set Subset to has 3m Follow up (n=390)

82. 82 Mental Health Problem (at Intake) vs. MH Treatment at 3 Months *Current Need on ASAM dimension B3 criteria (past 90 days) ** ‘Services’ is self-report of any days of mental health treatment at 3 months Source: 2011 King County Data Set Subset to has 3m Follow up (n=394)

83. 83 Relapse Potential (at Intake) vs. Urine/Breathalyzer at 3 months *Current Need on ASAM dimension B5 criteria (past 90 days) ** ‘Services’ is self-reported receipt of one or more breathalyzer or urine test at 3 months Source: 2011 King County Data Set Subset to has 3m Follow up (n=396)

84. 84 Recovery Environment (at Intake) vs. Self Help at 3 Months *Current Need on ASAM dimension B6 criteria (past 90 days) ** ‘Services’ is self-report of any days of self-help attendance at 3 months Source: 2011 King County Data Set Subset to has 3m Follow up (n=387)

85. 85 GAIN Administration Fidelity Index (GAFI) Source: 2011 King County Data Set (n=5,538) *Proportional sum of 7 items (n=3,063) **n=3245

86. 86 GAFI – King County Compared to CSAT CSAT 2010 Summary Analytic Data Set (n=22,122) Sources: 2011 King County Data Set (n=3,063) and

87. 87 GAFI by King County Agency Source: 2011 King County Data Set (n=3,063) *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

88. 88 Cumulative Distribution of GAIN-I Administration Time – KC vs CSAT Time in Minutes Sources: 2011 King County Data Set (n=5,507) and CSAT 2010 Summary Analytic Data Set (n=26,207) Both Have Medians around 90-100 Minutes

89. 89 GAIN-I Admin. Time by Count of Major Clinical Problems* at Intake Source: 2011 King County Data Set (n=5,507) *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

90. 90 GAIN-I Administration Time by King County Agency Source: 2011 King County Data Set (n=5,507)

91. 91 Cumulative Distribution of GAIN-M90 Administration Time – KC vs CSAT Time in Minutes Sources: 2011 King County Data Set (n=700) and CSAT 2010 Summary Analytic Data Set (n=21,307) KC faster than CSAT (Medians of 55 vs 95 Min.)

92. 92 GAIN-M90 Administration Time by King County Agency Source: 2011 King County Data Set (n=647)

93. 93 Percent of 1 st Quarter 2012 Recruits with 3 Month Follow-up Source: 2011 King County Data Set (n=407 Q1 recruits, n=40 3-month follow-ups) 80% Target