1. Chapter 18 Other Special Topics GAIN Coordinating Center (11/21/2012). Normal, IL: Chestnut Health Systems. November 2012. Available from www.gaincc.org/slideswww.gaincc.org/slides Created for: Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) under contract number 270-2012-00001

2. 2 Other Special Topics  This section presents various other topics including: –GLBTQ status, –ASAM placement, –ASAM treatment planning statements, –Individual Clinical Profile items, –Unmet need and health disparities, –Summary profiles by instrument, –Problem count by instrument, –Treatment Episode Data Set comparisons.

3. 3 GLBTQ  Gay, Lesbian, Bisexual, Transgendered, or Questioning (GLBTQ) is based on sexual pattern and reported gender for all GAIN versions, with the addition of sexual preference for GAIN version 5.4 and earlier, and also with the addition of sexual attraction and orientation for GAIN version 5.5 and later. –Sexual Pattern is defined by the gender of the sexual partner(s) a participant has had in the past year (all versions). –Sexual Preference is defined as the gender of a preferred sex partner (version 5.4 and earlier). –Sexual Attraction is defined by the gender of one’s current significant sexual or romantic attraction (version 5.5 and later). –Sexual Orientation is defined as the label that the participant most identifies with to describe his/her sexual orientation identity (version 5.5 and later).

4. 4 Sexual Pattern by GLBTQ SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,440)

5. 5 GLBTQ Hetero 95.1% (n=27,529) GLBTQ 4.9% (n= 1,428) SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,957)

6. 6 GLBTQ by Age SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,957)

7. 7 GLBTQ by Gender SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,949) Females may be more likely to report GLBTQ preferences, attraction, and behaviors than males

8. 8 GLBTQ by Race SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,943)

9. 9 GLBTQ by Substance Use Severity SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,568)

10. 10 GLBTQ by Risk of Homelessness SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,842)

11. 11 GLBTQ by Severity of Victimization SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,877) Also of interest is the finding that, of those who identify as GLBTQ, 67% fall in the high severity category

12. 12 GLBTQ by Mental Health Disorders SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,902)

13. 13 GLBTQ by Health Problems SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,698)

14. 14 GLBTQ by Crime and Violence SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,919)

15. 15 GLBTQ by Intensity of Justice System Involvement SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,838)

16. 16 GLBTQ by Program SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,957)

17. 17 GLBTQ by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,938)

18. 18 GLBTQ by Type of Treatment SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,068)

19. 19 Treatment Needs and Performance Measures

20. 20 GAIN Treatment Planning/Placement Grid The problem recency/severity axis allows you to classify the client’s problem according to whether it is a current problem, a past problem, or there is no problem –“Current problem” is further broken down into low to moderate severity or high severity problem The treatment history axis allows you to classify whether the client is currently receiving treatment for a problem, received treatment in the past, or never received treatment  Problem severity and treatment history are determined using responses to GAIN questions For more information on defining problem severity, see Chapter 6 of the GAIN manual, available free for download at http://www.gaincc.org/_data/files/Instruments%20and%20Reports/Instruments%20Manuals/ GAIN-I%20manual_combined_0512.pdf or email GAINclinical@chestnut.org http://www.gaincc.org/_data/files/Instruments%20and%20Reports/Instruments%20Manuals/ GAIN-I%20manual_combined_0512.pdfGAINclinical@chestnut.org Together, the two axes allow for categorization of the client’s problem according to whether they have a problem and whether they are receiving treatment for it already. In general: –More severe problems indicate the need for a higher level of care, particularly if current or prior interventions have been unsuccessful –Lower severity problems may be addressed with a lower-intensity interventions, unless there is a prior history of intervention –This applies to problems on any ASAM treatment planning dimension.

21. 21 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

22. 22 GAIN Placement Cells by ASAM Dimension SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,382)

23. 23 GAIN Placement Cells by ASAM Dimension - Interpretation  Some ASAM dimensions are of relatively low concern in this predominantly adolescent population (Intoxication/Withdrawal and Biomedical concerns)  The most severe problems appear in the Environment (B6), Relapse potential (B5), Treatment acceptance/resistance (B4), and Psychological/behavioral dimensions –Of these, Relapse potential shows a high level of current treatment for these problems (treatment or medication in the past 90 days; NOTE: this includes receiving a breathalyzer) –Relapse potential also has the highest percentage of those with no problem receiving treatment  The highest rate of no problems is for intoxication/withdrawal, however, current problems are measured in the past 7 days for this dimension, rather than the past 90 days used for the other dimensions  The high number of untreated past problems on the Biomedical dimension compared to the low number receiving treatment for these problems suggests this may be an area of concern for this population

24. 24 ASAM Dimension Treatment Planning Needs  For each ASAM dimension, there is a large number of possible treatment planning recommendations  These statements can be generated based on responses to GAIN questions and are included as recommendations in the GAIN Recommendation and Referral Summary Report (a text-based narrative designed to be edited and shared with specialists, clinical staff from other agencies, insurers, and lay people)  The following slides provide data on the most commonly produced treatment planning needs generated from responses to the GAIN by ASAM dimension

25. 25 B1. Intoxication/Withdrawal – Common Treatment Planning Needs SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,665) Few clients with dimension B1 needs; most common is need for detox (high withdrawal or substance use in the past two days or daily use)

26. 26 B2. Biomedical – Common Treatment Planning Needs *n = 12,684 ** n = 10,812 SAMHSA 2011 GAIN Summary Analytic Data Set (n=24,349) Most common are reduction of risky sexual behavior and tobacco cessation

27. 27 B3. Psychological – Common Treatment Planning Needs *n = 13,868 SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,436) More than 75% of clients need to coordinate services with the justice system and more then 50% have problems with anger management and behavior control

28. 28 B4. Readiness – Common Treatment Planning Needs *n=28,901 SAMHSA 2011 GAIN Summary Analytic Data Set (n=14,774) Most (>60%) are required and/or under pressure to attend treatment

29. 29 B5. Relapse Potential – Common Treatment Planning Needs SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,923) More than 60% are not close to anyone in recovery

30. 30 B6. Environment – Common Treatment Planning Needs *n=14,592 **n=12,229 ***n=7,316 SAMHSA 2011 GAIN Summary Analytic Data Set (n=25,254) Environmental risk considers people the client spends time with who are involved in school, training, illegal activities, arguing/fighting, using substances or treatment, or are in recovery

31. 31 GAIN Individual Clinical Profile Individual Clinical Profile (ICP) is a report generated from GAIN data which provides detailed information on diagnosis, placement, and treatment planning. It includes the core scale scores, detailed tables, and notes about the questions and conditions that met the various criteria. Designed to help triage problems and help the clinician go back to the GAIN for more details if necessary The following slides focus on the ASAM Placement Profile and Service Utilization in the past 90 days sections of the ICP –The Placement Profile section provides a numeric and graphical summary of the participant’s responses. particularly useful for seeing patterns and prioritizing problems across sections. Within each section are rows to identify the recency, breadth, and prevalence of problems. –Past 90 day service utilization should be used to distinguish between a lack of problems and a lack of problems while the corresponding treatment and services are being provided. While most of this information is presented elsewhere in this presentation, the ICP organizes it so that problems and services can be examined simultaneously by ASAM Dimension.

32. 32 ICP: ASAM A. Diagnosis SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,342)

33. 33 SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,649) ICP: ASAM B1. Acute Intoxication/ Withdrawal – Problems (Past 90 days) * Past week **Lifetime

34. 34 SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,651) ICP: ASAM B1. Acute Intoxication/ Withdrawal – Services (Past 90 Days)

35. 35 SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,591) ICP: ASAM B2. Biomedical – HIV Risk Problems (Past 90 Days) * Past Year

36. 36 SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,197) ICP: ASAM B2. Biomedical – Health Problems (Past 90 Days) * Past Year **Lifetime

37. 37 SAMHSA 2011 GAIN Summary Analytic Data Set (n=20,639) ICP: ASAM B2. Biomedical – Services (Past 90 Days)

38. 38 SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,595) ICP: ASAM B3. Internalizing Disorders (Past Year)

39. 39 SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,582) ICP: ASAM B3. Externalizing Disorders (Past year)

40. 40 SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,361) ICP: ASAM B3. Crime & Violence (Past Year)

41. 41 SAMHSA 2011 GAIN Summary Analytic Data Set (n=20,639) ICP: ASAM B3. Emotional, Behavioral, or Cognitive – Services (Past 90 Days)

42. 42 SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,394) ICP: ASAM B4. Readiness to Change – Current Problems * Scores are reversed to reflect that low scores are of high clinical severity. + n=13,429 ++ n=12,802 # n=16,475 ## n=4,294

43. 43 SAMHSA 2011 GAIN Summary Analytic Data Set (n=20,639) ICP: ASAM B4. Readiness to Change and Relapse Potential – Services (Past 90 Days)

44. 44 SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,563) ICP: ASAM B5. Relapse Potential – Current Problems * Past 90 days **Lifetime ** Scores are reversed to reflect that low scores are of high clinical severity.

45. 45 SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,401) ICP: ASAM B6. Recovery Environment – Environmental Risk Problems (Past Year) * Lifetime

46. 46 SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,134) ICP: ASAM B6. Recovery Environment – School and Work Problems (Past 90 Days)

47. 47 SAMHSA 2011 GAIN Summary Analytic Data Set (n=11,845) ICP: ASAM B6. Recovery Environment – Support Problems (Past 90 Days) * Past Year **Current *** Scores are reversed to reflect that low scores are of high clinical severity.

48. 48 SAMHSA 2011 GAIN Summary Analytic Data Set (n=25,800) ICP: ASAM B6. Recovery Environment – Services (Past 90 Days)

49. 49 Need Based Performance Measures –Clients with Mod/High Need is calculated as an ASAM cell placement of (3) low or moderate problems and not in treatment, (4) severe problems and not in treatment, (6) low or moderate problems and currently in treatment, or (7) severe problems and currently in treatment. It is reported as the extent of the need for treatment. Higher numbers are bad. –Percent with no treatment of those with need is the number of people with mod/high need for treatment who did NOT receive treatment after 3 months divided by the total number who needed treatment. It is reported as the degree of unmet need for treatment. Higher numbers are bad. –Clients receiving services is calculated as any days of treatment received in the past 90 days where treatment is defined appropriately by dimension (see footnotes on each slide). Higher numbers are good. –Percent with no/low need of those served is the number of people with low or no need for treatment who received services divided by the total number of those who received treatment after 3 months. Higher numbers are bad. Need/Unmet Need Services/Un- targeted Services

50. 50 Any AOD Use, Abuse, or Dependence at Intake vs. SA Treatment at 3 Months *Any past year AOD problems, use, abuse, or dependence ** ‘Services’ is self-report of any days of SA treatment at 3 months SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=18,899) Services for drug use are well targeted with those in need receiving services and services not being spread to those without need

51. 51 Any AOD Use, Abuse, or Dependence but No SA Treatment at 3 Months * p<.05 GenderRace* SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=5,029) Lower for Whites

52. 52 ASAM B1: Intoxication/Withdrawal (at Intake) vs. Detox Treatment at 3 Months Primary issues are unmet need and untargeted services *Current need on ASAM dimension B1 criteria (past 7 days) ** ‘Services’ is self-reported receipt of detox treatment at 3 months SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=21,441)

53. 53 ASAM B2: Physical Health Problem (at Intake) vs. Medical Treatment at 3 Months Need, unmet need, and untargeted services are all of approximately equal concern *Current Need on ASAM dimension B2 criteria (past 90 days) ** ‘Services’ is self-report of any days of physical health treatment at 3 months SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=21,379)

54. 54 ASAM B2: Physical Health Need but No Medical Treatment at 3 Months * p<.05 Gender*Race* Significantly higher for Males SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=8,517) Higher for Hispanics

55. 55 ASAM B3: Mental Health Problem (at Intake) vs. MH Treatment at 3 Months High rate of co-occurring mental health problems; Large unmet need *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)

56. 56 ASAM B3: MH Need but No MH Service at 3 Months * p<.05 Gender*Race* Significantly higher for Males SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=14,358) Higher for African Americans & Hispanics

57. 57 ASAM B4: Treatment Readiness Need (at Intake) vs. Six Weeks of Engagement Services are well targeted with those in need receiving services and services not being spread to those without need *Current Need on ASAM dimension B4 criteria (past 90 days) ** ‘Services’ is engagement; client has been in treatment 6 weeks or more (from records) SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=18,866)

58. 58 ASAM B4: Treatment Readiness Need but No Engagement at 3 Months * p<.05 GenderRace* Higher for African Americans SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=15,067)

59. 59 ASAM B5: 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 tests at 3 months SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=21,517) Services are well targeted with those in need receiving services and services not being spread to those without need

60. 60 ASAM B5: Relapse Potential but No Urine/Breathalyzer at 3 Months * p<.05 Race*Gender* Higher for Other Significantly higher for Females SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=17,601)

61. 61 ASAM B6: 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 SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=21,451) Extremely high rate of recovery environment problems; Large unmet need

62. 62 * p<.05 Race*Gender* Higher for African Americans & Hispanics Significantly higher for Males SAMHSA 2011 GAIN SA Data Set subset to has 3m Follow up (n=21,228) ASAM B6: Recovery Environment Need but No Self-Help Service at 3 Months

63. 63 GAIN Family of Instruments – Problem Profiles  Each instrument in the GAIN family covers a larger number of possible problem areas (least to most: SS, GQ, GI main scales, GI subscales)  For each instrument, a variable is created that counts the number of scales or screeners across domains for which an individual falls into the moderate or high problem category  The following slides: – Detail the scales or screeners that comprise a count of problems across domains available in each instrument – Provide the total count of moderate to high problems across all component scales/screeners, grouped into Low (0 moderate/high problems), Moderate (1-2 moderate/high problems), or High (3+ moderate/high problems)

64. 64 GAIN Short Screener (GAIN-SS) Version 2 Problem Profile *Not used in the GSS Problem Count SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,660) Across the 4 screeners on the SS 59% of respondents have 3 or more that rate as moderate to high problems

65. 65 GAIN Quick (GAIN-Q) Version 3 Problem Profile *Not used in the GQ Problem Count **n=15,721 ***n=14,825 +n=13,540 ++n=21,578 SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,650) Across the 9 screeners on the Q3 82% of respondents have 3 or more that rate as moderate to high problems

66. 66 GAIN-I Main Scales Problem Profile SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,436) Across 13 main scales on the GI 82% of respondents have 3 or more that rate as moderate to high problems

67. 67 *Low=no use; Mod=use; High=dependence/abuse/weekly use; Only moderate or high is counted in the GI Problem Count scale. GAIN-I Problem Profile - Subscales: Substance Problems SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,675)

68. 68 GAIN-I Problem Profile - Subscales: Internalizing Mental Health Problems SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,345)

69. 69 GAIN-I Problem Profile - Subscales: Externalizing Mental Health Problems SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,490)

70. 70 GAIN-I Problem Profile - Subscales: Crime/Violence Problems SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,490)

71. 71 GAIN-I Problem Profile - Subscales: General Factors/Stress Problems SAMHSA 2011 GAIN Summary Analytic Data Set (n=13,682) *n=19,534 **n=22,674

72. 72 GAIN-I Problem Profile - Subscales: Physical Health Problems SAMHSA 2011 GAIN Summary Analytic Data Set (n=13,023) *n=29,477

73. 73 GAIN-I Problem Profile - Subscales: Risk Behavior Problems SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,844) *n=15,159 Across 40 subscales on the GI 91% of respondents have 3 or more that rate as moderate to high problems

74. 74 GAIN Family of Instruments – Moderate/High Problem Counts  Each instrument in the GAIN family covers a larger number of possible problem areas (least to most SS, GQ, GI main scales, GI subscales)  The following slides compare the count of screeners or scales from the previous slides that fall into the moderate or high group for each instrument, then present mean problem count for each instrument by breakouts

75. 75 Mod/High Problem Count by Instrument SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,268) The GAIN-I subscales provide the opportunity to identify more problem areas for the client than the shorter instruments

76. 76 Mean Mod/High Problem Count by Instrument by Age SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,268) Adults (18+) have fewer problems than adolescents on the GAIN-SS and GAIN-Q screeners, but more on the GAIN-I scales

77. 77 Mean Mod/High Problem Count by Instrument by Gender SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,257) Across instruments females have more problems than males

78. 78 Mean Mod/High Problem Count by Instrument by Race SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,253) Across instruments African Americans report the fewest problems

79. 79 Mean Mod/High Problem Count by Instrument by Substance Use Severity SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,845) Substance use is part of the problem count for all instruments, and becomes a bigger portion of that count the longer the instrument.

80. 80 Mean Mod/High Problem Count by Instrument by Risk of Homelessness SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,132) Homelessness is associated with a higher number of problems on all instruments

81. 81 Mean Mod/High Problem Count by Instrument by Severity of Victimization SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,035) Despite being a small or non-existent part of each problem count, severity of victimization shows a clear relationship with problems in other domains across instruments

82. 82 Mean Mod/High Problem Count by Instrument by Mental Health Disorders SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,171) Mental health disorders are part of the problem count for all instruments, and becomes a bigger portion of that count the longer the instrument.

83. 83 Mean Mod/High Problem Count by Instrument by Health Problems SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,966) Health problems are associated with a higher number of problems on all instruments

84. 84 Mean Mod/High Problem Count by Instrument by Crime and Violence SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,189) Crime and violence are part of the problem count for all instruments, and becomes a bigger portion of that count the longer the instrument.

85. 85 Mean Mod/High Problem Count by Instrument by Intensity of Justice System Involvement SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,106) Justice involvement has little relationship with number of problems

86. 86 Mean Mod/High Problem Count by Instrument by Program * Not available for ATM or CYT SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,268) Adult programs and randomized experiments show the highest problem counts

87. 87 Mean Mod/High Problem Count by Instrument by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,235) Individuals with higher problem counts are also those in more intense levels of care, validating the problem count variables

88. 88 Mean Mod/High Problem Count by Instrument by Type of Treatment SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,366) Those with the highest problem counts are receiving non- evidence based treatments

89. 89 Treatment Episode Data Set (TEDS) Case Mix and the GAIN  The Treatment Episode Data Set (TEDS) contains a set of CORE and OPTIONAL demographics and substance abuse characteristics for people entering publicly funded substance abuse treatment.  The following 4 slides validate the GAIN problem counts to these more widely available measures of case mix from TEDS to demonstrate their validity  There are two versions of TEDS measures - a 4 item version using only CORE items and a broader 10 item version using those plus optional items.

90. 90 TEDS Case Mix (4 Items) *Mean of 4 items SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,456) More than 75% of clients first used before the age of fifteen, but less than half have received prior substance abuse treatment

91. 91 TEDS Case Mix (4 items) by GAIN Problem Count TEDS Case Mix GAIN Problem Count SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,782) GAIN count of major clinical problems covers a wider range of problems than the core TEDS problem count As the count of TEDS problems increases, so does the count of GAIN major clinical problems

92. 92 TEDS Case Mix (10 Items) *Mean of 10 items SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,246) Lifetime justice system involvement is even more common (88%) than use before the age of 15 (79%)

93. 93 TEDS Case Mix (10 items) by GAIN Problem Count GAIN Problem Count SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,782) GAIN count of major clinical problems also covers a wider range of problems than the optional TEDS problem count TEDS Case Mix