Transcript Insert Workshop Title

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
Detailed Acknowledgements
2
• 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.
Goals
3
• 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
2011 King County GAIN Data Set
4
• 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
Source: 2011 King County Data Set (n=5,507)
Pioneer
Valley Cities
Sound MH
Integrative
Friends
176
44
179
104
21
Renton Area
129
343
612
700
Youth East.
36
0
Com. Psych
WAPIFASA
Northshore
36
100
Vashon
CHS
357
888
883
856
900
Kent
131
305
1,000
Auburn
Navos
200
346
400
Asian Coun.
300
156
500
Therapeutic
Consejo
GAIN-I Interviews
2011 KC Data by Agency
5
800
600
2011 KC Data Set by Gender
6
Females
30.3%
(n= 1,694)
Other
0.04%
(n= 2)
Males 69.7%
(n=3,904)
Source: 2011 King County Data Set (n=5,600)
2011 KC Data Set by Age
7
26+ Years
10.8%
(n=606)
Under 15 Years
(<15)
17.3%
(n=967)
18 -25
Years
14.3%
(n=802)
15-17 Years
57.6%
(n=3,227)
Source: 2011 King County Data Set (n=5,602)
2011 KC Data Set by Race
8
Mixed
18.2%
(n=1,005)
African
American
14.0%
(n=777)
Hispanic
13.6%
(n=750)
White
45.4%
(n= 2,514)
Source: 2011 King County Data Set (n=5,534)
Other
8.8%
(n=488)
2011 KC Data Set by
Risk of Homelessness
9
At Risk
11.9%
(n=658)
Group or
Institution
2.3%
(n=128)
Source: 2011 King County Data Set (n=5,551)
Currently
Homeless
7.4%
(n=409)
Housed
78.5%
(n=4,356)
2011 KC Data Set by
Co-Occurring Disorders
10
Both
28.4%
(n=1,557)
Internalizing
Disorders
Only
10.3%
(n=566)
Source: 2011 King County Data Set (n=5,488)
Neither
41.1%
(n=2,253)
Externalizing
Disorders
Only
20.3%
(n=1,112)
2011 KC Data Set by
Substance Use Severity
11
No Past Year
Use 1.7%
(n=93)
Past Year
Dependence
47.9%
(n=2,616)
Source: 2011 King County Data Set (n=5,464)
Past Year
Use
19.3%
(n=1,056)
Past Year
Abuse
31.1%
(n=1,699)
Substance Use Disorders in Past Year
by Major Substances
12
Any SUD…
Marijuana
32%
Alcohol
18%
Amphetamine* 6%
Cocaine 5%
Opiates 4%
Sed/hyp/anx
Hallucinogens
Other drugs
Inhalants
PCP 0%
Tobacco **
35%
79%
0%
20%
40%
60%
80%
*n=9,134
**Not counted in Any SUD Diagnosis. No abuse available for Tobacco.
Source: 2011 King County Data Set (n=4,802)
Dependence
Abuse
Use
No Use
100%
Pattern of Weekly Use (13+/90 days)
13
Anything
57%
Cannabis
Alcohol
Opioid
42%
16%
4%
Amphetamines
3%
Other Drugs
2%
Cocaine
2%
Tobacco
Controlled Environment
Any Needle Use*
42%
13%
3%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
*Not a weekly measure; any in past 90 days
Source: 2011 King County Data Set (n=5,578)
Substance Use Problems
14
Any Past Year
Diagnosis
79%
First Use < Age 15
68%
Weekly Use of AOD
57%
3+ Years Use
51%
Past Year Dependence
48%
Any Withdrawal
34%
Prior SA Treatment
29%
Severe Withdrawal 3%
Substance Use
Problems*
21%
46%
33%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
*Count of 8 items
High (6-8)
Source: 2011 King County Data Set (n=5,496)
Mod. (3-5)
Low (0-2)
Substance Problem Recognition
15
Can Give 1+ Reasons to Quit*
88%
Client Believes Need ANY
Treatment
61%
Acknowledges Having an AOD
Problem
26%
0%
Source: 2011 King County Data Set (n=5,579)
20%
40%
60%
80%
100%
HIV Risk Scale: Needle Problems
16
Use a needle to shoot up drugs
3.4%
Reuse needle you had used before
2.3%
Let someone else inject you w/ needle
2.1%
Skip cleaning needle after done
1.7%
Reuse needle w/o cleaning first
1.4%
Let use water/cooker/cotton after you
1.4%
Reuse water/cooker/cotton after
1.1%
Let someone else use needle
1.1%
Use needle someone else used
1.0%
0%
20%
* Mean of 36 items from the next four slides. Intake only.
Source: 2011 King County Data Set (n=5,553)
40%
60%
80%
100%
HIV Risk Scale: Sex Risk
17
Sex in past year
68%
Sex w/o barrier of any kind
38%
36%
36%
Have sex w/you or partner high on AOD
2 or more sex partners in past year
Use AOD to make sex longer or hurt less
5%
5%
3%
3%
2%
1%
1.1%
0.8%
Have sex involving anal intercourse
Pain during sex or after sex
Sex with injection drug user
Trade sex for drugs, gifts, or money
Sex w/man who has sex with other men
Sex with someone HIV positive
Use drugs/gifts/money to purchase sex
0%
* Mean of 36 items. Intake only.
Source: 2011 King County Data Set (n=5,424)
20%
40%
60%
80%
100%
HIV Risk Scale: Victimization
18
35%
33%
32%
Ever hurt by striking/beating
Abused emotionally
Ever attacked w/ gun, knife, other weapon
Ever forced sex acts against your will/anyone 9%
Age of 1st abuse < 18
Any several times or for long time
Was person family member/trusted one
Any with more than one person involved
Were you afraid for your life/injury
People you told not believe you/help you
Result in oral, vaginal, anal sex
Currently worried someone abuse emotionally
High
Severity
(4-15)
51%
32%
27%
27%
17%
10%
7%
8%
Moderate
Severity
(1-3)
Currently worried someone beat/hurt 6%
Low
Severity
(0)
Currently worried someone attack 5%
Currently worried someone force sex acts
1%
42%
General Victimization Scale*
0%
*Mean of 15 items
Source: 2011 King County Data Set (n=5,468)
20%
17%
40%
60%
42%
80%
100%
HIV Risk Scale
19
Moderate
47%
(n=2,637)
High
17%
(n=939)
Low
36%
(n=1,992)
Source: 2011 King County Data Set (n=5,568)
HIV Risk Scale* by
Co-Occurring Disorders
20
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Low
(0-2)
Moderate
(3-9)
40%
25%
3%
Neither
(OR=1.0)
* Available at intake only.
10%
Externalizing Internalizing
Disorders
Disorders
Only
Only
(OR=3.5)
(OR=10.9)
Source: 2011 King County Data Set (n=5,487)
Both
(OR=21.5)
High
(10-36)
HIV Risk Scale* by
Substance Use Severity
21
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Low
(0-2)
Moderate
(3-9)
28%
1%
No Past
Year Use
(OR=1.0)
6%
9%
Past Year Use
(OR=5.4)
Past Year
Abuse
(OR=8.7)
* Available at intake only.
Source: 2011 King County Data Set (n=5,436)
Past Year
Dependence
(OR=35.3)
High
(10-36)
HIV Risk Scale* by
Severity of Victimization
22
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Low
(0-2)
Moderate
(3-9)
39%
1%
Low Severity
(OR=1.0)
Moderate
Severity
(OR=3.9)
* Available at intake only.
Source: 2011 King County Data Set (n=5,516)
High Severity
(OR=226.6)
High
(10-36)
Homicidal/Suicidal Thoughts
23
Thought about committing
11%
suicide
Thought about
killing/hurting someone
High
Severity
(4-5)
8%
Had a plan to commit
suicide
4%
Attempted suicide
3%
Gotten gun etc. to
carry out plan
3%
Moderate
Severity
(1-3)
13%
Homicidal Suicidal
Thought Scale* 3%
0%
20%
*Mean of 5 items
Source: 2011 King County Data Set (n=5,509)
Low
Severity
(0)
84%
40%
60%
80%
100%
Para-Suicidal Behavior
24
Cut, burned, or hurt self
9%
on purpose - PY
High
Severity
(3-4)
Cut, burned, or hurt self
7%
on purpose - P90 days
Felt can't stop cut, burn,
or hurt self - PY
3%
Needed medical attention
after cut, burn, or hurt self
2%
Moderate
Severity
(1-2)
Parasuicidal Index * 3%6%
0%
20%
*Sum of 4 items
Source: 2011 King County Data Set (n=1,566)
Low
Severity
(0)
91%
40%
60%
80%
100%
Past Year Violence & Crime
25
Any Violence or Illegal Activity
60%
Physical Violence
47%
Any Illegal Activity
45%
Any Property Crimes
34%
Other Drug Related Crimes*
26%
Any Interpersonal/ Violent Crime
23%
Lifetime Justice Involvement
55%
1+/90 days In Controlled…
47%
Current Justice involvement
40%
0%
20%
40%
60%
80%
*Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)
Source: 2011 King County Data Set (n=4,907)
100%
Type of Crime
26
Other
Crime*
20%
Drug Use
only
58%
Violent
Crime
22%
*Other crime includes vandalism, possession of stolen goods, forgery, and theft.
Source: 2011 King County Data Set (n=4,645)
Type of Crime by
Co-Occurring Disorders
27
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Drug Use
only
Other
Crime*
37%
33%
13%
10%
Neither
(OR=1.0)
Externalizing
Disorders
Only
(OR=4.4)
Source: 2011 King County Data Set (n=4,580)
Internalizing
Disorders
Only
(OR=1.4)
Both
(OR=5.2)
Violent
Crime
Type of Crime by
Substance Use Severity
28
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Drug Use
only
Other
Crime*
6%
No PY Use
(OR=1.0)
12%
18%
PY Use
(OR=2.3)
PY Abuse
(OR=3.7)
Source: 2011 King County Data Set (n=4,583)
30%
PY Dependence
(OR=7.2)
Violent
Crime
Type of Crime by
Severity of Victimization
29
100%
90%
Drug Use
only
80%
70%
60%
Other
Crime*
50%
40%
30%
20%
10%
0%
26%
34%
9%
Low Severity
(OR=1.0)
Moderate Severity
(OR=3.4)
Source: 2011 King County Data Set (n=4,626)
High Severity
(OR=5.0)
Violent
Crime
Intensity of Justice System Involvement
30
Drug Court
On
1%
prob/parole
14+ days w/
1+ drug
screens
9%
Other
prob/parole/
detention
11%
Other JJ/CJ
status
15%
Past
arrest/JJ/CJ
status
10%
Source: 2011 King County Data Set (n=4,676)
In detention/
jail 14-29 days
3%
In detention/
jail 30+ days
4%
Past year
illegal activity/
SA use
48%
Intensity of Justice Involvement by
Gender
31
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Past yr illegal
activity/SA use
Past arrest/JJ/CJ
status
Other JJ/CJ status
Other probation,
parole, detention
Prob/parole 14+ days
w/ 1+ drug screens
Drug Court
Male
Source: 2011 King County Data Set (n=4,673)
Female
Detention/jail 14-29
days
Detention/jail 30+
days
Intensity of Justice Involvement by Age
32
100%
90%
Past yr illegal
activity/SA use
80%
Past arrest/JJ/CJ
status
70%
Other JJ/CJ status
60%
Other probation,
parole, detention
50%
40%
Prob/parole 14+ days
w/ 1+ drug screens
30%
Drug Court
20%
Detention/jail 14-29
days
10%
0%
<15
15-17
18-25
Source: 2011 King County Data Set (n=4,676)
26+
Detention/jail 30+
days
Intensity of Justice Involvement by Race
33
100%
Past yr illegal
activity/SA use
90%
Past arrest/JJ/CJ
status
80%
70%
Other JJ/CJ status
60%
50%
Other probation,
parole, detention
40%
Prob/parole 14+ days
w/ 1+ drug screens
30%
Drug Court
20%
10%
Detention/jail 14-29
days
0%
African Hispanic
American
Other
Source: 2011 King County Data Set (n=4,612)
White
Mixed
Detention/jail 30+
days
Recency of System Involvement
34
Never
More than
90 days ago
74%
23%
21%
15%
12%
MH Tx
At Work
Arrested
SA Tx
PH Tx
43%
In School
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Source: 2011 King County Data Set (n=5,386)
Past 90
days
Count of Major Clinical Problems at Intake
35
Cannabis disorder
34%
Alcohol disorder
33%
Other drug disorder
21%
Four
Conduct Disorder
38%
ADHD
33%
Depression
Three
31%
26%
Trauma
Anxiety
Two
13%
60%
Violence/ illegal activity
Victimization
Suicide
Five to
Twelve
One
58%
11%
Major Clinical Problems*
None
40%
0%
20%
Source: 2011 King County Data Set (n=5,522)
11% 12% 14% 12% 10%
40%
60%
80%
100%
Count of Major Clinical Problems*
at Intake by Gender
36
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
None
One
Two
Three
37%
Male
(OR=1.0)
Source: 2011 King County Data Set (n=5,598)
48%
Four
Five to
Twelve
Female
(OR=1.6)
Count of Major Clinical Problems*
at Intake by Age
37
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
None
One
Two
Three
34%
38%
<15
(OR=1.0)
15-17
(OR=1.2)
44%
56%
Four
Five to
Twelve
Source: 2011 King County Data Set (n=5,602)
18-25
(OR=1.5)
26+
(OR=2.5)
Count of Major Clinical Problems*
at Intake by Race
38
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
None
One
Two
Three
32%
32%
38%
43%
African
American
(OR=1.0)
Hispanic
(OR=1.0)
Other
(OR=1.3)
White
(OR=1.6)
Source: 2011 King County Data Set (n=5,534)
47%
Four
Five to
Twelve
Mixed
(OR=1.9)
Count of Major Clinical Problems*
at Intake by Risk of Homelessness
39
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
None
One
Two
Three
69%
36%
Housed
(OR=1.0)
45%
52%
Four
Five to
Twelve
Group/Inst
(OR=1.5)
Source: 2011 King County Data Set (n=5,602)
At Risk of
Homelessness
(OR=1.9)
Currently
Homeless
(OR=4.1)
Count of Major Clinical Problems*
at Intake by Co-Occurring Disorders
40
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
None
One
Two
92%
42%
3%
Neither
(OR=1.0)
Three
Four
50%
Five to
Twelve
Externalizing
Disorders
Only
(OR=24.7)
Source: 2011 King County Data Set (n=5,488)
Internalizing
Disorders
Only
(OR=34.0)
Both
(OR=369.2)
Count of Major Clinical Problems*
at Intake by Substance Use Severity
41
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
None
One
Two
Three
63%
1%
No PY Use
(OR=1.0)
12%
PY Use
(OR=12.6)
Source: 2011 King County Data Set (n=5,464)
26%
PY Abuse
(OR=32.0)
Four
Five to
Twelve
PY
Dependence
(OR=159.5)
Count of Major Clinical Problems*
at Intake by Severity of Victimization
42
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
None
One
Two
69%
Four
40%
12%
Low
Severity
(OR=1.0)
Moderate
Severity
(OR=4.8)
Source: 2011 King County Data Set (n=5,464)
Three
High
Severity
(OR=16.0)
Five to
Twelve
Count of Major Clinical Problems*
at Intake by King County Agency
43
100%
None
90%
80%
One
70%
Two
60%
0%
Source: 2011 King County Data Set (n=5,516)
79%
55%
52%
53%
51%
52%
47%
44%
40%
42%
35%
32%
31%
30%
10%
4%
20%
22%
30%
40%
40%
60%
50%
Three
Four
Five to
Twelve
OR=90.3 for most/
least severe
Family History of
Physical Health Problems
44
Problems with alcohol use
63%
Problems with drug use
50%
Heart or blood problems
48%
Diabetes
48%
Psychological problems
40%
Other probs or in Tx a lot
32%
Any Family History of
Physical Health Problems
86%
0%
Source: 2011 King County Data Set (n=5,335)
20%
40%
60%
80%
100%
Recovery Environment - Peers
45
Social Peers Getting Drunk
Weekly+
50%
School/Work Peers Getting Drunk
Weekly+
42%
Others at Home Getting Drunk
Weekly+
30%
Social Peers Using Drugs
66%
School/Work Peers Using Drugs
56%
Others at Home Using Drugs
26%
0%
Source: 2011 King County Data Set (n=5,403)
20%
40%
60%
80%
100%
Recovery Environment - Home
46
Family History of Substance Use
69%
Weekly Alcohol Use at Home
23%
Weekly Family Problems
19%
Weekly Drug Use at Home
9%
0%
Source: 2011 King County Data Set (5,448)
20%
40%
60%
80%
100%
Sources of Stress: Personal
47
Death of family member/
close friend
32%
Health problem of family/friend
30%
Major change in
relationships/divorce
22%
Fights with boss/ teacher/
coworkers
21%
Other family changes/problems 11%
Birth/adoption of new family
8%
member
0%
Source: 2011 King County Data Set (n=1,523)
20%
40%
60%
80%
100%
Sources of Stress: Other
48
23%
Major change/bad housing
Transportation problems
18%
Interruption or loss of house/
job/school
16%
Hard work or school schedule
15%
Threat of losing job/house/
school/transportation
14%
New job, position, or school
14%
Something you saw
14%
Discrimination in community/
work/etc.
5%
Other environmental demands
4%
Sources of Stress Index*
0%
High
(3-15)
Moderate
(1-2)
Low
(0)
35%
20%
*Sum of 15 items
Source: 2011 King County Data Set (n=1,519)
31%
40%
34%
60%
80%
100%
Treatment Readiness
49
Can get help you need
in Tx program
Need to be in Tx for at least
a month
Old friends may try to get
you drunk/high
A lot of pressure to be
in Tx
Need support from friends/
relatives
Being in Tx program too
demanding
Too many responsibilities to
be in Tx
Be hard to resist AOD
where you live
Will need to come back
to Tx 1/more times
56%
Low
(0-2)
34%
34%
31%
31%
Moderate
(3-5)
30%
27%
16%
High
(6-9)
13%
Treatment Readiness*
30%
0%
20%
*Sum of 9 items
Source: 2011 King County Data Set (n=5,478)
12%
59%
40%
60%
80%
100%
Treatment Readiness by Age
50
100%
90%
20%
22%
80%
High
(6-9)
44%
70%
75%
60%
Moderate
(3-5)
50%
40%
30%
Low
(0-2)
20%
10%
0%
<15
(OR=1.0)
15-17
(OR=1.2)
Source: 2011 King County Data Set (n=5,123)
18-25
(OR=3.2)
26+
(OR=12.6)
Treatment Readiness by
Co-Occurring Disorders
51
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
21%
23%
45%
42%
High
(6-9)
Moderate
(3-5)
Low
(0-2)
Neither
(OR=1.0)
Externalizing Internalizing
Disorders
Disorders
Only
Only
(OR=1.1)
(OR=3.0)
Source: 2011 King County Data Set (n=5,022)
Both
(OR=2.7)
Treatment Readiness by
Substance Use Severity
52
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1%
15%
18%
45%
High
(6-9)
Moderate
(3-5)
Low
(0-2)
No Past
Year Use
(OR=1.0)
Past Year
Use
(OR=16.5)
Source: 2011 King County Data Set (n=5,027)
Past Year
Past Year
Abuse
Dependence
(OR=20.5) (OR=73.5)
Individual Strengths
53
86%
Doing well with close friends
Listening, caring or communicating
with others
Problem solving and figuring
things out
72%
70%
Doing well at with your family
Doing well at sports, exercise,
physical activity
67%
50%
Doing well at school or training
Doing well at music, dancing, acting,
other performing art
Drawing, painting, design or
other art activities
49%
44%
Low
Problems
(10-7)
28%
46%
Strength Self-Efficacy Index* 8%
0%
Moderate
Problems
(6-3)
61%
Working or playing with computers
Doing well at work
High
Problems
(2-0)
78%
20%
*Sum of 10 items
Source: 2011 King County Data Set (n=1,520)
40%
46%
60%
80%
100%
General Social Support Strengths
54
Friends to hang out with
83%
Family members/close partners
79%
Someone to talk to about emotions
78%
Someone to help cope with problems
76%
Legal hobby or activity
49%
Professional counselor/health provider
48%
57%
57%
General Social Support Index* 8% 15%
*Sum of 9 items
Source: 2011 King County Data Set (n=1,522)
Moderate
Problems
(4-2)
73%
People at work/school:
get assignments
People at work/school:
day to day things
Friends/colleagues from other
companies/schools
0%
High
Problems
(1-0)
20%
Low
Problems
(9-5)
77%
40%
60%
80%
100%
Potential Mentors in the Recovery
Environment
Home
55
83%
None involved in illegal activity
63%
Little shouting, arguing or fighting most weeks
Know anyone in treatment
Know anyone in recovery
20%
14%
School or
Work
58%
None involved in illegal activity
Know anyone in treatment
Know anyone in recovery
27%
13%
70%
Little shouting, arguing or fighting most weeks
Social
Peers
Critical
gap in
connection
to recovery
community
77%
Little shouting, arguing or fighting most weeks
50%
Know anyone in treatment
33%
Know anyone in recovery
16%
Environmental Strengths Index* 9%
38%
None involved in illegal activity
0%
High Problems (2-0)
20%
54%
40%
Moderate Problems (5-3)
*Sum of 12 items
Source: 2011 King County Data Set (n=5,398)
60%
80%
100%
Low Problems (16-12)
Quarterly Cost to Society
56
 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
Quarterly Cost to Society – 2010 Dollars
57
Description
Unit
Inpatient hospital day
Days
$
1,432.81
Emergency room visit
Visits
$
269.88
Outpatient clinic/doctor’s office visit
Visits
$
76.83
Nights spent in hospital
Nights
$
1,432.81
Times gone to emergency room
Times
$
269.88
Times seen MD in office or clinic
Times
$
76.83
Days bothered by any health problems
Days
$
25.63
Days bothered by psych problems
Days
$
9.90
How many days in detox
Days
$
258.99
Nights in residential for AOD use
Nights
$
151.65
Days in Intensive outpatient program for AOD use
Days
$
104.19
Times did you go to regular outpatient program
Times
$
280.70
Days missed school or training for any reason
Days
$
18.38
How many times arrested
Times
$
2,125.81
Days on probation
Days
$
5.77
Days on parole
Days
$
18.59
Days in jail/prison/detention
Days
$
81.06
Days detention/jail
Days
$
113.60
*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.
Cost 2010 dollars
Quarterly Cost to Society
58
$10,000+
% of
Population 4% 24%
(5,602)
72%
$2,000 - $9,999
% of Total
Dollars
($8,224,406;
mean=$1,939)
0%
48%
17%
35%
$0-$1,999
20%
40%
Source: 2011 King County Data Set (n=5,602)
60%
80%
100%
Quarterly Cost to Society* by Age
59
$3970
$5,837
100%
$11,648 $16,904 <- Annual Cost
$10,000
90%
$9,000
80%
$8,000
70%
$7,000
60%
$4,226
50%
30%
20%
$4,000
$2,000
$993
$1,000
<15
$10,000+
$3,000
$1,459
10%
0%
$2,000 $9,999
$5,000
$2,912
40%
$6,000
$0-$1,999
15-17
18-25
Source: 2011 King County Data Set (n=4,241)
26+
$0
*Using 2010 Dollars
Mean
Quarterly Cost to Society* by
Risk of Homelessness
60
100%
$10,000
90%
$9,000
80%
$8,000
$7,230
70%
$7,000
60%
$6,000
$4,192
50%
$2,842
40%
30%
$4,000
$1,554
$10,000+
$3,000
$2,000
10%
$1,000
Housed
$2,000 $9,999
$5,000
20%
0%
$0-$1,999
Group/
Inst
At Risk
Currently
of
Homeless
Homelessness
$0
*Using 2010 Dollars
Source: 2011 King County Data Set (n=4,202)
Mean
Quarterly Cost to Society* by
Co-Occurring Disorders
61
100%
$10,000
90%
$9,000
80%
$8,000
70%
$7,000
60%
$6,000
50%
$3,022
$3,347
40%
$1,515
20%
$1,017
$2,000
$1,000
Neither
Externalizing Internalizing
Disorders
Disorders
Only
Only
Both
$0
*Using 2010 Dollars
Source: 2011 King County Data Set (n=4,190)
$10,000+
$3,000
10%
0%
$2,000 $9,999
$5,000
$4,000
30%
$0-$1,999
Mean
Quarterly Cost to Society* by
Substance Use Severity
62
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
$2,857
$1,265
$1,179
$614
No PY Use PY Use PY Abuse
PY
Dependence
$10,000
$9,000
$8,000
$7,000
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$0
*Using 2010 Dollars
Source: 2011 King County Data Set (n=4,185)
$0-$1,999
$2,000 $9,999
$10,000+
Mean
Quarterly Cost to Society* by
Severity of Victimization
63
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
$3,032
$1,716
$1,056
Low
Severity
Moderate
Severity
High
Severity
$10,000
$9,000
$8,000
$7,000
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$0
*Using 2010 Dollars
Source: 2011 King County Data Set (n=4,232)
$0 - $1,999
$2,000 $9,999
$10,000+
Mean
Cross Validation of Four Summary Indices
64
100%
90%
38.1%
80%
56.6%
70%
60%
50%
Beneficial
High
Mod
Low
40%
20%
10%
0%
11%
Problem
Prevalence
*n=8,973
Index
4%
Quarterly
Cost to
Society
Quality of Life General
Index
Satisfaction
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.
Source: 2011 King County Data Set (n=3,192)
Problematic
30%
Low
Mod
High
Quality of Life
65
 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.
General Satisfaction Index
66
 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.
General Satisfaction Index* by
Problem Prevalence Index
67
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
22%
33%
45%
General
Satisfaction
High (5-6)
Moderate (3-4)
Low (0-2)
Low
(0-5)
(OR=1.0)
Moderate
(6-24)
(OR=5.6)
High
(25-100)
(OR=18.1)
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.
Source: 2011 King County Data Set (n=1,477)
Problems are
subjectively
unpleasant and
are associated
with lower
satisfaction
General Satisfaction Index* by
Quarterly Cost to Society
68
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
36%
47%
General
Satisfaction
High (5-6)
63%
Moderate (3-4)
Low (0-2)
Low
($0-$1,999)
(OR=1.0)
Moderate
($2,000-$9,999)
(OR=0.5)
High
($10,000+)
(OR=0.3)
Quarterly Cost to Society
*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)
Higher costs are
subjectively
unpleasant and are
associated with
lower satisfaction
General Satisfaction Index* by
Quality of Life
69
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
General
Satisfaction
31%
51%
74%
High (5-6)
Moderate (3-4)
Low (0-2)
Low
(0-36)
(OR=1.0)
Moderate
(37-69)
(OR=2.4)
High
(70-100)
(OR=6.3)
Quality of Life
*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)
Quality of life is
subjectively
pleasant and is
associated with
higher satisfaction
70
Treatment Needs and
Performance Measures
GAIN Treatment Planning/Placement Grid
71
Problem Recency/Severity
None
Current (past 90 days)*
Past
Low-Mod
1. No problem
None
Past
Current
Treatment History
0. Not Logical
Check understanding of
problem or lying
and recode.
2. Past problem
Consider
monitoring
and relapse
prevention.
5. No current
problems;
Currently in
treatment
Review for step
down or
discharge.
3. Low/Moderate
problems;
Not in treatment
Consider initial or
low invasive
treatment.
6. Low/Moderate
problems;
Currently in
treatment
Review need to
continue or step up.
* Current for Dimension B1 = Past 7 days
|
High Severity
4. Severe
problems;
Not in treatment
Consider a more
intensive treatment
or intervention
strategies.
7. Severe
problems;
Currently in
treatment
Review need
for more intensive
or assertive levels.
GAIN Placement Cells by ASAM
Dimension
72
B1.Intoxication/
Withdrawal
B2. Biomedical
B3 Psychological/
Behavioral
B4. Tx Acceptance/
Resistance
B5. Relapse
Potential
B6. Environment
0%
10%
20%
30%
Inconsistent
Past Problem
High Problems
Low/Moderate Problems in Treatment
Source: 2011 King County Data Set (n=5,437)
40% 50% 60% 70% 80%
No problem
Low/Moderate Problems
No Problems in Treatment
High Problems in Treatment
90%
100%
B1. Intoxication/Withdrawal –
Common Treatment Planning Needs
73
Detox/withdrawal services
41%
Meds for non-opioid
withdrawal & relapse
19%
Meds for opiate withdrawal &
relapse
2%
Monitoring withdrawal &
AOD meds compliance
1%
0%
Source: 2011 King County Data Set (n=5,587)
20%
40%
60%
80%
100%
B2. Biomedical –
Common Treatment Planning Needs
74
Risky sexual behavior
70%
Tobacco cessation
49%
Compliance with PH meds
28%
Accommodate medical condition*
21%
Meds for physical health problems
19%
ER/hospitalization history
16%
Current Tx for medical problem
15%
Tetanus shot**
10%
0%
*n = 1,552 ** n = 1,262
Source: 2011 King County Data Set (n=5,529)
20%
40%
60%
80%
100%
B3. Psychological –
Common Treatment Planning Needs
75
Behavior control
Anger management
Coordinate with justice system
Interpersonal illegal acts
Drug-related illegal activities
Homicidal/suicidal risk
Current Tx for psych problems
Illegal activities
Current meds for psych problems
Arrest history
Civil court*
Problems w/ reading & writing
63%
45%
41%
22%
21%
19%
18%
17%
16%
12%
11%
8%
0%
*n = 1,528
Source: 2011 King County Data Set (n=5,103)
20%
40%
60%
80%
100%
B4.Readiness –
Common Treatment Planning Needs
76
Case management
70%
Any Tx Pressure
64%
Tx required
39%
Partner to understand Tx process
36%
Review expectations for length of
Tx
Dissatisfaction with past 90 day
Tx*
18%
8%
0%
*n=227
Source: 2011 King County Data Set (n=3,318)
20%
40%
60%
80%
100%
B5. Relapse Potential –
Common Treatment Planning Needs
77
69%
Recovery Coach
CC after controlled environment
16%
Significant time in controlled
environment
13%
Discuss substance abuse Tx
history
2%
0%
Source: 2011 King County Data Set (n=5,304)
20%
40%
60%
80%
100%
B6. Environment –
Common Treatment Planning Needs
78
Any school past 90 days
Environmental risk
Coping with stress*
Need for change**
Child maltreatment
School problems
Family fighting
Other vocational help
Substance use in the home
Financial counseling***
Employed past 90 days
Housing situation
Recent victimization
74%
74%
67%
66%
58%
51%
37%
35%
30%
22%
21%
19%
18%
0%
*n=1,473
**n=1,946
20%
***n=1,531
Source: 2011 King County Data Set (n=5,036)
40%
60%
80%
100%
Exploring Efficiency &
Health Disparities
79
– 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.
Intoxication (at Intake) vs.
Detox Treatment at 3 Months
80
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
97%
12%
22.2%
Clients With Mod/High
Services** Going to
Need* (n=46/394)
Those in Need (n=2/9)
Need but No Service
After 3 Months
(n=44/46)
*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)
Physical Health Problem (at Intake) vs.
Medical Treatment at 3 Months
81
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
54%
44.0%
36%
Clients With Mod/High
Need* (n=139/390)
Services** Going to
Those in Need
(n=59/134)
Need but No Service
After 3 Months
(n=80/139)
*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)
Mental Health Problem (at Intake) vs.
MH Treatment at 3 Months
82
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
85.0%
70%
61%
Clients With Mod/High
Need* (n=276/394)
Services** Going to
Those in Need
(n=108/127)
Need but No Service
After 3 Months
(n=168/276)
*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)
Relapse Potential (at Intake) vs.
Urine/Breathalyzer at 3 months
83
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
90%
88.5%
16%
Clients With Mod/High
Need* (n=355/396)
Services** Going to
Those in Need
(n=300/339)
Need but No Service
After 3 Months
(n=55/355)
*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)
Recovery Environment (at Intake) vs.
Self Help at 3 Months
84
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
98%
97%
68%
Clients With Mod/High
Need* (n=379/387)
Services** Going to
Those in Need
(n=122/124)
Need but No Service
After 3 Months
(n=257/379)
*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)
GAIN Administration Fidelity Index
(GAFI)
85
Max Breaks
100.0%
Average Denial/
Misrepresentation
64.7%
Context Effects
50.2%
Inconsistencies
84.2%
Administration
Duration
Don't Know's in
Change Scale Items
0.0%
Mod
Fidelity
84.8%
84.2%
Total GAINEdits**
GAFI*
Low
Fidelity
High
Fidelity
66.7%
28.0%
20.0%
66.9%
40.0%
*Proportional sum of 7 items (n=3,063)
**n=3245
Source: 2011 King County Data Set (n=5,538)
60.0%
80.0%
100.0%
GAFI – King County
Compared to CSAT
86
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
33%
45%
High
Fidelity
(80-100%)
Moderate
Fidelity
(70-79%)
Low
Fidelity
(0-69%)
CSAT
(OR=1.0)
KC
(OR=1.7)
Sources: 2011 King County Data Set (n=3,063) and
CSAT 2010 Summary Analytic Data Set (n=22,122)
GAFI by King County Agency
87
100%
80%
70%
17%
18%
90%
28% 28%
35% 39%
41%
47%
53%
67%
61%
49% 51%
56%
11%
25%
56%
60%
50%
40%
High
Fidelity
(80-100%)
Moderate
Fidelity
(70-79%)
30%
20%
10%
0%
*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: 2011 King County Data Set (n=3,063)
Low
Fidelity
(0-69%)
Cumulative Distribution of GAIN-I
Administration Time – KC vs CSAT
88
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
CSAT
King
Co.
Time in Minutes
Sources: 2011 King County Data Set (n=5,507) and
CSAT 2010 Summary Analytic Data Set (n=26,207)
360
340
320
300
280
260
240
220
200
180
160
140
120
100
80
60
40
20
0
Both Have Medians
around 90-100 Minutes
GAIN-I Admin. Time by Count of
Major Clinical Problems* at Intake
89
None
89
One
90
Two
97
Three
97
Four
103
Five to Twelve
116
0
30
60
90
120
Time in Minutes
150
*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: 2011 King County Data Set (n=5,507)
180
GAIN-I Administration Time
by King County Agency
90
Median Time in Minutes
180
168
143
134
120
104
124 127
127
113
99 95
97
74
60
0
Source: 2011 King County Data Set (n=5,507)
114 108
92 94
103
112
89
Cumulative Distribution of GAIN-M90
Administration Time – KC vs CSAT
91
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
CSAT
King
Co.
Time in Minutes
Sources: 2011 King County Data Set (n=700) and
CSAT 2010 Summary Analytic Data Set (n=21,307)
360
340
320
300
280
260
240
220
200
180
160
140
120
100
80
60
40
20
0
KC faster than CSAT
(Medians of 55 vs 95 Min.)
GAIN-M90 Administration Time
by King County Agency
92
360
303
Time in Minutes
300
240
220
183
165
180
119
120
78
60
71 59 65
78 68
41
0
Source: 2011 King County Data Set (n=647)
96
59
88
50
62
Percent of 1st Quarter 2012 Recruits
with 3 Month Follow-up
93
100%
80% Target
90%
80%
70%
60%
50%
40%
33%
30%
20%
10%
0%
17% 14%
10% 8%
0%
18%
11%
18%
15%
6% 7%
0%
4%
0%
0%
0% 3%
Source: 2011 King County Data Set (n=407 Q1 recruits, n=40 3-month follow-ups)
0%