Global Appraisal of Individual Global Appraisal of Individual NeedsNeeds

The Global Appraisal of Individual Needs (GAIN) is a progressive and The Global Appraisal of Individual Needs (GAIN) is a progressive and integrated family of instruments for:integrated family of instruments for:

initial screenings, brief interventions and referralsinitial screenings, brief interventions and referrals standardized biopsychosocial clinical assessments for diagnosis, standardized biopsychosocial clinical assessments for diagnosis,

placement and treatment planningplacement and treatment planning monitoring of changes in clinical status, service utilization, and costs monitoring of changes in clinical status, service utilization, and costs

to societyto society subgroup and program level needs assessment and evaluationsubgroup and program level needs assessment and evaluation

The GAIN has been used with both adolescents and adults and in The GAIN has been used with both adolescents and adults and in outpatient, intensive outpatient, partial hospitalization, methadone, outpatient, intensive outpatient, partial hospitalization, methadone, short-term residential, long-term residential, therapeutic short-term residential, long-term residential, therapeutic communities, and correctional programs.communities, and correctional programs.

The GAIN Family of InstrumentsThe GAIN Family of Instruments

GAIN-SS (Short Screener)GAIN-SS (Short Screener) GAIN-Q (Quick)GAIN-Q (Quick) GAIN-I (Initial)GAIN-I (Initial) GAIN-M (Monitoring)GAIN-M (Monitoring)

GAIN-SSGAIN-SS PurposePurpose:: Designed as a Screener for use in general populations to Designed as a Screener for use in general populations to

quickly and accurately identify a client’s risk of having a disorder that quickly and accurately identify a client’s risk of having a disorder that warrants further assessmentwarrants further assessment

Administration TimeAdministration Time: : 5 minutes5 minutes

ModeMode:: Staff* administered on paper copy (can be self-administered, but Staff* administered on paper copy (can be self-administered, but not recommended for screening individuals) not recommended for screening individuals)

ScalesScales:: There are There are 44 subscales, each measuring 5 symptoms subscales, each measuring 5 symptoms (Total/20).(Total/20).

ID ID Scr - Internal disorders (i.e. somatic, depression, suicide, anxiety), Scr - Internal disorders (i.e. somatic, depression, suicide, anxiety), EDEDScr - External disorders (behavioral disorders i.e. ADHD, conduct Scr - External disorders (behavioral disorders i.e. ADHD, conduct disorders), disorders), SDSDScr - Substance use disorders (abuse, dependence), and Scr - Substance use disorders (abuse, dependence), and CVCVScr - Crime/violence (interpersonal violence, property crime, Scr - Crime/violence (interpersonal violence, property crime, drug-related crime)drug-related crime)

DeterminingDetermining the Riskthe Risk GAIN-SS responses are given in terms of the GAIN-SS responses are given in terms of the recencyrecency of of

the problem described in the questions: the problem described in the questions: 3 = past month3 = past month2 = 2 to 12 months ago2 = 2 to 12 months ago1 = 1+ years ago1 = 1+ years ago0 = never. 0 = never.

The number of past-month symptoms = number of The number of past-month symptoms = number of 3s 3s

The number of past-year symptoms = number of 2s The number of past-year symptoms = number of 2s or 3s or 3s

We will only be concerned with the number of 3s We will only be concerned with the number of 3s and 2s and 2s

*Note: Other practitioners who want to consider the number of lifetime *Note: Other practitioners who want to consider the number of lifetime symptoms, would also include the number 1s. symptoms, would also include the number 1s.

Instructions for GAIN-SS itemsInstructions for GAIN-SS items This instrument is designed to find out how you

are doing in terms of your health and behavior. The information is _______ *(privacy statement).

It will only be used to _________ *(choose) (Help me know who you should talk to.) (Make a good referral for you.) It takes about 5 minutes to answer and you can

say that you do not know or that you do not want to answer any question.

If you are not sure about an answer, please give us your best guess.

Several questions will ask you about things that have happened during Several questions will ask you about things that have happened during the past month, 2-12 months ago, more than 12 months ago, or never. the past month, 2-12 months ago, more than 12 months ago, or never. To help you remember these time periods, please look at this calendar.To help you remember these time periods, please look at this calendar.

Do you recall anything that was going on about (DATE 30 DAYS AGO)? (PROBE Do you recall anything that was going on about (DATE 30 DAYS AGO)? (PROBE FOR SPECIFIC EVENT, SEE BELOW IF PROBLEMS.) When the last time FOR SPECIFIC EVENT, SEE BELOW IF PROBLEMS.) When the last time something happened was since (NAME OF EVENT THAT WAS 30 DAYS AGO), something happened was since (NAME OF EVENT THAT WAS 30 DAYS AGO), please answer, “Past month.” please answer, “Past month.”

Do you recall anything that was going on about (DATE 12 MONTHS AGO)? Do you recall anything that was going on about (DATE 12 MONTHS AGO)? (PROBE FOR SPECIFIC EVENT, SEE BELOW IF PROBLEMS.) When the last (PROBE FOR SPECIFIC EVENT, SEE BELOW IF PROBLEMS.) When the last time something happened was between (30 DAY AGO EVENT) and (12 MONTH time something happened was between (30 DAY AGO EVENT) and (12 MONTH AGO EVENT), please answer, “2-12 months ago.” AGO EVENT), please answer, “2-12 months ago.”

When the last time something happened was before (12 MONTH AGO EVENT), When the last time something happened was before (12 MONTH AGO EVENT), please answer, “1+ years ago.” please answer, “1+ years ago.”

If something has never happened, please answer, “Never.”If something has never happened, please answer, “Never.”

IF PARTICIPANT IS UNABLE TO RECALL ANY EVENTSIF PARTICIPANT IS UNABLE TO RECALL ANY EVENTS: Do you remember any : Do you remember any birthdays, holidays, sporting or other special events that happened around (DATE birthdays, holidays, sporting or other special events that happened around (DATE 90 DAYS/12 MONTHS AGO)? Did anything change in terms of where you were 90 DAYS/12 MONTHS AGO)? Did anything change in terms of where you were living, who you were with, whether you were in school or someplace else? Where living, who you were with, whether you were in school or someplace else? Where were you living then? Were you in treatment, working, in school, or involved with were you living then? Were you in treatment, working, in school, or involved with the law then?the law then?

Instructions, Instructions, continuedcontinued

The following questions are about common psychological, behavioral or personal problems. These problems are considered significant when you have them two or more weeks, when they keep coming back, when they keep you from meeting your responsibilities, or when they make you feel like you can’t go on.

After each of the following statements, please tell us the last time you had this problem, if ever, by responding:

“In the past month”; “2-12 months ago”; “1 or more years ago”; or, never.

**NOTE: It is very important for the client to fully understand the meaning of “significant”. **NOTE: It is very important for the client to fully understand the meaning of “significant”.

Examples of itemsExamples of items1. When was the last time you had significant

problems…a. with feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future?b. with sleeping, such as bad dreams, sleeping restlessly or falling asleep during the day?c. with feeling very anxious, nervous, tense, fearful, scared, panicked or like something bad was going to happen? d. when something reminded you of the past, and you

became very distressed and upset? e. with thinking about ending your life or committing suicide?

SCORING THE GAIN-SSSCORING THE GAIN-SS

We are scoring past-year symptoms.We are scoring past-year symptoms. Count Count the number of 3s (past month) or 2s (2-12 the number of 3s (past month) or 2s (2-12 months ago) to get the number of symptoms months ago) to get the number of symptoms occurring in the past year: occurring in the past year:

1a to 1e for the Internalizing Disorder Screener 1a to 1e for the Internalizing Disorder Screener 2a to 2e for the Externalizing Disorder Screener 2a to 2e for the Externalizing Disorder Screener 3a to 3e for the Substance Disorder Screener 3a to 3e for the Substance Disorder Screener 4a to 4e for the Crime/Violence Screener 4a to 4e for the Crime/Violence Screener 1a to 4e or sum of above for the Total Disorder 1a to 4e or sum of above for the Total Disorder

Screener Screener

SCORING THE GAIN-SSSCORING THE GAIN-SS ““COUNT” COUNT” the number of responses that are 3s and the number of responses that are 3s and

2s for each section (don’t “Sum”). For example of 2s for each section (don’t “Sum”). For example of responses to Section 1responses to Section 1(InternalizingDisorders) : (InternalizingDisorders) :

1a = 1a = 33 (past month)(past month) 1 11b = 1b = 2 2 (2-12 months ago)(2-12 months ago) 1 11c = 1c = 33 (past month)(past month) 1 1 1d = 1 1d = 1 (more than 12 months ago)(more than 12 months ago) 0 01e = 0 1e = 0 (never) (never) + 0+ 0

= 3= 3

The score for the IDScr section is The score for the IDScr section is “3”“3”

SCORING THE GAIN-SSSCORING THE GAIN-SS Example SDScr (Substance Disorder Example SDScr (Substance Disorder

Screener) : Screener) : • 3a = 3a = 22 (2 – 12 mo. ago) 1 (2 – 12 mo. ago) 1• 3b = 1 (1+ years ago) 0 3b = 1 (1+ years ago) 0 • 3c = 0 (never) 03c = 0 (never) 0• 3d = 0 (never) 03d = 0 (never) 0• 3e = 0 (never) 3e = 0 (never) + 0+ 0

= 1 = 1

The total for the SCScr is “1” The total for the SCScr is “1”

Scoring TemplateScoring TemplateScoring: Scoring: Count (do not sum) the number of 3’s & 2’s …Count (do not sum) the number of 3’s & 2’s …

ScreenerScreener ItemsItems Past Year (3,2)Past Year (3,2)

1. IDScr 1. IDScr 1a-1e1a-1e

2. EDScr 2. EDScr 2a-2e2a-2e

3. SDScr3. SDScr 3a-3e3a-3e

4. CVScr4. CVScr 4a-4e4a-4e

TotalTotal 1a-4e1a-4e

Record the Scoring Record the Scoring

On the Screener, you will record the total On the Screener, you will record the total number of 3 and 2 responses for each number of 3 and 2 responses for each section. section.

For the first four sections (ID, ED, SD, For the first four sections (ID, ED, SD, C/V) you should have a 0 – 5 as a section C/V) you should have a 0 – 5 as a section total. total.

0 – 20 will be written in the space marked 0 – 20 will be written in the space marked “TDScr” (Total Disorder Screener) .“TDScr” (Total Disorder Screener) .

A demonstration…A demonstration…

InterpretationInterpretation Does the student need to be referred for further Does the student need to be referred for further

assessment? Look at the past-year totals (3s assessment? Look at the past-year totals (3s and 2s) in the four sub-sections, and then in the and 2s) in the four sub-sections, and then in the Total Disorder section (TDScr):Total Disorder section (TDScr): LowLow (0) (0) : unlikely to have a diagnosis: unlikely to have a diagnosis

ModerateModerate (1-2) (1-2): a possible diagnosis and are likely to : a possible diagnosis and are likely to benefit from a brief intervention. benefit from a brief intervention. *Referral indicated*Referral indicated

HighHigh (3-5 (3-5 on a sub-screen; on a sub-screen; 3-20 3-20 on the total on the total screenerscreener)): high probability of a diagnosis and need for : high probability of a diagnosis and need for more formal intervention. more formal intervention. *Referral strongly *Referral strongly recommendedrecommended

Internal Disorder ScreenerInternal Disorder Screener(IDScr)(IDScr)

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

Externalizing Disorder Screener Externalizing Disorder Screener (EDScr)(EDScr)

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

Substance Disorder Screener Substance Disorder Screener (SDScr)(SDScr)

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

Crime/Violence Screener Crime/Violence Screener (CVScr)(CVScr)

Moderate or High on the Crime/Moderate or High on the Crime/

Violence ScreenerViolence Screener suggests the need for suggests the need for assessment for help with interpersonal assessment for help with interpersonal violence, drug-related crime, property violence, drug-related crime, property violations, and, in more extreme cases, violations, and, in more extreme cases, interpersonal, violent crime.interpersonal, violent crime.

Total Disorder Screener (TDScr)Total Disorder Screener (TDScr)

Dr. Dennis and colleagues found that Dr. Dennis and colleagues found that persons with a high score (3 or more) on persons with a high score (3 or more) on the TDScr were very likely to have one or the TDScr were very likely to have one or more diagnoses (90% sensitivity); more diagnoses (90% sensitivity); converselyconversely those who scored below this those who scored below this point were very unlikely to have any point were very unlikely to have any diagnosis (90% specificity). diagnosis (90% specificity).

The individual screeners had 90% The individual screeners had 90% sensitivity and 70% specificity.sensitivity and 70% specificity.

Are you ready to practice?Are you ready to practice?

Pair up with a partnerPair up with a partner Have a copy of the GAIN-SS, a calendar, Have a copy of the GAIN-SS, a calendar,

and the response cardand the response card Interview your partner and score the tool Interview your partner and score the tool

(please feel free to role play a typical client(please feel free to role play a typical client—this does not mean a combination of the —this does not mean a combination of the worst traits from every client you have worst traits from every client you have ever seen)ever seen)

Switch the interviewer and client roles and Switch the interviewer and client roles and repeatrepeat

For More Info on the GAINFor More Info on the GAIN

www.chestnut.org/LI/gain/index.html

It’s just a screening tool!It’s just a screening tool!

Remember…Remember… You are not assessing the behaviorsYou are not assessing the behaviors

You are not making a diagnosisYou are not making a diagnosis

You are screening for riskYou are screening for risk You are screening to determine the need for You are screening to determine the need for

further assessment ---further assessment ---to which you will…to which you will…

REFER! REFER!

Questions? Questions?