Chapter 16 Subset of Overview by Level of Care GAIN Coordinating Center (11/21/2012). Normal, IL: Chestnut Health Systems. November Available from Created for: Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) under contract number

2 SAMHSA/CSAT Full GAIN Outcome Data Set Sample: The 2011 SAMHSA/CSAT data set includes data on 29,782 clients from 230 local evaluations, recruited between who were due for at least one follow-up and available in the last quarterly data set of Levels of Care: Outpatient, Intensive Outpatient, Short-term & Moderate/Long-term Residential, Corrections-Based Treatment and Post-Treatment Continuing Care Instrument:Global Appraisal of Individual Needs (GAIN) (see Versions 3 (CYT & ATM) and 5.1 through Follow-up:89% with one or more follow-ups at 3, 6, 9 & 12 months post intake, and 66% with two or more Funding: SAMHSA/CSAT contracts and and 230 individual grants (see Detailed Acknowledgement)

3 Level of Care LTR: Long Term Residential 8.4% (n=2,418) STR: Short Term Residential 1.2% (n=334) OP: Outpatient 70.5% (n=20,263) CC-OP: Continuing Care – Outpatient 7.1% (n=2,030) IOP: Intensive Outpatient 12.9% (n=3,704) SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,749)

4 Risk and Protective Factors by Level of Care  The following slides present information on demographics, and risk and protective factors by different age groups for clients at intake, including:  Demographics  Substance use  Risk behaviors  Victimization  Mental health disorders  Physical health problems  Crime and violence  Sources of stress and strengths  Costs  Summary indices (problem prevalence, quality of life, general satisfaction)  Non-client characteristics (program, level of care, and type of treatment)

5 Age by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,749)

6 Gender by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,738)

7 Race by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,734)

8 8 Risk of Homelessness by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,616)

9 Past Year Substance Severity by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,370)

10 Primary Substance by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,684)

11 Number of Substance Problems by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,684)

12 Tobacco Diagnosis by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,366)

13 HIV Risk Scale* by Level of Care * Available at intake only. SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,713)

14 HIV Risk Change Index* by Level of Care *Can be used to measure change. SAMHSA 2011 GAIN Summary Analytic Data Set (n=25,845)

15 Number of Sex Partners* by Level of Care *In the past 90 days SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,732)

16 Severity of Victimization by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,469)

17 Mental Health Disorders by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,651)

18 Homicidal/Suicidal Thoughts by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,437)

19 Health Problems by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,450)

20 Health Care Utilization Cost* by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,477) *Using 2011 Dollars

21 Crime & Violence by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,671)

22 Type of Crime by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,347) * Violent crime includes assault, rape, murder, and arson. ** Other crime includes vandalism, possession of stolen goods, forgery, and theft.

23 Cost of Crime* by Level of Care *Using 2011 Dollars SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,376)

24 Intensity of Justice System Involvement by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,585)

25 Count of Major Clinical Problems* at Intake by Level of Care *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 SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,749)

26 Sources of Stress Index by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,331)

27 Treatment Readiness by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,363)

28 Self-Help Activities by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=7,848)

29 Strength Self-Efficacy Index by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,514)

30 General Social Support Index by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=14,462)

31 Spiritual Social Support by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,220)

32 Environmental Strengths Index by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,594)

33 Quarterly Cost to Society* by Level of Care *Using 2011 Dollars SAMHSA 2011 GAIN Summary Analytic Data Set (n=25,748)

34 Problem Prevalence Index by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,575)

35 Quality of Life by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=21,545)

36 General Satisfaction by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,026)

37 Program by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,749)

38 Type of Treatment by Level of Care SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,849)

39 Outcomes  The following slides present information on the outcomes of substance abuse treatment by level of care, including:  Abstinence  Recovery  GPRA outcomes (vocationally engaged, housed, no justice system involvement, social consequences, abstinence, and social connectedness) and  NOMS outcomes (treatment initiation, engagement and continuing care; no problems with: health, mental health, family, illegal activity; abstinent, vocationally engaged and housed).  Data on follow up rates, months to last follow up, and number of follow ups per client are provided in the Methods Appendix.Methods Appendix

40 Percent Change in 6 Month Abstinence by Level of Care *This is due to continued low rates of abstinence post-treatment SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=19,483)

41 Relative Percent Change in 6 Month Abstinence by Level of Care *This is due to continued low rates of abstinence post-treatment SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=19,483)

42 Past Month AOD Abstinence by Level of Care *Interpolated SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

43 Recovery* by Level of Care * Recovery defined as no past month use, abuse, or dependence symptoms while living in the community. SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups **Interpolated

44 Change in GPRA Outcomes by Level of Care (Intake to Last Wave*) OP IOP CC-OP M-LTR STR *Last wave is the last follow-up SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

45 NOMS Outcome: Number of Treatment Received Outcomes Met* by Level of Care *Based on a count of initiation within 14 days, evidence based practice, engagement for at least 6 weeks, and any continuing care. SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=24,620)

46 SAMHSA Outcome: Treatment Cost Bands by Level of Care SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=17,856)

47 Change in Selected NOMS Outcomes by Level of Care (Intake to Last Wave) OPIOPCC-OPM-LTR STR *Past monthSAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

48 NOMS Outcomes: Count of Positive Outcomes (Last FU–Intake) by Level of Care SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=24,620)