No Wrong Door An approach to service organization that provides individuals with or links them to appropriate service interventions regardless of where they enter the system of care. This principle commits all service agencies to respond to the individual’s stated and assessed need through either direct service or a linkage to appropriate programs, as opposed to sending the person from one agency to another. (Co-Occurring Center for Excellence; Substance Abuse and Mental Health Services Administration)

The principles of the No Wrong Door approach include: A truly integrated system of care that increases access to services through multiple points of entry where every doorway in the system is the “right door” regardless of the presenting problem. Eliminating gaps in services by promoting interagency partnerships through the development of shared resources. A continuum of services that are culturally and linguistically competent and age appropriate when addressing the complex needs of individuals with co-occurring disorders. A family-driven and youth-guided system of care that minimizes confusion, enhances individual choice, and supports informed decision making for children, adolescents, and their families. A system that addresses significant changes and improvements at the conceptual, organizational, and provider levels.

Entry Point: AOD DMH DOE COC DSS DJJ Health Entity Administe r GAIN SS Decisi on AOD high? AOD/MH equal? MH high? AOD Assesses MH Assesses Staff Tx Recommendations & Referrals: Demo Site Partners Parent Adolescent Staff (phon e)

Using the GAIN Short Screener Administration, Scoring and Interpretation GAIN-SS Version 2.0.1

Objectives At the conclusion of this session, participants will be able to: Administer the GAIN Short-Screener to participants Score and interpret the SS for individuals; as a measure of change; and for program planning Utilize the web version of the SS

Overview of the GAIN-SS A 3- to 5-minute screener Used in general populations to identify or rule-out clients with behavioral health disorders Easy for use by staff with minimal training or direct supervision Provides a measure of change Designed for self- or staff-administration, with paper and pen, computer, or on the web Spanish version available

Tour of the GAIN-SS

Comprised of Four Screeners Internalizing Disorder Screener (IDScr) Externalizing Disorder Screener (EDScr) Substance Disorder Screener (SDScr) Crime/Violence Disorder Screener (CVScr) ______________ TOTAL Disorder Screener

Internalizing Disorder Screening (IDScr)

Externalizing Disorder Screening (EDScr)

Substance Disorder Screening (SDScr)

Crime/violence Disorder Screening (CVScr)

Other Items

Administration

Administration Guidelines Ask the items exactly as printed. You can clarify words/phrases Ask every item. Read each item completely. Repeat items that are misunderstood. Read items at an appropriate pace. Do not suggest answers. Use Common Sense!

Preparation Find a quiet, private place Read the sample introduction or develop an alternative for your specific situation If the GAIN-SS is self-administered, ask clients if they want your help Consider using the Cognitive Impairment screener if you suspect intoxication or mental problems Develop individualized “anchors” with clients

Introducing the GAIN-SS Explain why the interviewer needs to ask the questions Tell whether the questions are asked of every client, or the basis for which the client is being asked the questions now Inform about confidentiality and any limits to confidentiality or privacy Describe how the client’s answers will be used Convey how long the assessment will take Use your common sense

Check for Cognitive Impairment Helps staff to verify the participant’s ability to locate him/herself in place and time prior to the assessment If there is a problem that appears to be transitory, reschedule the interview If there is a problem but you are continuing with the interview, orally administer it, and avoid over-interpreting the responses. (It will take longer.) Note the client’s problems when reporting the results

Instructions Complete the header Read the introductory paragraph Read each item carefully Do not skip items Choose only 1 response Read the stem at the beginning of each section

Instructions (Continued) Do not accept “sometimes,” “sort of,” or “maybe” as answers Clearly mark any corrections Write verbatim responses neatly Let clients know it’s okay to ask questions Review the form for completion/accuracy

Developing Personalized Anchors Help participants be clear about the time period covered by the questions Clearly state the time period in the question Identify personal “anchors”

Completing the Staff Use Box

Items Record the Site, Staff, and Client ID numbers and names Item 11 - Record the mode of administration Item 12 – Use for scoring past-year symptoms Item 13 - If applicable, check where the client is being referred Item 14 - Record the primary program code of the place where the client is being referred, using project/agency-specific codes Item 15 – Referral comments

Scoring & Interpretation

Types of Scores The GAIN-SS generates two types of scores: DOMAIN scores One score for each of the four domains or subscreeners TOTAL score Score for the entire tool

Scoring the GAIN-SS DOMAIN Scoring Count the number of symptoms the client endorses experiencing in the past year (responses of 3/“Past Month” or 2/“2-12 months ago”). Since there are five items in each domain the maximum score in each domain is five. Adding the four domain scores yields the TOTAL Score. Record the score for each subscale and the TDScr in the staff use box.

Scoring the GAIN-SS (con’t) Low (0): Unlikely to have a diagnosis or need services Moderate (1 to 2): A possible diagnosis High (3 to 20 on the total screener; 3 to 5 on the sub-screeners): High probabilities of a diagnosis

Table 1. Scoring Template Screener Items Past month (3s) Past year (3s, 2s) Lifetime (1s, 2s, or 3s) Internalizing Disorder Screener (IDScr) 1a-1e Externalizing Disorder Screener (EDScr) 2a-2e Substance Disorder Screener (SDScr) 3a-3e Crime/Violence Screener (CVScr) 4a-4e Total Disorder Screener 1a-4e

___ IDScr (items 1a-1e) EDScr (items 2a-2e) SDScr (items 3a-3e) CVScr (items 4a-4e) ______________ TDScr (items 1a-4e) Scoring Amber’s GAIN-SS

Interpretation at the Individual Level Someone with a high score (3 to 20) on the Total Disorder Screener (TDScr) will probably have a diagnosis when given the full GAIN Use scores in the moderate range (1-2) or high range (3-5) on the 4 sub-screeners to identify the specific kinds of behavioral health services that are needed

Interpretation at the Individual Level (Continued) Moderate/high scores on the Internalizing Disorder Screener suggest mental health treatment related to somatic complaints, depression, anxiety, trauma, suicide and serious mental illness.

Interpretation at the Individual Level (Continued) Moderate/high scores on the Externalizing Disorder Screener suggest mental health treatment related to attention deficits, hyperactivity, impulsivity, conduct problems and gambling.

Interpretation at the Individual Level (Continued) Moderate/high scores on the Substance Disorder Screener suggest the need for substance abuse, dependence, and substance use disorder treatment.

Interpretation at the Individual Level (Continued) Moderate/high scores on the Crime/Violence Screener suggest the need for help with interpersonal violence, drug-related crimes, property crimes interpersonal/violent crimes.

Interpreting GAIN-SS Scores as a Measure of Change The past-month symptom count in the TDScr (0-20) or any of the 4 sub- screeners (0-5) can be used as a simple measure of change after intervals of a month or more. The past-year and lifetime measures can be used to create trajectories and predict risk.

Interpreting GAIN-SS Scores as a Measure of Change  High severity in early remission: 3 or more lifetime problems and 0 past- month problems (2s and 1s with no 3s)  High severity in sustained remission: 3 or more lifetime problems and 0 past-year problems (1s with no 2s or 3s)

Interpretation for Quality Assurance and Program Planning The GAIN-SS can be used as a simple form of needs assessment Help guide program development/planning and decisions about the purchase of further training or technical assistance Can compare staff or sites on the extent to which expected diagnoses/referrals turn into actual cases Gives an objective guidepost to compare performance and track it over time