chapter 3 overview of adolescent treatment sites

Chapter 3Overview of Adolescent

Treatment Sites

GAIN Coordinating Center (11/21/2012).Normal, IL: Chestnut Health Systems. November 2012.

Available from www.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

http://www.gaincc.org/slides

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 1997-2011 who were due for at least one follow-up and available in the last quarterly data set of 2011.

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 www.gaincc.org/gaini) Versions 3 (CYT & ATM) and 5.1 through 5.6

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 270-07-0191 and 270-2012-00001 and 230 individual grants

(see Detailed Acknowledgement)

http://www.gaincc.org/gaini

3

Risk and Protective Factors The following slides present information on

demographics, and risk and protective factors 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)

4

Age

18+ Years

9.5% (n=1,919)

Under 15 Years (<15) 17.0%

(n=3,427)

15-17 Years 73.4%

(n=14,777)

Source: CSAT 2011 AT Summary Analytic Data Set (n=20,123)

5

Gender

Males 72.7%

(n=14,635)

Females 27.2% (n= 5,479)

Other 0.04%

(n=9)


6

Race

Multi-racial 14.3% (n=2,866)

African American 16.1% (n=3,233)

Hispanic 23.9%

(n=4,807)

White 41.3% (n=8,314)

Other 4.4%

(n=890)


7

12 to 14 Years Old

15 to 17 Years Old

18+ Years Old

African American

Mixed/Other

Hispanic*

Caucasian

GLBTQ

Married

Female

0% 20% 40% 60% 80% 100%

17%

73%

10%

16%

19%

30%

41%

4%

1%

27%

Demographic Characteristics

*Any Hispanic ethnicity separate from race group

CSAT data dominated by male, minority,

age 15 to 17


8

Environment

Any School in P90

Single Parent Custody (ado-lescents only)

Mod-High Health Problems

Ever Homeless or Runaway

Any Work in P90

Not Housed in the Community

Military History*

0% 20% 40% 60% 80% 100%

88%

49%

47%

32%

29%

9%

.1%

*n = 8,286


9


Current Risk of Homelessness

At Risk 8.9%

(n=1,785)

Housed 79.8%

(n=16,028)

Group or Institution

7.9% (n=1,577)

Currently Homeless

3.4% (n=691)

10

Substance Problem Recognition

Can Give 1+ Reasons to Quit*

Client Believes Need

ANY Treatment

Acknowledges Having

an AOD Problem

0% 20% 40% 60% 80% 100%

92%

72%

26%

* n=10,899


11

Substance Severity by Time Period

Lifetime Past Year Past Month0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

56%48%

19%

Dependence

Abuse

Use

No Use


12

Marijuana 62.0% (n=11,189)

Past 90 Day Primary Substance

Cocaine2.4%

(n=433)

Alcohol 25.6%

(n=4,624)

Amphetamines 5.1% (n=920)


Other Drugs 2.4%

(n=434)

Opioids2.5% (n=459)

13

First Use < Age 15

Any Past Year Diagnosis

Weekly Use of AOD

3+ Years Use

Past Year Dependence

Any Lifetime Withdrawal

Prior SA Treatment

Severe Past Week Withdrawal

Substance Use Problems*

0% 20% 40% 60% 80% 100%

82%

81%

58%

56%

48%

40%

33%

3%

28% 49% 23%

EAST

Low SU (0-2)

Moderate SU (3-5)

Substance Use Problems

*Count of 8 items


14

Pattern of Weekly Use (13+/90 days)

Anything

Cannabis

Alcohol

Other Drugs

Opioid

Cocaine

Amphetamines

Tobacco

Controlled Environment

Any Needle Use*

0% 20% 40% 60% 80% 100%

58%

46%

16%

4%

3%

3%

3%

54%

24%

2%

*Not a weekly measure; any in past 90 days


15

Marijuana

Alcohol

Amphetamine*

Opiates

Cocaine

Sed/hyp/anx

Hallucinogens

Other drugs

Inhalants

PCP

Tobacco **

Any SUD

0% 20% 40% 60% 80% 100%

19%

6%

5%

1%2%

1%

40%

81%

Use

Abuse

Dependence

Series5

Substance Use Disorders in Past Year by Major Substances

*n=6,364**Not counted in Any SUD Diagnosis. Abuse is not an option for Tobacco.


16

Tobacco Diagnosis


Never Used20%

(n=3,617)

Past Use5% (n=881)

Current PY Use35%

(n=6,202)

Depen-dence/Daily

Use40%

(n=7,139)

17

Recovery Environment - Peers

Social Peers Getting Drunk Weekly+

School/Work Peers Getting Drunk Weekly+

Others at Home Getting Drunk Weekly+

Social Peers Using Drugs

School/Work Peers Using Drugs

Others at Home Using Drugs

0% 20% 40% 60% 80% 100%

51%

45%

32%

71%

62%

28%


18

Recovery Environment - Home

Family History of Substance Use

Weekly Family Problems*

Weekly Alcohol Use at Home*

Weekly Drug Use at Home*

0% 20% 40% 60% 80% 100%

75%

27%

26%

12%


*Past 90 days

19

HIV Risk Scale* Past Year at Intake: Needle Use

Use a needle to shoot up drugs

Let someone else inject you w/ needle

Reuse needle you had used before

Skip cleaning needle after done

Let someone else use needle

Reuse needle w/o cleaning first

Let use water/cooker/cotton after you

Reuse water/cooker/cotton after

Use needle someone else used

0% 2% 4% 6% 8% 10%

2.2%

1.6%

1.3%

1.1%

1.0%

1.0%

0.8%

0.8%

0.8%

* Mean of 36 items from the next four slides. Intake only.


20

HIV Risk Scale* Past Year at Intake: Sex

Sex in past year

2 or more sex partners in past year

Unprotected Sex

Sex w/you or partner high on AOD

Use AOD to make sex longer or hurt less

Sex involving anal intercourse

Pain during sex or after sex

Sex with injection drug user

Trade sex for drugs, gifts, or money

Sex with someone HIV positive**

Use drugs/gifts/money to purchase sex

Sex w/man who has sex with other men

0% 20% 40% 60% 80% 100%

77%

41%

40%

39%

7%7%

4%

2%

2%

1%

1%

0.8%

* Mean of 36 items. Intake only.


**n=3,424

21

HIV Risk Scale* Past Year at Intake: Victimization

Is age first abused UNDER 18?**

Ever attacked you with a weapon

Ever hurt you by striking/beating you

Any several times or for long time

Any with more than one person involved

Abused you emotionally

Was person family member/trusted one

Were you afraid for your life/injury

People you told not believe you/help you

Forced sex against your will

Result in oral, vaginal, anal sex

0% 20% 40% 60% 80% 100%

94%

38%

33%

31%

30%

30%

26%

18%

11%

7%

6%

* Mean of 36 items. Intake only.


**n=12,065

22

Currently worried someone attack you

Currently worried someone abuse you emotionally

Currently worried someone beat/hurt you

Currently worried someone force sex acts

HIV Risk Scale

0% 20% 40% 60% 80% 100%

10%

9%

8%

1%

31% 50% 19%

Series1

Low Risk(0-2)

Moderate Risk(3-9)

HIV Risk Scale* Past Year at Intake: Trauma

*Mean of 36 items. Available at intake only.


23

HIV Risk Change Index* in Past 90 Days at Intake

Sexually active

Mulitple Sex partners

Any unprotected Sex

Victimized

Current worries about being victimized

Any needle use

Shared needles

HIV Risk Change Index* (P90 days)

0% 20% 40% 60% 80% 100%

65%

31%

29%

20%

18%

2%

1%

49% 41% 10%

East

Low Risk(0-1)

Moderate Risk (2-3)

*Count of 7 items listed. Can be used to measure change.


24

Number of Sex Partners*

No Sex Partners

37% (n=7,139)

1-2 Sex Partners

46% (n=9,068)

3+ Sex Partners

17% (n=3,351)


*In the past 90 days

25

Severity of Victimization Scale

Ever attacked w/ gun, knife, other weapon

Ever hurt by striking/beating

Ever abused emotionally

Ever forced sex acts against your will/anyone

Age of 1st abuse < 18*

Happened several times or for long time

By multiple people

By family member/trusted one

Victim afraid for life/injury

People you told not believe you/help you

Result in oral, vaginal, anal sex

Currently worried someone attack

Currently worried someone abuse emotionally

Currently worried someone beat/hurt

Currently worried someone force sex acts

General Victimization Scale**

0% 20% 40% 60% 80% 100%

38%

33%

30%7%

94%

31%

30%

26%

18%

11%

6%

10%9%

8%1%

37% 19% 44%

EAST

Low Severity (0)

Moderate Severity (1-3)

**Mean of 15 items


*n=12,065

26

Past YearMental Health Disorders

Internalizing Disorders

Only 7.3%

(n=1,471)

Externalizing Disorders

Only 23.2%

(n=4,657)

Both 35.5%

(n=7,114)

Neither 34.0%

(n=6,818)


27

Any Co-Occurring Psychiatric Problem

Conduct Disorder

Attention Deficit/Hyperactivity Disorder

Mood Disorder NOS

Traumatic Stress Disorder

General Anxiety Disorder

Ever Physical, Sexual or Emotional Victimization

High Severity Victimization (GVS>3)

Ever Homeless or Runaway

Any Homicidal/Suicidal Attempts/Thoughts PY

Any Self Mutilation*

Prior Mental Health Treatment

Count of Co-Occurring Psychiatric Diagnoses**

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

65%

49%

42%

35%

25%

14%

62%

44%

32%

21%

13%

40%

35% 19% 17% 13% 10% 7%

bar

None

One

Two

Three

Four

Co-Occurring Psychiatric Problems

*n=12,661** Count of Conduct Disorder, ADHD/ADD Major Depressive Disorder, Traumatic Stress Disorder, and Generalized Anxiety Disorder


28

Homicidal/Suicidal Thoughts

Thought about killing/hurting someone

Thought about committing suicide

Had a plan to commit suicide

Attempted suicide

Gotten gun etc. to carry out plan

Homicidal Suicidal Thought Scale*

0% 20% 40% 60% 80% 100%

14%

12%

5%

5%

4%

79% 18%

3%

EAST

Low Severity (0)


*Mean of 5 items


29

Para-suicidal Index

Cut, burned, or hurt self on purpose - PY

Cut, burned, or hurt self on purpose - P90 days

Felt can't stop cut, burn, or hurt self - PY

Needed medical attention after cut, burn, or hurt self

Parasuicidal Index *

0% 20% 40% 60% 80% 100%

13%

9%

3%

2%

10%3%

Series1


*Sum of 4 items


30

Family History of Health Problems

Problems with alcohol use

Problems with drug use

Heart or blood problems

Diabetes

Psychological problems

Other probs or in Tx a lot

Any Family History of Physical Health Problems

0% 20% 40% 60% 80% 100%

67%

58%

54%

51%

39%

31%

90%


31

Past 90 Day Health Problems

High Problems

8.4% (n=1,674)

Low Problems

52.9% (n=10,541)

Moderate Problems

38.7% (n=7,703)


32

Quarterly Cost of Health Care Utilization

Using the GAIN, we are able estimate the quarterly cost to society of tangible services (e.g., hospital visits, emergency room visits, etc.) in 2011 dollars for the 90 days before intake.

For the 20,123 clients served in 161 sites between 1998-2011, the average Quarterly Cost of Health Care Utilization (HCU) per client:– in the quarter before they entered treatment, was $2,681 and

totaled $51,337,594 across clients.– in the year before they entered treatment, was $10,724 per

client and totaled $205,350,376 across clients.

33

HCU Cost to Society – 2011 Dollars

*Quarterly Health Care Utilization 2011 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.

Description UnitCost 2011

dollars

Inpatient hospital day Days $ 2,202.87

Emergency room visit Visits $ 6,477.04

Outpatient clinic/doctor’s office visit Visits $ 68.58

Nights spent in hospital Nights $ 2,202.87

Times gone to emergency room Times $ 6,477.04

Times seen MD in office or clinic Times $ 79.77

How many days in detox Days $ 234.86

Times in ER for AOD use Times $ 270.51

Nights in residential for AOD use Nights $ 121.62

Days in Intensive outpatient program for AOD use Days $ 94.36

Times did you go to regular outpatient program Times $ 32.50

34

Health Care Utilization Cost

% of Total Dollars ($51,337,594; mean=$2,681)

% of Population (19,148)

0% 20% 40% 60% 80% 100%

24%

41%

76%

11%48% $0

$1 - $7,599

$7,600+


35

Past Year Crime and Violence

High 38.0%

(n=7,620)

Low 36.7%

(n=7,357)

Moderate 25.4%

(n=5,087)


36

Any Violence or Illegal Activity

Physical Violence

Any Illegal Activity

Any Property Crimes

Other Drug Related Crimes*

Any Interpersonal/ Violent Crime

Lifetime Justice Involvement

Current Justice involvement

1+/90 days In Controlled Envi-ronment

0% 20% 40% 60% 80% 100%

79%

66%

63%

47%

44%

42%

83%

68%

45%

Past Year Crime & Justice Involvement

*Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)


37

Violent Crime*41%

(n=8,113)

Other Crime**16% (n=3,093)

Drug Use only44%

(n=8,669)

Type of Crime

* Violent crime includes assault, rape, murder, and arson.** Other crime includes vandalism, possession of stolen goods, forgery, and theft.


38

Cost of Crime in the Past Year

Using the GAIN we are able estimate the cost to society associated with economic losses due to criminal activity (e.g., vandalism, forgery, theft, assault, arson, rape, murder) in 2011 dollars for the year prior to intake

Of the 20,123 clients served in 161 sites between 1998-2011, the average Cost of crime per client, in the year before they entered treatment, was $293,376 and totaled $5,244,973,817 across clients.

39

Cost of Crime – 2011 Dollars*

*Cost of Crime 2011 dollars w/ SA TX based on McCollister, K. E., French, M. T., & Fang, H. (2010). The cost of crime to society: New crime-specific estimates for policy and program evaluation. Drug and Alcohol Dependence, 108(2)(1-2), 98-109.

Description UnitCost 2011

dollars

Purposely damaged or destroyed property Times $5,095.64

Passed bad checks/forged a prescription/took money from employer Times $5,745.70

Taken money/property (not from a store) Times $8,360.63

Broken into a house/building to steal Times $6,775.32

Taken a car that didn't belong to you Times $11,294.29

Used a weapon, force, or strong-arm methods to get money or things from a person Times $44,361.43

Hurt someone badly enough they needed bandages or a doctor Times $112,208.95

Made someone have sex with you by force Times $252,450.22

Been involved in the death or murder of another person (including accidents) Times $9,418,450.51

Intentionally set a building, car, or other property on fire Times $22,126.20

40

Cost of Crime

% of Total Dollars ($5,244,973,817; mean=$293,376)


0% 20% 40% 60% 80% 100%

97%

21%58% 21%$0

$1 - $119,00

$120,000+


41

Intensity of Justice System Involvement

Past year illegal activity/ SA use

21%

Past arrest/JJ/CJ status

8%

Other JJ/CJ sta-tus16%

Other prob/parole/ de-tention

18%

On prob/parole 14+ days w/ 1+ drug screens

26%

In detention/ jail 14-29 days

5%

In detention/ jail 30+ days7%


42

In S

ch

oo

l

PH

Tx

Arr

es

ted

At

Wo

rk

MH

Tx

SA

Tx

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

87%

43%31% 29% 22% 20%

Past 90 days

More than 90 days ago

Never

Recency of System Involvement


43

Count of Major Clinical Problems at Intake

Cannabis disorder

Other drug disorder

Alcohol disorder

CD

ADHD

Depression

Trauma

Anxiety

Violence/ illegal activity

Victimization

Suicide

Major Clinical Problems*

0% 20% 40% 60% 80% 100%

36%

35%

21%

49%

42%

35%

25%

14%

79%

62%

12%

6%9% 11% 13% 12% 48%

East

None

One

Two

Three

Four

*Based on count of self reporting criteria to suggest alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal activitySource: CSAT 2011 AT Summary Analytic Data Set (n=19,654)

44

GAIN-Initial Profile: Behavior Change Scales at Intake

Cu

rre

nt

Wit

hd

raw

al

(0/1

-11

/12

-22

)

Fin

an

cia

l*

(0-1

3/1

4-4

9/5

0-1

00

)

Wo

rk P

rob

lem

s

(0/1

0-7

5/7

6-1

00

)

Su

bs

tan

ce

Pro

ble

ms

(0

/1-9

/10

-16

)

He

alt

h P

rob

lem

s(0

-9/1

0-3

2/3

3-1

00

)

HIV

Ris

k

(0-1

/2-3

/4-7

)

Re

co

ve

ry E

nv

iro

nm

en

t...

Em

oti

on

al

Pro

ble

ms

(0

-13

/14

-50

/51

-10

0)

Ille

ga

l A

cti

vit

y

(0/1

-75

/76

-10

0)

Su

bs

tan

ce

Fre

qu

en

cy

...

Sc

ho

ol

Pro

ble

ms

(0

/10

-75

/76

-10

0)

0%10%20%30%40%50%60%70%80%90%

100% 3% 2% 6% 8% 8% 10% 13% 12%

37% 37% 38% High

Moderate

Low

* n=6,801


45

Sources of Stress: Personal

Death of family member/close friend

Health problem of family/friend

Fights with boss/ teacher/coworkers

Major change in relationships/divorce

Other family changes/problems

Birth/adoption of new family member

0% 20% 40% 60% 80% 100%

32%

29%

24%

22%

11%

7%


46

Sources of Stress: Other

Hard work or school schedule

New job, position, or school

Something you saw

Transportation problems

Major change/bad housing

Threat of losing job/house/school/transportation

Interruption or loss of house/job/school

Discrimination in community/work/etc.

Other environmental demands

Sources of Stress Index*

19%

18%

16%

15%

14%

9%

8%

6%

3%

33% 32% 35%

East

Low Stress(0)

Moderate Stress (1-2)

*Sum of 15 items


47

Treatment Readiness

Can get help you need in Tx program

Need to be in Tx for at least a month

Need support from friends/ relatives

Old friends may try to get you drunk/high

A lot of pressure to be in Tx

Too many responsibilities to be in Tx

Being in Tx program too demanding

Be hard to resist AOD where you live

Will need to come back to Tx 1/more times

Treatment Readiness*

68%

47%

36%

34%

29%

23%

23%

18%

16%

38% 56% 5%

East

High Readiness (6-9)

ModerateReadiness (3-5)

*Sum of 9 items


48

Self-Help Activities Scale

You understood others Other people understood you

Received advice from meeting Agreed with advice

Read recovery readings Prayed for help

Shared at meeting Meetings important part of life

Talked w/sponsor or others outside mtg. Help someone from meeting

Actively worked 12 steps Asked for help

Member of a home group Had a spiritual awakening

Performed service at meeting Had a sponsor

Participated in group sponsored events Talked to sponsor at meeting

Sponsored someone elseSelf-Help Activities Scale*

0% 20% 40% 60% 80% 100%

11%10%10%9%9%

8%7%

6%5%4%4%3%

3%2%2%2%

2%2%0%

0.0270.102 0.871

EAST

High Ac-tivity (12-19)

Moderate Activity (1-11)

*Mean of 19 items


49

Individual Strengths

Doing well with close friends

Listening, caring or communicating with others

Doing well at sports, exercise, physical activity

Doing well with your family

Problem solving and figuring things out

Working or playing with computers

Doing well at school or training

Doing well at music, dancing, acting, other performing art

Drawing, painting, design or other art activities

Doing well at work

Strength Self-Efficacy Index*

0% 20% 40% 60% 80% 100%

87%

73%

71%

70%

66%

59%

58%

48%

43%

36%

49% 43% 8%

EAST

High Strength (7-10)

Moderate Strength(3-6)

*Sum of 10 items


50

Friends to hang out with

Family members/close partners

Someone to talk to about emotions

Someone to help cope with problems

Legal hobby or activity

People at work/school: day to day things

People at work/school: get assignments

Friends/colleagues from other com-panies/schools

Professional counselor/health provider

General Social Support Index*

0% 20% 40% 60% 80% 100%

88%

83%

77%

75%

75%

69%

69%

56%

47%

81% 14% 6%

EAST

High Support(5-9)

Moderate Support (2-4)

General Social Support Strengths

*Sum of 9 items


51

Spiritual Social Support Index

Consider your beliefs to be very important to you?

Religiously affiliated

Consider your beliefs to be very strong?

Beliefs often influence your de-cisions?

Consider self a good member?

Regularly attend services or ceremonies?

Important that friends share your beliefs?

Spiritual Socual Support Index*

0% 20% 40% 60% 80% 100%

51%

43%

42%

33%

23%

18%

13%

0.113 0.303 0.584

Consider your be-liefs to be very im-portant to you? Re-ligiously affiliated Consider your be-liefs to be very strong? Beliefs of-ten influ-ence your deci-sions? C...

* Sum of 7 items


52

Potential Mentors in the Recovery Environment

None involved in illegal activity

Little shouting, arguing or fighting most weeks

Know anyone in treatment

Know anyone in recovery









Environmental Strengths Index*

0% 20% 40% 60% 80% 100%

74%52%

24%17%

64%45%

30%15%

58%40%

31%16%

66% 28% 6%

WEST High Strength (12-16) Moderate Strength (3-5)

Ho

me

Sch

oo

l or

Wo

rkS

oci

al

Pee

rs

*Sum of 12 items

Critical gap in

connection to recovery community


53

Quarterly Cost to Society

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 2011 dollars for the 90 days before intake

Of the 20,123 clients served in 161sites between 1998-2011, the average Quarterly Cost to Society (QCS) per client:– in the quarter before they entered treatment, was $4,554 and

totaled $81,829,957 across clients.– in the year before they entered treatment, was $18,216 per

client and a total of $327,319,828 across clients.

54

Quarterly Cost to Society – 2011 Dollars*

*Quarterly cost to society 2011 dollars w/ SA TX based on Dennis, M. L., French, M. T., McCollister, K. E., & Scott, C. K. (2011). The economic costs of quarterly monitoring and recovery management checkups for adults with chronic substance use disorders. Journal of Substance Abuse Treatment, 41, 201-207.

Description Unit Cost 2011 dollars

Inpatient hospital day Days $ 2,202.87

Emergency room visit Visits $ 6,477.04

Outpatient clinic/doctor’s office visit Visits $ 68.58

Nights spent in hospital Nights $ 2,202.87

Times gone to emergency room Times $ 6,477.04

Times seen MD in office or clinic Times $ 79.77

Days bothered by any health problem Days $ 26.47

Days bothered by psych problems Days $ 10.72

How many days in detox Days $ 234.86

Times in ER for AOD use Times $ 270.51

Nights in residential for AOD use Nights $ 121.62

Days in Intensive outpatient program for AOD use Days $ 94.36

Times did you go to regular outpatient program Times $ 32.50

Days missed school or training for any reason Days $ 19.19

How many times arrested Times $ 2,192.92

Days on probation Days $ 5.94

Days on parole Days $ 19.30

Days in jail/prison/detention Days $ 84.15

55


% of Total Dol-lars

($81,829,957; mean=$4,554)


0% 20% 40% 60% 80% 100%

8%

50%

73%

38%

80%

12% $0-$1,999

$2,000 - $9,999

$10,000+


56

Problem Prevalence Index

Summarizes days of problems across domains: substance use, internalizing disorders, externalizing disorders, physical health risk behaviors, criminal involvement, vocational problems, and environmental concerns.

Calculation: the average of the percent of days with problems (of past 90) on each of 23 items across 8 areas. The resulting score is multiplied by 100 to get an index score from 0 to 100.

Interpretation: continuous; where higher values represent more problems across multiple domains.

Triage groups: Low (0-5), Moderate (6-24) or High (25-100) based on roughly 50%, 40% and 10% of the clinical population.

57

Quality of Life

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.

Calculation: 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.

Interpretation: continuous; where higher values represent greater quality of life.

Triage groups: Low (0-36), Moderate (37-69) or High (70-100) groups.

58

General Satisfaction Index

Summarizes life satisfaction in 6 areas (sexual relationship, living situation, family relationships, school/work, free time, and getting help with problems). This index is optional.

Calculation: sum of these dichotomous items Interpretation: continuous; where higher values represent

greater satisfaction with life situations. Triage groups: Low problems (5-6), Moderate problems (3-

4) or High problems (0-2) groups. High satisfaction corresponds to low problems.– However, for the purposes of this presentation, the groups are not

reversed, so in the following slides, low satisfaction scores (0-2) are in the low group, and high satisfaction scores (5-6) are in the high group.

59

Problem Prevalence

Index


Quality of Life Index

General Sat-isfaction In-

dex*

0%10%20%30%40%50%60%70%80%90%

100% 8% 12%

0.366

0.115Low

Mod

High

High

Mod

Low

Cross Validation of Four Summary Indices

Pro

ble

mat

icB

en

efic

ial

*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.


60

General Satisfaction Index by Problem Prevalence Index

Low Prevalence

(0-5)

Moderate Prevalence

(6-24)

High Prevalence

(25-100)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%9% 12%

26% Low Satis-faction (0-2)

Moderate Satisfaction (3-4)

High Satis-faction (5-6)

Problems are subjectively

unpleasant and are associated with

lower satisfactionSource: CSAT 2011 AT Summary Analytic Data Set (n=6,685)

61

Low ($0-$1,999)

Moderate ($2,000-$9,999)

High ($10,000+)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%10% 13% 12%

Low Satis-faction (0-2)

Moderate Satisfaction (3-4)

High Satis-faction (5-6)

General Satisfaction Index by Quarterly Cost to Society

Higher costs are subjectively

unpleasant and are associated with

lower satisfactionSource: CSAT 2011 AT Summary Analytic Data Set (n=6,189)

62

Low Quality(0-36)

Moderate Qual-ity

(37-69)

High Quality(70-100)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%17%

9% 11%

Low Satisfac-tion (0-2)

Moderate Sat-isfaction (3-4)

High Satisfac-tion (5-6)

General Satisfaction Index by Quality of Life

Quality of life is subjectively

pleasant and is associated with

higher satisfactionSource: CSAT 2011 AT Summary Analytic Data Set (n=6,743)

63

Funder

CSAT Adolescent Treatment (AT): 100% (n=20,123; 161 grants)


64

Grant Program in Chronological Order of first grant cohort

• 1997-2001, Cannabis Youth Treatment (CYT) • 1998-2001, Adolescent Treatment Models (ATM)• 2002-2007, Strengthening Communities – Youth (SCY)• 2002-2011, Targeted Capacity Expansion (TCE)• 2003-2006, Adolescent Residential Treatment (ART)• 2003-2007, Effective Adolescent Treatment (EAT)• 2006-2011, Adolescent Assertive Family Treatment

(AAFT)

65

11%

32%

27%

11%

3%

8%

7%

Grant Program

TCE: Targeted Capacity Expansion (n=2,243; 13 grants)

EAT: Effective Adolescent Treatment

(n=6,393; 37 grants)

AAFT: Adolescent AssertiveFamily Treatment (n= 5,497; 75 grants)

SCY: Strengthening Communities-Youth (n=2,299; 9 grants)

CYT: Cannabis Youth Treatment (n=600; 4 grants)

ART: Adolescent Residential Treatment (n=1,636; 13 grants)

ATM: Adolescent Treatment Models

(n=1,455; 10 grants)

Source: CSAT AT 2011 Summary Analytic Data Set (n=20,123)

66

Level of CareLTR: Long Term

Residential 10.9% (n=2,124)

STR: Short Term Residential

1.7% (n=330)

OP: Outpatient

74.0% (n=14,457)

CC-OP: Continuing

Care – Outpatient 5.4% (n=1,051)

IOP: Intensive

Outpatient 8.0%

(n=1,563)Source: CSAT 2011 AT Summary Analytic Data Set (n=19,525)

67

Type of Treatment

Local Tx Manual: Specific

Manualized Treatment 9.0%

(n=1,732)

MET/CBT: Motivational

Enhancement Therapy/Cognitive-Behavioral Therapy

43.2% (n=8,303)

Other: Non-manualized Treatment 8.4%

(n=1,613)

Other EBTx: Evidence Based Treatment 8.4%

(n=1,606)

A-CRA/ACC: Adolescent Community

Reinforcement Approach/ Assertive

Continuing Care

31.0% (n=5,967)


68

Outcomes The following slides present information on the outcomes of

substance abuse treatment by age, 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.

http://gaincc.org/_data/files/Posting_Publications/19._Methods_Appendix_2011.pptx

http://gaincc.org/_data/files/Posting_Publications/19._Methods_Appendix_2011.pptx

69

Pre-CE Intake 3 Month 6 Month 9 Month 12 Month

0

5

10

15

20

25

30

35

40

45

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Mari-juana

Alcohol

To-bacco*

Amphet-amine

Cocaine

Opiates

Days of Use in the Past 90 Days by Substance

Source: CSAT 2011 AT SA Data Set subset to 1+ Follow ups

Da

ys

Us

ed

in P

as

t 90

–s

olid

lin

e

*There is no pre-ce information available for tobacco

Da

ys U

se

d in

Pa

st 90

– da

she

d lin

e

70

Percent Change in 6 Month Abstinence

Series10%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

22%

Source: CSAT 2011 AT SA Data Set subset to those with 6-Month Follow up (n=14,290)

• Percent change in 6 month abstinence is calculated as

• % abstinent at 6 month minus % abstinent at intake

• Abstinence increased 22% from 36% at intake to 58% at 6-months.

71

Relative Percent Change in 6 Month Abstinence

Series10%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

61%

• Relative percent change in 6 month abstinence is calculated as: • (% abstinent at 6 month minus %

abstinent at intake) divided by % abstinent at intake

• Relative percent of change can be large (i.e., greater than 100%) if baseline abstinence is low.

• Abstinence increased by almost two-thirds (61%) against the intake value. (22% increase/36% at intake).

Source: CSAT 2011 SA Data Set subset to those with 6-Month Follow up (n=14,290)

72

Past Month AOD Abstinence Over Time

Intake 3 Month 6 Month 9 Month* 12 Month0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Source: CSAT 2011 AT SA Data Set subset to 1+ Follow ups *Interpolated

73

Recovery*


* Recovery defined as no past month use, abuse, or dependence symptoms while living in the community.

Intake 3 Month 6 Month 9 Month** 12 Month0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

**Interpolated

74

GPRA Outcomes Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Vocationally Engaged

Housing

No Justice System Involvement

No Social Con-sequences

Abstinence

Socially Connected

Source: CSAT 2011 AT SA Data Set subset to 1+ Follow ups *Interpolated

75

Change in GPRA Outcomes (Intake to Last Wave*)

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

0%

20%

40%

60%

80%

100%

Vocationally Engaged

Housing No Justice System

Involvement

No Social

Consequences

Abstinence Socially Connected


*Last wave is the last follow-up

76

NOMS Outcome: Number of Treatment Received Outcomes Met*

Initiation within 14 days

Evidenced Based Practice

Engagement for at least 6 weeks

Any Continuing Care (91-180 days)

Number of Treatment Received Outcomes Met*

0% 20% 40% 60% 80% 100%

83%

81%

77%

63%

0.317 0.393 0.221 0.063

Total

4

3

2

1

Source: CSAT 2011 AT SA Data Set subset to 1+ Follow ups (n=17,202)

*Based on a count of initiation within 14 days, evidence based practice, engagement for at least 6 weeks, and any continuing care.

77

NOMS Outcome: Estimated Treatment Episode Cost by Treatment Modality

*Used in slides; ** Inter-quartile range of actual costs in 2006 dollarsSource: 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.

ModalitySAMSHA Episode

Cost (2004)*

French’s Estimated Episode Cost

(2008)**

Adolescent Early Intervention $200-$1,200 -

Adult Outpatient - $1,132 - $2,099

Adolescent Outpatient $1,000 - $5,000 $1,517 - $3,237

Intensive Outpatient/Continuing Care $1,000 - $7,000 $1,384 - $5,780

Adult Drug Court - $2,486 - $4,888

Adult Methadone Maintenance - $4,277 - $13,395

Adult Residential $3,000 - $10,000 $2,907 - $11,260

Adult Therapeutic Community/Residential $3,000 - $10,000 $14,818 - $32,361

Adult Therapeutic Community/In-Prison - $1,249 - $2,112

78

SAMHSA Outcome: Treatment Cost Bands


Below5% (n=675)

Within52% (n=7,412)

Above43% (n=6,153)

79

Selected NOMS Outcomes Over Time


*Interpolated

**Past month


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%No Health Problems

No Mental Health Prob-lems

No Family Problems

Abstinence

No Illegal Ac-tivity

Vocationally Engaged**

Housed

80

Change in Selected NOMS Outcomes (Intake to Last Wave)

Inta

ke

La

st

Wa

ve

Inta

ke

La

st

Wa

ve

Inta

ke

La

st

Wa

ve

Inta

ke

La

st

Wa

ve

Inta

ke

La

st

Wa

ve

Inta

ke

La

st

Wa

ve

Inta

ke

La

st

Wa

ve

0%10%20%30%40%50%60%70%80%90%

100%

Vocationally Engaged*

No Health

Problems

No MH Problems

Past Month

Abstinent

No Illegal Activity

Housed


No Family Problems

*Past month

81

NOMS Outcomes: No Problems at Intake


Use

Abuse/Dependence Sx*

Physical Health

Mental Health

Nights of Psychiatric Inpatient

Illegal Activity

Arrests

Housed in Community

Family/Home Problems

Vocational Problems*

Social Support/Engagement

Recovery Environment Risk


In Work/School

0% 20% 40% 60% 80% 100%

15%

39%

36%

11%

97%

58%

78%

56%

34%

30%

1%

33%

5%

82%

* Variable measures the last 30 days. All others measure the past 90 days.

82

NOMS Outcomes: Outcome Status at Last Wave


UseAbuse/Dependence Sx*

Physical HealthMental Health

Nights of Psychiatric Inpatient Illegal Activity

Arrests Housed in Community**

Family/Home ProblemsVocational Problems*

Social Support/Engagement Recovery Environment Risk

Quarterly Cost to SocietyIn Work/School**

0% 20% 40% 60% 80% 100%

53%74%

40%

44%99%

80%90%

67%71%

46%11%

49%47%

89%

32%65%26%16%99%73%90%63%55%46%3%49%14%79%

No Prob-lem

Reduced 50% or No Problem

*This variable measures the last 30 days. All others measure the past 90 days.**The blue bar represents an increase of 50% or no problem.

83

NOMS Outcomes: Count of Positive Outcomes* (Last FU– Intake)

Less than negative one7% (n=1,229)

Negative one6% (n=1,033)

None8% (n=1,495) One

11% (n=1,928)

Two13%

(n=2,215)

Three13% (n=2,312)

Four13% (n=2,293)

Five +29% (n=5,217)


*Based on count of a reduction in the following variables: Substance use frequency, Abuse/Dependence Sx (past 30d), Physical Health (past 90d), Mental Health (past 90d), Nights of Psychiatric Inpatient (past 90d), Illegal Activity (past 90d), Arrests (past 90d), Housed in Community (past 90d), Family/Home Problems (past 90d), Vocational Problems (past 30d), SocialSupport/Engagement (past 90d), Recovery Environment Risk (past 90d), Quarterly Cost to Society (past 90d), In Work/School (past 90d) Minus No problems at intake with these variables

78% have one or more

improved areas

84

Baseline 3 Month 6 Month 12 Month0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

39%

62% 65% 65%

53%

34% 31% 31%

9% 4% 4% 4%

High (10-16)

Moderate (1-9)

Low (0)

Past Month Substance Problems Scale Groups Over Time


85

Current Withdrawal Scale Groups Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

76%87% 91% 91%

21%11% 8% 7%3% 2% 2% 2%

High (12-22)

Moderate (1-11)

Low (0)


86

Health Problems Scale Groups Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

53%45% 44% 44%

39%45% 47% 47%

9% 9% 9% 9%

High (33-100)

Moderate (10-32)

Low (0-9)


87

Emotional Problems Scale Groups Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

37%47% 51% 55%

51%46% 43% 40%

12% 7% 6% 6%

High (51-100)

Moderate (14-50)

Low (0-13)


88

Employment Problems Scale Groups Over Time



10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

97% 99% 99% 99%

High (6-8)

Moderate (3-5)

Low (0-2)

89

Employment Problems Scale Groups Over Time – Subset to Those Employed



10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

87%97% 97% 97%

12%2% 3% 3%

High (6-8)

Moderate (3-5)

Low (0-2)

90

Training Problems Scale Groups Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

33%

73%80% 86%

37%

22%17%

12%30%

6% 4% 2%

High (6-8)

Moderate (3-5)

Low (0-2)


91

Training Problems Scale Groups Over Time – Subset to Those in School/Training


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

26%

70%78% 83%

41%

24%18%

14%33%

6% 4% 3%

High (6-8)

Moderate (3-5)

Low (0-2)


92

Illegal Activities Scale Groups Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

25% 25% 25% 23%

38%45% 45% 48%

38%31% 30% 29%

High (11-100)

Moderate (1-10)

Low (0)


93

Treatment Resistance Index Groups Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

38%46% 49% 48%

54%47% 44% 44%

8% 8% 7% 8%

High (3-4)

Moderate (1-2)

Low (0)


94

Self-Efficacy Scale Groups Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

62%74% 76% 76%

28%

21% 19% 19%

11% 6% 5% 4%

High Prob-lems (0-2)

Moderate Problems (3-4)

Low Prob-lems (5)


95

Substance Abuse Treatment Index Groups Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

81%

27%

66%

85%

8%

47%

20%

7%11%

26%14% 9%

High (14-100)

Moderate (1-13)

Low (0)


96

Mental Health Treatment Index Groups Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

82% 80% 83% 86%

8% 9% 8% 7%10% 11% 9% 8%

High(14-100)

Moderate (1-13)

Low (0)


97

Physical Health Treatment Index Groups Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

64% 64% 66% 65%

24% 25% 24% 24%

12% 11% 10% 11%

High (14-100)

Moderate (1-13)

Low (0)


98

Criminal Justice System Index Groups Over Time


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

47% 44% 48%60%

18%9%

10%

9%

35%47% 42%

31%High (14-100)

Moderate (1-13)

Low (0)


chapter 3 overview of adolescent treatment sites

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