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Using the GAIN-Q Screener and MET/CBT5 in Student Assistance Programs

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Title: Using the GAIN-Q Screener and MET/CBT5 in Student Assistance Programs


1
Using the GAIN-Q Screener and MET/CBT5 in Student
Assistance Programs
  • Funded by
  • The Center for Substance Abuse Treatment (CSAT)
  • Substance Abuse and Mental Health Services
    Administration (SAMHSA)
  • U. S. Department of Health Human Services
    (DHHS)

2
Presentation Goals
  • Reason for program changes
  • Description of GAIN-Q Screener
  • Description of MET/CBT5 intervention
  • Discuss Implementation Issues

3
SCY
Strengthening Communities - Youth
Developing Community Treatment Options
Iowa City, IA
Bloomington, IL
Harlem, NY
Oakland, CA
St. Louis MO
Phoenix, AZ
Mobile, AL
Tucson, AZ
2001
2002
Sponsored By
Center for Substance Abuse Treatment (CSAT),
Substance Abuse and Mental Health Services
Administration (SAMHSA),
U.S. Department of Health and Human Services
(DHHS)
4
GAIN Screening Manual-Based Intervention at
Schools
GAIN Screening Assessment at Juvenile Justice/JDC
Strengthening McLean County for Youth (SCY)
Evaluating Aftercare Following OP
Evaluating Manual-Based Intervention in OP
MIS Development for Continuum and System of Care
Coordination with Other Human Service Agencies
5
Why the GAIN-Quick?
  • Provides a standardized screening for all
    students referred to the SAP counselor
  • Wanted consistency with other measurement in
    continuum of care
  • Can be completed in 20 minutes or so
  • Also evaluates need for mental health screening

6
Why MET/CBT5?
  • For Quality Control, we felt it was important to
    train and supervise staff in one known
    intervention
  • Found to be effective in CYT study
  • Manual-guided
  • Could be adapted for school settings (i.e. all
    individual sessions)
  • Approach is designed to increase motivation for
    treatment, non-confrontational, and brief

7
Chestnut Health Systems Student Assistance
Program (SAP) Central Illinois Region
8
Current Chestnut Service Structure
  • Recruitment, Assessment, Treatment
  • Early Intervention
  • Outpatient IOP
  • Day Treatment
  • Residential Treatment
  • Continuing Care

9
Outpatient Offices Residential Treatment
School and Recreation Services
10
General Information
  • Established in 1985
  • Initially in one school in McLean County (the
    largest geo. county in Illinois)
  • Currently 14 staff in 34 schools throughout the
    county

11
(No Transcript)
12
The students we see
  • Eleven high schools/junior high schools
  • Ten elementary schools
  • In 2002-2003, staff saw nearly 1300 individual
    students
  • Staff ran over 125 different groups on grief,
    COA, depression, bullying, etc.

13
Referral process (typical)
Concerned person (school staff, student, parent)
Fills out referral form
Staff meets with student, goes over nature of
services, HIPAA, confidentiality
Staff gives student GAIN-Q, then develops Service
Plan with student based upon results
Refer, discontinue, or continue to meet
14
Number of Hours in Schools
15
Funding
  • Combination of four primary sources
  • School Districts
  • McLean County Health Department
  • Office of Alcoholism and Substance Abuse (OASA)
  • Federal Funds (SCY Project)

16
Quality Assurance/Evaluation
  • Number and timeliness of SALs
  • Number of GAIN-Qs and when given
  • Number of students seen
  • Number of MET/CBT initiated/completed
  • Student Descriptors
  • School Personnel Satisfaction
  • Pre-Post GAIN-Q in selected schools

17
Staff Characteristics Certification
18
Staff Characteristics Educational Level
19
Program Marketing
Present as part of School Staff Orientation
Distribution of SAP flyers throughout community
and school district
Send SAP flyers home as part of registration
Monthly newsletter, FYI, distributed to all
school personnel
Classroom presentations on what SAP is and how to
refer
Meetings with teachers, Superintendents, PTO,
School Board
20
Reasons for Referral
  • Declining school performance, absenteeism,
    truancy
  • Depression, grief, loss
  • Suspected of or known substance abuse (self or
    family member)
  • Self-mutilation, eating disorder, other mental
    health concern
  • Other

21
Types of Services Provided
  • Crisis Intervention and Referral
  • Screening of students using the GAIN-Q
  • Referral assistance to community based agencies
  • Assistance obtaining more extensive evaluation
    using the GAIN-I
  • Assistance obtaining OPT and residential services
    if needed

22
Types of Services (Continued)
  • Conducting small groups on topics as needed COA,
    grief, etc.
  • Doing classroom presentations as needed on wide
    range of topic areas, including substance abuse,
    depression, grief, family roles, etc.
  • Consult with teaching staff and parents about
    concerns

23
Types of Services (Continued)
  • Education with students related to drug or mental
    health concerns
  • Brief intermittent intervention
  • MET/CBT5 as appropriate

24
Prior to Implementation of GAIN measures and
MET/CBT
  • Possible SASSI
  • Possible referral for a GAIN-I evaluation
  • Possible referral to center for treatment
  • If refuse treatment, then intervention in school
    varied by SAP counselor

25
Global Appraisal of Individual Needs Quick
(GAIN-Q) Developers Mike Dennis, Janet Titus,
et al.,
26
Can be Administered via Computer or Paper
27
What is the GAIN-Q?
  • It is an instrument designed to efficiently and
    effectively identify adolescents or adults in
    need of referral for a more detailed assessment
    on substance use and/or mental health problems

28
Background of GAIN-Q
  • GAIN family of measures has evolved from over a
    half dozen grants from CSAT, NIAAA, NIDA, and the
    Interventions Corp. since 1993 (Dennis
    colleagues, 1993, 1995, 1996, 1998)
  • In use by over 50 researchers/clinical groups
    across the country
  • Scales have developed excellent consistency and
    ability to reliably predict initial level of
    treatment

29
When/Where is the GAIN-Q used?
30
The GAIN-Q can be used for
  • Screenings at juvenile detention
  • Screenings at court services
  • SAP screenings at school
  • Screenings at other agencies/groups

31
When to proceed to a full GAIN-I?
  • Collaborative reports suggest use, despite the
    adolescent NOT self-reporting any use
  • The GAIN-Q report indicates a need for further
    assessment

32
Taking a closer look at the GAIN-Q
Distribute copy of GAIN-Q
33
Description of GAIN-Q Instrument
  • Fifteen pages in length
  • Can be Interviewer- or Self-administered
  • Length of time to administer instrument is 20 to
    30 minutes
  • Most items written in a yes/no format

34
Description of Instrument cont.
  • Organized into 12 sections
  • Background
  • General Factors
  • Sources of Stress
  • Physical Health
  • Emotional Health
  • Behavioral Health
  • Substance-Related Issues
  • Service Utilization
  • End
  • Case Disposition
  • Reasons for Quitting
  • Optional Study Questions

35
Overview of Sections
  • First four sections (Background, General Factors,
    Sources of Stress, Physical Health) provide
    background and formative indices of factors that
    are related to behavioral health problems

36
Overview of Sections cont.
  • Next four sections (Emotional Health, Behavioral
    Health, Substance-Related Issues, Service
    Utilization) contain the core behavioral health
    indices
  • The core symptom scales cover behavior during the
    past year and each concludes with an item on
    whether these problems have occurred in the past
    three months

37
Overview of Sections cont.
  • EndMisc. questions about setting, type of
    administration, time
  • Case DispositionReferral Source, Issues,
    Placement, Add. Comments
  • Reasons for QuittingUsed if plan to provide MET
  • Special Study Section--Optional

38
After completing the GAIN-Q what direction or
step should you take?
39
GAIN-Q Recommendation and Referral Summary
(Q-RRS)
  • Narrative-based for easier interpretation
  • Provides a recommendation for each section
  • Reports the range of urgency according to the
    appropriate index for each subscale within each
    larger section

Distribute Copy of Q-RRS
40
GAIN-Q Recommendation and Referral Summary (QRRS)
cont.
  • List the symptoms endorsed for each section
  • List the days and/or times a particular problem
    occurred during the past 3 months (90 days)
  • Lists days during past 3 months that services
    were utilized for each area
  • May range in length from 2-6 pages depending on
    the severity of the individual

41
Can Produce the Personalized Feedback Report Used
during MET
42
Training Monitoring of Staff in GAIN-Q
  • Training by a certified trainer
  • Required certification in the Q by all staff who
    would be using it.
  • Required role play
  • Tapes that are evaluated for certification using
    a certification form
  • Continued to review tapes on a random basis
    after certification

43
Percentage of students completing GAIN-Qs
referred for GAIN-Is (N 271)
n24
44
Percentage of students participating in MET/CBT5
at schools where available (N140)
45
Ohhthe Possibilities
  • 15 were not referred for further assessment, but
    enrolled in MET/CBT at the school
  • 5 were referred for further assessment, refused
    and were not enrolled in MET/CBT
  • 2 were referred for further assessment, refused,
    but did enroll in MET/CBT
  • 3 were referred for further assessment, completed
    the GAIN-I (2 recommended for OP and 1
    recommended for IOP but none were admitted to
    Chestnut), and enrolled in MET/CBT

46
Emotional and Behavioral Health
47
Motivational Enhancement Therapy/ Cognitive
Behavior Therapy 5 (MET/CBT5)
CYT
  • Sampl, S., Kadden, R. (2001)
  • University of Connecticut Health Center
  • Farmington, CT USA

Cannabis Youth Treatment Experiment
Treatment Series Volume 1
48
CYT
Cannabis Youth Treatment Experiment A
Collaborative Study of the Effectiveness of
Treatment for Cannabis Use Disorders
Sites Univ. Conn. Health Center, Farmington,
CT Operation PAR, St. Petersburg, FL Chestnut
Health Systems, Madison County, IL Childrens
Hospital of Phil., Philadelphia, PA
Coordinating Center Chestnut Health Systems,
Bloomington, IL, and Chicago, IL University
of Miami, Miami, FL University of Connecticut
Health Center, Farmington, CT
Sponsored by Center for Substance Abuse
Treatment (CSAT), Substance Abuse and Mental
Health Services Administration (SAMHSA), U.S.
Department of Health and Human Services
49
Purpose
  • What are the characteristics and needs
  • To evaluate the relative effectiveness, cost and
    cost-effectiveness of 5 interventions
  • To provide validated models of these
    interventions to the treatment field

50
Figure 1 General Pattern of CYT Clinical
Outcomes
90
100
90
80
80
70
70
60
60
50
Percent In Recovery
Average Days Abstinent per Quarter
50
40
40
30
30
20
20
10
10
0
0
Intake
3
6
9
12
51
Figure 2. Effectiveness of CYT Therapies Across
Sites
Trial 1
Trial 2
300
50
290
45
280
40
270
35
260
30
Total day abstinent over 12 months
Percent in Recovery at Month 12
250
25
240
20
230
15
220
10
210
5
200
0
MET/CBT5
MET/CBT12
FSNM
MET/CBT5
ACRA
MDFT (n99)
(n102)
(n95)
(n102)
(n99)
(n100)
Total Days Abstinent
Percent in Recovery
52
Introduction to MET
  • A style of intervention based on the premise that
    people are most likely to change when the
    motivation comes from themselves, rather than
    being imposed by the therapist
  • Based on a trans-theoretical model
  • 1) stages of change theory
  • 2) client-centered approaches
  • 3) clinical research
  • A strengths-based approach

53
The Stages of Change Model Prochaska
DiClemente, 1986
              
Permanent Exit?
Precontemplation
Relapse
Maintenance
Contemplation
Action
Determination
54
MET Session 1
  • (see page 32)
  • Rapport-building orientation to treatment- 20
    min.
  • Review of the Personalized Feedback Report (PFR)-
    30 min.
  • Summarization preparation for next session- 10
    min.

Distribute sample PFR report
55
Five Strategies of MET MI
  • 1. Express Empathy
  • 2. Develop Discrepancy
  • 3. Avoid Argumentation
  • 4. Roll with Resistance
  • 5. Support Self-Efficacy

56
MET Session 2
  • (see page 41)
  • Review of Progress- 15 min.
  • Goal-Setting- 20 min.
  • Functional Analysis- 20 min.
  • Preparation for Group- 5 min.

57
CBT for Adolescents
  • Cognitive Behavioral Therapy aims to help
    adolescents identify triggers for substance use,
    and to learn practice coping strategies as an
    alternative to substance use.

58
3 CBT Sessions
  • Drug/Alcohol Refusal Skills
  • Increasing Social Support
  • SupplementIncreasing Pleasant Activities
  • Planning for Emergencies Coping With Relapse

59
Structure of CBT Group Sessions
  • Intros Rapport Building
  • Review of Progress
  • Introduction Teaching of Coping Skill
  • In-Session Practice Exercise
  • Assign Real-Life Practice Exercise
  • Closing

60
Implementation Issues
  • Training
  • Ongoing Individual supervision
  • Group supervision
  • Used a certification process that includes tape
    reviews and rating forms
  • Adapted forms for use in the schools

61
Certification Process
  • Helps to ensure that intervention is being
    delivered as outlined in manual
  • Video or audio tape sessions
  • Supervisor reviews several random tapes initially
    and rates performance by using TSS
  • Use of TSS, Global and Individual procedure
    checklists
  • Consistent ratings of 4 and above on a standard
    scale are necessary for certification, as well
    as, a demonstration of implementing the
    intervention in a competent and consistent manner

62
Use of Audio and/or Video Tapes
  • Obtain release from student
  • Use in individual or group supervision
  • Learning tool for role-plays
  • Self-monitoring
  • Track progress
  • Adherence and competency related to manualized
    treatment
  • Monitoring therapist drift

63
Case Review Tracking Form
Columns with procedures
CASE
Weeks
FA-
No.
Open Date
Status
Date to Close
in Tx
client

parent

together
PFR
Use
FA-PS
GOC
A
2/13/2001
E
5/8/2001
13
12
4
3
1
1
4
B
2/15/2001
D
5/10/2001
13
6
1
1
1
2
C
2/26/2001
E
5/21/2001
11
9
1
1
1
2
D
3/13/2001
E
6/5/2001
9
7
1
1
2
1
1
2
E
3/19/2001
E
6/11/2001
8
7
2
1
2
1
F
3/19/2001
E
6/11/2001
8
6
2
1
1
1
G
4/19/2001
N
7/12/2001
4
2
1
1
1
H
4/27/2001
N
7/20/2001
3
2
1
1
1
I
4/26/2001
N
7/19/2001
3
2
1
1
1
64
Group/Team Supervision
  • Provides support, feedback, problem-solving,
    sense of team/decreases isolation, increases
    cohesiveness
  • Activities depend on needs case
    reviews/presentations (new and active), tape
    reviews, peer feedback/interaction, role-playing,
    on-going training, etc.
  • Promote team problem-solving, assistance,
    support, praise and encouragement
  • Foster/stimulate supportive positive environment
  • Helps convey same information at same time

65
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66
Implementation Issues
67
School Year 02-03
  • Implemented GAIN-Quick Screenings in 2 schools
  • Implemented the MET/CBT5 intervention for youth
    screened as having substance abuse issues in same
    two schools
  • Implemented follow-up GAIN-Q interviews by
    research assistants with all students seen 3 or
    more times who signed an informed consent

68
School Year 03-04
  • Implemented GAIN-Quick Screenings in all 10
    schools
  • Implemented the MET/CBT5 intervention for youth
    screened as having substance abuse issues in 5
    schools

69
Implementation Issues Referral Sources
  • Who are they?
  • What information needs to be shared
  • with school boards?
  • with administrators?
  • with school counselors?
  • with teachers?

70
Data Collection Monitoring
  • Set up system to track what happens with every
    referralGAIN-Q helps
  • Type of referralswhat are the possibilities?
  • Track important student descriptors
  • Track referral sourceswhat are yours?
  • Track reasons for referral

71
How will the new intervention fit with existing
SAPprocess?
72
How will you do these things?
  • Initial Training
  • On-going Training
  • Use of Audio and/or Video Tapes
  • Certification Process
  • Individual Supervision
  • Group/Team Supervision
  • Tools to assist with Supervision Process
  • Assistance/Support for Supervisors

73
SAP Implementation Issues
  • What is your access to students
  • CBT in groups vs. individual sessions
  • of sessions
  • How will you assess needs?
  • Confidentiality
  • How is the SAP person identified in the school?
  • Parental permission involvement
  • Making materials user friendly (see page. 42-
    50)

74
More Considerations
  • Spaceplays into confidentiality
  • How to handle crises when using
    manual-based intervention?
  • What about after MET/CBT5?
  • Check-in sessionsreview procedures
  • Clinical supervision/support

75
Implementation Issues Materials
  • Some handouts are focused primarily on marijuana
    and can be adapted to reflect a broader range of
    drugs alcohol.
  • Electronic copies of more generic hand-outs can
    be sent
  • Posters for providing CBT sessions need to be
    made.
  • Provide a site specific Paperwork Flowchart
  • Provide cheatsheet for use in initial sessions

76
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77
For more Information
  • On GAIN-Q
  • http//www.chestnut.org/LI/gain/index.html
  • MET/CBT Manual
  • Can order a free copy from NCADIphone
    800-729-6686, BKD384
  • Can download from http//www.chestnut.org/LI/book
    store/index.html

78
Contact Information
  • Susan H. Godley, Rh.D.
  • Senior Research Scientist
  • Chestnut Health Systems
  • 720 W. Chestnut St.
  • Bloomington, IL 61704
  • 309.829.3543 ext.83343
  • sgodley_at_chestnut.org

Bruce Boeck, M.S. Associate Director of
Early Intervention Chestnut
Health Systems 720 W. Chestnut St.
Bloomington, IL 61704 309.829.3543 ext. 3627
bboeck_at_chestnut.org
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