Enhancing the GAIN Treatment Planning and Placement Capability

1. Enhancing the GAIN Treatment Planning and Placement Capability LaVerne Hanes Stevens, PhD, NCC, MAC, BCCC

2. Presentation Objectives • Describe the results of a three-year effort to expand the treatment planning and placement components generated by the GAIN • Describe how the treatment plan statements were developed, reviewed by expert panels, and organized in the text • Describe highlights of new features that allow clinicians to select alternative diagnoses and treatment recommendations in the GAIN software

3. Overview: The GAIN and GRRS • The Global Appraisal of Individual Needs (GAIN) is a family of comprehensive bio-psychosocial assessment tools. • The GAIN Recommendation and Referral Summary (GRRS) is a computer-generated 8 to 9 page preliminary treatment planning. • For each ASAM dimension, the GRRS includes: • Problems • Treatment history • Treatment planning recommendations

4. Guiding Principles: GAIN Tx Planning • Individualized treatment plan must be informed by the needs assessment • Treatment plan and level of care placement are based upon the client’s problem history/severity and treatment history • Problem severity determined by recency, breadth and prevalence • Treatment plan precedes level of care placement • GRRS is a tool to facilitate clinical judgment and the linkage to evidenced based practice; it is not a substitute for clinical judgment

5. GAIN Users Asked For… While the GRRS has been well-received over the past five years, staff and clinical supervisors have consistently requested: • Tools to help with workforce development in a diverse workforce environment • More detailed treatment planning statements; particularly important for those linked to standards and/or evidenced based practice • Specific level of care recommendations

6. GCC Goals/Response • Expand the treatment planning and placement components of the GRRS • Involve current users in a collaborative effort to develop the model • Develop a GRRS product that can assist with workforce development

7. Treatment Planning Grid * Current for Dimension B1 = Past 7 days

8. Phase 1Developing the Template • Key Definitions • Determining problem definitions • Determining treatment history definitions • Developing treatment plan statements • Using ASAM, JHACO, etc. • Organizing the treatment planning statements • Client requests • Statements based on cell in treatment grid • Specific interventions based upon general expectations of regulatory and accrediting bodies or links to evidenced based practice • Determining a place for “hard to fit” items • Determining an ASAM Dimension for miscellaneous GAIN items

9. Determining Problem Definitions Example: B-5 (Relapse, Continued Use…) High Severity Problem: • Using in the past 48 hours, or using daily (45+/90) • Or using crack, opioids or methamphetamine weekly (13+/90) • Or high risk on self-efficacy to resist relapse combined with past 90 use and a low problem-orientation Low-Moderate Severity Problem: • Person does not meet the above criteria for high severity • Person does have the following: • Any past 90-day use OR past month substance dependence, abuse or induced disorders OR weekly (13+/90) substance use • Hiding use or substance-related family problems • At least a moderate risk related to self-efficacy to resist relapse

10. Determining Treatment Definitions Example: B-5 (Relapse, Continued Use…) Current Treatment/Intervention: • Currently taking SA meds, or • In SUD treatment now or in past 90 days, or • Current urine/saliva/hair monitoring at least weekly Past Treatment/Intervention: • Not currently taking SA meds • Not in SA tx in the past 90 days • Not currently in SA tx • No urine/saliva/hair monitoring occurring at least weekly

11. Developing and Organizing Treatment Plan Statements Example: B-5 (Relapse, Continued Use…) …See Handout… Three parts for each dimension: • Client requests(Last participant items in each GAIN-I section) • Cell specific statements(Based on cells 0-7) • General statements related to that dimension(e.g. victimization, suicidality, pregnancy, etc.)

12. “A place for everything and….” Determining an ASAM dimension for miscellaneous GAIN items, e.g., if client requests… • Getting treatment [S10a6] • Making transportation arrangements [B9a1] • Making child care arrangements [B9a2] • Scheduling around work, school or family responsibilities [B9a3] • Paying for treatment [B9a4] • Language, religious, ethnic or cultural issues [B9a5] • Clothing [B9a6] • Food [B9a7] …these are in Dimension B4 (part 1) because they can either affect or be indicative of the client’s readiness to get help for their problems.

13. Distinguishing ASAM B4, B5 and B6 Issues • B4 – Readiness to Change: The will; Internal motivation factors; RFQs • B5 – Relapse, continued use, continued problem potential: The ability; Supports for reduced use or abstinence • B6 – Recovery Environment: The context; People, places and things that affect risk

14. Phase 2Review by panel of GAIN users The role of this panel was to review the specific text statements that had been drafted for each of the options in the table; and feedback in 3 main areas: I. The Model (Generally) II. The Statements (Specifically) a. Definitions b. Treatment Plan Statements III. Implications for Workforce Training Summer 2006: the panel met in Bloomington for 3 days.

15. Phase 3Revisions and Finalization • Incorporated feedback from the user panel • Revised the treatment planning grid • Revised definitions and intervention statements as necessary • Incorporated other features: • Option to select alternative diagnoses • Option to select alternative cell placements • Option to suppress sections when printing

16. The Final Product • GRRS is a highly individualized assessment with treatment planning recommendations for all ASAM dimensions • Includes specific recommendations for special needs, priority population and high-risk situations • Over 40 quadrillion possible treatment plan recommendation combinations!

17. Next… Rod Funk… What characteristics are most likely to sit together among clients presenting for substance abuse treatment?