Development of the Global Appraisal of Individual

Needs-Quick, version 3 (Q3)

Janet C. Titus, Ph.D.Presented August 17, 2011

Chestnut Health SystemsNormal, IL

1. Describe the development (“life story”) of the Q3

2. Describe how a pilot study and feedback from the field influenced the development

3. Present the “final” Q3

Goals of this presentation are to…

Progressive Continuum of Measurement (Common Measures)

Screening to Identify Who Needs to be “Assessed” (5-10 min)– Focus on brevity, simplicity for administration & scoring– Needs to be adequate for triage and referral– GAIN Short Screener for SUD, MH & Crime– ASSIST, AUDIT, CAGE, CRAFT, DAST, MAST for SUD– SCL, HSCL, BSI, CANS for Mental Health– LSI, MAYSI, YLS for Crime

Quick Assessment for Targeted Referral (20-30 min)– Assessment of who needs a feedback, brief intervention or referral for

more specialized assessment or treatment– Needs to be adequate for brief intervention– GAIN Quick – ADI, ASI, SASSI, T-ASI, MINI

Comprehensive Biopsychosocial (1-2 hours) – Used to identify common problems and how they are interrelated– Needs to be adequate for diagnosis, treatment planning and placement

of common problems– GAIN Initial (Clinical Core and Full)– CASI, A-CASI, MATE

Specialized Assessment (additional time per area)– Additional assessment by a specialist (e.g., psychiatrist, MD, nurse,

spec ed) may be needed to rule out a diagnosis or develop a treatment plan or individual education plan

– CIDI, DISC, KSADS, PDI, SCAN

Screener Quick C

omprehensive S

pecial

More E

xtensive / Longer/ E

xpensive

What is the GAIN-Q (v. 2)?

20-30 minute instrument used to briefly assess multiple mental health, substance abuse, and environmental problems

Used in a variety of settings, including SAP, juvenile detention, child welfare, health clinics, and EAP

Used to support brief interventions

Current GAIN-Q content

Items cover 7 content areas– General Factors– Sources of Stress– Physical Health– Emotional Health– Behavioral Health– Substance-Related Issues– Service Utilization

Optional section – Reasons for Quitting (focused on substance abuse)

Current GAIN-Q item formats

Most items focus on behavior or experiences during the past year.– yes/no items

At the end of most sections and in the “Service Utilization” section, items focus on the past 90 days.– number of days items

Current GAIN-Q results

Results support efforts to sort individuals into three groups:– those who probably do not have problems requiring

attention– those who have mild problems that might be

appropriate for a brief intervention– those who are in need of a more detailed assessment

and/or specialized treatment.

What are its strengths?

Length

Range of topics

Ability to efficiently triage individuals

Two narrative reports– Quick Recommendation and Referral Summary

(QRRS)– Personal Feedback Report (PFR) for individuals for

whom a brief intervention may be appropriate

What are its weaknesses?

Lacks scales to support analyses or outcomes related to change over time.

Item response choices do not provide information about lifetime problems or problems that have occurred in finer gradations of time within the past year.

Current Personal Feedback Report focuses only on substance use and does not address the other content areas of the GAIN-Q.

Only about 60% of the items can be directly imported into the GAIN-I.

Redesigning the Q: Blueprint topics

1) Q as a series of short screeners

2) Cover more ground

3) Retain and refine

4) Rescale response sets

5) Expand Personal Feedback Report

6) Option for screening and brief intervention intertwined

1) Q as a series of short screeners

Each section of the GAIN-Q3 starts with a 5-6 item “screener”

The screener items are from the corresponding full-length GAIN-I symptom scales.

For full-length GAIN-I scales that have several subscales… at least one item from each subscale will be on a screener (all sub-domains represented).

1) Q as a series of short screeners

Items were selected based on Rasch measurement modeling.

Each set of items is optimal for screening (goal of over 90% sensitivity).

Screener scores are good estimates of scores obtained on the corresponding full-length GAIN symptom scales (goal of correlation over .90 with full scales).

Each screener ends with several “number of days” items (in the past 90).

2) Cover more ground

Vocational Problems Screener (School/Work)

Health Problems Screener

Sources of Stress Screener

General Victimization Screener (Risk Behaviors)

Internalizing Disorder Screener

Externalizing Disorder Screener

Substance Disorder Screener

Crime & Violence Screener

3) Retain and refine

Sources of Stress Index– personal and environmental stressors

Service Utilization– services received during past 90 days – costs to society during past 90 days

Demographics

4) Rescale response sets

Replace the “yes/no” response set with the GAIN-I’s recency scale (“When was the last time…?”):– Past month– 2-12 months ago– 1+ years ago– Never

This will support analyses of outcomes related to change over time and analyses of lifetime problems or problems that have occurred in finer gradations of time within the past year.

5) Expand Personal Feedback Report

For each GAIN-Q area in which an individual reports a problem, items focused on reasons/readiness to change behaviors will be asked.

Responses will be used to support a motivational intervention.

6) Measure to support brief intervention

When an individual reports a problem in any particular area, items to support a brief intervention in that area are administered.

Assessment generates a summary of the results (Q3RRS) as well as a Personal Feedback Report to be used with the individual for a brief intervention.

Report content– symptoms reported– frequency of symptoms from P90 items– reasons/readiness for changing behavior

Reports will be editable.

GAIN-Q (v. 3) as best of both worlds

Retaining strengths– Length– Range of topics– Efficiently categorize– Narrative reports

Addressing weaknesses– Response sets to capture

lifetime/more recent behaviors– Items support analyses of

change over time– More in-depth PFR– 90% of items directly imported

into GAIN-I

Pilot Study – Winter 2010 11 sites participated Participation was voluntary. Pilot sites had varying levels of GAIN experience Sites were provided with:

– GAIN-Q administration and interpretation web training

– GAIN-Q pilot ABS accounts In return, sites were asked to:

– Collect at least 10 GAIN-Q pilot interviews– Provide feedback during the pilot on the GAIN-Q

instrument, Q-ICP, and Q-ABS accounts Sites will complete a formal feedback survey at the

completion of the pilot project.

Lessons Learned

Pilot Study Analyses and User Feedback

Add items/split items

Reasons for change well endorsed, add long-term

More detail on victimization/abuse

Decision rules for administering reasons/readiness

Special populations

Feedback from the field

CSAT - homelessness, pregnancy, military service and veterans status, sexual orientation

From pilot to “final”, 129 changes.

GAIN-Q3 (3.1.2)

Multipurpose assessment used to identify and address a wide range of life problems among adolescents and adults in both clinical and general populations

Used in diverse settings - employee assistance programs, student assistance programs, health clinics, juvenile and criminal justice programs, child welfare programs, mental health and substance abuse treatment

Overall aim of the Q3 - triage (quickly sort people)

For participants whose results indicate mild problems, the Q3 system provides the means to conduct a brief intervention based on the principles of motivational interviewing.

Used as its own follow-up assessment

Heart of the Q3

Nine separate screeners (4 to 8 items long)

Measure problem recency (“last time”) for past month, past 90 day, past 12 month, and lifetime behaviors

Q3 Section Q3 Screener Name 1. School Problems............................................ School Problems Screener (SPScr) 2. Work Problems.............................................. Work Problems Screener (WPScr) 3. Physical Health.............................................. Health Problems Screener (HPScr) 4. Sources of Stress ........................................... Sources of Stress Screener (SSScr) 5. Risk Behaviors for Infectious Diseases......... Risk Behaviors Screener (RBScr) 6. Mental Health................................................ Internalizing Disorders Screener (IDScr) ................................................. Externalizing Disorders Screener (EDScr) 7. Substance Use ............................................... Substance Disorders Screener (SDScr) 8. Crime and Violence....................................... Crime & Violence Screener (CVScr)

Life Impact Measures

Collection of four measures that provide a unique lens on the costs associated with life problems and the benefits associated with improving one’s life situation.

Quality of Life IndexProblem Prevalence Index Quarterly Costs to Society

Index Life Satisfaction Index

Life Impact Measures

Values vary according to complexity in a participant’s life– As the complexity of life problems increases, measures

of problem prevalence and quarterly costs to society should increase,

– As complexity decreases, quality of life and life satisfaction should increase

The Life Satisfaction Index is a standalone measure; the other three Life Impact measures are constructed from information pulled from each of the main sections of the Q3.

Building Blocks of the Q3

The set of nine screeners composes the most basic form of the Q3.

Adding successively more items to this base creates additional versions of the Q3.

Q3-Lite

The most basic form of the assessment

Consists only of the nine screeners, measuring only the recency of the participant’s behaviors

Also provides a measure of the participant’s quality of life

Takes about 20 minutes to administer

Q3-Standard

Enhanced with supplementary items (the median number per section is 6) that record information on the frequency of the participant’s behaviors during the preceding 90 days.

Provides more detailed outcome measures than the Q3-Lite - additional information can be used to monitor the participant’s progress when the Q3 is used as a follow-up assessment

Includes indices on the participant’s prevalence of problems, quarterly costs to society, and life satisfaction

Takes about 35 minutes to administer.

Q3-MI (Motivational Interview)

Further enhanced with reasons and readiness items

For any life area that screens as problematic, Q3 interviewers have the option of collecting information on the participant’s reasons and readiness to change their behaviors.

Information is used during the Q3 brief intervention (conducted either during the assessment session or at a separate meeting)

Time required to conduct the screening and brief intervention varies depending on the number of life areas the participant reports as problematic – on average, Q3-MI takes about 45 minutes to administer; Q3-MI and brief intervention takes about 60 to 75 minutes on average.

Administration and Clinical Reports

Q3RRS

Q3ICP

Q3PFR

VR (validity report)

Current Development Status

Done/Final Touches

Q3 instrument, ABS admin

Q3ICP, Q3QRRS, VR

Training – Moodle, in-person presentations

QA/certification model

Evaluation materials

Site profiles

In Development

Brief intervention

Q3-PFR