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Next-Generation GAIN Software

David Smith, B.G.S. and Michael L. Dennis, Ph.D.Chestnut Health Systems, Bloomington, IL

Workshop Presentation for the Joint Meeting on Adolescent Treatment EffectivenessBaltimore, Maryland

March 29, 2006, Maryland A Room

Preparation of this presentation was supported by funding from the Center for Substance Abuse Treatment (CSAT Contract no. 270-2003-00006). The contents of this presentation are the opinions of the authors and do

not reflect the views or policies of the government. Available on line at www.chestnut.org/LI/Posters or by contacting Joan Unsicker at 720 West Chestnut, Bloomington, IL 61701, phone: (309) 827-6026, fax: (309)

829-4661, e-Mail: junsicker@chestnut.org

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This think tank will…

• Emphasize our commitment to making the GAIN Software widely available, adaptable and compatible with existing and new systems;

• Provide a brief overview of the GAIN with some of the implications for the GAIN Software;

• Review the history of GAIN Software;

• Discuss features and capabilities that we would like to add to the next-generation of GAIN Software;

• Solicit your input on what would make the GAIN Software more useful to clinicians, clinical researchers, and software developers.

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GAIN Overview

The Global Assessment of Individual Needs (GAIN) is a family of assessment instruments that is widely used in research and clinical settings throughout the United States and Canada.

The GAIN has played a significant part in the renaissance of adolescent treatment research and is on the leading edge of the innovative use of assessment data in both research and clinical practice for adolescents and adults.

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The GAIN is a Family of Instruments

There are seven primary instruments:

• GAIN-I – a 100-page comprehensive biopsychosocial instrument;

• GAIN-M90 – the follow-up version of the GAIN-I

• GAIN-SS – a 2-page screener for general populations;

• GAIN-Q – a 10-page quick assessment;

• GAIN-QM – the follow-up version of the GAIN-Q;

• GAIN-CI – a 58-page collateral instrument;

• GAIN-CM – the follow-up version of the GAIN-CI.

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The GAIN-I is Comprehensive

The current GAIN-I has:

• A total of 1936 possible questions;

• Hundreds of related instructions, transition statements and other text items;

• 156 skips or conditional branches;

• 314 internal consistency checks;

• Hundreds of calculated variables per case to support clinical diagnosis and placement decision-making

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The GAIN Instruments are Customizable

Most GAIN instruments are customized:

• Each is available as a “Core” with a set of required questions, and a “Full” with optional questions added.

In addition, the makeup of the “Core” can vary by:

• Individual Studies

• Regional Systems

• Individual Agencies or sites

• Populations within sites

And “Special Study” questions can be added to the end of most instruments.

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The GAIN is Constantly Evolving

1993 GAIN 1.x created for NIDA Training and Employment Program (TEP) as an integrated clinical and research instrument based on ASI, IAP, DATOS, & several existing scales.

1996 GAIN 2.x revised for Drug Outcome Monitoring Study (DOMS) to focus more specifically on DSM, ASAM, JACHO/CARF and map onto epidemiological data based.

1998 GAIN 3.x revised for CYT and ATM to address problems in DOMS and incorporate GPRA versions 1 & 2.

2000 GAIN 4.x revised to include several new modules to address specific NIDA and NIAAA research studies (not widely used).

2002 GAIN 5.x revised for SCY and other CSAT adolescent treatment studies to incorporate reasons for quitting, treatment history & process measures, GPRA versions 3 & 4, several state reporting requirements. Currently on its fourth major revision (version 5.4.0).

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The GAIN is Widely Used in Research

• 1995-1997 Drug Abuse Treatment Outcome Study (DOMS)

• 1997-2000 CSAT’s Cannabis Youth Treatment (CYT) experiments

• 1998-2003 CSAT’s 10 Adolescent Treatment Models (ATM)

• 2000-2003 CSAT’s Persistent Effects of Treatment Study (PETS-A)

• 2002-2007 CSAT’s 12 Strengthening Communities for Youth (SCY)

• 2002-2007 CSAT’s 12+ Targeted Capacity Expansion TCE/HIV

• 2003-2009 NIDA’s 14 individual research grants and CTN studies

• 2003-2006 CSAT’s 17 Adolescent Residential Treatment (ART)

• 2003-2007 CSAT’s 38 Effective Adolescent Treatment (EAT)

• 2004-2007 NIAAA/CSAT’s study of diffusion of innovation

• 2004-2009 CSAT 22 Young Offender Re-entry Programs (YORP)

• 2005-2008 CSAT 20 Juvenile Drug Court (JDC)

• 2005-2008 CSAT 16 State Adolescent Coordinator (SAC) grants

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The GAIN is Widely Implemented

The GAIN has played a role in:

• Most of the studies that have supported the current Renaissance of Adolescent Treatment Research;

• The development of clinical expert systems and statistical models to improve diagnosis, placement, treatment planning, program evaluation, and economic evaluations; and

• Creating the infrastructure supporting the move toward evidence based practice.

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All Adolescent and Adult, Clinical and Research Sites Using the GAIN since 1993

Indiana

Kansas

Mississippi

Montana

NebraskaNevada

North Dakota

Arkansas

Maine

Oklahoma

South Dakota

Tennessee

Alabam

a

Idaho

Minnesota

New Mexico

North Carolina

West

Virginia

Georgia

Iowa

Louisiana

SouthCarolina

Utah

Kentucky

Alaska

Virginia

PennsylvaniaM

ichigan

Ohio

Oregon

Colorado

New York

Arizona

Texas

Florida

Wisconsin

Missouri

Illinois

California

Washington

Wyoming

Number of Sites

1 to 1415 to 3031 to 88

Puerto Rico

New Hampshire

Delaware

Hawaii

Rhode Island

New Jersey

District Of Columbia

Maryland

Connecticut

Vermont

Massachusetts

None (yet)

1+ Statewide syst.1+ Statewide systconsidering it

3/06

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Where is the GAIN Going?

• Growth:- The number of sites has doubled every year for five years and is projected

to continue to do so for the next five years.

• Better Integration:- Across records from multiple sources (e.g., participant, collateral, urine)

and/or over time.

- Into existing and new information systems supporting diagnosis, placement, treatment planning, monitoring, and billing.

• Decision Support:- Clinical, including how to better use assessment information in diagnosis,

placement, and treatment planning.

- Supervisory, including monitoring of and technical assistance to staff, grantee or clinic sites to support supervisors, administrators, and funders.

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Where is the GAIN Going?

• Flexibility:- More specialized versions, different languages, self administration,

and better modularization/set up for local customization (subsets, new items).

• Technical Innovation:- Incorporation of computer adaptive testing (CAT) to shorten the

administration time and other complex statistical modules to improve validity and provide clinical guidance.

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The Evolution of GAIN Software

GAIN Software has been evolving for over a decade:1993 – Version 1 (FICS) was written in Fortran on DOS for the

PC-AT, math-coprocessor emulators, 24-page narrative report that nobody read.

1997 – Version 2 (DOMS) written in Microsoft Access95 with direct synchronization and a statistical summary.

1998 – Version 3 (ABSLite) written in Access97 for data-entry only with direct synchronization and data exports, limited reports.

2000 – Version 4 (ABS) written in Visual Basic with Jet database engine with data export and statistical summaries (ICP).

2003 – Version 5 (ABS) Update of software to address HIPAA requirements, allow interactive interviews and add clinical narrative report (GRRS), GPRA tool and GRL.

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Current GAIN Software

• Working in hundreds of agencies around the country.• Easy to use – user training takes less than half a day.• Clinical reports available immediately after an online

interview or after data has been keyed. • Data can be pooled over server/network/internet, uploaded

from a remote/laptop on demand, or exported and sent via e-mail, FTP, or HTP (in a password-protected file).

• Features for interactive administration, data entry, editing, note making, rekeying and resolution, read-only, report generation.

• Privacy/security features to aid in complying with HIPAA, 42 CFR and other privacy and security policies.

• Deployable over LAN/WAN and Internet using Terminal Server or Citrix.

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Moving to the Next-Generation GAIN Software

Up to now we’ve talked about the context in which we’re working on the new GAIN Software.

Now we’d like to talk about how we are envisioning that new software and begin what we hope will be an ongoing conversation about how it will look and work.

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Initial Decisions

• The GAIN is too complex for the GAIN Coordinating Center to be able to define and test for multiple developers of GAIN software.

• The GCC’s core competency is the GAIN content – we don’t want to become a big software developer.

• We want to create new GAIN software, not a new case management system.

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What We Want From a New System

Anyone designing a new system these days wants many of the same things:

• Open

• Scalable

• Secure

• Flexible

• Maintainable

• Internet-capable

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What We Want From a New System

In our environment there are several other things that are important to us:

• Maximum Clinical utility

• Maximum Research utility

• Easy interaction with statistical/software/CAT modules

• Easy interface with other systems

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Next-Generation

• We want to build on our existing software strengths:- End-user ease of use- Support for Data Submission process

• While we add:- Ease of Startup/Implementation- Ease of Local Support- Ease of Tailoring Instruments- Ease of integration with other systems- Robust, modern, standard platforms- Enhanced remote access- Enhanced research and clinical utility- Flexibility and extensibility

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Next-Generation

• Overview of typical system

• Implementation Options (CHS Hosted, Other Hosted (Datacenter), Local Installation, Laptop)

• Focus on features – - Customization (Templates)

- Clinical Reporting (GRRS)

- Integration

• Discussion

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Next-Generation GAIN Software Overview

Based on:

• Web browser interface

• SQL database

• .NET codebase

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GAIN Software System Architecture

Middleware on.NET

Framework

MS SQL Server

Web PagesASP.NETPresentation

Logic

BusinessLogic

Data LogicDB2

Oracle

Future support for

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Implementation Options

• Internet Hosted – Cross-system

• Internet Hosted – System-based

• Locally Hosted

• Stand-alone

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Hosting Options

New Version of the

instrument

Data Export

New Version of the

instrument

Data Export

CHS Server

GAIN Hosted at Agency MIS GAIN Publicly Hosted

`

Workstation 1

`

Agency BDisconnected Laptop Version Agency C Laptop Version

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Publicly Hosted

New Version of the instrument

Data Export

CHS Server

GAIN Publicly Hosted

Agency C Laptop Version

`

Agency A

`

Agency B

`

Agency C

Acc

essi

ng G

AIN

App

licat

ion

Acc

essi

ng G

AIN

App

licat

ion

Accessing GAIN Application Accessing GAIN Application

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Agency Hosted

New Version of the instrument

Data Export

CHS Server

GAIN Hosted at Agency MIS

`

Workstation 1

`

Workstation 2Disconnected Laptop Version

Acc

essi

ng G

AIN

App

licat

ion

Acc

essi

ng G

AIN

App

licat

ion

Upload Asseessment

Accessing GAIN Application

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3rd Party Interaction

GAIN Server

Case Management System Billing System

`

Agency A

`

Agency A

Acc

essi

ng G

AIN

Da

ta

Acc

essi

ng G

AIN

Da

ta

Accessing GAIN Case Management

Accessing Billing system

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GRRS Process

Conduct an assessment

Mark assessment as completed

Edit GRRS

Compute ICP Variables

Save GRRS

Reports

Generate GRRS