Chapter 11 Subset of Overview by Mental Health Disorders

Chapter 11Subset of Overview by Mental Health Disorders

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

Past Year Pattern of Mental Health Disorders

Internalizing Disorders

Only 9.3%

(n=2,770)

Externalizing Disorders

Only 20.6%

(n=6,128)

Both 32.8%

(n=9,727)

Neither 37.3%

(n=11,059)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,684)

4

Risk and Protective Factors by Mental Health Disorders

The following slides present information on demographics, and risk and protective factors by different age groups 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)

5

Age by Mental Health Disorders

Neither Externaliz-ing

Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

12%2%

24%

8%

15%

7%

21%

13%

61%

72%

47%

66%

12%19%

8% 14%

<15

15-17

18-25

26+


6

Gender by Mental Health Disorders


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

19% 17%

42% 39%

81% 83%

58% 61% Male

Female


7

Race by Mental Health Disorders


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

22% 16% 15% 9%

31%

27% 31%26%

4%

3% 4%

4%

33%40% 37%

44%

11% 14% 14% 16%Multi-Racial

White

Other

Hispanic

African American


8

8

Risk of Homelessness by Mental Health Disorders


Disorders Only

Internaliz-ing

Disorders Only

Both0%

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

100%

80% 81%67% 67%

2% 2% 7% 7%Currently Homeless

At Risk of Homeless-ness

Group/Inst

Housed


9

Past Year Substance Severity by Mental Health Disorders


Disorders Only


Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

24%

46% 52%

74%

PY De-pendence

PY Abuse

PY Use

No PY Use


10

Primary Substance by Mental Health Disorders


Disorders Only


Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

29% 24% 29% 23%

55% 66%39% 51%

Other drug

Opioids

Amphetamines

Cocaine

Marijuana

Alcohol


11

Neither Externaliz-ing Disor-ders Only


Only

Both0%

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

100% 9%18% 24%

44%High SU (6-8)

Moderate SU (3-5)

Low SU (0-2)

Number of Substance Problems by Mental Health Disorders


12


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

29%38% 44% 48%

Dependence/Daily Use

Current PY Use

Past Use

Never Used

Tobacco Diagnosis by Mental Health Disorders


13

HIV Risk Scale* by Mental Health Disorders

* Available at intake only.


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 5% 12%27%

40%High Risk(10-36)

Moderate Risk(3-9)

Low Risk(0-2)


14

HIV Risk Change Index* by Mental Health Disorders


Disorders Only

InternalizingDisorders

Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 2% 6% 8% 18% HighRisk(4-7)

ModerateRisk(2-3)

LowRisk(0-1)

*Can be used to measure change.


15

Number of Sex Partners* by Mental Health Disorders



Only

Both0%

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

100%12% 18% 11% 19%

3+ Sex Partners

1-2 Sex Partners

No Sex Partners

*In the past 90 days


16

Severity of Victimization by Mental Health Disorders


Disorders Only

Internaliz-ing

Disorders Only

Both0%

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

100%

25%39%

59%71%

High Severity (4-15)

Moderate Severity (1-3)

Low Severity (0)


17

Neither Externaliz-ing Disor-

ders Only

Internaliz-ing Dis-orders

Only

Both0%

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

100% 4% 8%High Severity(4-5)

Moderate Severity (1-3)

Low Severity (0)

Homicidal/Suicidal Thoughts by Mental Health Disorders


18

Health Problems by Mental Health Disorders


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 5% 7% 12% 14%High Problems(33-100)

Moderate Problems (10-32)

Low Prob-lems(0-9)


19

Health Care Utilization Cost* by Mental Health Disorders

*Using 2011 Dollars


DisordersOnly


Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

$5,000

$1,246

$1,688

$3,113

$4,393 $7,600+

$1-$7,599

$0

Mean


20

Crime and Violence by Mental Health Disorders


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%14%

46%

21%

57%

High Crime(7-29)

Moderate Crime (3-6)

Low Crime(0-2)


21

Type of Crime by Mental Health Disorders


Disorders Only


Only

Both0%

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

100%20%

49%

24%

54%

Violent Crime*

Other Crime**

Drug Use only


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

22

Cost of Crime* by Mental Health Disorders

*Using 2011 Dollars


DisordersOnly


Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0$100,000$200,000$300,000$400,000$500,000$600,000$700,000$800,000$900,000$1,000,000$1,100,000$1,200,000

$120,972

$457,291

$299,985

$1,117,770 $120,000+

$1-$119,000

$0

Mean


23


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Detention/jail 30+ days

Detention/jail 14-29 days

Drug Court

Prob/parole 14+ days w/ 1+ drug screens

Other probation, parole, detention

Other JJ/CJ status

Past arrest/JJ/CJ sta-tus

Past yr illegal activ-ity/SA use

Intensity of Justice System Involvement by Mental Health Disorders


24

Count of Major Clinical Problems* at Intake by Mental Health Disorders


Disorders Only


Only

Both0%

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

100% 4%

48% 49%

94%

Five to Twelve

Four

Three

Two

One

None

*Based on count of self reporting criteria to suggest alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal activity


25


Disorders Only

Internaliz-ing

Disorders Only

Both0%

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

100%17%

30%

52%65%

High Stress(3-15)

Moderate Stress(1-2)

Low Stress(0)

Sources of Stress Index by Mental Health Disorders


26


Disorders Only


Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 5% 6% 4% 4%Low Readiness (0-2)

ModerateReadiness (3-5)

High Readiness (6-9)

Treatment Readiness by Mental Health Disorders


27

Self-Help Activity by Mental Health Disorders


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

80% 81%65% 63%

Low Ac-tivity (0)

Moderate Activity (1-11)

High Ac-tivity (12-19)


28


Internaliz-ing Dis-orders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%8% 7% 7% 8%

Low Strength(0-2)

Moderate Strength (3-6)

High Strength (7-10)

Strength Self-Efficacy Index by Mental Health Disorders


29

Neither Externalizing Disorders

Only


Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%10% 3% 7% 3%

Low Support(0-1)

Moderate Support (2-4)

High Support(5-9)

General Social Support Index by Mental Health Disorders


30

Spiritual Social Support by Mental Health Disorders


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

48%59%

43%53%

Low Support (0-2)

Moderate Support (3-5)

High Support (6-7)


31



Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%9% 5% 11% 7%

Low Strength(0-2)

Moderate Strength (3-5)

High Strength(12-16)

Environmental Strengths Index by Mental Health Disorders


32


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000$9,000$10,000$11,000

$3,330 $4,051

$5,607

$7,181

$10,000+

$2,000 - $9,999

$0-$1,999

Mean

Quarterly Cost to Society* by Mental Health Disorders


*Using 2011 Dollars

33

Problem Prevalence Index by Mental Health Disorders


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 1% 4% 5%18% High Preva-

lence(25-100)

Moderate Prevalence (6-24)

Low Preva-lence(0-5)


34



Both0%

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

100% 4%

31%22%

72%

Low Quality (0-36)

Moderate Quality (37-69)

High Quality(70-100)

Quality of Life by Mental Health Disorders


35

General Satisfaction by Mental Health Disorders


Disorders Only


Only

Both0%

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

100%10% 8%

22% 22% Low Satis-faction(0-2)

Moderate Satisfaction(3-4)

High Satis-faction(5-6)


36

Program by Mental Health Disorders


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%ATMARTCYTYORPORPATDCSCYAAFTDCEATTCEOther


37

Level of Care by Mental Health Disorders



Both0%

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

100%

76% 73% 69% 63%

14%11% 16%

13%

6%7% 7%

9%

5% 8% 7%13%

STR

M-LTR

CC-OP

IOP

OP


38

Type of Treatment by Mental Health Disorders


Disorders Only

Internaliz-ing

Disorders Only

Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

41% 40%29% 32%

13% 10%

12% 9%

27% 30%

27% 29%

17% 13%28% 19%

3% 7% 4% 11%Tx Man

Other

ACRA/ACC

Other EBTx

MET/CBT


39

Outcomes The following slides present information on the outcomes of

substance abuse treatment by mental health disorders, 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

40

Percent Change in 6 Month Abstinence by Mental Health Disorders

Neither Externalizing Disorders Only

Internalizing Disorders Only

Both0%

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

100%

20% 21%18% 20%

SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=20,135)

41

Relative Percent Change in 6 Month Abstinence by Mental Health Disorders



Both0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

39%

57%

37%

54%

SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=20,135)

42

Past Month AOD Abstinence by Mental Health Disorders

Intake 3 Month 6 Month 9 Month* 12 Month0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Neither

Externalizing Disorders Only


Both

*InterpolatedSAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

43

Recovery* by Mental Health Disorders

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

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Neither

Externalizing Disorders Only


Both

* Recovery defined as no past month use, abuse, or dependence symptoms while living in the community. SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups **Interpolated

44In

take

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

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

100%

Vocationally Engaged

Housing

No Justice Sys-tem Involve-ment

No Social Consequences

Abstinence

Socially Connected

Change in GPRA Outcomes by Mental Health Disorders (Intake to Last Wave*)


BothInternalizing Disorders Only

*Last wave is the last follow-upSAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

45

NOMS Outcome: Number of Treatment Received Outcomes Met* by Mental Health Disorders


Only


Only

Both0%

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

100%

32% 32% 28% 28%

40% 41% 40% 41%

None

One

Two

Three

Four

*Based on a count of initiation within 14 days, evidence based practice, engagement for at least 6 weeks, and any continuing care.SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=24,564)

46

SAMHSA Outcome: Treatment Cost Bands by Mental Health Disorders


Only


Only

Both0%

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

100%

51% 51%40% 45%

Above

Within

Below

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=17,822)

47

Change in Selected NOMS Outcomes by Mental Health Disorders (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

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%No Health Prob-lems

No Mental Health Problems

No Family Prob-lems

Abstinence

No Illegal Activ-ity

Vocationally Engaged*

Housed

Externalizing Only

Internalizing Only

Neither Both

*Past monthSAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

48

NOMS Outcomes: Count of Positive Outcomes (Last FU–Intake) by Mental Health Disorders

Neither(69% w/ 1+)

Externalizing Disorders

Only(80% w/ 1+)


Only(77% w/ 1+)

Both(84% w/ 1+)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

17%31% 26%

38%

Less than negative one

Negative one

None

One

Two

Three

Four

Five +

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=25,452)

Chapter 11 Subset of Overview by Mental Health Disorders

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