Transcript Juvenile Treatment Drug Court

Juvenile Treatment Drug
Court GAIN Data Issues
SAMHSA / CSAT
Treatment Drug Court Grantee Meeting
Melissa Ives
Kate Moritz
June 10, 2009
Anaheim, CA
Outline
1.
Overview of current data: March 2009 JDTC/FDC
data with YORP and CSAT 2008
2.
Using your own GAIN data/Resources: Reminder of
available GCC resources for evaluators
3.
A.
Using the scales and variables files
B.
Review of current characteristics profile
Accessing CSAT GAIN data: Review of process for
requesting cross-project data for publications,
Available Datasets:
A.
Full GAIN data-Version 5 records only
B.
Summary analytic dataset Vertical
C.
Summary analytic dataset Horizontal
Growth in DC data set
• CSAT 2006 dataset, GAIN-I N = 79
– and 36 follow-ups (3m).
• CSAT 2007 dataset, GAIN-I N = 534
– and more than 700 follow-ups (3m-12m).
• CSAT 2008 dataset, GAIN-I N = 1,147
– and more than 1600 follow-ups (3m-12m).
• As of March 2009, GAIN-I N = 1,845
– and more than 1,600 follow-ups (3m-12m*).
– more than doubled in 7 months!
• It is important to have HIGH follow-up rates
– The goal is 80% or higher each wave.
*9 and 12-month follow-ups are not required for Drug Court sites
Follow-up Rates for 3 and 6 month
100%
87%
90%
80%
75%
79%
57%
54%
78%
70%
60%
50%
67%
40%
46%
30%
20%
10%
77%
78%
68%
64%
76%
57%
63%
61%
0%
CSAT AT
(N=14,053*;
12,868**)
3 month*
JDTC
(N=1359*;
1180**)
6 month**
FDC (N=118*;
96**)
3* or 6 month
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
YORP
(N=2108*;
2038**)
3 and 6** month
*(Of those) due for 3m wave
**(Of those) due for 6m wave
Demographics
JTDC like AT:
Gender, Age
Female
Minority status
African American
CSAT AT (N=14,358)
Caucasian
Hispanic
JTDC* (N=1,965)
Mixed
YORP (N=2,193)
<15
15-17 years
18+ years
0% 10% 20% 30% 40% 50% 60% 70%
JTDC like YORP:
Minority Status
80% 90%
100
(Hispanic)
%
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
*Includes 2 Family Drug Court sites
Years of Use
0%
20%
40%
60%
CSAT AT
2008
JTDC*
YORP
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
80%
100%
22%
24%
Less than 1
1-2 years
3-4 years
5 or more years
40%
*Includes 2 Family Drug Court sites
Index Admission Level of Care
0%
20%
CSAT AT
2008
60%
80%
70%
51%
JTDC*
YORP
40%
25%
100%
JTDC like AT:
Treatment
Placement
11%
23%
13%
Outpatient
IOP
Partial Hosp.
Any Residential
Corrections
Other
48%
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
*Includes 2 Family Drug Court sites
Pattern of Comorbidity
0%
CSAT AT 2008
(66% any)
JTDC* (62% any)
YORP (55% any)
Neither
20%
33%
40%
60%
7%
38%
36%
8%
45%
Internal only
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
32%
8%
25%
Both
80%
100%
24%
23%
22%
External only
*Includes 2 Family Drug Court sites
Past Month Abstinence
0.8
JTDC: Same pattern of
improved abstinence, lower
severity
0.7
0.6
0.5
CSAT AT 2008
JTDC*+
YORP+
0.4
0.3
0.2
0.1
0
Intake
3m
6m
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
9m
12m
*Includes 2 Family Drug Court sites;
+9m & 12m not required
No Past Month Substance Problems
100%
90%
80%
70%
60%
CSAT AT 2008
JTDC*+
YORP+
50%
40%
30%
20%
10%
0%
Intake
3m
6m
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
9m
12m
*Includes 2 Family Drug Court sites;
+9m & 12m not required
No Major Health Problems
100%
90%
80%
70%
60%
CSAT AT 2008
JTDC*+
YORP+
50%
40%
30%
20%
10%
0%
Intake
3m
6m
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
9m
12m
*Includes 2 Family Drug Court sites;
+9m & 12m not required
No Major Mental Health Problems
100%
90%
80%
70%
60%
CSAT AT 2008
JTDC*+
YORP+
50%
40%
30%
20%
10%
0%
Intake
3m
6m
9m
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
12m
*Includes 2 Family Drug Court sites;
+9m & 12m not required
No Illegal Activity
100%
90%
80%
70%
60%
CSAT AT 2008
JTDC*+
YORP+
50%
40%
30%
20%
10%
0%
Intake
3m
6m
9m
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
12m
*Includes 2 Family Drug Court sites;
+9m & 12m not required
No Family/Home Problems
100%
90%
80%
70%
60%
CSAT AT 2008
JTDC*+
YORP+
50%
40%
30%
20%
10%
0%
Intake
3m
6m
9m
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
12m
*Includes 2 Family Drug Court sites;
+9m & 12m not required
No problem or 50%+ Reduction
on… (at last FU)
100%
90%
80%
70%
CSAT AT 2008 (Mo to last FU: 8.73)
JTDC* (Mo to last FU: 6.12)
YORP (Mo to last FU: 5.99)
60%
50%
40%
30%
20%
10%
0%
Substance Substance
Health
Frequency Problem Problems
Scale
Scale
Scale
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
Emotional
Problems
Scale
Illegal
Activity
Scale
*Includes 2 Family Drug Court sites
No problem or 50%+ Reduction
on… (at last FU)
100%
CSAT AT 2008 (Mo to last FU: 8.73)
JTDC* (Mo to last FU: 6.12)
YORP (Mo to last FU: 5.99)
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Family
problems
Social Risk
Recovery
Index
Environment
Risk Index
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
Cost to
Society
Behavioral
problems
*Includes 2 Family Drug Court sites
ASAM Treatment Planning Clusters
YORP
13% 8% 8%
52%
A Low Severity-Low Tx
B Low-Mod
C Mod-Mod
JTDC*
23%
14%
20%
D Hi-Low
12%
E Hi-Mod
F Hi-Hi (CC)
G Hi-Mod (Env Sx; PH Tx)
CSAT AT
2008
20%
0%
10
%
20
%
30
%
40
%
H Hi-Hi (Intx Sx/PH/MH Tx)
14% 9%
15%
50
%
60
%
70
%
80
%
Source: March 2009 YORP/JTDC, CSAT AT 2008 dataset
90 100
% %
*Includes 2 Family Drug Court sites
GRRS Treatment Planning Needs:
Substance Use and Treatment
Case Management
Residential treatment-RER
Not close to one in recovery
Tobacco use
Detox or w/drawal services
Cont. care after controlled env.
Non-opioid w/drawal & relapse svs
JTDC
Tx dissatisfaction
Realistic Treatment Goals and CC
FDC
Relapse prevention
Treatment Mentor
Opiate w/drawal & relapse svs
Monitor withdrawal & compliance
0%
Source: GI_GM_DrugCourt_033109_Horizontal
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
GRRS Treatment Planning Needs:
Mental Health
Use pers'l strengths/support
Comorbidity SA/MH
Behavior control problems
Anger manangement
Major psycho-social stressors
Reading/Writing problems
JTDC
Homocide/suicide risk
MH Medication compliance
FDC
FU on Self-mutilation
Eating disorder
Monitor Self-mutilation
Cognitive impairment
MH Hospital History
0%
10%
Source: GI_GM_DrugCourt_033109_Horizontal
20%
30%
40%
50%
60%
70%
80%
90%
100%
GRRS Treatment Planning Needs:
Physical Health
Publicly-funded health insurance
No Health Insurance
Discussing PH med compliance
JTDC
Medical condition
FDC
PH-ER/hospitalization history
Need Tetanus shot
Current infectious disease
Current Pregnancy
Physical disability
Recent birth
0%
10% 20% 30% 40% 50% 60% 70% 80% 90%
Source: GI_GM_DrugCourt_033109_Horizontal
100
%
GRRS Treatment Planning Needs:
Environment
Environment and Legal
Env. dissatisfaction/goals for change
Substance use in the home
Need stable housing
Substance use in public housing
JTDC
FDC
Homelessness
JJ/CJ system involvement
Legal
Illegal activities--Interpersonal
Illegal activities--Drug related
Arrest History
Illegal activities--Other
Civil Court involvement
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100
%
Source: GI_GM_DrugCourt_033109_Horizontal
GRRS Treatment Planning Needs:
SES/Vocation
Recent school problems
Below Poverty Line
Need voc'l/gov't assistance
JTDC
Need vocational counseling
FDC
Unemployment
Need School/GED
Need financial counseling
Recent work problems
SSI, SSDI, disability comp.
TANF benefit recipient
Need gambling counseling
0%
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Source: GI_GM_DrugCourt_033109_Horizontal
GRRS Treatment Planning Needs:
HIV risk and Child issues
Sexual risk
Recent victimization
JTDC
Needle risk
FDC
Child maltreatment
Coordinate DCFS/CPS
care
Child Welfare System
Involvement
Child custody issues
Children involved with
DCSF/CPS/state
0%
10%
20%
Source: GI_GM_DrugCourt_033109_Horizontal
30%
40%
50%
60%
70%
80%
90%
100%
Intoxication (at intake) vs. Detox
Treatment at 3 months (es=.06)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
How well sites are
matching service
based on need
95%
No Treatment
Treatment
% with unmet need
after 3 months
Low Need
(n=1089 (88%))
High Need*
(n=146 (12%))
*3+ on ASAM dimension B1 criteria
Source: GI_GM_DrugCourt_033109_Horizontal
Number in need at
intake
Intoxication (at intake) vs. Detox
Treatment at 3 months
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Higher values
indicate more
triage of services
to those in need.
95%
25%
12%
% of Clients With
% of Services
% w Need but No
Mod/High Need Going to Those in Service After 3
(n=146/1235)*
Need (n=7/28)
months
(n=139/146)
*3+ on ASAM dimension B1 criteria
Source: GI_GM_DrugCourt_033109_Horizontal
Physical Health problem (at intake)
vs. Medical Treatment at 3 months
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
54%
52%
40%
% of Clients With
% of Services
% w Need but No
Mod/High Need Going to Those in Service After 3
(n=489/1222)*
Need (n=233/432)
months
(n=256/489)
*3+ on ASAM dimension B2 criteria
Source: GI_GM_DrugCourt_033109_Horizontal
Mental Health Problem (at intake)
vs. MH Treatment at 3 months
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
89%
78%
66%
% of Clients With
% of Services
% w Need but No
Mod/High Need Going to Those in Service After 3
(n=806/1214)*
Need (n=176/197)
months
(n=630/806)
*3+ on ASAM dimension B3 criteria
Source: GI_GM_DrugCourt_033109_Horizontal
Tx Readiness Need (at intake) vs.
Low Tx Motivation+ at 3 months
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
87%
96%
83%
% of Clients With
% of Services
% w Need but No
Mod/High Need Going to Those in Service After 3
(n=137/157)*
Need (n=24/25)
months
(n=113/137)
*3+ on ASAM dimension B4 criteria
Source: GI_GM_DrugCourt_033109_Horizontal
Relapse Potential (at intake) vs.
Urine/Breathalyzer at 3 months
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
97%
97%
5%
% of Clients With
% of Services
% w Need but No
Mod/High Need Going to Those in Service After 3
(n=1162/1202)*
Need
months
(n=1101/1134)
(n=61/1162)
*3+ on ASAM dimension B5 criteria
Source: GI_GM_DrugCourt_033109_Horizontal
Recovery Environment (at intake)
vs. Self Help at 3 months
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100%
100%
69%
% of Clients With
% of Services
% w Need but No
Mod/High Need Going to Those in Service After 3
(n=1230/1230)* Need (n=383/383)
months
(n=847/1230)
*3+ on ASAM dimension B6 criteria
Source: GI_GM_DrugCourt_033109_Horizontal
Residential Treatment need (at intake) vs.
7+ Residential days at 3 months
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
84%
51%
29%
% of Clients With
% of Services
% w Need but No
Mod/High Need Going to Those in Service After 3
(n=343/1203)*
Need (n=54/107)
months
(n=289/343)
Source: GI_GM_DrugCourt_033109_Horizontal
Count of Unmet needs* by Program:
Based on service area and placement recommendation
100%
90%
80%
70%
60%
50%
40%
30%
20%
49%
39%
40%
6
5
4
3
2
1
0
10%
0%
JTDC (n=1534)
FDC (n=131)
Source: GI_GM_DrugCourt_033109_Horizontal
Total
*High Need (ASAM B1-B6,ResTx) & no treatment
for those with 3m data and valid responses for need.
64%
71%
55%
60%
78%
82%
57%
70%
66%
80%
78%
90%
61%
100%
79%
89%
MH issues at intake vs.
MH Treatment+ at 3 months
30%
31%
50%
40%
17%
30%
8%
20%
10%
0%
3+ ASAM B3
Any prior MH Tx (N Any Co-Occ. d/o (N Multiple Co-Occ.
Any Suicide prob.
w/Need=363)
w/Need=578)
d/o (N w/Need=371)
(N w/Need=95)
In need of treatment
Services to those in need
Source: GI_GM_DrugCourt_033109_Horizontal
Need but no treatment
77%
79%
79%
74%
39%
60%
57%
70%
58%
80%
66%
90%
82%
100%
78%
89%
MH issues (victimization) at intake vs.
MH Treatment+ at 3 months
20%
23%
17%
30%
17%
40%
23%
50%
10%
0%
3+ ASAM B3
PY
EverVictimized/ Current victim
Victimization
Worried
(N
(N
(n=704)
w/Need=209)
w/Need=407)
In need of treatment
Services to those in need
Source: GI_GM_DrugCourt_033109_Horizontal
High level
Victimization
(N
w/Need=478)
Need but no treatment
59%
0.6
65%
0.7
60%
60%
0.8
61%
0.9
83%
80%
HIV Risk at intake vs.
HIV Prevention/Education at 3 months
0.5
20%
0.3
20%
0.4
0%
0.1
6%
2%
0.2
0
Mod/High HIV Risk (n
w/Need=134)
In need of treatment
Mod/High Sexual Risk
(n=138)
Mod/High Needle Use (n
w/Need=4)
Services to those in need
Source: GI_GM_DrugCourt_033109_Horizontal
Mod/High GVS* (n
w/Need=104)
Need but no treatment
Resources and Tools
GAIN-I /
M90 data
Syntax &
template
files
FUL/TTL
Reports
Electronic
Site
Profiles
Encyclopedia
(GI S&V)
Evaluator
Or
Analyst
LI Analytic
Training
Series
Memos
Adult &
FTP
Common
Site
Adolescen
t Norms
Using Characteristics Profiles
•
•
Profiles are updated quarterly (in January,
April, July , October) for all CJ programs,
posted on APSS site and e-mailed to each PI.
Profiles include:
–
–
–
–
–
–
–
–
Demographics
Substance use data
Comorbidity data
Risk data
Treatment information
Selected outcomes
Individual site graphs
Two site comparison graphs
Where can I get more help
understanding characteristics profiles?
• Read documentation and descriptors first on
introduction page.
• For specific questions, email
[email protected].
• A teleconference or web conference can be
conducted to give targeted training on using
characteristics reports, or FUL/TTL reports or
anything else your site is having questions
on regarding managing or using data.
Using Site data
• Each site may use it’s own local data for analysis.
• Sites may sign a Data Sharing Agreement with one
or more other sites and share data for cross-site
analysis.
• Fully prepared datasets are provided by the GCC
Data Team to each site on a quarterly basis
– (JTDC data returned in January, April, July and October)
• The FTP Common Site has SPSS syntax and
information to help export and prepare local data.
• For more help, contact [email protected]
Process for accessing GAIN data
• Submit abstract to [email protected] for feasibility
review.
• After feasibility review and edits, abstracts are distributed
to all PI’s via listserv.
• PI’s have 2 weeks to review and respond or participation
is assumed.
• CSAT project officer gives final approval. Once this step
is complete, the GCC Evaluation team will create dataset.
• For analyses on general topics using data from programs
that are no longer in the field or if sites are not identified
and using the full CSAT AT dataset of 17,000+ cases, PI
distribution step is not needed but all other steps are.
Creating an abstract
• A structured abstract (maximum of 3 pages)
containing the following information:
1.
2.
3.
4.
5.
6.
Title
Lead author
Other (potential) authors
Proposed forum(s) (journal or conference)
Target Dates
Data sources (what data set, data and/or time
periods)
7. Objectives or questions to be addressed
8. Methods/Design/Main analyses
9. Variables to be created
10. Relevance to field
Abstract Planning and Evaluation Resources
•
•
CSAT CJ Publication Policy
FTP Common Site – Evaluator Folder
ftp://data.chestnut.org
•
Username: Common
•
Password: public
•
GAIN Website: www.chestnut.org\li\gain
– Accessing GAIN Data – LI Training Series Memo
– Data Sharing Agreements
– GAIN-I Scales and Variables File
•
Determine purpose, interpretations, availability, syntax
– Norms for adolescents and adults
•
APSS website www.chestnut.org/li/APSS/DC
– Quarterly Follow-up, Treatment Transition reports
– Site Characteristics Profiles tables and charts
•
[email protected]
What happens next….
•
•
•
•
•
•
•
•
Feasibility Review is completed.
Abstract is updated if needed based on the results of the
Feasibility Review.
Final Abstract is presented to those from whom permission is
sought (current grantees, CSAT).
Grantees are provided time on the conference call to ask
questions of the author(s).
Grantees have 2 weeks after the conference call to decline
participation.
Data sharing agreement (DSA) is completed (can be done
concurrently with above or in advance).
A de-identified dataset is provided to the evaluator or analyst.
Do the work and include the acknowledgement!
Please stay in contact if you have questions and send us a
copy of the final presentation or article!
GAIN datasets
• Full GAIN Version 5 dataset
–
–
–
–
Includes all GAIN records received.
Includes all GAIN variables and calculated items.
Doesn’t include ATM or CYT data
Doesn’t include FUL, TTL, WAI or TxSI data
• Summary Analytic dataset
– Subset to records with planned GAIN Follow-up (not
GPRA only), with GAIN-I data (no ‘loose’ M90s), with FUL
data (FUPLAN=1), sites with >80% of GAIN data
corresponding to FUL and TTL records, clients at or past
the 3-month follow-up window.
– Subset variables to Identifiers, Demographics, Days/Times
variables, Scales, Indices, and calculated variables used in
reports and analyses.
– Matched with FUL, TTL, WAI/TxSI data (on the intake
record.)
– Does not include individual symptoms.
Horizontal vs. Vertical file
WHEN to use
– When ATM and CYT data should be used – If
comparing to newer studies, be aware of version
differences in scales and indices,
– When WCG measures are needed (uses FUL and TTL
data), or costs are needed.
– When TxSI or WAI data are to be used,
– When planned follow-up and opportunity for follow-up,
accurate data, standard description are desired,
– Stacked Vertical File:
•
When NOT looking at individual change
•
Example: running mixed linear models over time and want to have a
random intercept
– Spread Horizontal File:
•
When individual change needs to be calculated and used
Types of Measures
• Scale: a set of “symptoms” or items that are intercorrelated (e.g., dependence, depression) where we
are interested in the pattern (i.e. common variance)
• Index: a set of items that may not be directly related
but add up to predict (e.g., sources of stress,
barriers to treatment, expenses)
• Ratio Estimators: one measure divided by another
(e.g., percent of unprotected sex acts)
• Status measures: a categorical status based on a
single question or created across multiple (e.g.,
vocational status, housing status)
• Survival: Time to first event (e.g., time to first use)
Interpretative Cut-Points
•
•
•
•
Definition of low, moderate and high clinical
significance bands to aid interpretation and decision
making (scale name + “g” for group)
Useful for defining need at both the client and program
level
Basis:
– DSM or other clinical standards where available
(e.g., clinical is 3+/7 dependence)
– 50th & 90th percentile for common issues (e.g.,
days of alcohol use)
– 1+ and median of 1+ for zero saturated (more than
half) and right skewed variables
Reverse-coded if “up” is low clinical significance
(e.g. Treatment Motivation)
Other Ways to get Help
1. Use our email support lines:
•
for GAIN and QA/certification questions;
[email protected]
•
for software questions:
[email protected];
•
for data submission/data questions:
[email protected],
•
for evaluation/analysis questions:
[email protected].
2. Contact GCC DC Project Coordinator
Kate Moritz
[email protected]
309-451-7831
Full presentation is available
on the GAIN website
www.chestnut.org\li\gain
(under Research Presentations and Posters)
or
on the APSS\DrugCourt website
(under Major Meeting Materials)
www.chestnut.org/li/APSS/DC