GAIN SS TRAINING
Global Appraisal of Individual needs
GAIN SS ver. 3.0.1 CAMH
Beth Powell
Cindy Smythe
OBJECTIVES
At the conclusion of this session,
participants will be able to:
• Administer the GAIN Short-Screener to participants
• Score and interpret the GAIN-SS for individuals; as
a measure of change; and for program planning
SCREENING VS. ASSESSMENT
It’s a Screener if . . .
• Is brief and easy to
administer/score
• Does not collect diagnostic
information but:
o Identifies individuals in
need of further
assistance (i.e.,
assessment or
intervention)
o Provides a general sense
of severity
It’s an Assessment if . . .
• Involves a more rigorous
scoring process
• Must be interpreted by a
trained/licensed
professional
• Asks comprehensive
questions that provide
diagnostic information
• Can be used to create a
detailed treatment plan
WHY SCREEN?
• Limited resources for assessment
• Individuals with co-occurring problems are more
likely to experience:
– problems with treatment and medication adherence
– shorter lengths of stay and administrative discharges
– worse outcomes following treatment (functional
status, community adjustment, quality of life, etc.)
TOUR OF THE GAIN-SS VER. 3.0.1 CAMH
OVERVIEW OF THE GAIN-SS
CAMH Modified
• A 3 - to 5 minute screener
• Used in general populations to identify clients with
behavioral health disorders – ages 12 and up
• Easy for use by staff with minimal training or direct
supervision
• Provides a measure of change
• Designed for self - or staff- administration, with
paper and pen, computer, or on the web
• Available in other languages
Comprised of Four Screeners
• Internalizing Disorder Screener (IDScr)
• Externalizing Disorder Screener (EDScr)
• Substance Disorder Screener (SDScr)
• Crime/Violence Disorder Screener (CVScr)
______________
• TOTAL Disorder Screener
• +6 Additional Questions added by CAMH
Internalizing Disorder Screener
(IDScr)
Externalizing Disorder Screener
(EDSCR)
Substance Disorder Screener
(SDScr)
Crime/Violence Screener
(CVScr)
Additional Questions
(CAMH)
Other Items
ADMINISTRATION
ADMINISTRATION GUIDELINES

Ask the items exactly as printed
– Explain words/phrases as needed

Ask every item

Read each item completely, including the header

Repeat items that are misunderstood

Read items at an appropriate pace

Do not suggest answers

Use common sense!
PREPARATION
• Find a quiet, private place
• Consider using the Cognitive Impairment Screener if you
suspect intoxication or other problems
• Read the introduction
• Develop individualized “anchors” with clients
• If the GAIN-SS is self-administered, ask clients if they
want your help
CHECK FOR COGNITIVE IMPAIRMENT
• Helps staff verify the participant’s ability to locate
him/herself in place and time
• The interview would ideally be rescheduled if there is
a temporary problem (e.g., intoxication).
• If you continue with the interview despite problems:
– Orally administer the screener
– Note the client’s problems in the Staff Use Box
– Avoid over-interpreting the results
DEVELOPING PERSONALIZED ANCHORS
• Responses for GAIN-SS items are “Past
month,”, “2-3 months ago”, “4 to 12 months ago”,
and “1+ years ago.”
• Anchors are life events that help clients
distinguish between these time periods.
• Instructions for anchoring are included in the
GAIN-SS manual
INTRODUCING THE GAIN-SS
• Explain why the interviewer needs to ask the
questions
• Address confidentiality and any exceptions to
confidentiality or privacy
• Describe how the client’s answers will be used
• Say how long the screener will take
• Use common sense!
INSTRUCTIONS
• Complete the header
• Read the introductory paragraph
• Read each item carefully
• Do not skip items
• Choose only 1 response per item
• Read the stem at the beginning of each section
INSTRUCTIONS
• Do not accept “sometimes,” “sort of,” or
“maybe” as answers
• Clearly mark any corrections
• Write verbatim responses neatly
• Let clients know it’s okay to ask questions
• Review the form for completion/accuracy
SCORING & INTERPRETATION
TYPES OF SCORES
The GAIN-SS generates two types of
scores:
– DOMAIN scores
One score for each of the four domains or
subscreeners
– TOTAL score
Score for the entire tool
Scoring the GAIN-SS
• DOMAIN Scoring
– Count the number of symptoms the client endorses
experiencing. You can score in the past month, past 90 days,
past year or ever. This means counting the numbers of 1s, 2s, 3s
and/or 4s reported in each subscreener.
• Adding the four domain (subscreener) scores yields the
TOTAL Score.
• Record the score for each subscreener and the Total
Disorder Screener in the Staff Use Box.
• The CAMH questions are not scored but simply used for
clinician information
Scoring the GAIN–SS Continued
• Adding the four domain (subscreener) scores yields the TOTAL Score.
• Record the score for each subscreener and the Total Disorder Screener
in the Staff Use Box.
• The CAMH questions are not scored but simply used for clinician
information
SCORING THE GAIN-SS
• Low (0): Unlikely to have a diagnosis or
need services
• Moderate (1 to 2): A possible diagnosis
• High (3 to 23 on the total screener; 3 to 5
on the sub-screeners): High probabilities
of a diagnosis
GAIN-SS DEMO
• Follow along and document the participant’s responses
on your blank GAIN-SS
• As you watch the demo, pay attention to:
• The introduction
• Establishing anchors
• The way the interviewer reads the questions
• Clarification of the participant’s responses
INTERPRETATION AT THE
INDIVIDUAL LEVEL
• Someone with a high score (3 to 23) on the
Total Disorder Screener (TDScr) will probably
have a diagnosis when given the full GAIN
• Use scores in the moderate range (1-2) or
high range (3-5) on the 4 sub-screeners to
identify the specific kinds of behavioral health
services that are needed
INTERPRETATION AT THE
INDIVIDUAL LEVEL
• Moderate/high scores on the Internalizing
Disorder Screener suggest mental health
treatment related to somatic complaints,
depression, anxiety, trauma, suicide and
serious mental illness.
INTERPRETATION AT THE
INDIVIDUAL LEVEL
• Moderate/high scores on the Externalizing
Disorder Screener suggest mental health
treatment related to attention deficits,
hyperactivity, impulsivity, conduct problems
and gambling.
INTERPRETATION AT THE
INDIVIDUAL LEVEL
• Moderate/high scores on the Substance
Disorder Screener suggest the need for
substance abuse, dependence, and
substance use disorder treatment.
INTERPRETATION AT THE
INDIVIDUAL LEVEL
• Moderate/high scores on the Crime/Violence
Screener suggest the need for help with
interpersonal violence, drug-related crimes,
property crimes interpersonal/violent crimes.
INTERPRETING GAIN-SS SCORES
AS A MEASURE OF CHANGE
• The past-month symptom count in the TDScr
(0-23) or any of the 4 sub-screeners can be
used as a simple measure of change after
intervals of a month or more.
INTERPRETING GAIN-SS SCORES
AS A MEASURE OF CHANGE
• The past-year and lifetime measures can be
used to create trajectories and predict risk.
– High severity in early remission: 3 or more lifetime
problems and 0 past-month problems (2s and 1s with
no 3s)
– High severity in sustained remission: 3 or more
lifetime problems and 0 past-year problems (1s with
no 2s or 3s)
INTERPRETATION FOR QUALITY
ASSURANCE & PROGRAM PLANNING
The GAIN-SS:
– Can be used as a simple form of needs assessment
to guide program development
– Can compare staff or sites on the extent to which
expected diagnoses/referrals turn into actual cases
– Gives an objective guidepost to compare
performance and track it over time
Strengths
•
•
•
•
•
Same language in both sectors
Standardized questions
Consistent data collection
Better understanding of prevalence of CD clients
Promotes integration of addiction and mental
health
• High risk clients – may be only contact
Building Staff Commitment*
• Staff were initially reluctant to use this tool but
once they started administering the tool, they
found it easy and useful in understanding [clients]
and underlying issues.
• The GAIN-SS was used to augment the information
taken at intake on [the client’s] emotional state,
mental health issues and substance use and to
develop a service plan. We found that several times
[clients] declared information on the GAIN-SS that
hadn’t been disclosed at intake.
Clinical use of data*
• The GAIN screener did prompt discussion amongst
staff at case review.
• Findings were discussed at weekly team meetings
and at staff supervision.
• The tool was employed at team meetings to
generate discussion on suicidality, substance use
and mental circumstances.
• The [clients] goals and service plans were reviewed
weekly with the team and the GAIN-SS results were
integrated into these discussions
About screening - from clients*
• You find out new things that help you to realize new things about why
you are using.
• It’s confidential, nothing was missed with questions.
• Fine with all questions asked. Weren’t complicated, were
straightforward and not too personal. Not uncomfortable.
• Best way to get information is to have one on ones…but it’s good to fill
out forms, but good to do both. Kind of balanced, forms are necessary.
Good starting point.
• Screeners are helpful for sure. They are helpful to recognize other
concerns… came in for concerns about depression and anxiety but then
started substance use treatment.
Barriers
• Implementation of any kind takes a very long
time
• Attitude to Action Gap
• If assessment is certain why screen?
• Narrative vs Tool
• Use of all Scales
INFORMATION AND REFERENCES
Local contact: Beth Powell [email protected],
519-858-5158 x20082
GAIN-SS Manual 3.0
http://www.gaincc.org/_data/files/Instruments%20and
%20Reports/Instruments%20Manuals/GAINSS_Manual_3_0.pdf
*Chaim, G. and Henderson, J. (2009). Innovations in
Collaborations. Canadian Mental Health Association: Ottawa, ON
THANK YOU