No Wrong Door

An approach to service organization that provides individuals with or links them to appropriate service interventions regardless of where they enter the system of care. This principle commits all service agencies to respond to the individual’s stated and assessed need through either direct service or a linkage to appropriate programs, as opposed to sending the person from one agency to another.

(Co-Occurring Center for Excellence; Substance Abuse and Mental Health Services Administration)

The principles of the No Wrong Door approach include: A truly integrated system of care that increases access to

services through multiple points of entry where every doorway in the system is the “right door” regardless of the presenting problem.

Eliminating gaps in services by promoting interagency partnerships through the development of shared resources.

A continuum of services that are culturally and linguistically competent and age appropriate when addressing the complex needs of individuals with co-occurring disorders.

A family-driven and youth-guided system of care that minimizes confusion, enhances individual choice, and supports informed decision making for children, adolescents, and their families.

A system that addresses significant changes and improvements at the conceptual, organizational, and provider levels.

Entry Point:AOD DMHDOE COCDSS DJJHealth Entity

AdministerGAIN SS

Decision

AOD high?

AOD/MH equal?

MH high?

AODAssesses

MHAssesses

Staff Tx Recommendations & Referrals:Demo Site PartnersParentAdolescent

Staff(phone)

Using the GAIN Short Screener

Administration, Scoring and Interpretation

GAIN-SS Version 2.0.1

Objectives

At the conclusion of this session, participants will be able to:

Administer the GAIN Short-Screener to participants

Score and interpret the SS for individuals; as a measure of change; and for program planning

Utilize the web version of the SS

Overview of the GAIN-SS A 3- to 5-minute screener Used in general populations to identify or

rule-out clients with behavioral health disorders

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 Spanish version available

Tour of the GAIN-SS

Comprised of Four Screeners Internalizing Disorder Screener (IDScr) Externalizing Disorder Screener (EDScr) Substance Disorder Screener (SDScr) Crime/Violence Disorder Screener

(CVScr)______________ TOTAL Disorder Screener

Internalizing Disorder Screening (IDScr)

Externalizing Disorder Screening (EDScr)

Substance Disorder Screening (SDScr)

Crime/violence Disorder Screening (CVScr)

Other Items

Administration

Administration Guidelines Ask the items exactly as printed.

You can clarify words/phrases Ask every item. Read each item completely. Repeat items that are misunderstood. Read items at an appropriate pace. Do not suggest answers. Use Common Sense!

Preparation Find a quiet, private place Read the sample introduction or develop

an alternative for your specific situation If the GAIN-SS is self-administered, ask

clients if they want your help Consider using the Cognitive Impairment

screener if you suspect intoxication or mental problems

Develop individualized “anchors” with clients

Introducing the GAIN-SS

Explain why the interviewer needs to ask the questions

Tell whether the questions are asked of every client, or the basis for which the client is being asked the questions now

Inform about confidentiality and any limits to confidentiality or privacy

Describe how the client’s answers will be used

Convey how long the assessment will take Use your common sense

Check for Cognitive Impairment

Helps staff to verify the participant’s ability to locate him/herself in place and time prior to the assessment

If there is a problem that appears to be transitory, reschedule the interview

If there is a problem but you are continuing with the interview, orally administer it, and avoid over-interpreting the responses. (It will take longer.)

Note the client’s problems when reporting the results

Instructions Complete the header Read the introductory paragraph Read each item carefully Do not skip items Choose only 1 response Read the stem at the beginning of

each section

Instructions (Continued)

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

Developing Personalized Anchors Help participants be clear about

the time period covered by the questions

Clearly state the time period in the question

Identify personal “anchors”

Completing the Staff Use Box

Completing the Staff Use Box

Items 8-10 - Record the Site, Staff, and Client ID numbers and names

Item 11 - Record the mode of administration Item 12 – Use for scoring past-year symptoms Item 13 - If applicable, check where the client

is being referred Item 14 - Record the primary program code of

the place where the client is being referred, using project/agency-specific codes

Item 15 – Referral comments

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 scoreScore for the entire tool

Scoring the GAIN-SS

DOMAIN Scoring Count the number of symptoms the client

endorses experiencing in the past year (responses of 3/“Past Month” or 2/“2-12 months ago”).

Since there are five items in each domain the maximum score in each domain is five.

Adding the four domain scores yields the TOTAL Score.

Record the score for each subscale and the TDScr in the staff use box.

Scoring the GAIN-SS (con’t)

Low (0): Unlikely to have a diagnosis or need services

Moderate (1 to 2): A possible diagnosis

High (3 to 20 on the total screener; 3 to 5 on the sub-screeners): High probabilities of a diagnosis

Table 1. Scoring Template

Screener ItemsPast month

(3s)Past year

(3s, 2s)Lifetime

(1s, 2s, or 3s)

Internalizing Disorder Screener (IDScr)

1a-1e      

Externalizing Disorder Screener (EDScr)

2a-2e      

Substance Disorder Screener (SDScr)

3a-3e      

Crime/Violence Screener (CVScr)

4a-4e      

Total Disorder Screener 1a-4e      

___

___

___

___

___

IDScr (items 1a-1e) EDScr (items 2a-2e) SDScr (items 3a-3e) CVScr (items 4a-4e) ______________ TDScr (items 1a-4e)

Scoring Amber’s GAIN-SS3

0

2

1

6

Interpretation at the Individual Level

Someone with a high score (3 to 20) 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 (Continued)

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 (Continued)

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 (Continued)

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 (Continued)

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 (0-20) or any of the 4 sub-screeners (0-5) can be used as a simple measure of change after intervals of a month or more.

The past-year and lifetime measures can be used to create trajectories and predict risk.

Interpreting GAIN-SS Scores as a Measure of Change 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 and Program Planning The GAIN-SS can be used as a simple form

of needs assessment Help guide program development/planning

and decisions about the purchase of further training or technical assistance

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