1 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 Effectiveness Baltimore, 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: [email protected]
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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)
• 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)
• 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
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Agency A
`
Agency B
`
Agency C
Acc
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App
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Acc
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App
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Accessing GAIN Application Accessing GAIN Application