GAIN-SS

Global Appraisal of Individual Needs–

Short Screener (GAIN-SS):
Administration and Scoring Manual
Version 2.0.1
December 2007

Michael L. Dennis, Ph.D.

Tim Feeney
LaVerne Hanes Stevens, Ph.D.
Liliana Bedoya, B.A.
Chestnut Health Systems
720 W. Chestnut
Bloomington IL 61701
Phone (309) 827-6026
Fax (309) 829-4661
[email protected]
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 ACKNOWLEDGEMENTS

The development of this manual was supported by the Substance Abuse and Mental Health
Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) under
contracts 207-98-7047, 277-00-6500, and 270-2003-00006, using data provided by the following
grantees: CSAT (TI-11320, TI-11324, TI-11317, TI-11321, TI-11323, TI-11874, TI-11424, TI-
11894, TI-11871, TI-11433, TI-11423, TI-11432, TI-11422, TI-11892, TI-11888, TI013313,
TI013309, TI013344, TI013354, TI013356, TI013305, TI013340, TI-130022, TI03345,
TI012208, TI013323, TI-14376, TI-14261, TI-14189,TI-14252, TI-14315, TI-14283, TI-14267,
TI-14188, TI-14103, TI-14272, TI-14090, TI-14271, TI-14355, TI-14196, TI-14214, TI-14254,
TI-14311, TI-15678, TI-15670, TI-15486, TI-15511, TI-15433, TI-15479, TI-15682, TI-15483,
TI-15674, TI-15467, TI-15686, TI-15481, TI-15461, TI-15475, TI-15413, TI-15562, TI-15514,
TI-15672, TI-15478, TI-15447, TI-15545, TI-15671, TI-11320, TI-12541, TI00567); NIAAA
(R01 AA 10368); NIDA (R37 DA11323, R01 DA 018183); the Illinois Criminal Justice
Information Authority (95-DB-VX-0017); the Illinois Office of Alcoholism and Substance
Abuse (PI 00567); the Intervention Foundation’s Drug Outcome Monitoring Study (DOMS); and
the Robert Woods Johnson Foundation’s Reclaiming Futures project. Any opinions about these
data are those of the authors and do not reflect official positions of the government or individual
grantees. Thanks to Janet C. Titus, Joan I. Unsicker, Rod Funk, Ya-Fen Chan, Michelle White,
Lexy Adkins, and David Smith for their help in writing this manual. Thanks to Sandra
McGuinness for developing the software application. Suggestions, comments, and questions can
be sent to Dr. Michael Dennis, Chestnut Health Systems, 720 West Chestnut, Bloomington, IL
61701, [email protected]. Please cite as:

Dennis, M. L., Feeney, T., Stevens, L. H. (2006). Global Appraisal of Individual

Needs–Short Screener (GAIN-SS): Administration and Scoring Manual for the GAIN-
SS Version 2.0.1. Bloomington, IL: Chestnut Health Systems. Retrieved on [insert
date] from http://www.chestnut.org/LI/gain/GAIN_SS/index.html.

Copyright © 2007 Chestnut Health Systems, Bloomington, IL

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 TABLE OF CONTENTS
Acknowledgements ..................................................................................................................................................... iii
Table of Contents...........................................................................................................................................................v
1. Introduction ...............................................................................................................................................................1
1.1 Overview of the GAIN-SS..................................................................................................................................1
1.2 Summary of Psychometrics ................................................................................................................................2
Figure 1. GAIN Model of Emotional, Behavioral, Substance, Crime, and Violence Problems......................2
2. Planning Guidelines...................................................................................................................................................3
2.1 Preparation ..........................................................................................................................................................3
2.2 Optional Use of the GAIN’s Cognitive Impairment Scale (CIS)........................................................................4
Figure 2. GAIN Cognitive Impairment Scale..................................................................................................5
3. Instructions for GAIN-SS Administration .................................................................................................................5
3.1 Instructions for Administration...........................................................................................................................6
3.2 Introducing the GAIN-SS to the Client...............................................................................................................7
3.3 Developing Personalized Anchors ......................................................................................................................7
3.4 Completing the Staff Use Box ............................................................................................................................8
Figure 3. Staff Use Box (Paper Version).........................................................................................................9
4. Scoring the GAIN-SS (item 12).................................................................................................................................9
Table 1. Scoring Template ............................................................................................................................10
Figure 4. Example of GAIN-SS profile.........................................................................................................10
5. Interpretation ...........................................................................................................................................................11
5.1 Interpretation at the Individual Level................................................................................................................11
Figure 5. Total Disorder Screener for Adolescents .......................................................................................12
Figure 6. Total Disorder Screener for Adults ................................................................................................12
5.2 Interpretation as a Measure of Change..............................................................................................................14
5.3 Interpretation for Quality Assurance and Program Planning ............................................................................14
5.4 Evaluation of Penetration and Referral Rates ...................................................................................................15
6. GAIN-SS Software ..................................................................................................................................................15
6.1 Introduction and Logging In .............................................................................................................................15
Figure 7. Log-in Screen.................................................................................................................................16
6.2 Self-Administration of the Online GAIN-SS....................................................................................................16
Figure 8. Disclosure Notice...........................................................................................................................16
6.3 Staff Administration of the Online GAIN-SS ...................................................................................................17
Figure 9. Sample Message Confirmation ......................................................................................................18
Figure 10. Staff Use Box...............................................................................................................................18
6.4 View and Edit a Previously Entered GAIN-SS.................................................................................................19
Figure 11. Search Results Screen ..................................................................................................................19
6.5 Implementing the GAIN Short Screener Application on Your Website ...........................................................19
References ...................................................................................................................................................................20
Glossary.......................................................................................................................................................................20
GAIN Short Screener (GAIN-SS) ...............................................................................................................................21
2006-2007 Calendar ....................................................................................................................................................23
2007-2008 Calendar ....................................................................................................................................................24
Tear-off Instructions for Self-Administration..............................................................................................................25
Tear-off Sample Introduction ......................................................................................................................................26
Tear-off Personalizing Time Anchors .........................................................................................................................26

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 GAIN Short Screener (GAIN-SS) Administration and Scoring Manual

1. INTRODUCTION

1.1 Overview of the GAIN-SS

The 5-minute GAIN Short Screener (GAIN-SS) is designed primarily for three things. First, it
serves as a screener in general populations to quickly and accurately identify clients (also known as
patients, respondents, or research participants) whom the full 1.5 to 2-hour GAIN–Initial would
identify as having one or more behavioral health disorders (e.g., internalizing or externalizing
psychiatric disorders, substance use disorders, or crime or violence problems), which suggests the
need for referral to some part of the behavioral health treatment system. Second, estimates of need
from the GAIN-SS can be used as a common metric across multiple systems or remote staff (e.g.,
employee assistance program with multiple contractors) and as a denominator for quality assurance
on the extent to which the rate of diagnoses/referrals are consistent with the estimated mix of
problems from the GAIN-SS (discussed further on page 15). Such measures of quality assurance
can be used for one-on-one supervision or performance-based contracting. Third, it serves as a
periodic measure of behavioral health change over time.

The full GAIN-SS is reproduced on p. 21.

The GAIN-SS is designed for self- or staff administration with paper and pen, on a computer, or on
the web. It can be easily converted to a scannable form or incorporated into existing instrument
batteries or systems. Versions in different languages (such as Spanish) are also available. The
GAIN-SS has been used on adolescents as young as 10; however, younger adolescent clients are
likely to need more concepts explained to them, and the interview may take longer than average.

GAIN-SS responses are given in terms of the recency of the problem described in the questions:
3 = past month; 2 = 2 to 12 months ago; 1 = 1+ years ago; 0 = never. The number of past-month
symptoms (number of 3s) is used as a measure of change; the number of past-year symptoms
(number of 3s and 2s) is used to identify people likely to have a current diagnosis; and the
number of lifetime symptoms (number of 3s, 2s, and 1s) is used as a covariate measure of
lifetime severity. The recency measures can also be combined to create course specifiers (e.g.,
early remission means having a lifetime problem but not in the past month; sustained remission
means having a lifetime problem but not in the past year).

An alternate past-year version of the GAIN-SS is also available at http://www.chestnut.org/

LI/gain/GAIN_SS. The past-year version is simplified to ask about problems that have occurred
only in the past 12 months, using a 0 = no and 1 = yes response set. The past-year version of the
GAIN-SS can give only a past-year symptom count and is scored by counting the number of 1s,
but it is otherwise parallel to the version of the GAIN-SS described in this manual. While the
past-year version does have a slightly shorter administration time and is in use by some systems
as the “minimum” required screener, it is generally not recommended for use because it lacks the
ability to provide past-month symptom counts (measure of change) or lifetime symptom counts
(as a covariate). The annual has the advantage of being easier for the client to answer.

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1.2 Summary of Psychometrics

Dennis, Chan, and Funk (2006) found that for both adolescents and adults the 20-item Total
Disorder Screener (TDScr) and its four 5-item subscreeners (internalizing disorders,
externalizing disorders, substance disorders, and crime/violence) have good internal consistency
(alpha of .96 on the total screener), were highly correlated (r = .84 to .94) with the 123-item
GAIN Individual Severity Scale (GISS) and its four respective main scales (Internal Mental
Distress Scale, Behavior Complexity Scale, Substance Problem Scale, Crime and Violence
Scale) in the full GAIN-I. The TDScr and four subscreeners have excellent sensitivity (90% or
more) for identifying people with a disorder and for correctly ruling out people who did not
(92% or more). A confirmatory factor analysis of the structure of the GAIN-SS (Figure 1) shows
that it is also consistent with the full GAIN model after allowing adolescent and adult path
coefficients to vary and cross-loading paths between conduct disorder items with crime/violence
items. The confirmatory factor analysis was slightly less accurate than the full-scale GAIN-I in
terms of the confirmatory fit index (CFI; .87 for the GAIN-SS vs. .92 for the full GAIN, where
as the CFI approaches 1 the model fits the data better) and slightly more precise in terms of the
root mean square error of approximation (RMSEA; .05 for GAIN-SS vs. .06 for the full GAIN,
where as the RMSEA goes down there is less unexplained variance). This suggests that each of
the subscreeners has good discriminant validity and that the total structure is consistent with the
model used with the full GAIN.

Figure 1. GAIN Model of Emotional, Behavioral, Substance, Crime, and Violence Problems

* Conduct disorder cross-loads with the Crime/Violence Scale in statistical versions of this model.
Dennis, Chan, and Funk (2006)

As reliable as the GAIN-SS is, it is still simply a self-reported screener and should supplement,
not replace, the judgment of clinical line staff with urine test results, collateral reports, or other
background information available to them. This is particularly important when screening in
settings that involve incarceration, welfare investigations, or other situations where the fear of
possible consequences or concerns about confidentiality may influence client answers and affect
the validity of their responses.

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Copies of the instruments, norms from clinical samples, and more detailed psychometrics are
available at http://www.chestnut.org/LI/gain/GAIN_SS/index.html.

2. PLANNING GUIDELINES

2.1 Preparation

o Find a quiet, private space for the client to work on the assessment.
o Develop a short transitional statement to help initiate the assessment. Section 2.2 gives
examples of introductions for different types of interviewing situations.
o For the paper version of the assessment make sure that the client has a pen, not pencil,
available. (Pencil is not considered secure.) For computer administration make sure that a
computer system is set up for the client’s use.
o Read the introduction on p. 7 as written, since paraphrasing can lead to mistakes and often
ends up taking more time than simply reading the introduction as written. If the context of
the interview is routinely different from the introduction on p. 7, consider writing an
alternative to be used consistently in your situation or tailored to specific interviewing
situations.
o If planning to have clients self-administer the GAIN-SS, be sure to ask them whether they
would like to complete it themselves or whether they would like you to read the items to
them and have them circle the responses themselves. Clients with reading difficulties will
generally take advantage of the offer or might want only certain items read, so be ready to
accommodate them. Also be sure to have a proctor or other staff member available to answer
questions and, if administering the GAIN-SS to a number of people simultaneously, ensure
that clients in a group focus on their own answers.
o If you are in a situation where people are cognitively impaired due to severe intoxication or
other mental health issues, consider having copies available of the GAIN Check for
Cognitive Impairment screener to help staff members decide whether to proceed with the
GAIN-SS. Instructions and a copy of this measure start on p. 4 of this manual.
o Whether self- or interviewer-administered, use the sample introduction to establish
individualized “anchors” with clients. Confusion about the recency of a problem is the most
common source of unreliable data, but validity can be improved by helping the client develop
personal anchors for past-month and past-12-month time frames. Be sure to have a calendar
available to help. As old calendars expire, they can be replaced by new calendars available for
download from http://www.chestnut.org/LI/gain/GAIN_QxQ/Index.html - calendar. (Please
see p. 7 for instructions on how to develop anchors.)
o Review procedures for scoring (p. 9), and determine any specific referral codes that you want
to use or types of referral comments that you want staff members to make.
o Set up procedures to check clients’ self-completed GAIN-SS forms for missing or unclear data.

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2.2 Optional Use of the GAIN’s Cognitive Impairment Scale (CIS)

Sometimes you may suspect that a client is experiencing some degree of cognitive impairment.
Such impairment may be the result of current intoxication or temporary or permanent mental
problems. You may know that the client is impaired before you start, or it may become apparent
as you attempt to do the interview. If the client is too distraught, distracted, intoxicated, or
otherwise impaired to do the assessment, it may make more sense to postpone the interview,
since the client must be able to place themselves in space and time in order for their responses to
be valid.

Prior to administering the GAIN-SS it is important to verify that the participant possesses the
necessary cognitive and literacy skills to complete the assessment, and doing so is required by
the Joint Commission on Accreditation of Healthcare Organizations (1995). This can be done by
directly observing participant performance on other tasks prior to the assessment or through
some kind of mini–mental-status exam when their mental status is unclear. Unfortunately,
impairment is often a matter of degree, and it is not always clear when someone is too impaired
to go through the interview process. For these situations interviewers have the option of using the
GAIN’s Cognitive Impairment Screener (CIS; Dennis et al., 2003), shown in figure 2. The CIS is
a modified version of the 10-item Short Blessed Scale of Cognitive Impairment (Katzman, Fuld,
Peck, Schechter, & Schimmel, 1983), which has been used extensively in research on substance
abuse, homelessness, head injury, Alzheimer’s, and other forms of cognitive impairment.

To administer the CIS, ask each question and then circle the code for the number of errors. Note
that each error does not equal one point: for example, missing one number when counting
backwards from 20 to 1 equals two points, and missing two numbers would equal 4 points.

As the number of errors go up it will likely be increasingly difficult to get reliable and valid
answers from the client. In general, about 5% of a substance abuse treatment population will
score 10 or higher (with 1-2% scoring 14 or more). In populations with head injury, Alzheimer’s,
or long-term forms of cognitive impairment, scores over 10 will generally exceed 80%. If the
client’s main problem is intoxication, distress, or another problem that appears to be transitory, it
is probably better to reschedule the interview if possible. If you do decide to proceed in spite of a
higher score, you should:

○ Orally administer the GAIN.

○ Assume that the interview will be more difficult or take longer.
○ Be very careful to avoid overinterpreting the responses.
○ Note the client’s problems when reporting the results.

In general, if a person cannot remember any of the recall test (the John Brown phrase, item e),
the interview will be very problematic, and alternative means of assessment should be considered
(e.g., relying on collateral report, psychiatric referral). If the total score is more than 12, the
person may be too impaired to continue. You will need to consult with your supervisor to
determine whether to reschedule, assess in another way, or proceed with the understanding that
the GAIN-SS’s summary reports may not be as accurate.

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During follow-up or a subsequent admission, it is not uncommon for higher-functioning people
to recall the entire CIS. Usually this can be interpreted as a sign that there are few (if any) recall
problems.

Figure 2. GAIN Cognitive Impairment Scale

Because we are going to ask you a lot of questions about when and how often things have
happened, I need to start by getting a sense of how well your memory is working right now.

ERROR SCORES
a. What year is it now? ________________
(Circle 4 for any error) ........................................................................ 0 4

b. What month is it now? ________________

(Circle 3 for any error) ........................................................................ 0 3

Please repeat this phrase after me: John Brown, 42 Mark Street, Detroit.
(No score -- used for f below)

c. About what time is it? ________________

(Circle 3 for any error) ........................................................................ 0 3

d. Please count backwards from 20 to 1.

[20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, 5, 4, 3, 2, 1]
(Circle 2 for one error, 4 for 2 or more errors).............................. 0 2 4

e. Please say the days of the week in reverse order.

[Sat, Fri, Thurs, Wed, Tues, Mon, Sun]
(Circle 2 for one error, 4 for 2 or more errors).............................. 0 2 4

f. Please repeat the phrase I asked you to repeat before.

[John/ Brown/ 42/ Mark Street/ Detroit]
(Circle 2 for each subsection of /text/ missed) ....................... 0 2 4 6 8 10

g. (Add up scores from a through f and record): ........................................... |__|__|

(If total is greater than 10, the individual is experiencing some degree of cognitive
impairment. You can attempt again later if intoxication is suspected, or proceed and take
into account when making the interpretation.)

3. INSTRUCTIONS FOR GAIN-SS ADMINISTRATION

On the next page are simple instructions that can be used to train staff members to administer
and score the GAIN-SS. The interviewer does not have to read these instructions to the client
but should instead use them as training instructions on how to administer the interview.

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The last two pages of this manual include tear-off instructions for self-administration, a sample
introduction, and guidelines for establishing personalized anchors. These pages omit some staff-
specific instructions and address the client as “you” for the purpose of client self-administration.

3.1 Instructions for Administration

To complete the form:

o Start at the top of the first page and enter the client’s first name, middle initial, and last name
in the designated fields.
o Enter the date in the space below the client’s name. Be sure to use only numbers and the
mm/dd/yyyy format—for instance, if the date is January 1st 2007, enter “01/01/2007.”
o Read the introductory paragraph.
o Read the first item, document the response, and continue in order.
o Please read each item carefully to avoid any misunderstanding. Be sure to follow the dotted
line to the response choices.
o Be sure to choose only one response. Make sure that the responses are marked clearly.
o If you have to make any corrections, be sure to cross out the original response and write the
new response neatly.
o Ask the client to answer as accurately as possible. If the client has trouble remembering the
last time something happened, ask for their best estimate.
o Note that the client can’t answer a question with “Sometimes” or “Sort of” or “Maybe.” If
this happens, ask the client to choose the response that comes closest to how they feel.
o If the client really can’t choose between responses, doesn’t know the answer, or simply does
not want to answer, leave the response blank. Those items will not be considered in the scoring.
o Don’t forget to read the stem at the beginning of each section (e.g., “When was the last
time…”). You should also repeat the stem before an item if you get interrupted and have to
repeat or restart a question.
o Be sure to write neatly the response to for item 5 neatly (Do you have other significant
psychological, behavioral, or personal problems that you want treatment for or help with?).
Problems are considered significant when clients have them for two or more weeks, when the
problems keep coming back, when they keep clients from meeting their responsibilities, or
when they make clients feel like they can’t go on. You can write “None” if applicable. Note
that the numbers v1, v2, and v3 are used for data entry purposes; if you have a long response,
it’s okay to use all three lines for one answer. Also note that you don’t have to provide three
responses but can write as much or as little as you like. You can also use the margin or
another sheet if you need more space.
o For item 6 fill in the client’s gender: 1 for male, 2 for female, 99 for other. If other, use the
line below the item to specify how the client identifies themselves (e.g., transgender male to
female, female to male).
o For item 7 fill in the client’s age as of the date of the interview.
o Tell the client to ask if they do not understand a question or word.
o If you are allowing the client to self-administer, ask them to please not write in the “For Staff
Use Only” box.

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o Please check the form before the client leaves to make sure that all of the responses have
been entered and everything is complete.

3.2 Introducing the GAIN-SS to the Client

Research suggests that the validity of clients’ responses is improved if they understand the
interview process and know how their information will be used (Boruch, Dennis, & Cecil, 1996).
Therefore, it is important to cover this material when introducing the GAIN-SS to the client. The
most common client concerns that should be addressed in the introduction include:
○ The purpose of the questions.
○ Whether the questions are asked of every client, or the basis for which the client is being
asked the questions now.
○ How private and confidential the responses are (particularly in criminal justice or
employment settings).
○ How the client’s answers will be used.
○ How long the assessment will take.

Below is a standard introduction:

To help us get a better understanding of any problems you might have, how they are related
to each other, and what kind of services might help you the most, I would like to spend about
5 minutes asking you 20 questions as part of a short screener that we use with many of our
clients. Your answers are private and will be used only for your treatment and to help us
evaluate our own services.

If you are not sure about an answer, please give us your best guess. If you simply do not
know the answer to a question, you can tell me and I’ll enter “DK” for that item. You may
also refuse to answer any question, and I’ll enter “RF” for that item. Please ask if you do not
understand a question or a word. At the end of the interview, I will check to make sure that
everything is complete, and I’ll answer any additional questions.

Do you have any questions before we begin?

3.3 Developing Personalized Anchors

Research suggests that the biggest impediment to reliability in a self-reported assessment is

confusion about the time period covered by the questions (Cottler, Robins, & Hezler, 1989;
Gaskell, Wright, & O’Muircheartaigh, 2000; Sudman & Bradburn, 1973). The classical solutions
to this problem are to clearly state the time period in the question and to identify personal
“anchors” that relate to these time periods. Because the GAIN-SS relies on the client’s
perception of the recency of their problems, a script for developing personalized anchors (also
incorporated into the script that appears on the last page of this manual as a tear-off sheet) is
provided here. A current calendar appears at the end of this manual, and updated calendars are
available at http://www.chestnut.org/LI/gain/GAIN_QxQ/index.html#CALENDAR.

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The interviewer or other staff member should read the script below and follow the UPPERCASE
instructions.

o Several questions will ask you about things that may have happened during the past month, 2
to 12 months ago, or more than 12 months ago. To help you remember these time periods,
please look at this calendar. (GIVE CALENDAR TO CLIENT.)
○ Do you recall anything that was going on about (DATE 30 DAYS AGO)? (PROBE FOR
SPECIFIC EVENT)
○ If the last time that something happened was since (NAME OF EVENT THAT WAS 30
DAYS AGO), please answer, “Past month.”
○ Do you recall anything that was going on about (DATE 12 MONTHS AGO)? (PROBE FOR
SPECIFIC EVENT)
○ If the last time that something happened was between (EVENT FROM 30 DAYS AGO)
and (EVENT FROM 12 MONTHS AGO), please answer, “2 to 12 months ago.”
○ If the last time something happened was before (EVENT 12 MONTHS AGO), please
answer, “1+ years ago.”
○ If something has never happened, please answer, “Never.”
If the client is unable to recall any events for either of the above time periods, ask this:
○ Do you remember any birthdays, holidays, sporting or other special events that happened
around (DATE 30 DAYS/12 MONTHS AGO)? Did anything change in terms of where you
were living, whom you were with, whether you were in treatment, work, school, or jail?
Where were you living then? Were you in treatment, working, in school, or involved with
the law then?
○ If the client still can’t recall any events, use the 30-day/12-month target dates for the
anchors.

3.4 Completing the Staff Use Box

Figure 3 shows the “For Staff Use Only” box from the second page of the GAIN-SS. For items 8,
9, and 10 record the Site ID, Staff ID, and Client ID numbers and names according to project- or
agency-specific protocol. Unless permitted at your site, it is best to use only a client ID and not a
client name to help avoid accidental disclosure or breach of privacy. For item 11 record the mode
of administration as either administered by project or agency staff, administered by someone else
(e.g., another adult, staff from another agency), or self-administered (including online self-
administration).

Item 12 is discussed further on page 9.

For item 13 check whether the client is being referred to mental health (MH), substance abuse
(SA), anger management (ANG), or other services. Check all that apply.

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 Figure 3. Staff Use Box (Paper Version)

For item 14 record the primary program code of the facility to which the client is being referred,
using project- or agency-specific codes. These codes should be determined ahead of time by each
local agency according to whatever organizing criteria they choose.

For item 15 please add any additional comments or recommendations that you want to appear in
the Summary Report.

4. SCORING THE GAIN-SS (ITEM 12)

The client’s past-year symptoms are scored in item 12. Count the number of 3s (past month) or
2s (2-12 months ago) to get the number of symptoms occurring in the past year:

o 1a to 1e for the Internalizing Disorder Screener (IDScr)

o 2a to 2e for the Externalizing Disorder Screener (EDScr)
o 3a to 3e for the Substance Disorder Screener (SDScr)
o 4a to 4e for the Crime/Violence Screener (CVScr)
o 1a to 4e or sum of above for the Total Disorder Screener (TDScr)

Be sure to count instead of sum the raw answers. For example, if the client’s responses for the
items in the Internalizing Disorder Screener were:

1a = 3 (past month)
1b = 2 (2-12 months ago)
1c = 3 (past month)
1d = 1 (more than 12 months ago)
1e = 0 (never)

—then the IDScr score would be 3, since 1a, 1b, and 1c reflect past-year symptoms. The past-
month, past-year, and lifetime symptom counts can be hand-scored by using Table 1 below, in
which each time frame is calculated separately; so the number of 3s is counted in the past-year
total and the number of 3s and 2s are counted in the lifetime total.

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 Table 1. Scoring Template
Past month Past year Lifetime
Screener Items (3s) (3s, 2s) (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

Generally, the past-month count is used as a measure of change, the past-year count is used to
screen for current disorders, and the lifetime measure is used as a covariate and to measure
remission. The latter is done by identifying people with a lifetime problem who are in early
remission (lifetime problems but no past-month problems) or sustained remission (lifetime
problems but no past-year problems). When scoring by hand the past-year count is recorded in
item 12 and is used to support screening and make an immediate decision in the field. All three
counts can be used in narrative reports (see example below).

Remember that on the past-year version of the GAIN-SS the response set is only yes and no, so
the measures described above don’t apply.

Figure 4 shows an alternative way of looking at GAIN-SS scores in a graphic profile. In this
example the number of 3s, 2,s and 1s are “stacked” with the lifetime total shown at the top of
each column.

Figure 4. Example of GAIN-SS profile

5
20 5

16 4 High
13
3 3
12 3
Medium

2
8 2
Prob Any Diag. -> Low Med. High

4 1
Low

0 0
Total Disorder Internalizing Externalizing Substance Crime/ 12+ months ago (1s)
Screener Disorder Disorder Disorder Violence
2-12 months ago (2s)
(TDScr) Screener Screener Screener Screener
1a-4e (IDScr) (EDScr) (SDScr) (CVScr) Past month (3s)
1a-1e 2a-2e 3a-3e 4a-4e
Lifetime (1s, 2s, or 3s)

10
Here the client has endorsed five past-month symptoms, four symptoms in the 2-12 month time
frame, and four symptoms from more than 12 months ago. With nine total past-year symptoms,
the left panel of figure 4 shows that the client is well into the “high” range on the Total Disorder
Screener. The right panel breaks out the client’s symptom pattern by subscreener. In this
example the first three screeners show that the client has one or more past-year symptoms, and
the fourth screener shows a lifetime history of problems. Internalizing problems are clearly more
severe recently, followed by externalizing problems. While there is a history of substance
problems, none have occurred in the past month. (Recall that on the past-year version of the
GAIN-SS, all questions are coded as 0 = no and 1 = yes. When using the past-year version, count
the number of 1s to get the scores for item 12.)

Below is an example of a paragraph describing the results that could be incorporated into a
narrative report.

John Doe was evaluated in a phone interview on 12/15/2006 using the GAIN Short
Screener. He endorsed 13 of the 20 lifetime symptoms, including 9 in the past year and 5
in the past month. During the past year he was in the high severity range for internalizing
and externalizing disorders subscales and in the moderate range for substance use
disorders. He also had a lifetime history of being in the high range on the substance
disorder and crime/violence subscales. Given his self-reported problems, the evaluator
talked to John about going to the Glen Elks Community Mental Health Center, helped
him to schedule an appointment for next week, and provided a bus token and instructions
on how to get there from his home.

5. INTERPRETATION

5.1 Interpretation at the Individual Level

To screen for diagnoses it is recommended that the past-year total and four subscreeners be
triaged into three groups based on the number of symptoms endorsed in the past year:

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

o Moderate (1 to 2): A possible diagnosis; the client is likely to benefit from a brief
assessment and outpatient intervention.
o High (3+ on the total screener; 3 to 5 on the subscreeners): High probabilities of a diagnosis;
the client is likely to need more formal assessment and intervention, either directly or
through referral. (Consider residential treatment, particularly for higher scores).

In general it can be assumed that over half the people with a moderate score (1 or 2) and virtually
all of those with a high score (3 to 20) on the Total Disorder Screener will have a diagnosis when
given the full GAIN. Figures 5 and 6 show the distribution of TDScr scores by age within level
of care for people who entered clinical programs. For adolescents, 84% of the outpatients and
96% of the residential clients scored in the high range (medians = 6 and 10.5 respectively). For
adults, 70% of the outpatient and 95% of the residential clients scored in the high range (median
of 4.5 and 8.5 respectively). While there is considerable overlap between problem severity in
clients entering outpatient and residential treatment, residential clients’ problem severity is

11
greater for both adolescents (figure 5, Cohen’s d = 0.75) and adults (figure 6, Cohen’s d = 0.68).
It should be noted that a subset of people who come from controlled environments, are mandated
to treatment by the courts, or are admitted for other reasons score 0 on the TDScr but are still
admitted to clinical programs.

Figure 5. Total Disorder Screener for Adolescents

11%
Low Moderate High -> OP/IOP (n = 2,499) Residential (n = 1,965)
10%
OP/IOP Residential
Median = 6.0 Median = 10.5
% within Level of Care and Age Group

9%

8%

7%

6%

5%

4%

3%

2%

1%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
TDScr Score

Figure 6. Total Disorder Screener for Adults

11%
Low Moderate High -> OP/IOP (n = 755) Residential (n = 1,187)
10% Residential
OP/IOP Median Median = 8.5
9% = 4.5
% within Level of Care and Age Group

8%

7%

6%

5%

4%

3%

2%

1%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
TDScr Score

12
We also recommend using scores in the moderate/high range (1 to 5) on the four subscreeners to
identify the specific kinds of behavioral health services (e.g., mental health, substance use, work
or school programs, welfare programs, justice programs) that are needed:

o Moderate/high scores on the Internalizing Disorder Screener (1+ on IDScr) suggest the
need for mental health treatment related to somatic complaints, depression, anxiety, trauma,
suicide, and, at extreme levels, more serious mental illness (e.g., bipolar, schizoaffective,
schizophrenia). If confirmed by a clinician, typical treatments often include a combination of
counseling (e.g., cognitive behavioral therapy [CBT], desensitization) and medication.
o Moderate/high scores on the Externalizing Disorder Screener (1+ on EDScr) suggest the
need for mental health treatment related to attention deficits, hyperactivity, impulsivity,
conduct problems, and, in rarer cases, for gambling or other impulse control disorders. These
rates are highest among adolescents but still common in about one in five adults in substance
abuse treatment. If confirmed by a clinician, typical treatments often include a combination
of counseling (e.g., CBT, contingency management [CM], dialectical behavior therapy
[DBT], multisystemic therapy [MST]), increased structure in the environment, contingency
management, and medications.
o Moderate/high scores on the Substance Disorder Screener (1+ on SDScr) suggest the
need for substance abuse, dependence, and substance use disorder treatment and, in more
extreme cases, the need for detoxification or maintenance services. If confirmed by a
clinician, typical treatments often include a combination of counseling (e.g., CBT, CM,
motivational interviewing [MI], community reinforcement approach [CRA], functional
family therapy [FFT]) and medications for the management of withdrawal, maintenance, and
craving reduction.
o Moderate/high scores on the Crime/Violence Screener (1+ CVScr) suggest the need for
help with interpersonal violence, drug-related crimes, property crimes, and, in more extreme
cases, interpersonal/violent crimes. If confirmed by a clinician, typical treatments include a
combination of counseling (e.g., anger replacement therapy [APT], cognitive restructuring
[CR], CBT, MI, CM, MST,) and medications to control impulsive violence and co-occurring
problems.

As noted earlier, Dennis and colleagues (2006) found that the 20-item TDScr was correlated .94
with the 123-item General Individual Severity Scale (GISS) in the full GAIN and that people with
a high score (3 or more) on the TDScr were likely to have one or more diagnoses (90% sensitivity)
when assessed with the full GAIN. Conversely, those who scored below 3 were unlikely to have
any diagnoses when assessed with the full GAIN (90% specificity). Dennis et al. found that the
subscreeners were correlated .85 or higher with their longer counterparts in the full GAIN, and the
moderate/high range had 90% sensitivity to detect diagnoses in each area and 70% specificity.
Once the score reached the high range for a particular subscreener, specificity also reached 90%.
Clinicians, however, are still encouraged to combine the GAIN-SS with other information (e.g.,
from a parent, spouse, probation officer, supervisor, or medical or other records) or to override the
GAIN-SS triage on individual cases where they suspect other problems.

13
5.2 Interpretation as a Measure of Change

The past-month symptom count in the TDScr or any of the four subscreeners can also be used as
a simple measure of change after intervals of a month or more. This can be used at the individual
level to chart the progress of a single client or at the group level as an outcome measure by
plotting the measure over time. The current (past year) and long-term (lifetime) measures can
also be used to create trajectories and predict risk.

Consider an example where two people both had 4 past-month symptoms. One person has 4
lifetime symptoms, and the other has 12 lifetime symptoms. The person with 4 lifetime
symptoms is likely to improve more than the person with 12 lifetime symptoms because the
latter is at a higher risk of relapse for problems that may not be currently present. Conversely, of
two people with 12 lifetime symptoms, one who currently is down to 4 past-month symptoms
has a better trajectory than one who still has 8 past-month symptoms.

You may also want to examine the extent to which a person with a problem in a given area goes
into remission:

o High severity in early remission: three or more lifetime problems (3s, 2s, or 1s) and no
past-month problems (no 3s).
o High severity in sustained remission: three or more lifetime problems (3s, 2s, or 1s) and no
past-year problems (no 3s or 2s)

5.3 Interpretation for Quality Assurance and Program Planning

Because of its efficiency and ease of implementation (minimal training and two pages per
administration), the GAIN-SS has the potential to help with policy and program planning. This is
important because of the rising number of federal, state, and local initiatives that mandate or at
least encourage standardized screening across a wide range of systems. These include school,
workplace, welfare, and justice systems, many of which are increasingly interested in early
identification and intervention related to behavioral health issues. The GAIN-SS can be used as a
simple form of needs assessment to help guide program development and planning and decisions
about the purchase of further training or technical assistance. Managers can compare staff
members or sites on the extent to which expected diagnoses and referrals turn into actual cases.

While there will probably be some overruling by clinicians, on average a clinician’s diagnosis
should be similar to the results of the GAIN-SS. If one clinician consistently over- or
underdiagnoses relative to other clinicians in the same context, it may be an important topic for
clinical supervision. Conversely, if several clinicians in the same context are routinely overriding
a GAIN-SS decision rule, it may suggest the need for a customized rule in the GAIN-SS or to
systemically collect other information on which this group of clinicians is reliably basing their
decisions. For program evaluation the GAIN-SS can also be used to evaluate and manage
penetration and referral rates and as a measure of change over time.

14
5.4 Evaluation of Penetration and Referral Rates

Many stakeholders (which may include funders; employers; managed care third-party
administrators; agencies spread out over several programs, sites, or subcontractors; multisite
evaluators; or individual clinicians) want to know how well programs and staff members are
identifying client problems and making appropriate referrals. A clinician in any given case may
override the GAIN-SS triage, but at the group level the GAIN-SS should provide a relatively
good estimate of the approximate number of people who should be diagnosed and referred in
each of the four screening areas.

By dividing the actual diagnoses, referrals, or services provided by the number predicted, you
can get a rate that is adjusted to the case mix of a given program, site, or clinician. For example,
consider two programs that each diagnose 10 out of 30 (33%) of their cases with internalizing
disorders. The two programs look the same in terms of the raw number of diagnoses (10) and
raw referral rate (10/30 = 33%). However, if their predicted number of diagnoses (based on
IDScr of 1+ out of 5 symptoms) was 15 and 5 respectively, then their rate of actual/expected
diagnoses would be very different: 10/15 = 67% vs. 10/5 = 200%. This suggests that the former
may be underdiagnosing and that the latter may be overdiagnosing internalizing disorders. Note,
however, that just as you should consider other information (collateral reports, treatment records,
etc.) for individual clients, you should also consider all plausible explanations for diagnostic
trends at the program level. In short, the GAIN-SS gives you an objective guidepost to compare
performance and track it over time.

6. GAIN-SS SOFTWARE

6.1 Introduction and Logging In

A simple web-based application written in Active Server Page (ASP) for use with the GAIN Short
Screener has been developed and is available to anyone with a GAIN license who would like to
host it on their website (ASP, Microsoft IIS, and SQL Server Express required). For a
demonstration see http://www.gaincc.org/gain_ss/index.asp; contact [email protected]
for technical information on hosting it. Staff members can use this application to orally administer
the GAIN-SS and review and edit assessments as well as view the reports, and participants can use
it for self-administration as well. For further questions about this application, please contact
[email protected].

To start using the GAIN-SS application, go to http://www.gaincc.org/gain_ss/index.asp. A login

screen will appear, similar to the one shown below. To start the demonstration, log on using the
ID “GAINSS” and password “testme” and click the Login button.

15
 Figure 7. Log-in Screen

After clicking the Login button, a disclaimer will appear. Read through this screen and then click
OK to move on to the administration module. (Note: If you enter an incorrect ID or password
you will get a message reading, “SORRY, YOU HAVE ENTERED AN INVALID LOGON ID
OR PASSWORD.” By clicking Attempt New Logon you will be taken back to the login screen.)

Once you have logged in, you will see three links: the “Self-administration of GAIN Short
Screener,” “Staff Administration of GAIN Short Screener,” and “View/Edit a previously entered
GAIN Short Screener.” The administration module looks nearly identical to the paper version of
the GAIN-SS (see p. 21).

6.2 Self-Administration of the Online GAIN-SS

After clicking on the self-administration link, a disclosure notice pops up that acts as a short
introduction and informs the participant of the purpose of the GAIN-SS. Once the participant
clicks OK, the administration begins.

Figure 8. Disclosure Notice

Instructions for the client:

o Start at the top of the first page and enter your first name, middle initial, and last name in the
designated fields. The program will fill in the date field for you.
o Read the introductory paragraph.
o Read the first item, select a response, and move to the next question. Note: you can tab to the
next item and use either arrow keys or a mouse click to choose a response.

16
o Please read each item carefully to avoid any misunderstanding.
o If you have to make any corrections, simply choose the new response.
o Answer as accurately as you can. If you have trouble remembering the last time something
happened, use your best estimate.
o Note that you can’t answer a question with “sometimes” or “sort of” or “maybe.” Choose the
response that comes closest to how you feel. If you really can’t choose between the responses
or don’t know the answer, leave the response blank.
o For item 5 (Do you have other significant psychological, behavioral, or personal problems
that you want treatment for or help with?) you can enter “None” if applicable. Problems are
considered significant when you have them for two or more weeks, when they keep coming
back, when they keep you from meeting your responsibilities, or when they make you feel
like you can’t go on. Note that the numbers v1, v2, and v3 are used for data entry purposes; if
you have a long response, it’s okay to use all three lines for one answer. Also note that you
don’t have to provide three responses but can write as much or as little as you like.
o For item 6 fill in your gender: 1 for male, 2 for female, 99 for other. If other, use the line
below the item to specify how you identify yourself.
o For item 7 fill in your age as of the date that you are doing the assessment.
o Please feel free to ask if you do not understand a question or word.
o When you are done, please tell the staff that you have finished. We will check it together to
make sure that everything is complete, and we will answer any additional questions that you
might have.

Note that there is no staff use box on the self-administered GAIN-SS. Staff members would collect
client information after self-administration if there were a need for follow-up and referral.

6.3 Staff Administration of the Online GAIN-SS

This link will allow staff members to administer the assessment to the client. This screen is very
similar to the Self-Administration screen with the exception that it includes administrative
questions for staff use only.

Instructions for administration:

o Start at the top and enter the client’s first name, middle initial, and last name in the
designated fields.
o The program automatically fills in the date field with the current date.
o Read the introductory paragraph.
o Read the first item, select a response, and move to the next question. Note: you can tab to the
next item and use either arrow keys or a mouse click to choose a response.
o If you have to make any corrections, simply choose the new response.
o If the client really can’t choose between the responses, doesn’t know the answer, or simply
does not want to answer, then leave the response blank. The skipped items are not considered
in the scoring.
o For item 5 (Do you have other significant psychological, behavioral, or personal problems
that you want treatment for or help with?), you can enter “None” if applicable. Note that the

17
 numbers v1, v2, and v3 are used for data entry purposes—if you have a long response, it’s
okay to use all 3 lines for 1 answer. Also note that you don’t have to provide three responses
but can write as much or as little as you like.
o For item 6 fill in the client’s gender: 1 for male, 2 for female, 99 for other. If other, use the
line below to specify how the client identifies their gender (e.g., transgender male to female,
female to male).
o For item 7 fill in the client’s age as of the date that you are doing the assessment.
o When you finish the interview, click the Submit and View Results button. If you have left
some responses blank, you will receive a message showing those items (figure 9). If you
click OK, the application will automatically generate the GAIN-SS Summary Report. If you
click Cancel, the application will take you back to the administration module.

Figure 9. Sample Message Confirmation

The Staff Use box at the bottom of the staff-administered version of the GAIN-SS (figure 10) is
identical to the paper copy. For information on how to complete this box, please refer to page 8
of this manual. (Note: the program assigns the client’s identification automatically. This
information is located in the upper left-hand corner of the report.)

Figure 10. Staff Use Box

18
There are several links in the upper and lower right corners of the Full Report page:

o Print: Prints the Summary Report on paper for your review.

o Manual: Opens up the GAIN-SS Administration and Scoring Manual in Adobe Acrobat.
o View Responses: Takes you back to the assessment, where you can see the client’s
responses.
o Full Report: Displays a custom-generated narrative report similar to the sample narrative
shown on p. 11, breakdowns of the scores for each subscreener and a summary of those
scores, and a scoring table similar to the one shown on p. 10.

6.4 View and Edit a Previously Entered GAIN-SS

On this page staff members can view clients’ reports and responses and edit existing assessments.
Staff members can search assessments by XPID, Client ID, Site ID, name, or date range.

o Search by XPID, Client ID, or Site ID: click the drop-down arrow. You will see a list of
assessments available. Select the number you want and then click the Submit button.
o Search by name or date range: enter the first name, last name, or date in the fields and click
the Submit button.

After searching, the results screen (figure 11) will be displayed.

Figure 11. Search Results Screen

When you get the correct assessment, click “View Report” and the program will take you to it.
Here you can edit an existing case or make corrections. When you have finished making
changes, click Update on the bottom of the screen.

6.5 Implementing the GAIN Short Screener Application on Your Website

Sites will receive the ASP code, the database, and instructions on how to set up the GAIN-SS
program. Sites will be responsible for modifying the links and implementing the code within
their websites. Sites will also be responsible for ensuring that the administrative pages are secure
and not accessible by the public. Sites without a log-in page of their own can modify the log-in
page created and packaged as part of the GAIN Short Screener application. Any modifications
made to the instrument are the responsibility of the site.

For more information regarding implementing the GAIN Short Screener application, please
contact [email protected].

19
 REFERENCES

Boruch, R., Dennis, M., & Cecil, J. (1996). Fifty years of empirical research on privacy and
confidentiality in research settings. In B. Stanley, J. Sieber, & G. Melton (Eds.), Research
ethics (pp. 129-173). Lincoln, NE: University of Nebraska Press.
Cottler, L. B., Robins, L. N., & Helzer, J. E. (1989). The reliability of the Composite
International Diagnostic Interview Substance Abuse Module (CIDI-SAM): A
comprehensive substance abuse interview. British Journal on Addictions, 84(7), 801-814.
Dennis, M. L., Chan, Y-.F., & Funk, R. R. (2006). Development and validation of the GAIN
Short Screener (GAIN-SS) for psychopathology and crime/violence among adolescents
and adults. The American Journal on Addictions, 15(Suppl. 1), 80-91.
Dennis, M. L., Titus, J. C., White, M., Unsicker, J., & Hodgkins, D. (2003). Global Appraisal of
Individual Needs (GAIN): Administration guide for the GAIN and related measures
(Version 5). Bloomington, IL: Chestnut Health Systems. Retrieved December 5, 2007,
from http://www.chestnut.org/LI/gain/index.html#Administration%20Manual.
Gaskell, G. D., Wright, D. B., & O’Muircheartaigh, C. A. (2000). Telescoping of landmark
events: Implications for survey research. The Public Opinion Quarterly, 64(1), 77-89.
Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R., & Schimmel, H. (1983). Validation of
a short orientation-memory-concentration test of cognitive impairment. American
Journal of Psychiatry, 140(6), 734-739.
Sudman, S., & Bradburn, N. M. (1973). Effects of time and memory factors on response in
surveys. Journal of the American Statistical Association, 68(344), 805-815.

GLOSSARY

Assessment: The hard copy of the GAIN-SS; also another name for the interview process.
Client: The person answering the questions. Also referred to as the patient, respondent, or client.
Item: The individual questions on the GAIN-SS. For example, item 4a on the GAIN-SS is,
“When was the last time you had a disagreement in which you pushed, grabbed, or
shoved someone?”
Item number: The number of the section plus the letter at the beginning of each item. For
instance, item 1a is, “When was the last time you had significant problems with feeling
very trapped, lonely, sad, blue, depressed, or hopeless about the future?”
Response choice: The possible answers for an item. On the recency version of the GAIN-SS the
response choices are 3 = past month, 2 = 2 to 12 months ago, 1 = 1+ years ago, or 0 =
never. On the past-year version of the GAIN-SS the response choices are 0 = no or 1 = yes.
Scales: The four different sets of 5 questions on the GAIN-SS. The scales are marked by initials
in the left margin (IDScr, EDScr, SDScr, and CVScr).
Stem: The statement at the beginning of each set of questions that forms the start of each item.
For instance, the stem at the beginning of section 1 on the GAIN-SS is, “When was the
last time you had significant problems with….”

20
 GAIN SHORT SCREENER (GAIN-SS)
Version [GVER]: GSS 2.0.1
What is your name? a.__________________________ b. ____ c. ________________________
(First Name) (M.I.) (Last Name)
What is today’s date (MM/DD/YYYY): ............................... ____/____/________

The following questions are about common psychological, behavioral or

2 to 12 Months Ago
personal problems. These problems are considered significant when you have
them for two or more weeks, when they keep coming back, when they keep you

1+ Years Ago
from meeting your responsibilities, or when they make you feel like you can’t

Past month
go on.

Never
After each of the following statements, please tell us the last time you had this
problem, if ever, by responding (circling) in the past month (3), 2-12 months
ago (2), 1 or more years ago (1), or never (0) 3 2 1 0
IDScr 1. When was the last time you had significant problems…
a. with feeling very trapped, lonely, sad, blue, depressed, or hopeless
about the future? ..........................................................................................3 2 1 0
b. with sleeping, such as bad dreams, sleeping restlessly or
falling asleep during the day? ......................................................................3 2 1 0
c. with feeling very anxious, nervous, tense, fearful, scared, panicked
or like something bad was going to happen? ...............................................3 2 1 0
d. when something reminded you of the past, and you became
very distressed and upset?............................................................................3 2 1 0
e. with thinking about ending your life or committing suicide?......................3 2 1 0

EDScr 2. When was the last time you did the following things two or more times?
a. Lied or conned to get things you wanted or to avoid having to do
something? ..................................................................................................3 2 1 0
b. Had a hard time paying attention at school, work or home? .......................3 2 1 0
c. Had a hard time listening to instructions at school, work or home?............3 2 1 0
d. Were a bully or threatened other people? ....................................................3 2 1 0
e. Started fights with other people? .................................................................3 2 1 0
SDScr 3. When was the last time...
a. you used alcohol or drugs weekly?..............................................................3 2 1 0
b. you spent a lot of time either getting alcohol or drugs, using alcohol or
drugs, or feeling the effects of alcohol or drugs (high, sick)? .....................3 2 1 0
c. you kept using alcohol or drugs even though it was causing social
problems, leading to fights, or getting you into trouble with other people?3 2 1 0
d. your use of alcohol or drugs caused you to give up, reduce or have
problems at important activities at work, school, home or social events?.. 3 2 1 0
e. you had withdrawal problems from alcohol or drugs like shaking hands,
throwing up, having trouble sitting still or sleeping, or that you used any
alcohol or drugs to stop being sick or avoid withdrawal problems?............3 2 1 0

21
 2 to 12 Months Ago
(Continued)

1+ Years Ago
Past month
After each of the following statements, please tell us the last time you had this

Never
problem, if ever, by responding (circling) in the past month (3), 2-12 months
ago (2), 1 or more years ago (1), or never (0)
3 2 1 0
CVScr 4. When was the last time you...
a. had a disagreement in which you pushed, grabbed, or
shoved someone? .........................................................................................3 2 1 0
b. took something from a store without paying for it?.....................................3 2 1 0
c. sold, distributed or helped to make illegal drugs? .......................................3 2 1 0
d. drove a vehicle while under the influence of alcohol or illegal drugs? ...... 3 2 1 0
e. purposely damaged or destroyed property that did not belong to you?.......3 2 1 0
5. Do you have other significant psychological, behavioral or personal problems
you want treatment for or help with? (if yes, please describe below) ................. 1-Yes 0-No
v1._____________________________________________________________
v2._____________________________________________________________
v3._____________________________________________________________
6. What is your gender? (if other, please describe below) …………1-Male 2-Female 99-Other
v1._____________________________________________________________
7. How old are you today? .............................................................................. |__|__| Years Old

For Staff Use Only

8. Site ID: __________ Site Name v.________________________________
9. Staff ID:__________ Staff Name v.________________________________
10. Client ID: _________ Comment v._________________________________
11. Mode: 1-Administered by staff 2-Administered by other 3-Self Administered
12. Number of 2&3s: IDSscr: ___ EDScr: ___ SDScr: ____ CVScr: ___ TDScr: ___
13. Referral: MH__ SA __ ANG __ Other __ 14. Referral Code: _____________
15. Referral Comments:
v1._____________________________________________________________
v2._____________________________________________________________
v3._____________________________________________________________
This instrument is copyrighted by Chestnut Health Systems 2005. Use of this measure is allowed for
anyone with an existing GAIN license or who is requesting a new one. For more information on the
measure or licensure, please see www.chestnut.org/li/gain or e-mail [email protected] or
contact Joan Unsicker at 309-827-6026, ext. 8-3413, [email protected].

22
2006-2007 CALENDAR

23
2007-2008 CALENDAR

24
 TEAR-OFF INSTRUCTIONS FOR SELF-ADMINISTRATION

To complete the form:

o Start at the top of the first page and enter your first name, middle initial, and last name in the
designated fields.
o Enter the date in the space below your name (be sure to use only numbers and the mm/dd/yyyy
format—for instance, if today is January 1st 2006, enter “01/01/2006”).
o Read the introductory paragraph.
o Start with the first item and continue in order.
o Please read each item carefully to avoid any misunderstanding. Be sure to follow the dotted
line to the correct response choices.
o Be sure to choose only 1 response. Make sure that your responses are marked clearly. (On the
computer version, make sure that you choose the correct response.)
o If you have to make any corrections, be sure to cross out the original response and write the
new response neatly.
o Answer as accurately as you can. If you have trouble remembering the last time something
happened, use your very best estimate.
o Note that you can’t answer a question with “Sometimes” or “Sort of” or “Maybe.” Choose the
response that comes closest to how you feel. If you really can’t choose between the responses
or don’t know the answer, write “DK” (for “don’t know”) in the margin next to the item.
o While we encourage you to complete all the items, you can refuse any question that you feel
uncomfortable answering. In that case we ask you to mark those items with “RF” for “refused.”
o It is important that you answer every question or write “DK” or “RF.” Otherwise, we will think
that you just missed the answer by mistake and will ask you about it again.
o Don’t forget to read the stem at the beginning of each section (e.g., “When was the last
time…”). You should also repeat it before an item if you get interrupted and have to repeat or
restart a question.
o For item 5 on the second page (Do you have other significant psychological, behavioral, or
personal problems that you want treatment for or help with?), be sure to write neatly. You can
write “None” if applicable. Note that the numbers v1, v2, and v3 are used for data entry
purposes—if you have a long response, it’s okay to use all 3 lines for 1 answer. You can also
use the margin or another sheet if you need more space. Also note that you don’t have to
provide 3 responses but can write as much or as little as you like.
o For item 6, fill in your gender: 1 for male, 2 for female, 99 for other. If “other,” use the line
below the item to specify how you identify yourself.
o For item 7, fill in your age as of the date that you are doing the assessment.
o Please feel free to ask if you do not understand a question or word. You can also put a question
mark (?) next to something you don’t understand and we can go over it when you are done.
o When you are done, please bring the form to me. We will check it together to make sure that
everything is complete, and I will answer any additional questions.
o Please don’t fill in the Staff Use Only box at the bottom of the second page. It will be used to
record administrative information and should be completed only by staff.

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 TEAR-OFF SAMPLE INTRODUCTION

The interviewer or other staff member should read the following script.

To help us get a better understanding of any problems you might have, how they are related to
each other, and what kind of services might help you the most, I would like to spend about 5
minutes asking you 20 questions as part of a short screener that we use with many of our clients.
Your answers are private and will be used only for your treatment and to help us evaluate our
own services.

If you are not sure about an answer, please give us your best guess. If you simply do not know
the answer to a question, you can tell me and I’ll enter “DK” for that item. You may also refuse
to answer any question, and I’ll enter “RF” for that item. Please ask if you do not understand a
question or a word. At the end of the interview, I will check to make sure that everything is
complete, and I’ll answer any additional questions.

Do you have any questions before we begin?

TEAR-OFF PERSONALIZING TIME ANCHORS

Several questions will ask you about things that may have happened during the past month, 2
to12 months ago, or more than 12 months ago. To help you remember these time periods, please
look at this calendar.
o Do you recall anything that was going on about (DATE 30 DAYS AGO)? (PROBE FOR SPECIFIC
EVENT, SEE BELOW IF PROBLEMS.)
○ If the last time that something happened was since (NAME OF EVENT THAT WAS 30
DAYS AGO), please answer, “Past month.”
o Do you recall anything that was going on about (DATE 12 MONTHS AGO)? (PROBE FOR
SPECIFIC EVENT, SEE BELOW IF PROBLEMS.)
○ If the last time that something happened was between (EVENT FROM 30 DAYS AGO)
and (EVENT FROM 12 MONTHS AGO), please answer, “2 to12 months ago.”
o If the last time something happened was before (EVENT 12 MONTHS AGO), please answer, “1+
years ago.”
o If something has never happened, please answer, “Never.”

If the client is unable to recall any events:

o Do you remember any birthdays, holidays, sporting or other special events that happened
around (DATE 30 DAYS/12 MONTHS AGO)? Did anything change in terms of where you were
living, who you were with, whether you were in treatment, work, school or jail? Where were
you living then? Were you in treatment, working, in school, or involved with the law then?
○ If the client still can’t recall any events, use the 30-day/12-month target dates for the
anchors.

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