Internal Consistency and Convergent Validity of the Portuguese Versions of the Global Appraisal of Individual Needs-Initial and Short Screener: Validity of the Portuguese GAIN-I and SS

The goal of this article is to present evidence on the internal consistency and convergent validity of the Brazilian Portuguese versions of the Global Appraisal of Individual Needs-"Initial" and "Short Screener" versions.

METHODS

One hundred sixty-eight individuals from an inpatient service and/or a community-based outpatient service located in São Paulo were interviewed using the Brazilian Portuguese versions of the instruments. The internal consistency of the instruments scales was computed, along with evidence for the convergent validity between corresponding subscales of the Initial and Short Screener instruments.

RESULTS

Cronbach's alpha values for both instruments' total scale scores were greater than .7. The Short Screener scales showed strong-to-moderate correlations with corresponding subscales of the Initial. The General Individual Severity Scale from the Initial and Total Disorder Screener from the Short Screener have convergent validity with each other (ρ = 0.801).

CONCLUSIONS

The Brazilian Portuguese instrument scales showed evidence for internal consistency and convergent validity performing similarly to the American English versions.

Rasch model of the GAIN substance problem scale among inpatient and outpatient clients in the city of São Paulo, Brazil

Introduction

This study used the Rasch model to evaluate the psychometric properties of the Portuguese version of the Substance Problem Scale (SPS) of the “Global Appraisal of Individual Needs - Initial” for use in Brazil. The SPS measures alcohol and drug problem severity within a DSM-IV-TR framework. The goal of the Rasch analysis was to assess scale dimensionality, item severity, and differential item functioning (DIF).

Methods

Data was collected from 40 inpatients and 70 outpatients in São Paulo, Brazil. The Rasch model fit and DIF by gender and level of care were examined.

Results

The SPS fit the Rasch model, with no items distorting the measure. Only three of the sixteen items performed differently between men and women and three performed differently by level of care.

Conclusions

The results were compatible with those from Rasch analyses of the American English and Canadian English versions of the scale. The Portuguese version of the SPS is, thus, valid for use in Brazil, both with men and women in inpatient and outpatient programs.

Supporting the need for an integrated system of care for youth with co-occurring traumatic stress and substance abuse problems

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.

The nature of victimization among youths with hearing loss in substance abuse treatment

The author profiles the prevalence, severity, and characteristics of victimization among a group of youths with hearing loss presenting to substance abuse treatment. Intake data on 111 deaf and hard of hearing youths (42% female) were analyzed and compared with data from a weighted, gender-matched sample of hearing youths. After gender is controlled, results indicate that the hearing loss group reported more widespread, more severe abuse than that reported by their hearing peers. Physical abuse and weapon attacks were significantly more prevalent among the deaf and hard of hearing youths, while no differences in sexual or emotional abuse were observed. Youths with hearing loss also reported increased rates of abuse by a trusted person and abuse that made them fear for their lives. Substance abuse treatment of deaf and hard of hearing youths should include routine assessment of victimization and trauma-informed methods.

A randomized controlled trial of telephone continuing care

Telephone continuing care (TCC) was compared to usual continuing care (UCC) on substance use and related problems among adults discharged from residential treatment. Participants were randomly assigned to receive either UCC or TCC. A tapered TCC protocol, initiated by paraprofessional staff and volunteers, was provided during the first 3 months following discharge. The TCC condition participants reported high satisfaction ratings with the procedure and were more than twice as likely to enter continuing care than UCC participants. At the 3-month point, TCC patients reported significantly fewer past-month substance problems than UCC patients. Among the subgroup of lower severity (LS) participants, the TCC-LS sample had both significantly more days abstinent and fewer past-month substance problems at 3 months than the UCC-LS sample. The significant between-group differences in substance use outcomes were not maintained at the 6-month follow-up. The high satisfaction ratings and early favorable response among TCC patients suggest the procedure is promising. Further research with larger samples and over a longer period is necessary.

Development and validation of short versions of the internal mental distress and behavior complexity scales in the Global Appraisal of Individual Needs (GAIN)

Co-occurring mental distress and behavior problems are the norm in substance abuse treatment but are often poorly assessed due to resource constraints. This paper describes the development and validation of scales measuring internalizing mental distress and externalizing behavior problems that are shorter versions of comorbidity scales found in the full Global Appraisal of Individual Needs (GAIN). GAIN data from two treatment outcome studies, one involving adolescents and the other on adults, were used in the creation and testing of the scales. Subsets of items from the full GAIN scales were selected for the short scales through the application of standard psychometric principles. The short comorbidity scales still have moderate to high reliability and are highly correlated with the full scales. Parallel tests of construct validity show no substantial loss when moving from the longer to shorter versions. The short scales maintain good sensitivity and specificity for predicting diagnostic impressions.

Characteristics of youths with hearing loss admitted to substance abuse treatment

The purpose of this study is to provide a profile of youths with hearing loss admitted to substance abuse treatment facilities. Intake data on 4,167 youths (28% female; 3% reporting a hearing loss) collected via the Global Appraisal of Individual Need-I assessment was used for the analyses. Information on demographics, environmental characteristics, substance use behaviors, and symptoms of co-occurring psychological problems for youths with and without a hearing loss was analyzed via Pearson chi-square tests and effect sizes. The groups reported similar backgrounds and comparable rates of marijuana and alcohol use. However, youths in the hearing loss group reported substance use behaviors indicative of a more severe level of involvement. Across all measures of co-occurring symptoms, youths with hearing loss reported greater levels of distress and were more often victims of abuse. Results of this study will help inform treatment needs of youths with hearing loss and define a baseline for future research.

The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials

This article presents the main outcome findings from two inter-related randomized trials conducted at four sites to evaluate the effectiveness and cost-effectiveness of five short-term outpatient interventions for adolescents with cannabis use disorders. Trial 1 compared five sessions of Motivational Enhancement Therapy plus Cognitive Behavioral Therapy (MET/CBT) with a 12-session regimen of MET and CBT (MET/CBT12) and another that included family education and therapy components (Family Support Network [FSN]). Trial II compared the five-session MET/CBT with the Adolescent Community Reinforcement Approach (ACRA) and Multidimensional Family Therapy (MDFT). The 600 cannabis users were predominately white males, aged 15-16. All five CYT interventions demonstrated significant pre-post treatment during the 12 months after random assignment to a treatment intervention in the two main outcomes: days of abstinence and the percent of adolescents in recovery (no use or abuse/dependence problems and living in the community). Overall, the clinical outcomes were very similar across sites and conditions; however, after controlling for initial severity, the most cost-effective interventions were MET/CBT5 and MET/CBT12 in Trial 1 and ACRA and MET/CBT5 in Trial 2. It is possible that the similar results occurred because outcomes were driven more by general factors beyond the treatment approaches tested in this study; or because of shared, general helping factors across therapies that help these teens attend to and decrease their connection to cannabis and alcohol.

Gender differences in victimization severity and outcomes among adolescents treated for substance abuse

This article uses data from the Global Appraisal of Individual Needs (GAIN) on 214 adolescents entering substance abuse treatment. The goals of the article are to validate the General Victimization Index (GVI), examine its relationship to gender and co-occurring problems, and determine its relationship to outcomes. The GVI includes 15 items on lifetime traumatic events, traumagenic factors, and current worries of victimization. The items fall along a severity dimension (alpha = .88), and evidence was generated to support the construct validity of cutoff scores for interpretation. Girls were significantly more likely than boys to have experienced a variety of victimization incidents. When used as grouping variables, gender and severity of victimization significantly interacted with measures of intake status and were significant predictors of 3-month postdischarge treatment outcomes.

The Cannabis Youth Treatment (CYT) experiment: rationale, study design and analysis plans

AIMS

This paper provides a description of the rationale, study design, treatments and assessment procedures used in the Cannabis Youth Treatment (CYT) experiment.

DESIGN

CYT was designed to (a) test the relative effectiveness, cost and benefit-cost of five promising treatment interventions under field conditions and (b) provide evidence based manual-guided models of these interventions to the treatment field.

SETTING

The study involved two community-based treatment programs and two major medical centers.

PARTICIPANTS

Participants were 600 adolescents recruited from the regular intake who were between the ages of 12 and 18, had used marijuana in the past 90 days, and met one or more criteria of dependence or abuse.

INTERVENTIONS

Participants were randomly assigned to one of five interventions: Motivational Enhancement Therapy (MET), Cognitive Behavioral Therapy (CBT), Family Support Network (FSN), Adolescent Community Reinforcement Approach (ACRA), or Multidimensional Family Therapy (MDFT).

MEASUREMENTS

Self-report data were collected at intake, 3, 6, 9 and 12 months post discharge using the Global Appraisal of Individual Needs (GAIN), as well as several supplemental self-reports, collateral reports, urine testing, and service logs.

FINDINGS

This paper reports on the study's implementation including the psychometric properties of the measures (alphas over 0.8), validity of self-report (kappa over 0.6), high rates of treatment completion (81% completed two or more months), and high rates of follow-up (over 94% per wave).

CONCLUSIONS

The feasibility of implementing the CYT manual-guided treatment and quality assurance model in community-based adolescent treatment programs is discussed.

The concept of fractional number among deaf and hard of hearing students

This study investigated deaf and hard-of-hearing students' understanding of the fractional number concept as measured by their ability to determine the order and/or equivalence of two fractional numbers presented in a pair. Analyses focused on the performance and strategies of 10-to-12 and 13-to-16 year old deaf and hard-of-hearing students (N = 21) and comparison groups of hearing students (N = 26). All students completed 18 fraction items requiring them to indicate which of two fractions presented in a pair was the larger value. On four items, students indicated their strategy. Results showed deaf and hard-of-hearing students in overall performance by fraction type and problem solving strategies. These students had a tendency to order fractions by the values of the counting numbers composing them.

Caring for medically fragile children at home: the parent-professional relationship

Forty-eight mothers and fathers caring for a medically fragile child at home completed questionnaires and were interviewed about the impact of this caregiving on their family and about their relationship with home care professionals. Factors contributing to a positive parent-professional relationship were professional competence, genuine caring for the child, and respectful, supportive collaboration with the family. More hours of care provided by home health aides increased mothers' strain with the professional caregivers; more hours of care from nurses increased fathers' strain. Family cohesion, family organization, and support from the community reduced the amount of strain parents reported having with home care providers. Implications for training providers and reducing the negative impact of home care are discussed.

Home care for medically fragile children: impact on family health and well-being

The health status of 48 families providing home care for their medically fragile children was studied. Mothers, as the primary caregivers, experienced a greater decline in their physical health than did fathers or siblings. When the financial burden of providing care was greater and when the relationship with care providers was more strained, families had more physical illness symptoms. Who provided home care services for the medically fragile child influenced the psychosocial impact on the family. Care provided by home health aides was associated with greater negative impact, whereas care from professional nurses reduced the negative impact. The trend toward home care for medically fragile children has been accelerating; this study points to the importance of studying the impact on the family of this kind of care. Policy implications regarding the amount and quality of services and payment for them are discussed.