GAINing Ground in Ontario

Screening and assessment tools help service providers determine the appropriate level and intensity of care that is needed for clients who are entering the substance use treatment system. The Screening, Assessment, and Recovery Monitoring (SARM) Project is drawing on the best available evidence as well as the feedback of key stakeholders throughout the province to develop and pilot new screening and assessment tools and procedures.

The SARM Project, led by Dr. Brian Rush (pictured left) is also piloting an evidence‐based protocol for recovery monitoring since monitoring the outcome of clients is a crucial part of the process of measuring the performance of the system. The project team hopes to determine if it is feasible to implement a recovery monitoring system for Ontario.

Since June, the SARM protocol has been piloted in four agencies across the province. (A fifth site started recruiting clients in fall 2012.) As of the beginning of December, 232 clients have joined the study! These clients receive the standard assessment protocol—the Admission and Discharge Criteria and Assessment Tools (ADAT)—which is currently mandated for publicly funded Ontario substance use agencies.

Clients also receive the newly developed screening and assessment protocol, and are regularly monitored by agency staff, using a brief questionnaire, during the course of their treatment. Clients are also followed up 3- and 6-months post-intake using a standardized instrument.  Study recruitment ended in September of this year for four of the pilot sites (and will end in December for the fifth pilot site). All follow-up interviews will wrap up by the end of February 2013.

While the formal results from the SARM Project are not yet in, preliminary feedback from the pilot sites has been positive, particularly related to the GAIN‐Q3 instrument, which is being used for both the assessment and follow-up components of the project. This widely used tool was selected for inclusion in the project based on its comprehensive assessment of several life areas, including mental health, its high validity and reliability, its administration time, its relatively low cost, and its ability to automatically generate treatment planning and referral reports via the GAIN Assessment Building System (ABS) the web-based platform used to administer the GAIN-Q3. An Ontario version of the tool, developed as part of this project, reflects substantial input from key stakeholders in the province’s addiction treatment system.

The SARM project has also resulted in substantial capacity building around the GAIN instruments. To date, of the 14 pilot agency staff who attended GAIN training, 12 have achieved Administration Certification. Ten have also achieved Local Trainer Certification, an accomplishment that represents many, many hours of work—all done on a voluntary basis! These Local Trainers have since gone on to train staff at their own agencies and recommend them for Administration Certification.

Ultimately, by using a common, evidence‐based approach, the SARM Project aims to improve the quality of the screening, assessment, and outcome monitoring processes in Ontario’s substance use treatment system. A more effective system will benefit funders, administrators, researchers, clinicians, and clients.