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Home My WebLink About20061607.tiff Weld County Department of Social Services Notification of Financial Assistance Award for Families,Youth and Children Commission(Core)Funds Type of Action Contract Award No. X Initial Award 06-CORE-70 Revision (RFP-FYC-06007; 06SAT07) Contract Award Period Name and Address of Contractor Beginning 06/01/2006 and Turning Point Center for Youth&Family Development Ending 05/31/2007 Sex Abuse Treatment 1644 South College Avenue Fort Collins, CO 80525 Computation of Awards Description Unit of Service The issuance of the Notification of Financial This program is committed to improving the Assistance Award is based upon your Request for quality of life of our clientele. Services include Proposal (RFP). The RFP specifies the scope of offense specific group therapy, individual therapy, services and conditions of award. Except where it is in family therapy,psycho-education, ongoing conflict with this NOFAA in which case the NOFAA monitoring and assessment. Services are targeted governs,the RFP upon which this award is based is an for perpetrators under the age of 18. It is estimated integral part of the action. 15 families per year will be served. Special conditions Cost Per Unit of Service 1) Reimbursement for the Unit of Services will be based Hourly Rate Per on an hourly rate per child or per family. Treatment Package $31.79 2) The hourly rate will be paid for only direct face-to- face contact with the child and/or family, as evidenced Hourly Rate per Court Testimony $31.79 by client-signed verification form, and as specified in the unit of cost computation. Enclosures: 3) Unit of service costs cannot exceed the hourly and X Signed RFP: Exhibit A yearly cost per child and/or family. X Supplemental Narrative to RFP: Exhibit B 4) Payment will only be remitted on cases open with, and Recommendation(s) referrals made by the Weld County Department of Social Services. X Conditions of Approval 5) Requests for payment must be an original submitted to the Weld County Department of Social Services by the end of the 25th calendar day following the end of the month of service. The provider must submit requests for payment on forms approved by Weld County Department of Social Services. 6) The Contractor will notify the Department of any changes in staff at the time of the change. Approvals: Program Official: By By M.J. Geile, Chair Judy riego, irector Board of Weld County Commissioners Weld unty Depaitnient of Social Services Date: JUN 1 4 NM Date: T/ 3 I/Q 2006-1607 H TO' jrte) r r turning point Center for Youth and Family Development, Inc. March 30, 2006 Mr. Pat Persichino Director of General Services 915 10th Street P.O. Box 758 Greeley, Co 80632 Re: Bid 001-06 (06005 through 06011 and 006-00, A, B, & C) Dear Mr. Persichino Please accept Turning Point Center for Youth and Family Development, Inc.'s enclosed proposal for Offense Specific Services in Weld County. If we may provide additional information, I or someone from Turning Point will be available to meet with staff from your Department. I may be reached by phone at 970- 221-0999 ext. 34. Sincerely, • .4)./atakiSt-3 toP hanie A. J. Brown, LCSW Chief Operating Officer Turning Point Center enc 1644 South College Avenue • Fort Collins, Colorado 80525 Phone 970.221.0999 • Fax 970.221.2727 • Website: www.turningpnt.org (. .-. (i) ,47-6 ,( l t INVITATION TO BID BID 001-06(06005-06011 and 006-00,A, B, &C)) DATE:March 1, 2006 BID NO: RFP-FYC-06007 RETURN BID TO: Pat Persichino,Director of General Services 915 10th Street,P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (RFP-FYC-06007)for:Colorado Family Preservation Act--Sexual Abuse Treatment Program--Emergency Assistance Program Deadline: March 31,2006,Friday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to Social Services, announces that competing applications will be accepted for approved providers pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26-5.5-101)and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act(C.RS. 26-5.3-101). The Families,Youth and Children Commission wishes to approve services targeted to run from June 1, 2006, through May 31, 2007, at specific rates for different types of service, the County will authorize approved providers and rates for services only. The Sexual Abuse Treatment Program must provide for therapeutic intervention designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetration, and to prevent further sexual abuse and victimization. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) BID MUST BE SIGNED IN INK R PRINTED S Se-Pfriv1/44 gneQtal,/ VENDOR per,.( (Name) Handwritten Signature By Authorized ikin/t.JL/_DB/EZOavnaSticer or Agent of/Vendor ADDRESS /jo tft !. ('/57 t ,t4ve TITLE ( 'ahEC ,4 Orast �r(,ri,Jc DATE 1/41.- 3a Go PHONE# 9 ys - 221-le' The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 41 T Bid 001-06(RFP-FYC-06007) Attached A SEXUAL ABUSE TREATMENT PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING FAMILY PRESERVATION PROGRAM 2006-2007 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2006-2007 BID 001-06,RFP-FYC-06007 NAME OF AGENCY: ,.ems -rte ADDRESS: A .9)A7 5 PHONE:(4-16) 22►-bra CONTACT PERSON:k ' 4 j/F �eez,��j TITLE: (.� „1�ri 40 .nee, DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Sexual Abuse Treatment Program must provide for therapeutic intervention through one or more modalities to prevent further sexual abuse perpetration or victimization, 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1,2005 Start End May 31,2006 End TITLE OF PROJECT: 61 irg4SE �PE i t Fl. it ie lrv` esreQnj,E ,J 3-3e-4,, Name d gnature of Person Preparing Document Date IPA-eaiE /2424..14/ ‘01 -,t-A, Name d ' ture Chief A inistrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. ject Description Target/Eligibility Populations Types of Services Provided Measurable Outcomes Service Objectives Workload Standards Proof of Collaboration Evidenced-based Outcomes Staff Qualifications Oc Unit of Service Rate Computation Billing Process Program Capacity per Month ertifrcate of Insurance ----------------------------------------------------------------------------------------------------- Date of Meeting(s)with Social Services Division Supervisor: 'a— /O—1.0 Page 29 of 41 " Bid 001-06(RFP-FYC-06007) Attached A Comments by SSD Supervisor: anst frita A41 ��/W°C Name Signatur f SSD Supervisor Date Page 30 of 41 Program Category Sexual Abuse Treatment Program Bid Category Project Title Offense Specific Program Provider Turning Point Center for Youth and Family Development, Inc. I. PROJECT DESCRIPTION Turning Point's overall vision is a world of empowered, healthy, and responsible families and adolescents appreciating and affirming themselves and others. Within Turning Point, we strive to work as a team to provide our clients with a safe, structured, accepting environment in which treatment can occur. To maintain this vision we provide a strong support system as well as consistent confrontation while modeling and teaching responsibility, accountability, positive leadership and teamwork. The members of the clinical team at Turning Point are committed to improving the quality of life of our clientele. We strive to provide high-quality care while upholding the ethical standards of our respective professions. It is our belief that, by providing an environment that is structured, stable and safe, opportunities for growth and change can be realized. We make every effort to maximize these opportunities by incorporating a variety of therapeutic modalities. Every attempt is made to individualize treatment in a manner that best meets the needs of the client, their family system, and the community. II. TARGET/ELIGIBILITY POPULATIONS Program services will be specifically targeted toward families of youth already involved in Turning Point's Offense Specific Residential services. Clients must be referred by Weld County DSS workers, and Turning Point reserves the option to accept or deny in-home services to youth, depending on the results of the safety assessment and other factors. In typical implementation, the DSS caseworker, Turning Point staff, youth, family and other stakeholders will all concur that outpatient offense specific programming is an appropriate service which will improve the safety and family functioning, while reducing out-of-home placement pursuant to C.R.S. 26-5.5-101. As per statutes, services to be delivered to Weld County families with youth who are: • in placement (thereby decreasing the youth's length of stay in out-of-home placement) • recently returned home from placement, but in need of family life skills programming so as to reduce the likelihood of recidivism • in some cases, younger youth in the family may be in risk of out-of-home placement, but not yet placed. The provision of outpatient offense specific services is directly linked to the therapeutic relationship developed between Turning Point's residential staff and the youth and families served. Turning Points services are targeted for perpetrators under the age of 18. Since this is a new service offered by Turning Point, numbers of families who will receive bicultural/bilingual services and the number of clients served from southern Weld County will depend upon the profile of open cases at Weld DSS which meet the conditions described in statute. The program does not have a projected minimum or maximum capacity; if 50% of the estimated youth served have families for which this is an appropriate service, an estimated 15 families per year will be served. Services will be billed on a fee for service basis, with no minimum financial commitment required on the part of Weld County. The fees for services are estimates at this point, with fees to be negotiated and confirmed with Weld DSS staff prior to contracting. The Turning Point team strives to meet the unique needs of each young person and his or her family. Our services will address and respect the culture and ethnicity of the clients we serve. We are aware of the importance of the values, beliefs, traditions, customs, and parenting styles of the families we serve. Whenever possible, Turning Point will strive to ensure all programs are culturally competent and sensitive; this includes the hiring of multi-lingual and multi-cultural staff. All Turning Point staff are required to attend regular cultural competency training. Additionally, Turning Point makes every effort to promote programs that respect and incorporate cultural differences. III. TYPE OF SERVICES TO BE PROVIDED Turning Point's outpatient Offense Specific Program is designed to allow for a smooth transition back into the youth's community while offering support and continued treatment from our residential setting. We will strive to have the youth continue working with a member of their treatment team to foster continuity of care and consistency. Services and frequency will be individually determined based on reason for referral and what is being requested by the DSS worker, assessment and staff recommendations. Through the referral process, we will work with the county caseworker to determine what other services are available to the youth through other payment sources and what is appropriate for us to offer through Core Service funding. The services will include: • Offense Specific Group Therapy • Individual Therapy • Family Therapy • Psycho-education • Ongoing Monitoring &Assessment These services will address: • Comprehensive, diagnostic and treatment planning with the family and other service providers. • Therapeutic intervention with flexibility to bring in other services if needed. • Therapeutic services through a variety of modalities including: individual, family, group, etc. • Therapy designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetration, and to prevent further sexual abuse. • Specialized intake/investigation function for families with sexual abuse allegations. Turning Point's program to treat juveniles who have committed sexual offenses follows the Colorado Offender Management Board (SOMB) Standards and Guidelines in order to offer the highest level of quality programming and community safety. The highest priority identified by the SOMB's Guiding Principals is community safety. Therefore, as the youth transitions out of residential care, Turning Point works with parents/guardians to ensure that youth are highly supervised and monitored both in the home and in the community. To provide for the ongoing assessment and treatment of juveniles who have committed sexual offenses, Turing Point has developed partnerships with several full operating providers in the community that meet the standards of practice for treatment providers recommended by the SOMB guidelines to provide on site supervision for our program therapist and program staff. Additionally, we have had all staff working with this population go through an extensive two week training which included Informed Supervision as well as ongoing program evaluation. IV. MEASURABLE OUTCOMES The true measure of success is the outcomes for youth, communities, and families. Turning Point will utilize the GAIN Assessment Tool as well as the families service plan goals to determine outcomes for the youth and their family. The GAIN Assessment Tool, a progressive and integrated series of measures and computer applications designed to support initial screenings, standardized bio-psychosocial clinical assessments for diagnosis and treatment planning, and outcome assessments in the areas of clinical status and service utilization. The assessment itself has eight core sections that contain questions concerning the recent problems and the breadth of symptoms that can be used for DSM-IV based diagnoses and ASAM based level of care placements. Also included in each core section are questions concerning the lifetime service utilization and the frequency of recent service utilization which support most state and federal reporting requirements. Through this tool, Turning Point is able to track client's progress in the program. Additionally, Turning Point utilizes a computerized client data base system (OSCAR) to maintain all client records, treatment planning and treatment goal progress. We have been able to generate the above client outcomes utilizing this software. Additionally, our clinical staff conduct follow up calls to all of our clients upon discharge to track how they are doing in the community, determine if there are any additional services or support they need and gain information on how we can alter our services to better meet their needs as they transition. We conduct these calls every month for a year after a client's discharge. We review our data monthly and are able to see trends for individual clients as well as for our programs and make any adjustments necessary in order to provide clients with a high level of care. While the outpatient Offense Specific Program is a new service to our agency, looking at Turning Point's most recent internal outcome data is an excellent indicator of our commitment to measure outcomes of the project. These outcomes indicate: • Average length of stay is now at 5.2 months • Clients successfully complete an average of 69% of treatment goals • Only 19% are not experiencing educational success (48% have completed GED or high school by the time of discharge; another 33% are in school and progressing at time of discharge) • 67% of clients return to home or move to their own home at the time of discharge • 18% moved to a level of care equivalent to Turning Point • Only 15% of clients moved to a more restrictive setting • According to our 12 month post-discharge follow-up, of the clients participating in the project: • 60% remained alcohol and drug free • 53% remained free of all police contact • 80% remained free of arrest • Recently released state reports indicate a recidivism rate for YOS youth — some of the state's most difficult adolescents and young adults—to be at 11%. Turning Point is pleased with our success with adolescents, especially considering the high rate of criminal involvement and substance abuse by the clients we typically serve. The goals and outcome measure of the outpatient Offense Specific Program will address: • Reduce rate of recidivism of sexual abuse perpetration • Decrease in re-victimization • Prevent victim perpetration • Improve parental competency • More rapid reunification of children and families V. SERVICE OBJECTIVES Turning Point's outpatient Offense Specific Program is designed to provide therapeutic support to clients and their families in the least restrictive, most appropriate setting, to assist in improving outcomes in the Performance Improvement Plan (PIP), and to achieve the following: • Children are secure and protected from harm • Children will progress toward stable, nurturing, and permanent living environments; and • When appropriate, children experience family continuity and community connectedness • Eliminating ongoing abuse, neglect, or maltreatment • Protecting the youth and the community • Re-establishing family stability, if appropriate • Assisting the youth to emancipate successfully, if appropriate • Minimizing the length and number of placements, facilitating a healthy, permanent living environment for youth. The outcomes mentioned in Section IV, detail the successes of clients leaving our programs. An individualized treatment plan is developed for each client that is begun within the first 10 days of admission into the program. This area is targeted to assist the youth with a smooth and efficient transition back into the community with resources they can access once they are no longer connected with our services. These objectives and measures will include: • Improve parental competency — capacity of parents to maintain sound relationships and appropriate physical and emotional boundaries with their children, and to empower non- abusing parents and victims. • Improve family conflict management — mediation and counseling designed to resolve conflicts and disagreements within the family contributing to child maltreatment and sexual abuse. • Improve personal and individual competencies — primarily in terms of self-esteem, victim awareness, awareness and management of one's own personal history of victimization, sex education, peer relationships enhancement, establishing appropriate physical and emotional boundaries, assertive in lieu of aggressive behaviors, and assuming responsibility for one's own behavior. • Improve ability to access resources — shall assist parent in learning to obtain help from other sources in the community and within local, state, and federal governments. • Improve outcomes in the Performance Improvement Plan as mentioned above. Referral processing —each referral to Turning Point is individually reviewed with consideration for community and client safety, the best fit of treatment team, client needs and agency services, and the needs of the referral agent and family. Assessment — each client is individually assessed regarding diagnosis, medical and psychiatric needs, psychosocial assessment, substance abuse, educational needs, and other relevant considerations. VI. WORKLOAD STANDARDS The Turning Point workload standards are as follows: • Hours of service are individualized to meet the goals of the referral and the youth/families service plan. • Staff are in place to serve transitional needs of their caseload and Turning Point will hire if the demand for the service increases • Maximum caseload per worker is 1:15 • Individualized—primary in home services. • Hours of service are individualized to meet the goals of the service • Maximum caseload per supervisor will be determined as the program grows. Currently one supervisor in place for 31 residential clients, a maximum of which are in the Offense Specific program, who also oversees their transitional services. • Turning Point's current insurance meets or exceeds all levels identified in Weld County Core Services RFP identified in Part A, Administrative Information, 35. A-D. (See Attachment F) VII. PROOF OF COLLABORATION A primary focus of the Turning Point outpatient Offense Specific Program is to connect youth with the abundant resources in our community, and to provide decreased levels of support as the youth increases utilization of other resources and their own capabilities. The youth is encouraged to utilize the skills they have learned in more restrictive environments, practice them in a safe, structured environment and then slowly transition into the community on their own as they demonstrate they are prepared. These services are individualized for each client and built into their treatment plan. Once a service is identified, releases are obtained from the youth and their guardian and it is reviewed with their Case Worker during monthly staffings and treatment plan reviews. Turning Point has extensive relationships in the community that we utilize to link youth to services. These include, but are not limited to, North Range Behavioral Health, Partners, LifeSpan, the Workforce Center, AIMS Community College, Colorado State University, local school districts and local employers. Attached are letters supporting some of the current relationships we have with community agencies. (See Attachment A) VIII. EVIDENCED-BASED OUTCOMES Turning Point individualizes the services to youth in our outpatient service and utilizes the following evidence based approaches: • Milieu Therapy: Based on the model by James Smith: Head, Heart& Hands • Functional Family Therapy: John J. Wilson, Acting Administrator OJJDP, Dec. 2000; Alexander et al, 2000; Alexander, Robbins, and Sexton, 1999; Alexander, Sexton, and Robbins, 2000. • Cognitive Behavioral Therapy: based on Quickskills Curriculum by Dr. Jim Tanner. • Dialectical Behavioral Therapy: theory and approach to treatment developed by Marsha Linehan in 1991 • Pathways Curriculum for Substance Abuse Treatment: Wanberg, K.W. & Milkman, H.B. (2004). Criminal Conduct and Substance Abuse Treatment for Adolescents: Pathways to Self-Discovery and Change. Denver, CO: Sage Publishing • Attached are supporting documents related to some of these approaches, as well as a sample assessment, treatment plan and monthly report. We do not currently have a sample request to renew services for a client as this has always occurred in collaboration with the DSS Caseworker and we do not anticipate that being different. (See Attachment B and C). IX. STAFF QUALIFICATIONS Turning Point has operated successful Residential and Core Services including Day Treatment, Home Based Family Services, Intensive Family Therapy and outpatient Drug & Alcohol Services beginning in 1989. Turning Point currently employs over 130 highly trained, qualified and committed staff. Staff qualifications include extensive training, professional certification, and licensure which far exceeds what is required by licensing agents and governmental agencies. Turning Point has a strong team of professionals including 3 Licensed Clinical Social Workers (LCSW), 7 Licensed Therapists, 10 Master Level Therapists and Treatment Specialists, and over 75 Bachelors Level counseling staff. Additionally, each semester Turning Point has between 12- 14 student interns, 20-25 Honor Society student tutors and approximately 100 community volunteers who assist staff in providing counseling, educational and support services to youth. Turning Point currently operates an accredited education program with nine Special Education Teachers (including an Education Director), and six Teacher's Aides. Turning Point's existing administrative and support staff have more than 70 years combined experience in non-profit administration, and delivery and supervision of youth treatment services. The Offense Specific Program is overseen by a Clinical Director who is a Licensed Clinical Social Worker(LCSW) and Certified Addictions Counselor III (CAC III) and a Program Director who is a Licensed Professional Counselor (LPC) and a Certified Addictions Counselor III (CAC III). The role of the Clinical Director is to guide the programming and services to be research-based best practices and to ensure all staff are trained in the best practice approach to serve the clients and maintain them in their home. The role of the Program Director is to directly supervise the service and the staff in the program and ensure that the client care is exemplary. Since the outpatient Offense Specific Program is a new service offered by Turning Point, we will hire for the position assigned to working directly with the youth and families if necessary. If the youth transitions from one of our existing residential programs, we will strive to have them continue treatment with members of their treatment team in order to provide continuity of care. The number of staff identified for this program is limited only by the number of youth in the program and could grow with the needs of the services. Caseloads would depend on the needs of the family and would likely average 1:15. X. UNIT OF SERVICE RATE COMPUTATION See Attachment D for budget sheet XI. BILLING PROCESS In order to generate billing, Turning Point's administrative staff run monthly rosters from our computerized database system for service delivery. These dates are confirmed with the Program Director. Program costs are billed at the agreed upon rate to Weld County Social Services. Attachment E provides a sample monthly billing form. XII. PROGRAM CAPACITY BY MONTH Turning Point is not requesting a minimum client capacity per month to support the program and has the ability to grow with demand as described above. Attachment A Turning Point Center for Youth and Family Development, Inc. 03/29/2006 15: 14 970-392-1354 NRBH PAGE 03/03 _Ji. ' _ North Range Behavioral Health March 29,2006 Turning Point Center for Youth and Family Development 1644 South College Avenue Ft. Collins, CO 80525 Re: Letter to Accompany Proposal to Weld County Department of Social Services To Whom it May Concern: This letter is written to support the application of Turning Point Center for Youth and Family Development to provide CORE Services through the Weld County Department of Social. Services. North Range Behavioral Health is pleased to commit to a collaborative relationship with Turning Point Center for Youth and Family Development to develop a system of care for children and families served to ensure that duplications in services are minimized, that gaps in needed services are eliminated and that services are billed to the appropriate payer source. For services involving Medicaid eligible clients North Range Behavioral Health will work with Turning Point Center to determine which services are benefits of the Medicaid Mental Health program and to facilitate a process through which Turning Point Center for Youth and Family Development can be compensated with Medicaid funds when services provided are a benefit of Medicaid. Sincerely, /, Wayne A.Maxwell,Ph.D. Executive Director Mission: North Range aehgv oral Health provides professional, culturally competent menial hosith services for Weld County. (CD: LARIMER COUNTY WORKFORCE CENTER 200 W.Oak St.,Suite 5000 P.O. Box 2367 418 E.4'"St. Fort Collins,CO 80522-2367 Loveland, CO 80537 (970)496-6600 (970)667-4261 Fax(970)498-6670 Fax(970)663-7271 www.larimerworkforce.org 3/29/06 Dear Review Team, The Larimer County Workforce Center provides services to a wide variety of customers in the Northern Colorado area focusing on employment and training related services. One particular area of service offered at the Larimer County Workforce Center includes the federally funded Workforce Investment Act (WIA) program. Under the WIA program, local Workforce Investment Board's and local Youth Council's must be established, brining community serving agencies to the same table to discuss, strategize, and implement services for job seekers and employers in the community. Turning Point Center for Youth and Family Development continues to be an important community partner with the Larimer County Workforce Center and WIA services. Turing Point is an active member of our local youth council and serves as a referral source to our WIA youth program. This partnership has been mutually beneficial and continues to strengthen as services are designed for customers who have employment and training service needs. Some of the services that Turning Point customers receive through WIA services include extensive career and education counseling, access to supportive services, paid and unpaid work internships, and access to post-secondary training scholarships for retraining needs. I find Turning Point to be a valuable contributor to our community who provides an excellent set of services to youth in the Northern Colorado area. If you have any further questions or would like to discuss our partnership in depth, please contact me at (970) 498-6624. Sincerely, Mark A. Johnston WIA Center Manger Larimer County Workforce Center LARIMER Attachment B Turning Point Center for Youth and Family Development, Inc. Evidence-Based Best Practices Therapy http://www.nacbt.org/evidenced-based-therapy.httn CBI NACBT Online Headquarters Search This site DNational Association of Cognitive-Behavioral Therapists The Leader in Evidence-Based Psychotherapy if Evidence-Based Therapy! Evidence-Based Counseling & Psychotherapy N CBTI in the Membership is To Read about the open to people of all countries. NACBT's statement by To join online, concerning evidence by based,best practice click here) psychotherapy, click here) Aldo R. Pucci, MA, DCBT (c)Copyright,2005 by Aldo It Pucci. All Rights Reserved. While it might seem to be the case,evidence-based psychotherapy is not new. The term "evidence-based"can be defined two ways: • an approach to therapy emphasizes the pursuit of evidence on which to base its theory and techniques,as well u encourages its patients or clients to consider evidence before taking action; or • an approach to therapy is supported by research findings,and those findings provide evidence that it is effective. In relation to the first definition,practitioners of virtually every approach to counseling or psychotherapy think that their approach is evidence-based(at least to some degree). Each approach to psychotherapy is based on the assumption that it is correct in tens of its explanation of human behavior. Therefore,practitioners of each approach believe that they have"evidence"that their approach is correct,or they would not waste their time practicing that approach. However,cognitive-behavioral therapists seek to acquire evidence to determine the accuracy of their theories and effectiveness of their techniques.For example,cognitive-behavioral therapists believe that their explanation of human behavior(that"learned"behaviors and emotions are caused by one's thoughts) is correct. Rather than assuming that their theory is correct,they base this assumption on psychosomatic research that in fact proves that the assumption is indeed correct Cognitive-behavioral therapists take into the therapy session this interest in gathering evidence and assessing it CBTers ask questions to obtain a clear,accurate picture of the client's experience. CBT therapists also look for evidence in relation to their clients'thoughts,and encourage clients to base thinking on the FACTS(the evidence). Therefore,cognitive-behavioral therapy has always been"evidence-based"and will continue to be so whether or not there is an emphasis by managed-care or governmental agencies to be so. However,not many approaches to counseling or psychotherapy are evidence-based in relation to the second definition. Many approaches to psychotherapy do not lend themselves well to being researched and proven effective because they either utilize techniques that are vague and difficult to repeat with consistency,or the approach attracts practitioners that are not very interested in testing the effectiveness of it Cognitive-behavioral therapy is the most researched psychotherapeutic approach because: • each cognitive-behavioral approach has specific techniques that can be tested for effectiveness; • CBT encourages the development of specific goals that are measurable,and therefore,can be researched; • cognitive-behavioral therapists(to varying degrees)are interested in the research and research process; • cognitive-behavioral therapists are not interested in techniques that"feel right"or"seem correct", but techniques that are effective. A Cautionary Statement About Psychotherapy Outcome Research • Evidence-Based Best Practices Therapy http://www.nacbt.org/evidenced-based-therapy.htm Most psychotherapy outcome research is focused on short-term reduction of symptoms,and this is the reason why many"studies"find that cognitive-behavioral therapy is as effective as antidepressants in the Mar President treatment of depression This has been a pretty consistent finding. Aldo Pucci.DCBT Olt &San However,cognitive-behavioral therapy is focused on"getting better"rather than"feeling better". So D,.Mace Mwddby while we are encouraged that clients improve their symptoms with cognitive-behavioral therapy,we are Dr Midad Rosenbaum more interested in helping them with the underlying thoughts and core beliefs that caused their emotional Dr.Michael Edelstein distress,helping them rid themselves of problematic,inaccurate thoughts,and replacing them with Please be edvlsed 1tr.HuWocobs thoughts that are healthy and accurate. Dr.gdl.cum gh that my NACBT advi Oaken mao certification was Dr.Manua Wage This emphasis on"getting better"helps clients to do well long-tens. one of the factrus In Dr.MaadDonton i my being elected u. en Simonton Foreign Affiliate In U.Ilamb Mims Today,many treatment centers and facilities are very interested N having then etafftrained or Dr.David sums cognitive-behavioral therapy. For information on in-house training options for CBT certification,please the mash Robbiecm5dd,MA write me at aldoatiacbtorq Psychological Dahill Hausa Society.' al renyvcn For other information on training in cognitive-behavioral therapy please visit ]iiLearhadt ACSw -Joe Roberts http://wvnv.nacbtorWworkshops.htm (c)Copyright,2005 by Aldo It Pucci. All Rights Reserved. 3 0 3 6 since May 7,2005 ' U.S.Department of Justice Office of Justice Programs Office of Juvenile Justice and Delinquency Prevention 4y 4.>n.. t syr,y.?(..LL. pv 1.P �$.JLL ,. 13A.,.A.RP,,.w.�,. ,1 .� $ ,Awn A......a. t .. 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Sexton and James F Alexander 'are lerjjeiy:k 'fectiue .4uyeni(eotfen- :faer>Nterptkvedtor3+theirfatfldt t• The Office of Juvenile Justice and Delin- ineffective and costly.By removing adoles- ..#.4nirMaiktliieveaftsbl{Yre3ur'n. : quency Prevention(OJJDP)is dedicated to cents from their families and communities ";trnlass 3hiJ1f#ndoliymg kreixatngtat preventing and reversing trends of increased punitive programs inadvertently make ado- iiiiiiiikiiiiiiiimiiiiiiiiiiiiiiissitiggigkiiid delinquency and violence among adoles- lescents'problems more difficult to solve attitiorwsblems ar'oltkaty to Ctinbhtiuta cents. These trends have alarmed the public in the long run.Regardless of how adoles iiiiiiwisigaikiiii4iiiiaimoNsimmimmi during the past decade and challenged the cents'problems manifest themselves,they :: juvenile justice system.It is widely accepted are complex behavioral problems embed utie ---'"amity Tttsi' (-T that increases in delinquency and violence ded in adolescents'psychosocial systems dtaxia onR 1.7tN:41;1 et!f,,,si 'sP ce nNj over the past decade are rooted in a num- (primarily family and community).Thus, <'tn,fe�arstly hasedgI' VS 1 on an-J.! berof interrelated social pmblems—child family-based interventions that adopt a fntervWnttcn s#faf[s'f Jte proQram•ap abuse and neglect,alcohol and drug abuse, multisystemic perspective :plies a gOtl'prehanalve_fiada3 pfcoon ` g y are well suited :Bter34 etripingatly eo:to pr,nerptes youth conflict and aggression,and early to treating the broad range of problems poni sexual involvement—that may originate found in juveniles who engage in deln 'mod A WV flttilFexpertencetttfhe within the family structure. The focus of quent and criminal behavior. :flat m ttOY.atccSk and detnquertt OJJDP's Fan*Strengthening Series is to s * Functional Family Therapy(FFF)is a provide assistance to ongoing efforts across ` ".B91W.M Cf3r960,13^M"5 Wvoiu family-based prevention and intervention gal the country to strengthen the family unit by Uor3 auWrrriare than thSf3a decade& program that has been applied successfully discussing the effectiveness of family inter- §et5 forth tie progratr.s¢ore pnn--. in a variety of contexts to treat a range of q imm toni v ftn pr and Comm prow. resources these high-risk youth and their families.As o £likik Sn cft , naabt Sne! to families and communities. f#Tt1WWS itSfesWarctt fOllndatlonS ` such,FFf is a good example of the current ratnmtintljt implarttentattari of PF€ Problems arising from juvenile crime are a generation of family-based treatments for :is described and an siampis of serious concern for many local communi- adolescent behavior problems(Mendel, affWCti'a ii pitealion sspmvtdatj, ties.Expressions of adolescent behavior 2000;Sexton and Alexander,1999).It cow problems range from minor offenses(e.g., bins and integrates the following elements fjirrfy!' !itfGtinroatnsear"ph curfew violations and trespassing)to seri- into a clear and comprehensive clinical :7ndt+�ta that -, qmal can prevent the. ous crimes(e.g.,drug abuse,theft,and model:established clinical theory,empiri- na8'taftlelingt#anoy S(:ttl reduce - violence)and result in staggering personal, cally supported principles,and extensive retadivtam At W inrual.and human economic,and social costs.Until recently, clinical experience.The FFf model allows �o05t Wall bekawthatexacted by the. most communities were left on their own for successful intervention in complex and punitive aPWOa[JtaB noted earlier j to determine how to address juvenile multidimensional problems through clinical ::etieve Uus Bulletin will help you crime,and many communities turned to practice that is flexibly structured and cut doonttsjdef the prastam$menIa exclusively punitive approaches such as turally sensitive—and also accountable to :ttryotirOatnmunity incarceration.Mounting evidence,how- youth,their families,and the community. bbiS.F Wilson ever,indicates that such approaches are Attire Adminjatrator Although commonly used as an interven- The Evolution of Alexander, 1999;see table),developing Lion program,FFT is also an effective pre- Functional Family a systematic approach to training and vention program for at-risk adolescents program implementation,and adding a and their families.Whether implemented Therapy comprehensive system of client,process, as an intervention or a prevention pro- More than 30 years ago,it became appar- and outcome assessment.The system gram,FF1'may include diversion,proba- ent to FFT progenitors that although the is implemented through a computer- tion,alternatives to incarceration,and/or rate and severity of juvenile delinquency, based client tracking and monitoring reentry programs for youth returning to violence,and drug abuse were growing at system known as the Functional Family the community following release from a a frightening pace,intervention programs Therapy-Clinical Services System(FFT- high-security,severely restrictive institu- remained seriously underdeveloped CSS).This most recent iteration of FFT tional setting. (Alexander and Parsons, 1973).In 1969, helps clinicians identify and implement researchers at the University of Utah's goals for therapeutic change in a way that Based on the results of extensive indepen- Psychology Department Family Clinic de- promotes accountability through process dent reviews, bl has been designated veloped FFT to serve diverse populations and outcome evaluation.As a result,FFT "variously as a"blueprint program"(Alex- has matured into a clinical intervention ander et al.,2000),an"exemplary model" of underserved and at-risk adolescents model that includes systematic training, ro am(Alexander,Robbins,and Sexton, and their families.These populations P lacked resources,were difficult to treat, supervision,process,and outcome as- 1999),and a me based empirically der, and often were perceived by helping pro- sessment components—all directed at supported treatment"(Alexander,Sexton, fessionals as not motivated to change. Improving the delivery of FFT in local and Robbins,302 years of cli designations ald Although these underserved populations communities. reflect hF of clinical and were diverse in terms of family organiza- research experience and its use at a wide presentingnamics l d ti l relational , range of intervention sites in the United lion, Core Principles, Goals, problems,and cultures,they often shared States and other countries. and Techniques a common factor They had entered the FFT targets youth between the ages of 11 school counseling,mental health,or juve- Functional Family Therapy is so named to and 18 from a variety of ethnic and cul- nile justice systems angry,hopeless,and/ identify the primary focus of intervention tural groups.It also provides treatment or resistant to treatment. (the family)and reflect an understanding to the younger siblings of referred addles- The developers of FFT recognized that that positive and negative behaviors both cents.FFT is a short-term intervention— influence and are influenced by multiple successful treatment of these populations including,on average,8 to 12 sessions for relational systems(i.e.,are functional). required service providers who were sen- mild cases and up to 30 hours of direct sitive to the needs of these diverse fami- FF1'is a multisystemic prevention pro- _ service(e.g.,clinical sessions,telephone gram,meaning that it focuses on the mul- liesand competent to work with them, calls,and meetings involving community tiple domains and systems within which resources)for more difficult cases.In and who understood why the families had adolescents and their families live.FF'is tradmost cases,sessions are spread over a past onally resisted treatment.Over the also multisystemic and multilevel as an 3-month period.Regardless of the target past 30 years,FFT providers have learned intervention in that it focuses on the that they do than simply stop population, emphasizes thetreatment system,family and individual tance of respecting all family members must more on bad behaviors;they must motivate land- functioning,and the therapist as major lies to change by uncovering family mem- bers'own terms(i.e., they experience tiers'unique strengths,helping families components.Within this context,FFT the intervention process). works first to develop family members' build on these strengths in ways that en- inner strengths and sense of being able to Data from numerous studies of FFT out- hance self-respect,and offering families improve their situations—even if mod- comes suggest that when applied as in- specific ways to improve. estly at first.These characteristics pro- tended,FFT reduces recidivism and/or the onset of offending between 25 and Since its development,FFT has been a vide the family with a platform for change 60 percent more effectively than other dynamic clinical system.It has retained and future functioning that extends be- programs(Alexander et al.,2000).Other its core principles while adding clinical yond the direct support of the therapist studies indicate that FFT reduces treat- features that improve successful out- and other social systems.In the long run, ment costs to levels well below those of comes in the diverse communities in the FFT philosophy leads to greater self- traditional services and other interven- which it has been implemented.More sufficiency,fewer total treatment needs, tions(Alexander et al.,2000).As FFT has than two decades ago,FFT began focusing and considerably lower costs. evolved,it has adopted a set of guiding on therapist characteristics and in-session At the level of clinical practice,FFI in- principles,goals,and techniques that processes from an integrated perspective eludes a systematic and multiphase can be used even when resources are that combines research and practice.This intervention map—Phase Task Analysis— limited—for example,in managed care perspective,in turn,has contributed to that forms the basis for responsive clinl- and similar contexts that restrict the training of therapists for subsequent cal decisions.This map gives FFT a flex- open-ended and non-outcome-based interventions by identifying specific step- ible structure by identifying treatment resource funding. by-step interventions and their impact on strategies with a high probability of suc- youth and other family members. cess and facilitating therapists'clinical In the late 1990's,FFT further articulated options.FFF's flexibility extends to all its clinical change model by refining the family members and thereby results in phases of intervention(Sexton and effective moment-by-moment decisions in 2 Functional Family Therapy Clinical Model: Intervention Phases Across Time Y x - <r;:l r7' : 'i3'7'.)fA E Y' >l ¢' ec i.s F rsr' 'KI $i!/YF Js? .a`� 3 '»"y 6 s.. �>s.Y s n s s 4 s s ss; i o i� 6 ; > s a am g # .. ��i nA9 '>r•,n r•.r!,.#. ¢:/.c:v:,3.�'!,.!.!{•<.. � s,k :.➢..s:�Jnrd.:',e,.a. U .'.,: Early Middle Late •vr:<.:<.r. :.rv<...:^.✓:::Rr::::::au. 'r' .!:.n'/!:.»?S{< .!;:'�iT.;"i ...� fii..G{<.<:./:.:9:,,(;t �3:n s€.Y...:..2...<:£<£:<.:.1,. ..fir:#i:'s.✓s ' ., ::.,. ............:...<.«:r.n.,• ::...: � ,..:.c:.<:n.c:.•a.:.:,.: ... �iAFS5TYpitt177s;.Y•s! ,,off.,'#≥f.:. s6 ;� , , • .:v;.3." ..,.,nn.. :...a... ..!''.. Engagement and Motivation Behavior Change Generalization Phase goals Develop alliances. Develop and implement Maintain/generalize change. individualized change plans Reduce ne ativi . p g ty,resistance. Prevent relapses. Improve communication. Change presenting Provide community resources delinquency behavior. necessary to support change. Minimize hopelessness. Build relational skills e. g., Reduce dropout potential. communication and Develop family focus. parenting). Increase motivation for change. Risk and Negativity and blaming(risk). Poor parenting skills(risk). Poor relationships with school/ protective Hopelessness(risk). Negativity and blaming(risk). community(risk). factors Low level of social support addressed Lack of motivation(risk). Poor communication(risk). (risk). Credibility(protective). Positive parenting skills positive relationships Alliance(protective). (protective). with school/community Treatment availability Supportive communication (protective). (protective). (protective). Interpersonal needs (depends on context). Parental pathology(depends on context). Developmental level(depends on context). Assessment Behavior(e.g.,presenting Quality of relational skills Identification of community focus problem and risk and protec- (communication,parenting). resources needed. tive factors). Compliance with behavior Maintenance of change. Relational problems sequence change plan. (e.g.,needs/[unctions). Relational problem sequence. Context(risk and protective factors). Therapist/ Interpersonal skills(validation, Structure(session focusing). Family case manager. Interventionist positive interpretation, Change plan implementation. Resource help. skills reattribution,reframing,and sequencing). Modeling/focusing/directing/ Relapse prevention High availability to provide training. interventions. services. Source:Sexton and Alexander,1999. 3 a -- . the intervention setting.Thus,FFT prac- of behavior sequences involved in delin- consider the adolescent's family be- tice is both systematic and individualized. quency),and emotional components(e.g., cause the family is the psychosocial The following sections describe inter- blaming and negativity).Clinicians provide context in which the adolescent lives. The foll phases and of the concrete behavioral intervention to guide Family factors considered in an FFT ven assessment.theA modelth clinical FF1'ap and model specific behavior changes(e.g., assessment include what goes on dur- clinical presented in the table on page 3 reflects, parenting,communication,and conflict ing daily family life(e.g.,parenting, FFT is a multiphase,goal-directed,and management).Particular emphasis is teaching,supporting,providing,and systematic program. placed on using individualized and de- relating).Behavioral and contextual velopmentally appropriate techniques that factors include external and social fac- fit the family relational system. tors that Influence the adolescent(e.g., Intervention Phases the presence or absence of risk and FFP's three specific intervention phases— Phase 3:Generalization.This FFT phase protective factors and the availability is guided by the need to apply(i.e.,gener- of community resources). and motivation,behavior change,andgeneralization—are inter- problem positive family change to other g problem areas and/or situations.FFT cli- • Assessment of family functioning— dependent and sequentially linked.Each nicians help families maintain change and rather than completion of a diagnostic has distinct goals and assessment objet- prevent relapses.To ensure long-term assessment—is the most helpful way fives,each addresses different risk and support of changes,FFT links families to identify appropriate treatment protective factors,and each calls for par- with available community resources.The options and approaches.The goal of ticular skills from the interventionist or primary goal of the generalization phase assessment is to plan the most therapi st providing treatment.The inter- Is to improve a family's ability to affect appropriate treatment. ventions in each phase are organized co- the multiple systems in which it is embed- herently,which allows clinicians to main- P y • Clinical,outcome,and adherence as- ded(e.g.,school,juvenile justice system, sessment are critical to successful tain focus in contexts that often involve considerable family and individual disrop- to mobilize community support systems community),thereby allowing the family implementation of the FFT model. lion.The three intervention phases are and modify deteriorated family-system FFT has identified formal and clinical described in the sections that follow. necessary,If relationships. tools for model,adherence,and outcome FFT clinicians Phase 1:Engagement and Motivation. intervene directly with the systems in assessment.These tools are incorporated This phase places primary emphasis on which a family is embedded until the fam- into the Functional Family Assessment maximizing factors that enhance inter- ily develops the ability to do so itself. Protocol—a systematic approach to un- vention credibility(I.e.,the perception derstanding families—and the Clinical that positive change might occur)and Assessment tion tool that allows therapists to track Services System(CSS)—an implementa- minimizingfactors likely to decrease that rteAssessment is an ongoing,multifaceted the activities(i.e.,session process goals, perception(e.g.,poor program image, process that is part of each phase of the comprehensive client assessments,and difficult location,insensitive referrals, FF11 clinical model.In FFT,assessment personal and/or cultural insensitivity, clinical outcomes)essential to successful and inadequate resources).In particular, wfohich n behavioral understanding the ways in implementation. therapists apply reattributfon(e.g.,re- which yla problems function compe- framing, inpositive themes)and within family relationship systems.The CSS seeks to improve therapists'compe- g,developing focus of assessment depends on the tence and skill by keeping them focused related techniques to address maladap- phase of treatment(see table,page 3). on the goals,skills,and interventions tive perceptions,beliefs,and emotions. needed for each phase of FFT.CSS's Use of such techniques establishes a In general,assessment in FFT is based on computer-based format gives therapists family-focused perception of the present- the following principles: easy access to a variety of process and ing problem that serves to increase fami- • FFT assessment should focus on the assessment information which,in turn, lies'hope and expectation of change,de- ways that family relational systems allows them to make good clinical deci- crease resistance,improve alliance and are related to the presenting behavior sions and provides them with the com- trust between family and therapist,re- plete outcome information needed to duce oppressive negativity within families problems—in both adaptive and mal- evaluate case success. and between families and the community, adaptive ways. and help build respect for individual dif- • FFT should identify risk and protective ferences and values. factors through clinical and formal as- Research Foundations Phase 2:Behavior Mange.During this sessment.In doing so,FFT helps iden- Throughout its development,FFT has re- phase,FFT clinicians develop and tify family,individual,and contextual quired step-by-step descriptions of the implement intermediate and,ultimately, issues that might become the targets clinical change process and rigorous of treatment. evaluation of outcomes.FFT also has in- long-term behavior change plans that are culturally appropriate,context sensitive, • Assessment should be multilevel, sisted on integrating science(as it applies and tailored to the unique characteristics multidimensional,and multimethod. to evaluation and research),clinical and of each family member.The assessment Individual factors include the cultural sensitivity,sound clinical judg- focus in this phase includes cognitive(e.g., adolescent's cognitive and develop- ment and experience,and comprehensive attributional processes and coping strate- mental level and any psychological theoretical principles.From 1973 to the gies),interactive(e.g.,reciprocity of posi- conditions that he or she may have present,published data have reflected tive rather than negative behaviors, (e.g.,depression/anxiety,thought the positive outcomes of FFT.Data show, competent parenting,and understanding disorders).Assessment should also for instance,that when compared with 4 standard juvenile probation services, residential treatment,and alternative Figure 1: Outcome Findings for Recidivism in Randomized Clinical therapeutic approaches,FFT is highly Trials, 1973-1998 successful.Both randomized trials and nonrandomized comparison group stud- les(Alexander et al.,2000)show that FFT significantly reduces recidivism for a wide range of Juvenile offense patterns.In 1998 0 £• `° .• s addition,studies have found that FFT dramatically reduces the cost of treat- ment.A recent Washington State study, m for example,shows savings of up to H $14,000 per family(Aos,Barnoski,and cTo o 1977maw, , ` Web,1998).FFT also significantly reduces potential new offending for siblings of c-5 treated adolescents(Klein,Alexander, U and Parsons,1977).Figures 1 (random- 1973 ized clinical trials)and 2(comparison studies)summarize the outcome findings of FFT studies conducted during the past 0 10 20 30 40 50 60 70 80 30 years.These studies show that when compared with no treatment,other family Recidivism Rates (%) therapy interventions,and traditional ju- venile court services(e.g.,probation), FFT can reduce adolescent rearrests • Functional Family Therapy i Juvenile court program by 20-60 percent. IN Alternative treatment tic No treatment Community Source:Alexander and Parsons,1973;Klein,Alexander,and Parsons,1977;Hansson,1998. Implementation of Functional Family Therapy Successful FFT programs,whether home Figure 2: Outcome Findings for Recidivism in Comparison Studies, based,clinic based,or school based,in- 1985-1995 elude programs grounded in diversion, probation,alternatives to incarceration, and reentry from high-security,severely restrictive institutional settings. 1995 ,:.-;^.f. :.1.> FFT currently has 50 active certified ser- vice sites in 15 States.These sites serve thousands of adolescents and their fami- lies each year.The ability to replicate FFT with fidelity has been achieved through a v 1985c specific training model and a sophisti- cated client assessment,tracking,and tq monitoring system(FFT-CCS)that pro- 19856 vides for clinical assessment,outcome accountability,and supervision.In addi- tion,the FFT Practice Research Network (FFT—PRN)allows clinical sites to develop 19858 4¢ 3s$P. .'s,:$�.W.lwe.,.................. and disseminate information on the FFT model.Clinicians who have successfully 0 20 40 60 80 100 implemented FFT include trained profes- sionals with master's degrees and,on Recidivism Rates(%) occasion,staff with bachelor's degrees from fields such as public health nursing, • Functional Family Therapy Juvenile court program social work,marriage and family therapy, Alternative treatment Base rate clinical psychology,licensed mental health counseling,probation services, •The three 1985 comparison studies(1985a,b,and c)appear in Barton et al., 1985. criminology,psychiatry,and recreation Source:Barton et al.,1985;Gordon et al.,1988;Gordon,Graves,and Arbuthnot,1995. therapy. 5 Communities have implemented FFT with referred to the Family Project by proba- compared with 36 percent of the success because its training program is tion officers.Because the Family Project treatment-as-usual comparison group. multisystemic,meaning that it focuses on was the only counseling service used by These data suggest that FFT reduced the therapist,community,and clinical the juvenile court during that period,this recidivism by roughly 50 percent,a figure delivery system.At any given site(e.g., group represented the entire population consistent with previous FFT randomized agency,intervention team,contracting of adolescents referred for counseling ser- clinical trials and replication studies. intervention program),FFT's four major vices.Of the group,80 percent completed Another measure of outcome is a pro- goals are to: FFT treatment services,a high rate of grams cost effectiveness.Figure 4 shows completion compared with the rate for the costs of various services within the • Replicate the program as it has been standard juvenile justice-based interven- used in previous sites(to increase the Clark County DFYS system during the lions.Thus,even though its services were 2-year probability that the site will have the study period.On average,FFT delivered in a university training center to same success),yet tailor the program which clients ha travel treatment costs during this time were be- d to for each ses- to the unique needs of the community. sion,the Family Project successfully en- tween$700 and$1,000 per family.By con- trast,the average cost of detention was at • Develop a self-sufficient site 0.e.,one gaged and retained a high percentage of a least$6,000 per adolescent and the aver- that will be able to provide FFT over diverse population of at-risk adolescents, age cost of the county residential program time Ina way that remains true to the all of whom were on probation.This was at least$13,500 per adolescent.Con- therapy's core principles). success was a function of both the FFT sidering that the county's residential clinical model and the clinic's extensive • Develop competent therapists and sup- outreach procedures! program has a 3-year recidivism rate of portive clinical and administrative more than 90 percent(i.e.,90 percent of structures. Figure 3 shows 1-year recidivism rates for those who complete the program commit a • Initiate and use the FFT clinical sys- those who completed the Family Project's subsequent offense within 3 years),FFT is tem to promote adherence to the FFT program and those who were part of a highly cost effective—resulting in a much model treatment-as-usual comparison group(a lower rate of recidivism(19.8 percent for 1 group that received probation services as year)at a much lower cost. Implementation of FFT focuses,in particu- usual).The figure also provides the lar,on developing therapist competence districtwide 3-year recidivism rate and Conclusion rather than simply teaching skills.A com- the 3-year recidivism rate for those who petent therapist is able to: received other available court services. FFT is one of the current generation of • Implement a treatment model's core Of those who completed the program, family-based treatments for adolescent elements. only 19.8 percent committed an offense behavior problems.As both a prevention _ during the year following completion, and an intervention program,FIT has • Treat each family member with clinical been implemented in various treatment and cultural sensitivity. contexts and with culturally diverse client ' Initial sessions were accompanied by many phone The success of FFT is due to • Enhance the treatment's effectiveness contacts to enhance treatment participation. populations. by making treatment decisions based on core principles of the model. The Family Project: Figure 3: Recidivism Rates—Functional Family Therapy Versus Other Y 1 Available Court Services A Recent FFT Replication FFT program The Family Project is a unique partner- completers* ship between a university(the University Treatment-as-usual of Nevada,Las Vegas)and a community comparison group service provider(the Clark County De- partment of Family and Youth Services Districtwide (DFYS)).The Family Project is currently population'* the largest FFT research and practice site Supervised in the Nation.Through this partnership, probation cases" located in one of the Nation's fastest • Residential growing and most multiculturally and eth- treatment cases" nically diverse urban areas,FFT services are provided to at-risk youth and their 0 20 40 60 80 100 families referred by juvenile probation.As the data below reflect,the effectiveness Recidivism Rates (Wa) of this true community project results from its use of marriage and family thera- pists in an established community clinic. • 1-year recidivism totals. "3-year recidivism totals. During a 2-year period,clinic-based thera- source:Sexton,in press. pists successfully contacted 231 families 6 Alexander,J.F.,Sexton,T.L.,and Robbins, Figure 4: Cost Effectiveness—Functional Family Therapy Versus M.S.2000.The developmental status of Other Available Court Services family therapy in family psychology inter- vention science.In Family Psychology In- tervention Science, edited by H.Liddle, ^y D.Santisteban,R.Leavant,and J.Bray. E Detention Washington,DC:American Psychological c (30 days) Association. Co'er Residential Aos,S.,Bamoski,R.,and Lieb,R. 1998. c 2 treatment(90 days) Watching the Bottom Line:Cost-Effective m Interventions for Reducing Crime in Wash- y in-home FFT ington. Olympia,WA:Washington State c'� (12 sessions) Institute for Public Policy. Clinic-based FFT Barton,C.,Alexander,J.F.,Waldron,H., i (12 sessions) `' m Turner,C.W.,and Warburton,J. 1985.Gen- e 0 $3,000 $6,000 $9,000 $12,000 $15,000 eralizing treatment effects of Functional Family Therapy:Three replications. Cost American Journal of Family Therapy 13: 16-26. Source:Sexton,in press. Gordon,D.A.,Arbuthnot,1,Gustafson, K.E.,and McGreen,P. 1988.Home-based behavioral-systems family therapy with its integration of a clear,comprehensive, James F.Alexander,Ph.D. disadvantaged juvenile delinquents.The and multisystemic clinical model with on- University of Utah American Journal of Family Therapy going research on clinical process and Department of Psychology 16(3):243-255. outcomes.FFT also includes a systematic 380 South 1530 East,Room 502 Gordon,D.A.,Graves,K.,and Arbuthnot, training and community implementation Salt Lake City,UT 84112 program.The results of more than 30 801-581-6538 J. 1995.The effect of Functional Family years of clinical research suggest that by E-mail:JFAFFT®psych.utah.edu Therapy for delinquents on adult criminal behavior.Criminal Justice and Behavior following these principles,FFT can reduce recidivism and/or prevent the onset of Kathie Shafer,Communication 22:60-73. Coordinator delinquency.These results can be accom- Hanson,K. 1998.Functional family plished with treatment costs well below University of Utah therapy replication in Sweden:Treatment those of traditional services and other Department of Psychology outcome with juvenile delinquents.Paper interventions. 380 South 1530 East,Room 502 presented to the Eighth Conference on Salt Lake City,UT 84112 Treating Addictive Behaviors,Santa Fe, Unique to FFT is its systematic yet indi- 702-499-9693,801-585-1807 NM. vidualized family-focused approach to E-mail:shafer@psych.utah.edu Juvenile crime,violence,drug abuse,and Klein,N.C.,Alexander,J.F.,and Parsons, other related problems.The phases of B.V.1977.Impact of family systems inter- FFT provide therapists with specific goals References venton on recidivism and sibling delin- for each family interaction.Although sys- Alexander,J.F.,and Parsons,B.V. 1973. quency:A model of primary prevention tematic,each phase is guided by core Short-term family intervention:A therapy and program evaluation.Journal of Consult- principles that help the therapist adjust outcome study.Journal of Consulting and ing and Clinical Psychology 45(3):469-474. and adapt the goals of the phase to the Clinical Psychology 2:195-201. unique characteristics of the family.In Mendel,R.A.2000.Less Hype,More Help: this way,FFT ensures treatment fidelityAlexander,J.F.,Pugh,C.,Parsons,B.V., Reducing Juvenile Crime, What Works— while remaining respectful of individual and Sexton,T.L.2000.Functional family and What Doesn't. Washington,DC: families and cultures and unique commu- therapy.In Blueprints for Violence Preven- American Youth Policy Forum. nity needs. lion(Book 3),2d ed.,edited by D.S.Elliott. Sexton,T.L.In press.Functional Family Boulder,CO:Center for the Study and Pre- vention of Violence,Institute of Behav- Therapy. Las Vegas,NV:The Family For Further Information coral Science,University of Colorado. Project. Thomas L.Sexton,Ph.D. Alexander,J.F.,Robbins,M.S.,and Sexton, Sexton,T.L.,and Alexander,J.F. 1999. Indiana University T.L. 1999.Family therapy with older,indi- Functional Family Therapy'Principles Department of Counseling and cated youth:From promise to proof to of Clinical Intervention,Assessment, Educational Psychology practice.In Center for Substance Abuse and Implementation. Henderson,NV: 201 North Rose Avenue Prevention Science Symposium:Bridging RCH Enterprises. Bloomington,IN 47405-1006 the Gap Between Research and Practice, 812-856-8350 edited by K.Kumpfer.Washington,DC: E-mail:thsexton@indiana.edu Center for Substance Abuse and Prevention. 7 • U.S.Department of Justice PRESORTED STANDARD POSTAGE PAID Office of Justice Programs DOSOJJDP Office ofJuvenile Justice and Delinquency Prevention PERMIT NO.G-91 Washington,DC 20531 Official Business Penalty for Private Use$300 RuttetErt NC,2 164743 Points of view or opinions expressed in this The Office of Juvenile Justice and Delin- ACilaOwiedgfnents document are those of the authors and do• quency Prevention is a component of the Of- Thomas t,.Seltton,Ph.D.,is a Profes. not necessarily represent the official position fice of Justice Programs, which also includes or policies of OJJDP or the U.S.Department the Bureau of Justice Assistance, the Bureau s©rtnlha tional sycho ogy at ling of Justice. and�<lUOattonat psychology at of Justice Statistics, the National Institute of Indiana tJntversity in elotiminglon 1n • /Justice,and the Office for Victims oCrime. that role,Dc Sexton d'irectsthe Clmlcal'Raining Cattier and the Center krr Adolesasnf and i✓amily Studies andteaches in the W7iversiVs : Share With Your Colleagues • naUanally accredited Counseling Psychology Program,James E Unless otherwise noted, OJJDP publications are not copyright protected.We Alexander.Ph.D.,is a Professor in the encourage you to reproduce this document,share it with your colleagues,and Department of Psychologyat t e reprint it in your newsletter or journal.However,if you reprint,please cite OJJDP LJniversityofUtah in settLake City. and the authors of this Bulletin.We are also interested in your feedback,such as Dit Alexander is a IaDari ai investigator how you received a copy,how you intend to use the information,and how OJJDP fot ihe_Center forTreatment Research materials meet your individual or agency needs.Please direct your comments and on Ad(itescentfiw sore which questions to: conducts psyctosnciai freahrrtirit Juvenile Justice Clearinghouse •reseatC on adotei Gent drug abuse. Publication Reprint/Feedback 0ts,Sexton and Alexander have each P.O.Box 6000 authored numerotis•pubicalons On • Rockville,MD 20849-6000 familyttterapyand the treatment of 800-638-8736 adolescents wrth alcohol,dntg abuse, 301-519-5600(fax) andrl entatheattll problems. ' E-mail:askncjrs@ncjrs.org . Dialectical behaviour therapy for borderline personality disorder— ... http://apt.rcpsych.org/cgiicontent/full/8/1/10 Advances in DR you want Psychiatric Treatment the We a lerKe` ! QUICK SEARCH: [advanced] Author: Keyword(s): HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS Go British Journal of Psychiatry Psychiatric Bulletin All RCPsych Journals Year: Ivolt:r Page:f Advances in Psychiatric Treatment(2002)8: 10-16 This Article ®2002 The Royal College of Psychiatrists F Full Text(PDFI Submit a response Dialectical behaviour therapy for borderline P Alert me when this article is cited personality disorder P Alert me when eLetters are posted F Alert me if a correction is posted F Citation Mao Robert L.Palmer Services Bob Palmer is the Clinical Director of the Leicestershire Eating Disorders Service and F Email this article to a friend an honomy consultant psychiatrist and senior lecturer at Leicester General Hospital F Similar articles In this iournal (University Department of Psychiatry,Brandon Mental Health Unit,Leicester General p Alert me to new issues of the journal Hospital,Leicester LE5 4PW,UK).He is the author of Helping People with Eating pownload to citation manager Disorders and other books and papers on the topic of the clinical eating disorders. ; Cited by other online articles The concept of borderline personality disorder(BPD)seems to include, PubMed almost by definition,the idea that people described by the term are difficult to F Articles by Palmer,R. L. help.The broad picture portrayed by the diagnostic criteria(Box 1R)is likely to be familiar to most clinicians and to cause the hearts of many to sink.A core issue for those with BPD is difficulty of relationship,and this will inevitably—even especially—include clinical and therapeutic relationship. It is all too common for distress to be met with much therapeutic effort but for little to change. Indeed,there is often a nagging sense that attempts at treatment may be making matters worse.The care of people with BPD presents an important challenge to mental health services. At the individual level,the patient continues to be at risk and to suffer and the clinician feels frustrated.At the service level,substantial resources may be ex ended to little a arent benefit. Box 1 DSM—Iv diagnostic criteria for borderline personality disorder A pervasive pattern of instability of interpersonal relationships,self-image,and affects,and marked impulsivity beginning by early adulthood and present in a variety of contexts,as indicated by five(or more)of the following: 1. frantic efforts to avoid real or imagined abandonment.Note:Do not include suicidal or self-mutilating behavior covered in Criterion 5 2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation 3. identity disturbance:markedly and persistently unstable self-image or sense of self 4. impulsivity in at least two areas that are potentially self-damaging(e.g.,spending,sex,substance abuse,reckless driving,binge eating).Note:Do not include suicidal or self-mutilating behaviour covered in Criterion 5 5. recurrent suicidal behavior,gestures,or threats,or self-mutilating behavior 6. affective instability due to a marked reactivity of mood(e.g.,intense episodic dysphoria,irritability,or anxiety usually lasting a few hours and only rarely more than a few days) 7. chronic feelings of emptiness 8. inappropriate,intense anger or difficulty controlling anger(e.g.,frequent displays of temper,constant anger,recurrent physical fights) 9. transient,stress-related paranoid ideation or severe dissociative symptoms �.- 1/11/111I1S F.SA AM Dialectical behaviour therapy for borderline personality disorder--... http://apt.rcpsych.org/cgi/contentlful1/8/1/10 (American Psychiatric Association, 1994:p. 654) If the worried clinician or service manager turns to the literature,there are many opinions on offer about how people with BPD may best be helped but much less in the way of clear evidence(Kisely, 1999).To date,there have been few randomised controlled trials(Perry et al, 1999).Dialectical behaviour therapy(DBT)is unusual in having been evaluated in two such trials. The first showed that DBT was superior to community-based`treatment as usual' in women with BPD associated with repeated self-harm(Linehan et al, 1991). Some benefit was retained at follow-up (Linehan et al, 1993, 1994). A further study showed similar benefits in women with BPD and substance misuse (Linehan et-al, 1999).Thus,DBT can claim an evidence base of a kind that other psychotherapeutic treatments currently lack.For this reason,it has been increasingly used in the USA,where it has been taken up with great enthusiasm. Sometimes,its advance has been associated with a degree of brouhaha that can be a little off-putting.Now DBT has arrived in the UK.What place should it have in British practice? ► The elements of DBT . DR Dialectical behaviour therapy is the brainchild of Marsha Linehan,a clinical a The elements of DBT I. The biosocial theory psychologist from Seattle with an impressive academic track record. She is the Components of DBT author of a book describing the treatment and of an accompanying skills training . Commitment . Consultant to the patient manual(Linehan, 1993a,/�However,although Linehan is the creator andvi Adaptations according to context undoubted guru of the enterprise,many others have contributed and the . Stages of treatment development of the treatment continues. The explicit aim has been and remains to - Training . Conclusions create a practical way of helping people who are otherwise very difficult to treat. • Multiple choice Questions In tune with this pragmatic stance,DBT is a hybrid created out of a variety of • References disparate elements.It seems to have a number of intellectual roots. Some are in its unusual name. Some are not.And at first sight,they form a strange collection. Cognitive—behavioural therapy One of DBT's several elements is cognitive—behavioural therapy(CBT). DBT espouses the scientific ethos.It makes use of self-monitoring,there is an emphasis on the here and now and much of the therapeutic technique is borrowed from CBT,including the style of open and explicit collaboration between patient and therapist. Furthermore,the treatment has a manual.The `bible' of DBT is Linehan's Cognitive Behavior Treatment of Borderline Personality Disorder(1993a). (She says that her publisher insisted on`cognitive behavior treatment'because they felt that a title including the word dialectical was less likely to sell well,particularly in the USA.) Dialectical thinking The `dialectical' in DBT refers to the way in which it uses a broad way of thinking that emphasises the limitations of linear ideas about causation. It substitutes 'both/and'for`either/or' and sees truth as an evolving product of the opposition of different views.The use of dialectical ideas in DBT arises largely from the clinical observation of the mixed and shifting nature of human emotion and experience in general and in patients with BPD in particular. Interaction with such a patient is unlikely to have the characteristics of a logical argument or even a orderly conversation. It is more likely to be akin to a dance to rapidly changing music in which clinician and patient each react nfi2 7/13/2005 6:54 AM Dialectical'behaviotir therapy for borderline personality disorder-- ... http://apt.rcpsych.org/cgi/content/full/8/1/10 to the other—sometimes to good effect,sometimes with much painful stamping on toes. A touch of Zen Dialectical thought emphasises the wholeness and interconnectedness of the world and the potential for the reconciliation of opposites.This emphasis is shared by the third element in DBT: the use of thinking and techniques drawn from Zen Buddhism.The key concept is that of mindfulness. The person with BPD is seen as having especial difficulties in being at all detached from his or her experience and,indeed,as often being overwhelmed by it. Developing the capacity for being mindful and living in the moment allows a greater potential for feeling appropriately in charge of the self.Zen is full of paradox, and there is something paradoxical about seeking greater mastery through a kind of detachment. However,when the alternative is being engulfed,then the place of mindfulness becomes clear. A related concept is the balance between acceptance and change. The most difficult idea for some is that the world is as it is.But again there is some paradox in the notion that acceptance—for instance,of unchangeable traumatic events in the past—may be necessary for change to be possible. Speaking metaphorically The metaphor of dance was employed above in discussing dialectics,and it is used quite often as a model of the therapeutic relationship in DBT. Indeed,DBT is bedecked with metaphors. Along with its apparently esoteric elements,it is characteristic of DBT that it also aspires to be down-to-earth. It contains a large measure of common sense expressed in folksy language,sometimes in a slightly self-conscious way. Aphorisms abound both in the handbook and in the hand-outs for patients. For example,the overriding attitude of the therapist should be that "patients are always doing the best they can" and that it is necessary to fmd the"kernel of truth" in the thoughts and assumptions of the sufferer.The need to try to gain something out of a set back or even a disaster is described as "making lemonade out of lemons".The active nature of the process from the patients'point of view is expressed by the saying that patients "may not have caused all of their own problems but they have to solve them anyway". Being effective is more important than being right.There is talk of discovering one's "wise mind". In general,therapy is about keeping things on the move.Furthermore,the judicious use of humour—"irreverence"—is advocated as a useful technique for keeping the therapeutic dance on the go when it might otherwise slow to a halt. Training may contain the slightly surreal experience of would-be therapists being asked to share their best funny lines. ► The biosocial theory aLu Dialectical behaviour therapy is thus a strange hybrid. Things that simply seem . The elements of DBT to work have been included.It is not essentially theory driven, and what theory The biosocial theory Components of DBT there is is limited. Its working model is the biosocial theory of BPD (Fig. ILO. . Commitment . Consultant to the patient . Adaptations according to context . Stages of treatment • Training . Conclusions . Multiple choice questions .References of t2 7/13/2005 6:54 AM Dialectical behaviour therapy for borderline personality disorder--... http://apt.rcpsych.org/cgi✓content/full/8/1/10 Fig. 1 Biosocial theory of borderline personality disorder a,m.sa w 4 .4 I5 Y •carveatatw1 .i T -3 ..a,v.parxr.... caw 16zw;Wixbtaxr»(Aex,11Cac emCiunt View larger version(28K): fin this windowl fin a new windowl The biosocial theory suggests that BPD is a disorder of self-regulation,and particularly of emotional regulation,which "results from biological irregularities combined with certain dysfunctional environments,as well as from their interaction and transaction over time" (Linehan, 1993a:p.42). People with BPD are seen as being unusually emotional by temperament but as having had this trait rendered maladaptive by a serially invalidating environment.They may have been made to feel that their emotional reactions are unjustified,inappropriate or a sign of illness.Vicious circles develop and the individual becomes trapped in the self-perpetuating cycle of BPD. Self-invalidation may make an important contribution once the process is underway and,of course,the individual's reactions may provoke undermining reactions from others.Linehan advocates the biosocial theory as one way of beginning to understand BPD and as likely to"engender an attitude of effective compassion"in clinicians. She sees individuals with BPD as being "involuntarily in hell",and the role of DBT is to help them to get out and stay out.The theory is explained to the patient as part of the process of commitment to treatment. ► Components of DBT �Ign Dialectical behaviour therapy is a treatment with several components.In its usual s The elements of DBT A. The biosocial theory form it is an out-patient treatment delivered over a period of 1 year, although • Components of DBT patients may join a DBT programme for a second year or stay in therapy for even . Commitment ic Consultant to the patient longer.The main components for the patients are a weekly individual out-patient -,Adaptations according to context session,attendance at a weekly skills training group and possible out-of-hours Stages of treatment telephone contact.In addition,for the therapy team there is a weekly consultation } Training . Conclusions meeting. Other treatment interventions such as drug treatment or emergency -. Multiple choice questions crisis admission may also occur,but these are not essential components of DBT. References Individual sessions Individual sessions typically last for 45-60 minutes and occur weekly. The past week is reviewed using `diary cards' that the patient has filled in.There is a recommended structure to sessions that follows a hierarchy of topics. Life-threatening behaviours should be discussed and dealt with first. Then come therapy-interfering behaviours, quality-of-life-interfering behaviours and attention to skills. In practice,the detailed content of sessions may be influenced by the style of the individual therapist.However,the whole process should be aimed at providing a setting that is validating for the patient. Typically,a good deal of attention is paid to the immediate antecedents of troublesome feelings and actions,and detailed chain analysis may be used to work out exactly how a particular crisis came about. There are forms that may help the patient and therapist to map out apparent chains of causation. At least at first,the a of 12 7/13/2005 6:54 AM Dialectical•behavionr therapy for borderline personality disorder-- ... http://apt.rcpsych.org/cgi/content/full/8/1/10 emphasis is on the promotion of the greater use of skills to survive and manage difficult feelings. These skills are taught mainly within the weekly training group. Skills training group Skills training is conducted in a weekly group,which typically lasts for 2 or 21/2 hours. The style of the group is didactic.Therefore the room may be arranged like a classroom,with the skills trainers—usually two—sitting at the front.The skills trainers may be also the individual therapists of some of the group members but this dual relationship is not attended to within the group. Process issues and evident emotion in the group are discussed and dealt with only if they are life-threatening or,more commonly,if they are noticeably interfering with therapy. Thus,that someone appeared sullen and inattentive would be addressed only if his or her behaviour was causing a major disruption to the running of the group. It would not be addressed as an issue in its own right or as an illustration of wider problems.This sometimes leads the trainers to have to carry on regardless of a group that seems to have its attention elsewhere. However,appearances may be deceptive. Or so the therapist has to hope. The skills training is organised around a manual that sets out the content of the programme in detail and gives advice about how it should be taught(Linehan, 1993b). The book also contains hand-outs for patients,which may be freely copied for the purpose. Groups may include group exercises and role-play, and homework is suggested. The content is divided into four modules,each of which is usually taught in blocks lasting a few weeks. Three modules are on topics—emotional regulation,distress tolerance and interpersonal effectiveness—similar to those found in other CBT and related programmes.The other module is on mindfulness. The mindfulness module is often repeated in short form between each of the other modules. Furthermore,it is typical for every skills training group to begin with a mindfulness exercise. Out-of-hours telephone contact Patients within a DBT programme may telephone their individual therapist between sessions. Pagers are often used for the initial contact. Such contact may sometimes be planned but is chiefly about helping the patient to get through crises. The contact should be mainly about coaching the patient in the appropriate use of the skills that have been learned previously in the group.Typically a DBT telephone call is brief—perhaps 5 or 10 minutes—and should not in general be used as an extra therapy session. Its function is different. It is mainly to try to help the patient avoid self-harm or sometimes to sustain or repair the therapeutic relationship. The patient is banned from contacting the therapist for 24 hours after an act of self-harm. The hours during which telephone contact is available are agreed between the therapist and the patient. What the therapist can manage is an explicit determinant and,indeed,is usually the limiting factor. The arrangement may be changed if it is misused.However,perhaps surprisingly,even highly disturbed patients usually respect the rules of the game.If they do not,this is discussed exhaustively as therapy-interfering behaviour. The consultation group The fourth essential component of DBT does not involve the patient directly. This is the weekly consultation group. DBT is a team treatment and the consultation group is where the team—the individual therapists and skills trainers— meet to review the programme and their practice. The dialectical style that characterises the practice of DBT with patients is continued even within this peer supervision group. The group is there"to treat the therapist",pushing and pulling appropriately to keep the process of therapy on the move. 5 of 12 __ 7/13/2005 6:54 AM Dialectical behaviour therapy for borderline personality disorder--... http://aptscpsych.org/cgi/content/full/8/1/10 1 Commitment Too Before DBT can begin,the patients have to commit themselves to participation in . The elements of DBT the therapy. This is an exercise in itself and may take several meetings.Both the a The biosocial theory . Components of DBT patient and the therapist make explicit commitments(Box 20). In practice,the • Commitment + Consultant to the patient therapist may initially'play hard to get' and lead the patient,to persuade him or + Adaptations according to context her that the programme is indeed justified.People with BPD have not + Stages of treatment uncommonly had experiences of previous treatments that have been at best w Training + Conclusions unrewarding. Consequent wariness needs to be validated and the new therapeutic + Multiple choice Questions endeavour presented in a realistic way as promising but also demanding. Time • References spent on commitment before therapy is a good investment.Likewise,if the therapeutic relationship becomes wobbly or threatens to break down,then time needs to be spent on explicit recommitment.It is usual for there to be an agreement that if three consecutive sessions of one kind are missed for any reason then the patient is out of the DBT programme. Box 2 Commitments in dialectical behaviour therapy Patient agreements Stay in therapy for the specified time period Attend scheduled therapy sessions Work toward reducing suicidal behaviours as a goal of therapy Work on problems that arise that interfere with the progress of therapy Participate in skills training for the specified period Therapist agreements Make every reasonable effort to conduct competent and effective therapy Obey standard ethical and professional guidelines Be available to the patient for weekly therapy sessions and provide needed therapy back-up Maintain confidentiality Obtain consent when needed F Consultant to the patient . Top Once the patient is in the programme the usual stance of the therapist is that of .The elements of DBT being a consultant to the patient. Whenever possible the patient is left as the The biosocial theory . Components of DBT agent of his or her life,with the therapist available for support,advice,coaching a commitment and`cheer-leading'. Sometimes this may run counter to usual clinical practice Consultant to the patient 6 of 12 7/13/2005 6:54 AM Dialecticalbehaviotir therapy for borderline personality disorder-- ... http://apt.rcpsych.org/cgi/content/full/8/1/10 and may consequently present the therapist with dilemmas. For instance,the + Adaptations according to context classic DBT stance with patients who fmd themselves in a crisis in an accident + Stages of treatment + Training and emergency(A&E)department would be not to advise the A&E clinicians on + Conclusions how to manage the patient but to advise the patient on how to manage the A&E + Multiple choice questions +References staff. However,this stance is not absolute and DBT is characteristically pragmatic.The patient should be left as the agent,because that is the way to facilitate learning.However,if the short-term gains(for the patient)of a more active intervention by the therapist clearly outweigh the long-term loss in learning then the therapist should do whatever seems to be required. ► Adaptations according to context 122 Sometimes the context in which DBT is practised may suggest or require a The elements of DBT a adaptations. These may be the use of special or additional components for The biosocial theory a Components of DBT particular patient groups. For example,there have been adaptations for people a Commitment with a major problem of drug misuse, and this variant has been evaluated in a Y Consultant to the patient Adaptations according to context trial,with positive results(Linehan et al, 1999). Likewise,DBT has been used + Stages of treatment with people with binge eating disorder(Wiser&Telch, 1999).In an as yet + Training unpublished study Leicester,DBT has been adapted for + Conclusions p in p people suffering from +Multiple choice questions eating disorder and comorbid BPD by the inclusion of an additional skills + References training module called `eatingness'. The standard out-patient form of DBT needs to be substantially changed if DBT is used in radically different settings such as secure forensic units or if it is generalised to inform the style and culture of a psychiatric day hospital. Such applications and adaptations seem to be accepted within the spirit of DBT. ► Stages of treatment I'm As a treatment for BPD,DBT seems to be especially well focused on managing . The elements of DBT the more egregious behaviours of the patient,who may be difficult to engage The biosocial theory a Components of DBT successfully in more conventional therapies. It is for people showing these a commitment difficulties that the more characteristic techniques of DBT seem most Consultant to the patient a Adaptations according to context appropriate.However,strictly speaking,DBT has four stages. • Stages of treatment +Training In the first stage,the targets are to reduce life-threatening behaviours, + Conclusions + Multiple choice questions therapy-interfering behaviours and quality-of-life-interfering behaviours and to + References increase behavioural skills.Probably,in practice,most DBT is done in relation to this first stage. Stage two is targeted at improving the experience of the patient who has reached a state of"quiet desperation",having perhaps overcome the more grossly damaging behaviours as a result of stage-one DBT. A characteristic focus of this second stage would be on post-traumatic stress responses. Stage three is supposed to promote a moving on to "ordinary happiness and unhappiness" by dealing with problems of 7 of 12 7/13/2005 6:54 AM Dialectical behaviour therapy for borderline personality disorder--... http://apt.rcpsych.org/cgi/content/full/8/1/10 living. There is even a fourth stage,which aims at an overcoming of a sense of incompleteness and the development of a "capacity for sustained joy". These later stages are not much discussed and probably little practised. It seems a fair guess that,not uncommonly, patients move on from DBT to other forms of talking therapy for which the DBT has rendered them more amenable. On these issues the literature is largely silent. ► Training -Ton Dialectical behaviour therapy is essentially a team treatment and anyone wishing a The elements of DBT The biosocial theory to undergo training in DBT must do so as part of a team.The training assumes . Components of DBT that those being trained are experienced clinicians from one of the mental health a Commitment professions.Acquaintance with CBT may be an advantage but therapists from a - Consultant to the patient a. Adaptations according to context wide variety of backgrounds seem to take readily to DBT.Although there are 1- . Stages of treatment or 2-day introductory courses,real training consists of a so-called intensive.An ' Training Conclusions intensive comprises 2 separate weeks of training held a number of months apart. Multiple choice questions There is an expectation that the team will begin to meet as a weekly consultation •References group between the 2 weeks and will start their treatment programme.The second of the 2 weeks builds on this experience. Intensive training courses are held regularly in the USA, and formal training in DBT is controlled by the central organisation in Seattle. So far,two open intensive training programmes have been held in the UK(see Box 3i a for sources of information about training). In some wider applications,clinicians may come to work within a DBT ethos without having been formally trained in the treatment. Box 3 Training for dialectical behaviour therapy Worldwide Training is mainly organised through the Behavioral Technology Transfer Group of Seattle(http://www.dbt-seattle.com) In the UK A good initial contact would be Susan B.Alexander,Psychological Therapies Research Centre,School of Psychology, University of Leeds, 17 Blenheim Terrace,Leeds LS2 9JT,UK ► Conclusions a len Dialectical behaviour therapy is an elaborate and expensive treatment. a The elements of DBT - The biosocial theory Furthermore,it is demanding of those who would practice it. However,it has - Components of DBT some claims to be an effective treatment for a group of patients who suffer and a Commitment 8 of 12 7/13/2005 6:54 AM Dialectical•behavionr therapy for borderline personality disorder-- ... http://apt.rcpsych.org/cgi/contentlfull/8/1/10 are at high risk. Other treatments for BPD have less evidence to support any a Consultant to the patient claims for efficacy.Furthermore,people with BPD are often served poorly by ; Adaptations according to context a Stages of treatment less specific treatments.Even with its evident costs,DBT is well worthy of .• Training consideration as a response to those patients for whom more routine management Conclusions mr Multiple choice questions seems to be failing. Too often such routine treatment runs the risk of being just as References expensive but ineffective or harmful. For the harassed clinican,DBT seems to be well worth a try. At the very least,it provides a coherent framework within which difficult-to-help people may be construed and managed. Typically,patients value it. Anecdotally,clinicians too usually feel good about their practice within DBT.These are not unimportant advantages in a field where too often patients feel hard done by and clinicians feel unappreciated and defeated. In the wider context of service provision,DBT needs further evaluation.In particular,it needs evaluation in the context of the British National Health Service. Its wider adoption might bring increased benefit and even save money. However,in practice,service innovations and evaluations are difficult to make.They seem to cost too much upfront, as it were.The greater benefits and cost savings that they might bring require initial investment of both effort and money to fund the programmes and their evaluation. There is currently a danger that this promising treatment will be neglected for this kind of reason.There is also another,perhaps less likely,danger that DBT will be widely adopted in the name of evidence-based treatment but in a way that fails to add to the real but modest evidence base on which it now stands. ► Multiple choice questions . Dm . The elements of DBT 1. The following are usual components of standard DBT: a The biosocial theory a. weekly skills training group . Components of DBT A. Commitment b. admission to hospital . Consultant to the patient c. keeping a behavioural diary .Adaptations according to context Stages of treatment d. availability of 24-hour telephone contact • . Training e. willingness to embrace Buddhist beliefs. a Conclusions • Multiple choice questions sr References 2. DBT has been shown to be better than the following in randomised controlled trials: a. CBT in women with BPD and alcohol dependence b. community treatment as usual in men with recurrent self-harm c. CBT in complicated bulimia nervosa d. community treatment as usual in women with recurrent self-harm e. dynamic therapy in BPD. 3. The following techniques are frequently used in DBT: a. interpretation of the transference b. twice-weekly individual therapy sessions c. irreverent communication style d. refusal under almost all circumstances to talk to other professionals involved in the care of the patient e. mindfulness exercises. 9 of 12 7/13/2005 6:54 AM Dialectical behaviour therapy for borderline personality disorder--... http://apt.rcpsych.org/cgi(content7u1l/8/1/10 4. Skills training groups in DBT have the following characteristics: a. long periods of silence b. attention to group process c. homework exercises d. use of handouts e. attention to individual patient's problems. 5. Full training in DBT should involve: a. training as part of a team b. being in personal therapy c. a 2-day course d. two 1-week intensive courses e. going to Seattle. View this table: MCQ answers fin this window] fin a new window] ► Footnotes This is the final in a series of papers in APT devoted to innovative cognitive psychotherapies.The previous papers discussed cognitive-analytic therapy(Denman,2001),very brief dynamic psychotherapy(Aveline,2001)and problem-solving therapy(Mynors-Wallis,2001). ► References a Aveline,M. (2001)Very brief dynamic psychotherapy.Advances in Psychiatric a The elements of DBT Treatment,7,373-380.fFree Full Text" a The biosocial theory a Components of DBT American Psychiatric Association(1994)Diagsnotic and Statistical Manual of a Commitment Mental Disorders(4th edn)(DSM-IV).Washington,DC:APA. a Consultant to the patient a Adaptations according to context Denman,C. (2001) Cognitive-analytic therapy.Advances in Psychiatric a Stages of treatment treatment,7,243-252.fFree Full Text" a Training a Conclusions a Multiple choice questions Kisely,S. (1999)Psychotherapy for severe personality disorder: exploring the References limits of evidence based purchasing.BMJ,318, 1410-1412.LFree Full Text" Linehan,M.M. (1993a) Cognitive-Behavioral Treatment of Borderline Personality Disorder.New York: Guilford Press. —(1993b)Skills Training Manual for Treating Borderline Personality Disorder.New York: Guilford Press. —,Armstrong,H. E., Suarez,A.,et al(1991)Cognitive-behavioral treatment of chronically parasuicidal borderline 10 of 12 7/13/2005 6:54 AM Dialectical behaviour therapy for borderline personality disorder--... http://apt.rcpsych.org/cgi/content/full/8/1/10 patients.Archives of General Psychiatry,48, 1060-10641-Abstract" —,Heard,H.L.&Armstrong,H. E. (1993)Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients.Archives of General Psychiatry,50,971-974.JAbstract" —,Tutek,D.A.,Heard,H. L.,et al(1994)Cognitive—behavioral treatment for chronically parasuicidal borderline patients: interpersonal outcomes.American Journal of Psychiatry, 151, 1771-1776.1-Abstract" —, Schmidt,H.,Dimeff,L. A.,et al(1999)Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence.American Journal on Addictions,8,279-292.1CrossRefj[Medlinej Mynors-Wallis,L. (2001)Problem-solving treatment in general psychiatric practice.Advances in Psychiatric Treatment,7,417-425.JFree Full Text" Palmer,R L. (2000)Helping People with Eating Disorders. Chichester: John Wiley& Sons. Perry,J. C.,Banon,E. &Ianni,F. (1999)Effectiveness of psychotherapy for personality disorders.American Journal of Psychiatry, 156, 1312-1321.[Abstract/Free Full Text" Wiser,S. &Teich,C.F. (1999)Dialectical behavior therapy for binge-eating disorder.Journal of Clinical Psychology,55,755-768.JCrossRefl[Medlinej This article has been cited by other articles: 11 of 12 7/13/2005 6:54 AM , Attachment C Turning Point Center for Youth and Family Development, Inc. - - -- - -� Copyrighted©2002-2005 by: Chestnut Health Systems Global Appraisal of Individual Needs - Initial (GAIN-I) - ART Core Version [OVER]: 5.4.0 Site ID [XSITE]: II I IIII Local Site Name [XSITEa]: I I I I I I Staff ID [XSID]: II I IIII Staff Initials [XSIN]: I II Part.ID [XPID]: II I IIII Observation [ROBS: 0,3,6,9,12]: I I I v. DE Staff ID [XDESID]:..- _I I II I I Initial Key Date [XDEDT]: V III I I / I I I II Disclaimer, Confidentiality,Acknowledgments& Copyright Notices This is a standardized bio-psycho-social assessment designed to help clinicians gather information for diagnosis,placement, and treatment planning.As with any self-report it is limited by the veracity of the individual respondent's answers and should be combined with other information collected by an appropriately trained staff person prior to taking any specific actions. The confidentiality of the information gathered from use of this instrument may be protected by Federal law, including the Confidentiality of Alcohol and Drug Abuse Patient Records(42 C.F.R.Part 2) and the Health Insurance Portability and Accountability Act(HIPAA)Privacy Standards(45 C.F.R.Parts 160 and 164)and may also be protected by state laws, including state mental health,child welfare or HIV/AIDS laws.Unauthorized disclosure could result in fines and/or other penalties.All staff with access to specific answers must understand the applicable confidentiality laws and handle the information gathered in accordance with those laws. The current version of this instrument was developed by Dr.Michael Dennis and others at Chestnut Health Systems.Its development was supported by grants and contracts from the Center for Substance Abuse Treatment, Interventions Foundation,National Institute on Alcohol Abuse and Alcoholism,and National Institute on Drug Abuse.It also incorporates several scales and questions based on the National Family Violence Survey,National Household Survey on Drug Abuse, and work by the American Psychiatric Association and the American Society of Addiction Medicine,as well as input from many individuals fully acknowledged in the manual and the website below. This instrument is copyrighted and owned by Chestnut Health Systems.For more information on its origins, administration,properties,licensing agreements and/or for permission to use it,please visit our website at www.Chestnut.Org/li/GAIN/or contact Joan Unsicker directly at Chestnut Health Systems,720 West Chestnut, Bloomington,IL 61701,Phone: 309-827-6026,Fax: 309-829-4661,jnsicker@Chestnut.org. 11/111111a__ GAIN-I A2. Check for Cognitive Impairment Because we are going to ask you a lot of questions about when and how often things have happened,we need to start by getting a sense of how well your memory is working right now. ERROR SCORES CIS 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 A2f 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,Thu,Wed,Tue,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.If you do this section over, record the original score below before revising.) h. (Original score) GI 5.4.0 GPRA ART Core 3 12/1/2005 GAIN-I A3. General Directions,Literacy and Initial Administration Questions * Several questions will ask you about things that have happened during the past 12 months or past 90 days. To help you remember these time periods,please look at the calendar at the end of this document. First,let's find today's date and circle it. * Next count back 13 weeks to about 90 days ago and circle that date. Do you recall anything that was going on about(DATE 90 DAYS AGO)? (PROBE FOR SPECIFIC EVENT, SEE BELOW IF PROBLEMS.) When we talk about things happening to you during"the past 90 days," we are talking about things that happened since about(NAME OF EVENT THAT WAS 90 DAYS AGO). al. Record anchor for 90 days,v. * Now, let's go back to a year ago and circle that date. Do you recall anything that was going on(DATE 12 MONTHS AGO)? (PROBE FOR SPECIFIC EVENT, SEE BELOW IF PROBLEMS.) When we talk about things happening to you during"the past 12 months," we are talking about things that happened since about(NAME OF EVENT THAT WAS 12 MONTHS AGO). a2. Record anchor for 12 months,v. IF UNABLE TO RECALL:Do you remember any birthdays, holidays, sporting or other special events that happened around(DATE 90 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? Yes No bl. Do you have any problems reading English in something like a newspaper or magazine9 1 0 b2. Do you have any problems writing English in something like a job application or resume9 1 0 b3. Do you have any problems understanding what you read? 1 0 c. [Document your initial administration decision] Done orally because of literacy or client choice 0 [READ ORAL INST] Staff chose in advance to administer 1 [READ ORAL INST] Self-administered 2 [READ SA INST] Other(Describe v. ) 99 [READ SA INST] Additional Instructions for Oral Administration Please keep this calendar handy and use it as we go through the interview to help you remember when different things happened. As we go through the questionnaire,I will read the questions and record your answers. It is important that you try to answer each question if you can and are willing to. We know that you will not always know the exact answer,but we would like you to give us your best guess if you can.You can also tell us if you simply"do not know" or if you do not want to or"refuse" to answer any questions. I also have some cards here that we will use to help answer some of the questions. Do you have any questions before we begin? GI 5.4.0 GPRA ART Core 4 12/1/2005 GAIN-I Optional Additional Instructions for Self-administration There are four types of questions in this assessment: (1)questions that ask you to answer in your own words; (2)questions that ask you to circle one answer in a list of answers; (3)questions that ask you to circle all that are MENTIONED; and (4)questions that ask you how many days or times something happened.Answers in your own words do not need to be long but try to write neatly so that we can read it. For questions that ask you to circle one, please pick the one that fits best. Questions where you circle all the responses mentioned should have a yes or no circled for each row. Questions that ask you how many days or times something happened should always be answered with a number. If the answer is no, none,never or 0,please print 0 in the open box. Where we are giving you instructions,they will appear in(bold and parentheses like this). After you answer some questions,there may be several more below it that do not apply to you. When this happens there will be a note between[SQUARE BRACKETS WITH BOLD CAPITAL LETTERS LIKE THIS].It will tell you to go to the next question that does apply to you.Never skip farther than the next question number. Can you show me how this works in the example below? Example Sb. Have you ever attended AA, CA,NA,or another self-help Yes No group for your alcohol or drug use9 1 0 [IF 0,GO TO S7] a. During the past 90 days,on how many days have you I I attended one or more self-help group meetings9 LI Days S7. Have you ever received treatment or counseling for your Yes No use of alcohol or any drug(not counting caffeine or cigarettes)? 1 0 There will also be several boxes marked "For Staff Use Only".You can skip any questions in them unless the staff mark them and ask you to do them. If you are not sure about an answer,please try and give us your best guess.If you change your mind,please cross through the old answer and circle the new answer. If you simply do not know, write "DK"to the right of the question. You may want to decline or refuse to answer any question simply by writing "RF" next to any question you do not want to answer. It is important that you either answer the question or write DK or RR Otherwise, we will think you just missed the answer by mistake and will ask you about it again. If you do not understand a question or word and want to go over it with a staff person,put a"?" to the right side.If you need a break,write the time you stopped working on the survey on the page you have reached.After your break,write the time you started up again on that same page. You will notice some abbreviations and'""s in the left column. These are to help staff when "reading" this instrument. Do you have any questions? 015 4.0 GPRA ART Core 5 12/1/2005 • GAIN-I B. Background and Treatment Arrangements Bl. What is your gender? Male 1 Female 2 Transgender(both) 3 Other(Please describe.) 99 v. B2. What is your date of birth? I I / 1 I I / I I I I Month Day Year a. How old are you today? I I I [If 18 OR OVER, Age GO TO B3a1 b. Who currently has legal custody of you?(Would you say...) (Circle one) Parents living together 1 Parents that are separated and share custody 2 A single parent 3 Other family members 4 Legally emancipated minor living on your own 5 Runaway/on own(without legal emancipation) 6 County/State(foster home or protective services) 7 Juvenile or correctional institution 8 Some other situation(Please describe) 99 v. Please answer the next questions using number of days. c. During the past 90 days on how many days were you in foster care? I I I (Use 0 for None) Days d. During the past 90 days on how many days were you in any other kind of group home or child care institution? IIIJ (Use 0 for None) Days Please answer the next questions using yes or no. PAI B2. During the past 12 months have you done any of the following things with your biological,foster or adopted parents? Yes No e. spent 30 minutes or more playing or doing fun things with them? 1 0 f. gone with them to an organized activity or event? 1 0 g. had them read to you,or you talked to them about a book, magazine or newspaper? 1 0 h. gotten help from them with your homework(reading, writing or math)? 1 0 j. had them meet with a teacher, social worker,lawyer,court official or police officer about you? 1 0 GI 5.4.0 GPRA ART Core 6 I2/1/2005 GAIN-I B3a. Which races and/or ethnicities best describe you?(Any others?) (RECORD AND CIRCLE ALL THAT APPLY) vl. v2. v3. MENTIONED Yes No 1. Alaskan Native(Please record Tribe above) 1 0 2. Asian 1 0 3. African American/Black 1 0 4. Caucasian/White 1 0 5. Hispanic, Latino or Chicano 1 0 a. Puerto Rican 1 0 b. Mexican 1 0 c. Cuban 1 0 e. Dominican 1 0 f. Other Central American 1 0 g. Other South American 1 0 z. Other(Please describe above) 1 0 6. Native American(Please record Tribe above) 1 0 7. Native Hawaiian 1 0 8. Pacific Islander 1 0 99. Some other group(Please describe above) 1 0 (If you are doing this on your own, please tell the staff person that you have finished the first section.) For Staff Use Only AGDM B11.DM Rating [BDM]:NONE ❑ o SOME❑ MISUNDER❑ 2 DENIAL O3 MISREP ❑4 GI 5 4.0 GPRA ART Core 7 12/1/2005 GAIN-I S. Substance Use(Alcohol,Marijuana and Other Drugs) The following questions are about your use of alcohol and other drugs. Alcohol includes beer, wine,whiskey,gin,scotch,tequila,rum or mixed drinks. "Other drugs"include a)marijuana, b) other street drugs like crack,heroin,PCP, or poppers,c)inhalants like glue or gasoline and d) any non-medical use of prescription-type drugs. Please do not include any prescription drugs you use/used under the direction of a doctor. Si. Between alcohol,marijuana,cocaine,heroin and any other drugs... For Staff Use a. which do you like to use the most? v. 1• I b. for which ones do you most need treatment? vl. 1. I I v2. 2. I_Ljj v3. . 3. 1 I I 1 GI 5.4.0 GPRA ART Core 8 12/1/2005 GAIN-I Detailed Drug Codes 0 None/No Others 6 Inhalants 9 Sedative,Hypnotic, 99 Other 6A Correction fluids or Anxiolytic 99A Amyl nitrite I Alcohol 6B Gasoline 9A Methaqualone(Parest, 99B Cough syrup(NyQuil, lA Beer 6C Glue Quaaludes, Sopor) Robitussin) 1B Wine 6D Lighters 9B GHB/GBL 99C Nitrous oxide IC Hard alcohol 6E Spray paint 9C Diazepam 99D NyQuil (Whiskey,gin,scotch, 6F Paint thinner (Valium,D-Pam, 99E Poppers tequila,rum or mixed 6Z Other inhalants Pro-Pam) 99F Ephedrine/ drinks) 9D Meprobamate Pseudoephedrine 7 Opioids (Deprol,Equanil,Miltown) 99G Steroids 2 Amphetamines 7A Heroin 9E Flunitrazepam 99Z Other 2A Methamphetamine 7B Speedball (Rohypnol) (Desoxyn,Methedrine) (Heroin and Cocaine) 9G Other 100 Tobacco 2B Methylphenidate 7C Karachi Benzodiazepines (Ritalin) (Heroin and Tranquilizers 2C Ecstasy/MDMA barbiturates) (alprazolam,Ativan, (methylenedioxy- 7D Heroin with other Benzotran,bromazepam, methamphetamine) drugs chlordiazepoxide, 2Z Other 7E Street methadone clonazepam,clorazepate, Amphetamines 7F Morphine Dalmane,Dormonoct, (Biphetamine, 7G Opium estazolam, Benzedrine, 7H Codeine Euhypnos,flurazepam, Dexedrine) 7J Tylenol w/codeine halazepam,Halcion, 7K Hydrocodone Hypam,Insoma, 3 Cannabis (Vicodin,Lorcet,Lortab) ketazolam,Klonopin, 3A Marijuana 7M Oxycodone Lexotan,Librium, 3B Hashish (Percocet,Percodan, lorazepam,loprazolam, 3C Blunts Oxycontin) Mogadon,Nitrados, (marijuana-filled cigar) 7Y Other Opiates or nitrazepam,Normison, 3D Marijuana with Opioids(Demerol, Nova-Pam,oxazepam, other drugs Dilaudid, Rivotril, Serax,Serapax, 3Z Other Cannabis hydromorphone, Serenid, Sompam, meperidine,pentazocine, temazepam,Tranxene, 4 Cocaine Talwin) trazepam,triazolam, 4A Inhaled cocaine 7Z Other Analgesics Tricam,tuazepam, 4B Injected cocaine (Darvocet,Darvon, Xanax) 4C Crack propoxyphene) 9H Other Barbiturates 4D Freebase (Alurate,amobarbital, 4Z Other Cocaine 8 PCP Amytal,aprobarbital, (Phencyclidine, butabarbital,butalbital, 5 Hallucinogens angel dust) Butisol,Fiorinal, 5A LSD(Lysergic acid Fioricet,Lotusate, diethylamide) Luminal,Mebaral, 5B Mushrooms mephobarbital, 5C Mescaline Nembutal,pentobarbital, 5D Peyote phenobarbital, 5E Psilocybin secobarbital,Seconal, 5F Ketamine(Ketalar, Tuinal,talbutal) special k) 9Z Other Sed./Hyp./Anx. 5Z Other (Doriden,ethchlorvynol, Hallucinogens glutethemide,Placidyl) Note:Copyrighted or registered trade names have been capitalized and appear in parentheses. GI 5.4.0 GPRA ART Core 9 12/1/2005 GAIN-I SFS S2. The next questions are about the last time,if ever,you used several substances. Please answer the questions(Using Card A)if it was 1-2 days ago,3-7 days ago, 1-4 weeks ago, 1-3 months ago, ,g ' 3 I 4-12 months ago, 1+years ago,or never. r 1.7 M 'T = ± When was the last time(if ever)you used ... 6 5 4 3 2 1 0 a. Any kind of alcohol(beer,wine,whiskey,gin,scotch,tequila,rum or mixed drinks)? 6 5 4 3 2 1 0 b. Alcohol until you were drunk(or had 5 or more drinks)? 6 5 4 3 2 1 0 c. Marijuana,hashish,blunts or other forms of THC(herb,reefer,weed)? 6 5 4 3 2 1 0 d. Crack, smoked rock or free base cocaine? 6 5 4 3 2 1 0 e. Other forms of cocaine? 6 5 4 3 2 1 0 f. Inhalants Or huffed(such as correction fluids,gasoline,glue,lighters,spray paints,or 6 5 4 3 2 1 0 paint thinner)? g. Heroin or heroin mixed with other drugs? 6 5 4 3 2 1 0 h. Nonprescription or street methadone? 6 5 4 3 2 1 0 j. Pain killers, opiates,or other analgesics(such as codeine,Darvocet,Darwin, Demerol,Dilaudid,'Karachi,'OxyContin,OXYS,Percocet,Propoxyphene,morphine,opium, 6 5 4 3 2 1 0 Talwin,or Tylenol with codeine)? k. PCP or angel dust(Phencyclidine)? 6 5 4 3 2 1 0 m. Acid,LSD,ketamine,special K,mushrooms,or other hallucinogens 6 5 4 3 2 1 0 (such as mescaline,peyote,psilocybin,or shrooms)? n. Anti-anxiety drugs or tranquilizers(such as Ativan,Deprol,Equanil,Diazepam, Klonopin,Meprobamate,Librium,Miltown,Serax,Valium or Xanax)? 6 5 4 3 2 1 0 p. "Speed," "uppers," amphetamines,methamphetamine, ecstasy, MDMA or other stimulants(such as Biphetamine,Benzedrine,crystal,Desoxyn, Dexedrine,ice,Methedrine or Ritalin)? - 6 5 4 3 2 1 0 q. "Downers," "sleeping pills,"barbiturates or other sedatives(suchas Dalmane,Donnatal,Doriden,Flurazepam,GHB,Halcion,liquid ecstacy,methaqualone, Placidyl,"quaalude,"Secobarbital,Seconal,Rohypnol or Tuinal)? 6 5 4 3 2 1 0 r. Some other drug(Please describe)(such as amyl nitrate,cough syrup,nitrous oxide,Nyquil,"poppers"or Robitussin)? v. 6 5 4 3 2 1 0 [IF"NO USE IN THE PAST 90 DAYS,GO TO S2s TO CONFIRM] • GI 5.4.0 GPRA ART Core 10 1V12005 GAIN-I SFS/ S2. Substance Use Frequency Grid I.Durine the 2. What was 3.Over 4.With how BAC (Read from left to right for those substances used past 90 days, the most how many many other in the past 90 days.) on how many (drinks/joints/ hours did people(if (If this is a self-administered assessment,please ask days have etc.)you had in you do any)were for staff assistance in completing the following you ... one day? this? you sharing? questions.) a. used any kind of alcohol? drinks b. gotten drunk or had 5 or more drinks? c. used marijuana, hashish, blunts or THC? joints d. used crack, smoked rock or free base? e. used other forms of cocaine? • ,E r 1� _ ..._. r...a f. used inhalants or huffed? g. used heroin(alone or mixed)? h. used nonprescription or street methadone? I j. used pain killers, opiates, or other analgesics? k. used PCP or angel dust? m. used acid,LSD, ketamine,special K, r mushrooms, or other hallucinogens? n. used anti-anxiety drugs or tranquilizers? P. used"speed," "uppers," amphetamines, methamphetamine,ecstasy,MDMA, or other stimulants? q. used"downers," "sleeping pills," barbiturates or other sedatives? - v r. used other drug? } � For 5w Use codes from Si or spell out Common Conversions and Norms(0 to 90th percentile of users) a.standard drink unitml beerl glass wine=l mired drink=l shot;00 ounces been3 drinks;Fifth=up to 26 drinks;(1-20 norm) c ounce25-30 joints;dime=65 joints;nickel-2-3 joints;J blunt--2-6 joints;I gram=l-2 joints;I bowhl joint;101-hit piper-I joint;(1-20 norm) d 8 ball=32 rocks;teen=16 rocks;gram=10 rocks;dime=1 rock;nickel=1 hit=1/2 rock;(1-20 norm) e.grant=4 quarter grams;(1-10 norm) 0-JO norm) g.(gram=10 dime bags);(1-10 norm) 015 4.0 GPRA ART Core 11 12/1/2005 GAIN-I The next questions are about your use of alcohol,marijuana, cocaine,heroin and other drugs all together. Please answer the next questions using days. SFS S2s. During the past 90 days, ... (Remember,write in 0 for none) Dams la. on how many days did you go without using any alcohol,marijuana or other drugs? I I I 11F 90,GO TO S2al 2. on how many days did you get drunk or were you high for most of the day? U 3. on how many days did alcohol or drug use problems keep you from meeting your responsibilities at work,school or home? I I I 4. what is the most days you have gone in a row without using alcohol,marijuana or other drugs? U Please answer the next questions using yes or no. S2t. During the past 90 days did you use alcohol or drugs ... Yes No 1. at home? 1 0 2. at someone else's home? 1 0 3. at a party/bar? 1 0 4. at work? 1 0 5. at school? 1 0 6. at a dealer's place(or shooting gallery)? 1 0 7. outdoors? 1 0 8. in a car? 1 0 99. somewhere else?(Please describe) 1 0 v. S2u. During the past 90 days did you use alcohol or drugs... Yes No 1. alone? 1 0 2. with your spouse/sexual partner? 1 0 3. with family? 1 0 4. with friends? 1 0 5. with a club or gang? 1 0 6. with coworkers 1 0 7. with classmates? 1 0 8. with someone you regularly drink or use drugs with(a running partner)? 1 0 9. with a drug dealer/pusher? 1 0 10. with a stranger? 1 0 99. with someone else? (Please describe) 1 0 V. GI 5.4.0 GPRA ART Core 12 12/1/2005 GAIN-I S2v. During the vast 90 days, have you taken alcohol or drugs by ... Yes No 1. drinking(alcohol or liquids), eating or taking pills orally?. .. 1 0 2. smoking" 1 0 3. inhaling,huffing, sniffing, or snorting? 1 0 4. injecting into skin or muscle(intramuscular)" 1 0 5. injecting into a blood vein or artery(intravenous)? 1 0 99. any other way?(Please describe) 1 0 v. S2w. During the past 90 days, did you use alcohol or drugs while or within an how prior to ... (If not applicable,circle no) Yes No 1. playing sports or recreating (e.g.,skiing,biking, swimming,skateboarding,roller-Wading, etc.)? 1 0 2. taking care of children" 1 0 3. being in training or school" 1 0 4. being at a paid job or work? 1 0 5. driving a vehicle(car,motorcycle,snowmobile,jet ski,boat,etc.)? 1 0 6. using knives, guns,equipment pawn mower,saw,stove)or heavy machinery(backhoe,front-end loader,apple picker,etc.)? 1 0 GI 5.4.0 GPRA ART Core 13 12/1/2005 GAIN-I SFS S2x. During the past 90 days, on how many days have you been in a jail,hospital or other place where you could not use alcohol, marijuana or other drugs?(Write in 0 for none) I I I IIF 0-12,GO Days TO S3al Pre Controlled Environment Use (If this is a self-administered assessment,please ask for staff assistance in completing the following information.) Let's get out the calendar and mark out the last 90 days when you were not in a jail,hospital or other place where you could not use alcohol,marijuana or other drugs.These next questions are about those 90 days when you were in the community and could have used alcohol or drugs. Please respond with the number of days.(Write in 0 for none or if no lifetime use previously reported.) S2x. In those 90 days in the community, . . . Days 1. on how many days did you go without using any alcohol, [IF 90,GO marijuana or other drugs'? I I I TO S3a1 2. on how many days did you get drunk or were you high for most of the day? I I 3. on how many days did alcohol or drug use problems keep you from meeting your responsibilities at work,school or home'? I I 4. what is the most days you went in a row without using any kind of alcohol,marijuana or other drugs'? I I S2y. On those 90 days in the community,on how many days did you use . . . a. any kind of alcohol'? I I I 1IF 0,S2yb=l b. alcohol until you were drunk(or had 5+drinks in one sitting)'? 1_1_1 c. any kind of marijuana,hashish,blunts or other forms of THC' I d. any kind of crack,smoked rock or free base cocaine? I I e. any other forms of cocaine? 1_1_1 f. inhalants or huffed I I I g• heroin or heroin mixed with other drugs'/ 1_1_1 h. non-prescription or street methadone'? I I j. any pain killers,opioids or other analgesics? I I k. PCP or angel dust? I I m. acid,LSD,ketamine,special K,mushrooms or other hallucinogens'? I I n. any anti-anxiety drugs or tranquilizers? I I I P. stimulants, amphetamines,ecstacy,MDMA, methamphetamine or other uppers'? I I q. any downers,sleeping pills,barbiturates or other sedatives? I I I r. any"other"kind of drug'/ I I (Please describe)V. GI 5.4.0 GPRA ART Core 14 12/1/2005 GAIN-I Please answer the next questions using yes or no. S3a. Have you ever had shaky hands,delirium tremens (d.t's), Yes No convulsions or seizures when you tried to stop, cut down or control your use of alcohol or other drugs? 1 0 S3b. Durina the past week, did you stop,try to stop, cut down or Yes No try to limit your use of alcohol or other drugs" 1 0 (IF NO,GO TO NEXT PAGE] CWS S3c. When you did this, did you have any of the following Yes No withdrawal symptoms orproblems? 1. Move and talk much slower than usual 1 0 2. Yawn more than usual 1 0 3. Feel tired 1 0 4. Have bad dreams that seemed real 1 0 5. Have trouble sleeping, including sleeping too much or not being able to sleep 1 0 6. Feel sad,tense or angry 1 0 7. Feel really nervous or tense 1 0 8. Fidget,pace,wring your hands or have trouble sitting still 1 0 9. Have shaky hands 1 0 10. Have convulsions or seizures 1 0 11. Feel hungrier than usual 1 0 12. Throw up or feel like throwing up 1 0 13. Have diarrhea 1 0 14. Have muscle aches 1 0 15. Have a runny nose or eyes watering more than usual 1 0 16. Sweat more than usual,have your heart race or goose bumps 1 0 17. Have a fever 1 0 18. See, feel or hear things that are not real 1 0 19. Forget a lot of things or have problems remembering 1 0 20. Have any of these withdrawal problems kept you from doing social, family,job or other activities9 1 0 21. Have you used the same or another drug to stop or avoid having any of these withdrawal symptoms" 1 0 99. Some other problem(Please describe) 1 0 v. GI 5.4.0 GPRA ART Core 15 12/1/2005 GAIN-I The next questions are about treatment for alcohol or drug use.Do not count any treatment that you received today or that was only for physical health or psychological problems. Yes No S4. Before today,have you ever had a breathalyzer or urine test to check for your alcohol or drug use? 1 0 lIF NO, GO TO S51 Please answer the next questions using times,days or nights. S4a. During the oast 90 days,how many times have you been given a breathalyzer or urine test to check for your alcohol or drug use?(Do not count any today) IJ Times 55. How many times in your life have you been admitted to a detoxification program for your alcohol or drug use? I fIF 0, GO Times TO S61 S5a. During the past 90 days on how many days have you been in a detoxification program to help you through withdrawal? Days S6. Have you ever attended Alcoholics Anonymous(AA), Cocaine Anonymous(CA),Narcotics Anonymous(NA), Social Recovery(SR)or another self-help group for Yes No your alcohol or drug use? 1 0 [IF NO, ENTER 0 in S6a1 S6a. During thepast 90 days,on how many days have you attended one or more self-help group meetings(such as • • AA,NA,CA or Social Recovery)? III Days $6b. Have you ever stayed overnight in a recovery home or Yes .No sanctuary? 1 0 [IF NO, GO TO S71 S6c. During the past 90 days,on how many nights have you stayed in a recovery home or sanctuary? I—I • Nights Useful Definitions Detoxification programs are places with professional help and often medication to help you through severe withdrawal;typically these are part of or affiliated with a larger agency or hospital. Self-help groups are groups of consumers that meet together to provide social support,mutual aid and guidance;while typically part of a large association,they are generally NOT run by professionals. !ecoverr homes and sanctuaries are groups of consumers or a cooperative that rent a home or apartment to provide a safe,inexpensive environment that is drug and/or alcohol free;while typically part of a large association,they often do not have professional staff working around the clock. O1 5.4.0 GPRA ART Core 16 12/1/2005 GAIN-I (Intake interview only: Do not count current treatment episode.) S7. How many times in your life have you been admitted to treatment or counseling for your use of alcohol or any drugs? [ I I Episodes IIF 0,GO TO S81 Detailed Treatment History Grid (If this is a self-administered assessment,please ask for staff assistance in completing the following information.) Next we need to fill out this form for all of the times you have been in substance abuse treatment from the first to the most recent treatment episode. What was the first(next...)treatment program you went to? (Attach prior grids if available and update) b. bl. c. d. dl. e. g. What is the name of the Program What type On about what Are you On about what About S7_ treatment program? Code of treatment date did you still in date did you how many was this? start? treatment? leave? days were (Use codes (mm/dd/yyyy) (If yes,skip(mm/dd/yyyy) you there? from next e&g) page) Y N 1. 1 0 2. 1 0 3. 1 0 4. 1 0 5. 1 0 6. 1 0 7. 1 0 8. 1 0 9. 1 0 10. 1 0 11. 1 0 12. 1 0 13. 1 0 14. 1 0 15. 1 0 99. For staff use only. Indicate row number of index treatment. Notes(Circle if you want them keyed into notes): GI 5 4.0 GPRA ART Core 17 12/1/2005 GAIN-I Summary of Treatment History and Directions and Codes — Please do not list detox,self-help groups,recovery homes,or sanctuaries. — Start with the earliest admission at the top and continue down to the most recent. — If the participant is still in treatment,leave the discharge date blank. — If you re-interview a participant,please attach and update the previous grid. Common Local Program Codes(b1)and Names(b): General Level of Care Codes(c): 10 Outpatient(OP) (Insert text or consult study-specific appendix) 15 Methadone Maintenance 20 Intensive Outpatient(OR) 30 Inpatient/Residential/Halfway house(ST/LT/HH) 99 Other Date Guidelines(d/e): Use the following rules if the participant is unsure of the exact date: DAY: Use the 5th for the beginning of the month, 15th for the middle of the month,and 25th for the end of the month. MONTH: Use March for early in the year,July for middle of the year,and October for later in the year,but try to make it so the number of weeks is about right. YEAR: Make best approximation based on age or other information. If the participant is still in treatment, leave the discharge date blank(so that it can be filled in later). GI 5.4.0 GPRA ART Core 18 12/1/2005 GAIN-I Please answer the next questions using episodes. (If available,use treatment history grid to help.) S7a. How many of these times were you . . 1. treated in an emergency room for your alcohol or drug use problems? IIII Episodes 2. admitted for at least one night to a residential, inpatient, or hospital program for your alcohol or drug use problems?_ I I I I Episodes 3. admitted to an intensive outpatient or day program for your alcohol or drug use problems? I I I I Episodes 4. admitted to a regular(1-8 hours per week)outpatient program for your alcohol or drug use problems? I I I I Episodes 5. given medication like methadone or antabuse to help with withdrawal or cravings? I I I I Episodes 99. in any other kind of treatment program or working with some other kind of case manager about your alcohol or drug use problems? I I I I Episodes (Please describe)v. S7b. What substances did you receive treatment or counseling for? MENTIONED (Any others?)(CIRCLE YES FOR ALL THAT APPLY) Yes No 1. Use of any End of alcohol... ... . . . - 1 0 2. Use of any kind of marijuana or hashish 1 0 3. Use of any kind of crack,free base or other forms of cocaine. 1 0 4. Use of any kind of heroin or other opioid 1 0 99. Use of any"other"kind of drug. 1 0 (Please use codes from SI or describe) v. Yes No S7c. Are you currently taking medication for alcohol or drug problems? 1 0 [IF NO, GO TO S7dl (If yes,please describe) v. S7cI. Are you currently taking methadone?(Code if given above) 1 0 GI 5.4.0 GPRA ART Core 19 12/1/2005 GAIN-I Using Card A ... S7d. When was the last time you received treatment,counseling,medication, case management or aftercare for your use of alcohol or any drug? (Circle one)(Card A) Within the past two days 6 3to7daysago 5 1 to 4 weeks ago 4 1 to 3 months ago 3 4 to 12 months ago 2 [GO TO S81 More than 12 months ago 1 ►GO TO S81 Never 0 [GO TO S81 Please answer the next questions using number of times,nights,or days (If no lifetime service use in S7a,record 0 in the respective row below.) SATI S7e. During the past 90 days,how many... 1. times did you go to an emergency room for your alcohol or substance abuse treatment'? Times 2. nights were you in a halfway house,residential,inpatient,or hospital program(for your alcohol or drug use problems)? Nights 3. days were you in an intensive outpatient or day program(for your alcohol or drug use problems)? I I I I Days 4. times did you go to a regular(1-8 hours per week)outpatient program(for your alcohol or drug use problems)? II II Times 5. days did you take medications like methadone or antabuse to help with withdrawal or cravings'? Days 99. days did you go to any other kind of treatment program or work with some other kind of case manager about your alcohol or drug use problems? I I I I Days (Please describe)v. S7f. Are you currently being treated regularly for alcohol or drug Yes No problems?(If yes,where do you go?) 1 0 [IF NO,GO TO S7g11 v. S7g. How long have you been treated regularly? L J + LH + L J + I II Years Months Weeks Days GI 5.4.0 GPRA ART Core 20 12/12005 GAIN-1 The next questions are about all of the kinds of substance abuse treatment you have received in the past 90 days. Please answer the next questions using yes or no. TxRS S7g. As a part of the substance abuse treatment, counseling, case management or aftercare you received in the past 90 days, did anyone ... (If not applicable,circle No) Yes No 1. work with you at your home? 1 0 2. call you on the phone in between appointments? 1 0 3. ask you what you thought were the benefits of being drug-free? 1 0 4. teach/review with you relapse prevention procedures? 1 0 5. ask you to talk about the fun things you could do without drugs/alcohol? 1 0 6. talk about different ways to solve problems 1 0 7. meet with family members of yours more than one time? 1 0 8. work with members of your family on communication 1 0 9. talk with you about your friends? 1 0 10. require you to take urine tests? 1 0 11. talk with you about probation? 1 0 12. talk with your probation officer? 1 0 13. talk with a counselor,teacher,or other adult at school? 1 0 14. hook you up with other services? 1 0 15. hook your family up with services? 1 0 16. encourage you to attend appointments? 1 0 17. ask if you went to appointments? 1 0 18. provide you with transportation to appointments? 1 0 19. help you figure out agency procedures or to understand your rights? 1 0 99. other than the treatment you've told us about or the services mentioned above,were there other services you received? 1 0 (Please describe)V. GI 5 4.0 GPRA ART Core 21 12/1/2005 GAIN-I (If more than one type of treatment in S7e, include all in answering the questions below.) The next statements are about how you feel about the staff in the programs where you have received treatment and/or case management.Please respond to the next statements using yes or no. TxSS S7jj. You are satisfied that the staff in(this/these)program(s). . . Yes No 1. did a good job 1 0 2. were fair with clients/patients 1 0 3. explained the rules of the program. 1 0 4. had the time to see you 1 0 5. respected clients/patients 1 0 6. (staff) and you agreed on what your problems were 1 0 7. explained what your treatment was supposed to accomplish. 1 0 8. asked for your opinions about your problems and how to solve them 1 0 9. (staff)and you agreed on what to do about your substance use 1 0 10. helped you do something about your substance use 1 0 11. (staff)and you agreed on what to do about your other problems 1 0 12. helped you do something about your other problems 1 0 13. were sensitive to your cultural background 1 0 14. gave you enough help for now 1 0 GI 5.4.0 GPRA ART Core 22 12/1/2005 • GAIN-I The next questions are about your current treatment and use. Please answer the next questions using yes or no. If any questions do not apply to you at this time,please answer"No". S8. Do you currently feel that.... Yes No TRI a. being in a treatment program is too demanding? 1 0 b. you have too many other responsibilities now to be in a treatment program? 1 0 c. it will be hard for you to resist alcohol or drugs where you currently live, work or go to school? 1 0 d. your old friends may try to get you to drink or use drugs again? 1 0 Do you currently feel that... TMl e. there is a lot of pressure for you to be in alcohol or drug treatment? 1 0 1 you can get the help you need in an alcohol or drug treatment program? 1 0 g. you need to be in treatment for at least a month9 1 0 h. you will probably need to come back to treatment again one or more times during your lifetime? 1 0 j. you need support from friends and relatives to - deal with your alcohol or drug use9 1 0 Do you currently think you... SES k. spend a lot of time thinking about alcohol or drugs? 1 0 m. could avoid using alcohol or drugs at home? 1 0 n. could avoid using alcohol or drugs at work or schools 1 0 p. could avoid using alcohol or drugs with your friends? 1 0 q. could avoid using alcohol or drugs when people around you were using them? 1 0 Do you currently think ... POS r. you have any problems related to alcohol or drug use (including those things we just talked about)? 1 0 [IF NO,GO TO S9c] s. you have a good understanding of how drug and alcohol use is related to your problems? 1 0 t. your problems can and will go away? 1 0 u. you know the course most of your problems will follow? 1 0 v. your problems are out of control? 1 0 w. your problems can be solved 1 0 GI 5.4.0 GPRA ART Core 23 12/1/2005 GAIN-I Next we want to go over a list of common problems related to alcohol or drug use. After (hearing/reading)each of the following statements,we would like you to tell us the last time you had this problem by using Card B and responding in the past month,2-12 months ago, 1 or more years ago, or never. N OC ,2 4 cu Nr 6. N Z S9. When was the last time that... (Please answer questions using Card B) 3 2 1 0 SPS/O c. you tried to hide that you were using alcohol or drugs? 3 2 1 0 d. your parents,family,partner,co-workers,classmates or friends complained about your alcohol or drug use? 3 2 1 0 e. you used alcohol or drugs weekly? 3 2 1 0 f. your alcohol or drug use caused you to feel depressed,nervous, suspicious,uninterested in things,reduced your sexual desire or caused other psychological problems? 3 2 1 0 g. your alcohol or drug use caused you to have numbness,tingling, shakes,blackouts,hepatitis,TB,sexually transmitted disease or any other health problems? 3 2 1 0 GI 5.4.0 GPRA ART Core 24 12/1/2005 • GAIN-I � r c O S9. When was the last time that... (Please answer questions using Card B) 3 2 1 0 SPS/A h. you kept using alcohol or drugs even though you knew it was keeping you from meeting your responsibilities at work,school, or home? 3 2 1 0 j. you used alcohol or drugs where it made the situation unsafe or dangerous for you, such as when you were driving a car,using a machine,or where you might have been forced into sex or hurt? 3 2 1 0 k. your alcohol or drug use caused you to have repeated problems with the laws 3 2 1 0 m. 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 SPS/D n. you needed more alcohol or drugs to get the same high or found that the same amount did not get you as high as it used to'/ 3 2 1 0 p. 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 q. you used alcohol or drugs in larger amounts,more often or for a longer time than you meant to? 3 2 1 0 r. you were unable to cut down or stop using alcohol or drugs 3 2 1 0 s. 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 t. 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 u. you kept using alcohol or drugs even after you knew it was causing or adding to medical,psychological or emotional problems you were having? 3 2 1 0 v. How old were you when you first got drunk or used any drugs? I I I Age For Staff Use Only AGDM 512. DM Rating[SDM]:NONE ❑o SOME ❑ ' MISUNDER ❑] DENIAL ❑3 MISREP❑ 4 GI 5 4.0 GPRA ART Core 25 12/1/2005 • GAIN-I P.Physical Health • The next questions are about your health and how you have been feeling physically. BAC P 1. About how tall are you(in feet and inches)? H + u Feet Inches P2. About how much do you weigh without shoes? I I Pounds HDS P3. During the past 12 months, would you say your health in general was. . .? (Circle one) Excellent 0 Very good 1 Good 2 Fair 3 Poor 4 Yes No P5_1. Have you ever(been/gotten someone)pregnant? 1 0 [IF NO,GO TO P9] P5a1. About when did(your/the)last pregnancy begin? (Clarify and circle one) During the past 90 days 1 4 to 6 months ago 2 7 to 9 months ago 3 10 to 12 months ago 4 More than a year ago 5 P5b1. What happened(or is happening)during that pregnancy? (Clarify and circle one) Carried the baby to term--live birth? 1 ICONTINUEI Miscarriage? 2 IGO TO P9] Abortion 3 IGO TO P9] Uncertain 4 IGO TO P91 Currently pregnant? 5 IGO TO P9] Other?(Please describe) 6 IGO TO P91 v. P5c1. How much did the baby weigh at birth? L!J u Pounds Ounces P5d. What was the baby's date of birth? I I / I I I / 1 1 ' 1 (mm/dd/yyyy) 61 5 4.0 GPRA ART Core 26 12/1/2005 GAIN-I Using Card A... HPS P9. When was the last time(if ever)that you were bothered by health or medical problems or that they kept you from meeting your responsibilities at work, school or home?(Please include asthma,allergies and problems with your period.) (Circle one)(Card A) Within the past two days 6 3 to 7 days ago 5 1 to 4 weeks ago 4 I to 3 months ago 3 4 to 12 months ago 2 IGO TO Pllal More than 12 months ago 1 IGO TO P11a1 Never 0 IGO TO Pllal Please answer the next questions using number of days. P9a. During the past 90 days on how many days were you bothered by any health or medical problems? I I IlF 0,GO TO Pllal Days P9b. During the past 90 days,on how many days have medical problems kept you from meeting your responsibilities at work, school or home? Days P9c. What is the problem you have been having? vl. v2. v3. GI 5.4.0 GPRA ART Core 27 12/1/2005 GAIN-I The next questions are about treatment for injuries or physical health problems (including pregnancy and giving birth). Do not count counseling or treatment that was only for alcohol/drug use or psychological problems here.(Record 0 for none) Please answer the next questions using number of times. P11. Flow many times in your life have you a. been treated in an emergency room for health problems? I I Times b. been admitted for at least one night to a hospital for health problems? I I I Times c. received any outpatient surgical procedures for health problems I I Times d. Are you currently taking medication for allergies Yes No or health problems?(If yes,please describe below) 1 0 v. Using Card A... e. When was the last time you saw a doctor or nurse about a health problem or took prescribed medication for one? (Circle one)(Card A) Within the past two days 6 3to7daysago 5 l to 4 weeks ago 4 1 to 3 months ago 3 4 to 12 months ago 2 IGO TO P121 More than 12 months ago 1 IGO TO P121 Never 0 IGO TO P121 Please answer the next questions using number of times,nights, or days. (If no lifetime service use above,enter 0 in the respective row below.) During the past 90 days,how many.... PHTI f. times have you had to go to the emergency room(for a health problem)? Times g. nights total did you spend in the hospital (for a health problem)? I I I Nights h. times did you have an outpatient surgical procedure(for a health problem)? I I I Times j. times did you see a doctor or nurse in an office or outpatient clinic(for a health problem)? I I Times ji. days did you take prescribed medication for a health problem? Days Yes No k. Are you currently being treated for a health problem? 1 0 [IF NO,GO (If yes,where do you go?) TO P121 v. m. How long have you been treated regularly? I +I I+I + I Years Months Weeks Days GI 5 4.0 GPRA ART Core 28 12/1/2005 GAIN-I The next questions are about blood relatives.This includes your children,brothers,sisters, parents,aunts,uncles and grandparents.(Please write"DK"if you don't know.) Please answer the next questions using yes or no. P12. Have any of your blood relatives ever had... Yes No a. problems with alcohol use? 1 0 b. problems with drug use? 1 0 c. heart or blood problems? 1 0 d. diabetes 1 0 e. emotional,mental or psychological problems? 1 0 F. other problems that caused them to be sick or in treatment a 1ot9 1 0 P12g. Are you adopted? 1 0 • For Staff Use Only AGDM P15. DM Rating [PDM]:NONE ❑o SOME 0i MISUNDER 0 z DENIAL ❑ MISREP 0 4 GI 5.4.0 GPRA ART Core 29 12/12005 GAIN-I R.Risk Behaviors and Disease Prevention Next, we would like to ask a few very personal questions about behaviors that may have put you at risk or reduced your risk for getting or spreading infectious diseases. Please remember that all of your answers are strictly confidential.The first questions are about the use of a needle to inject you with drugs or medication.Do not include shots given by a doctor or nurse. Please include if you were injected by someone else or if you injected medication. Using Card A... NFS Rl. When was the last time(if ever)that you used a needle to inject drugs or medication?(Please include medication prescribed by a doctor.) (Circle one)(Card A) Within the past two days 6 3 to 7 days ago 5 1 to 4 weeks ago 4 1 to 3 months ago 3 4 to 12 months ago 2 More than 12 months ago I [GO TO R21 Never 0 [GO TO R21 Please answer the next questions using yes or no. NPS Rl. During the past 12 months, did you... Yes No a. use a needle to shoot up drugs? 1 0 b. reuse a needle that you had used before? 1 0 c. reuse a needle without cleaning it with bleach or boiling water fast? 1 0 d. use a needle that you knew or suspected someone else had used before? 1 0 e. use someone else's rinse water, cooker, or cotton after they did? 1 0 f. ever skip cleaning your needle with bleach or boiling water after you were done? 1 0 g. let someone else use a needle after you used it? 1 0 h. let someone else use the rinse water, cooker or cotton after you did? 1 0 j. allow someone else to inject you with drugs? 1 0 [IF 4 TO 12 MONTHS AGO REPORTED IN Rl,GO TO R21 Please answer the next questions using number of days or people. NFS k. During the past 90 days, on how many days did you use a needle to inject any kind of drug or medication? I I I [IF 0,GO TO R21 Days m. During the past 90 days,with how many people have you shared needles or works? I I I [IF 0,GO TO R21 People n. During the past 90 days,on how many days did you share needles with other people? I I Days GI 5.4.0 GPRA ART Core 30 12/1/2005 GAIN-I The next questions are about having sex. When we refer to sex it includes vaginal, oral and anal sex with anyone. (Vaginal sex is when a man puts his penis into a woman's vagina. Oral sex is when one person puts his or her mouth onto the other person's penis or vagina.Anal sex is when a man puts his penis into another person's anus or butt.) Using Card A... R2. When was the last time(if ever)that you had any kind of sex (vaginal,oral or anal)with another person? (Circle one)(Card A) Within the past two days 6 3to7daysago 5 1 to 4 weeks ago 4 1 to 3 months ago 3 4 to 12 months ago 2 More than 12 months ago I .iGO TO R41 Never 0 (GO TO R41 Please answer the next questions using yes or no. _ SxRS R2. During the past 12 months,did you... Yes No a. have sex while you or your partner was high on alcohol or drugs" 1 0 b. have sex with someone who was an injection drug user? 1 0 c. have sex involving anal intercourse(penis to butt)? 1 0 d. have sex with a man who might have had sex with other men? 1 0 e. trade sex to get drugs,gifts, or money? 1 0 f. use drugs,gifts,or money to purchase or get sexy 1 0 g. have two or more sexual partners'? 1 0 h. have sex with a male partner? 1 0 j. have sex with a female partner'/ 1 0 k. have sex without using any kind of condom,dental dam or other barrier to protect you and your partner from diseases or pregnancy? 1 0 m. have a lot of pain during sex or after having had sex'? 1 0 n. use alcohol or drugs to make sex last longer or hurt less? 1 0 GI 5 4.0 GPRA ART Core 31 12/12005 GAIN-I R2 Continued [IF 4 TO 12 MONTHS AGO REPORTED IN R2,GO TO R3] Please answer the next questions using number of partners or times. [IF NO PAST-YEAR MALE PARTNERS,ENTER'0'IN R2p] [IF NO PAST-YEAR FEMALE PARTNERS,ENTER'0'IN R2gl During the past 90 days, .... p. how many sexual partners did you have who were male? I I I Partners q. how many sexual partners did you have who were female? ... I I Partners SPR r. how many times did you have any kind of sex(vaginal, oral, or anal)with another person9 I I Times [IF 0,GO TO R4] s. when you had sex,how many times did you use any kind of condom,dental dam or other barrier to protect you and your partner from diseases or pregnancy? I I I Times Using Card A... R4. When was the last time you smoked or used any kind of tobacco?(Please include cigarettes,cigars,chewing tobacco and pipes) (Circle one)(Card A) Within the past two days 6 3to7daysago 5 1 to 4 weeks ago 4 1 to 3 months ago 3 4 to 12 months ago 2 [GO TO NEXT PAGE] More than 12 months ago 1 IGO TO NEXT PAGE] Never 0 ]GO TO NEXT PAGE] Please answer the next questions using number of days or times. a. During the past 90 days,on how many days have you smoked or used any kind of tobacco? I I I [IF 0,GO TO Days NEXT PAGE] b. On those days,how many times per day did you usually smoke or use any kind of tobacco? I I I Times Note:A pack of cigarettes would be about 20 times. For Staff Use Only AGDM R9. DM Rating [RDM]:NONE ❑o SOME ❑ ' MISUNDER ❑2 DENIAL 0 l MISREP D GI 5 4.0 GPRA ART Core 32 1211/2005 GAIN-I M. Mental and Emotional Health The next questions are about common nerve,mental or psychological problems that many people have. These 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 they make you feel like you cannot go on.Please answer the next questions using yes or no. IMDS/ Ml a. During the past 12 months have you had significant problems with... Yes No GMDS/ 1. headaches,faintness,dizziness,tingling,numbness,sweating SSI or hot or cold spells? 1 0 2. sleep trouble,such as bad dreams,sleeping restlessly or falling asleep during the day? 1 0 3. having dry mouth,loose bowel movements,constipation, trouble controlling your bladder or related itching? 1 0 4. pain or heavy feeling in your heart,chest, lower back,arms, legs or other muscles? 1 0 IMDS/ MI b. During the past 12 months have you had significant problems with... GMDS/ 1. feeling very trapped, lonely,sad,blue,depressed,or DSS hopeless about the future? 1 0 3. remembering,concentrating,making decisions, or having your mind go blank? 1 0 4. feeling very shy,self-conscious or uneasy about what people thought or were saying about you? 1 0 5. thoughts that other people did not understand you or appreciate your situation 1 0 6. feeling easily annoyed, irritated, or having trouble controlling your temper? 1 0 7. feeling tired,having no energy or like you could not get things done? 1 0 8. losing interest or pleasure in work,school,friends,sex or other things you cared about? 1 0 9. losing or gaining 10 or more pounds when you were not trying to? 1 0 10. moving and talking much slower than usual? 1 0 IMDS/ Ml c. During the past 12 months,have you... GMDS/ 1. thought about killing or hurting someone else'/ 1 0 HSTS 2. thought about ending your life or committing suicide? 1 0 [If 0,GO TO Mid] 3. had a plan to commit suicide? 1 0 4. gotten a gun,pills or other things to carry out your plan? 1 0 5. attempted to commit suicide? 1 0 G15.4.0 GPRA ART Core 33 12/1/2005 GAIN-I IMDS/ M l d. During the past 12 months,have you had significant problems with... Yes No GMDS/ 1. feeling very anxious,nervous,tense, scared,panicked or AFSS like something bad was going to happen? 1 0 2. having to repeat an action over and over, or having thoughts that kept running over in your mind9 1 0 3. trembling,having your heart race or feeling so restless that you could not sit still9 1 0 4. getting into a lot of arguments and feeling the urge to shout,throw things, beat, injure or harm someone? 1 0 5. feeling very afraid of open spaces, leaving your home, having to travel or being in a crowd? 1 0 6. avoiding snakes,the dark,being alone,elevators or other things because they frightened you9 1 0 7. thoughts that other people were taking advantage of you, not giving you enough credit or causing you problems9 1 0 8. thoughts that someone was watching you,following you or out to get you? 1 0 9. seeing or hearing things that no one else could see or hear or feeling that someone else could read or control your thoughts? - - 1 0 10. thoughts that you should be punished for thinking about sex or other things too much'? 1 0 11. having a lot of tension or muscle aches because you were worried9 1 0 12. being unable or fmding it difficult to control your worries9 1 0 The next questions are about all the different kinds of nerve,mental or psychological problems just mentioned. Using Card A... EPS Ml e. When was the last time(if ever)your life was significantly disturbed by nerve,mental or psycological problems or that you felt you could not go on (including those things we just talked about)? (Circle one)(Card A) Within the past two days 6 3 to 7 days ago 5 1to4weeks ago-- 4 1 to 3 months ago 3 4 to 12 months ago 2 IGO TO M21 More than 12 months ago 1 IGO TO M21 Never 0 IGO TO M21 Please answer the next questions using number of days. f. During the past 90 days, on how many days were you bothered by any nerve,mental, or psychological problems9 I 1 I Days g. During the past 90 days, on how many days did these problems keep you from meeting your responsibilities at work, school or home,or make you feel like you could not go on? I 1 I Days GI 5 4.0 GPRA ART Core 34 12/1/2005 GAIN-I Using Card A... EPS m2. When was the last time(if ever)your life was disturbed by memories of things from the past you did, saw or had happen to you? (Circle one)(Card A) Within the past two days 6 3 to 7 days ago 5 1 to 4 weeks ago 4 1 to 3 months ago 3 4 to 12 months ago 2 More than 12 months ago 1 (GO TO M31 Never 0 (GO TO M31 Please answer the next questions using yes or no. IMDS/ M2. During the past 12 months have the following situations happened to TSS you? Yes No a. When something reminds you of the past,you became very distressed and upset 1 0 b.— You had nightmares about things in your past that really happened 1 0 c. When you think of things you have done,you wish you were dead 1 0 d. It seemed as if you have no feelings 1 0 e. Your dreams at night are so real that you awaken in a cold sweat and force yourself to stay awake 1 0 f. You felt like you could not go on 1 0 g. You were frightened by your urges 1 0 h. Sometimes you used alcohol or other drugs to help yourself sleep or forget about things that happened in the past 1 0 j. You lost your cool and exploded over minor,everyday things 1 - - 0 k. You were afraid to go to sleep at night 1 0 in. You had a hard time expressing your feelings,even to the people you cared about 1 0 n. You felt guilty about things that happened because you felt like you should have done something to prevent them 1 0 p. Had any of the above problems for three or more months 1 0 [IF 4 TO 12 MONTHS AGO REPORTED IN M2,GO TO M31 Please answer the next question using number of days. EPS q. During the past 90 days,on how many days have you been disturbed by memories of things from the past that you did,saw or had happen to you? I I I Days GI 5.4.0 GPRA ART Core 35 12/1/2005 GAIN-I Using Card A... EPS M3. When was the last time(if ever)you had any problems paying attention, controlling your behavior or broke rules you were supposed to follow? (Circle one)(Card A) Within the past two days 6 3to7daysago 5 1 to 4 weeks ago 4 1 to 3 months ago 3 4 to 12 months ago 2 More than 12 months ago 1 IGO TO M4i Never 0 IGO TO M4i Please answer the next questions using yes or no. BCS/ M3a. During the past 12 months,have you done the following things two IDS or more times? Yes No 1. Made mistakes because you were not paying attention 1 0 2. Had a hard time paying attention at school,work or home. 1 0 3. Had a hard time listening to instructions at school,work or home 1 0 4. Not followed instructions or not finished your assignments. 1 0 5. Had a hard time staying organized or getting everything done. 1 0 6. Avoided things that took too much effort, like school work or paper work 1 0 7. Lost things that you needed for school,work or home 1 0 8. Been unable to pay attention when other things were going on. - 1 0 9. Been forgetful or absent-minded 1 0 BCS/ 10. Fidgeted or had a hard time keeping your hands or feet still HIS when you were supposed to 1 0 11. Been unable to stay in a seat or where you were supposed to stay. 1 0 12. Felt restless or the need to run around or climb on things 1 0 13. Gotten in trouble for being too "loud" when you were playing or relaxing 1 0 14. Felt like you were always on the"go" or "driven by a motor". 1 0 15. Talked too much or had others complain that you talked too much. 1 0 16. Gave answers before the other person finished asking the question 1 0 17. Had a hard time waiting for your turn. 1 0 18. Interrupted or butted into other people's conversations or games.-- 1 0 19. Have you had any of the above problems in the past six months? 1 0 GI 5 4.0 GPRA ART Core 36 12/1/2005 GAIN-I BCS/ M3b. During the past 12 months,have you done the following things CDS two or more times? Yes No 1. Been a bully or threatened other people. 1 0 2. Started fights with other people 1 0 3. Used a weapon in fights 1 0 4. Been physically cruel to other people 1 0 5. Been physically cruel to animals 1 0 6. Taken a purse,money or other things from another person by force 1 0 7. Forced someone to have sex with you when they did not want to. 1 0 8. Set fires 1 0 9. Broken windows or destroyed property 1 0 10. Taken money or things from a house,building or car 1 0 11. Lied or conned to get things you wanted or to avoid having to do something 1 0 12. Taken things from a store or written bad checks to buy things. --- 1 0 13. Stayed out at night later than your parents or partner wanted 1 0 14. Run away from home(partner)for at least one night 1 0 15. Skipped work or school 1 0 17. (Have you/Before you were 18 did you)ever run away for 2 or more days or 2 or more times? 1 0 Before you were 13 years old,did you... 18. often stay out at night later than your parents wanted? 1 0 19. skip school(or work)many times9 1 0 [IF 4 TO 12 MONTHS AGO REPORTED IN M3,GO TO M4] Please answer the next question using number of days. EPS M3c. During the past 90 days,on how many days have you had any problems paying attention, controlling your behavior or breaking rules you were supposed to follow9 I I I Days GI 5.4.0 GPRA ART Core 37 12/1/2005 GAIN-1 Please answer the next questions using True or False. M4. Do each of the following statements describe you during the past 12 months? True False PCSS/ a. You could not really trust most people 1 0 CPI b. Rather than get mad,you wanted to get even.-- 1 0 c. You daydreamed or tried to space out the world a lot. 1 0 d. You did not care to be around other people much. 1 0 e. You were not very emotional about other people or things 1 0 f. You were afraid that you were crazy 1 0 PCSS/ g. You often just did not pay bills or live up to your commitments. 1 0 IPI h. You lied often and easily 1 0 j. You got bored easily or hated routines 1 0 k. You often acted before thinking about the trouble you might get into 1 0 m. You were a very moody person or had your feelings toward others change drastically 1 0 n. You did not like being told by others what you should be doing 1 0 p. You could usually get people to do things your way 1 0 q. Other people think your problems are worse than they really are 1 0 PCSS/ r. You spent a lot of time trying to think through your WPI problems or what to do 1 0 s. You got mad at yourself a lot because you did not do a good enough job 1 0 t. You felt like you could not make it through life. 1 0 u. You had a hard time deciding what to do. 1 0 v. You had a hard time changing the way you did things 1 0 w. You often felt critical of others or picked on them 1 0 x. You were very concerned about your health and other things that happened to you 1 0 Please answer the next questions using True or False. M4z. During the past 12 months you. . . [IF 1. cut,burned, or hurt yourself on purpose? 1 0 0, GO M5al 2. needed medical treatment after you cut,burned,or hurt yourself on purpose? - 1 0 3. felt like you could not stop yourself from cutting, burning or hurting yourself? 1 0 M4z4. During the past 90 days on how many days have you cut,burned,or hurt yourself on purpose? I I Days GI 5 4.0 GPRA ART Core 38 12/1/2005 GAIN-I The next questions are about treatment for mental, emotional, behavioral or psychological problems. This includes taking medication like Ritalin that a regular doctor may have given you to help you focus or calm down.Do not count treatment that was only for substance use or health problems. M5a. Has a doctor,nurse or counselor ever told you that you have a mental,emotional or psychological problem or told you the name of a particular condition you have/had? (Please record and/or circle all that apply below) vl. v2. v3. MENTIONED (Circle all that apply-blanks will be treated as No) Yes No 0. Any condition reported 1 0 [IF MSa0=0, 1. Alcohol or drug dependence 1 0 MARK 2. Attention-deficit/hyperactivity disorder 1 0 REMAINING ITEMS Ol 3. Antisocial personality disorder 1 0 4. Anxiety or phobia disorder 1 0 5. Borderline personality 1 0 6. Conduct disorder 1 0 7. Major depression 1 0 8. Depression, dysthymia or other mood disorder 1 0 9. Mental retardation, developmental or other communication disorder 1 0 10. Oppositional defiant disorder 1 0 11. Pathological gambling 1 0 12. Post or acute traumatic stress disorder 1 0 13. Somatoform,pain,sleep, eating or body.disorder 1 0 14. Other cognitive disorder(like delirium,dementia, amnesic) 1 0 15. Other mental breakdown,nerves or stress 1 0 16. Other personality disorder(like avoidant,dependent, histrionic,narcissistic, obsessive-compulsive,paranoid, schizoid or schizotypal) 1 0 17. Other schizophrenia or psychotic disorder 1 0 99. Other(Please describe) 1 0 v. GI 5.4.0 GPRA ART Core 39 12/1/2005 GAIN-I Please answer the next questions using number of times. M5. How many times in your life have you ... Times b. been treated in an emergency room for mental, emotional, behavioral or psychological problems" I I I c, been admitted for at least one night to a hospital for mental, emotional,behavioral or psychological problems? II I M5d. Are you currently taking medication for mental,emotional, Yes No behavioral or psychological problems? 1 0 (If yes,please describe) v. Using Card A... MHTI M5e. When was the last time(if ever)you were treated for a mental, emotional,behavioral or psychological problem by a mental health specialist or in an emergency room,hospital or outpatient mental health facility or with prescribed medication? (Circle one) (Card A) Within the past two days 6 3 to 7 days ago 5 1 to 4 weeks ago 4 1 to 3 months ago 3 4 to 12 months ago 2 IGO TO NEXT PAGE] More than 12 months ago. . . . . .. ... . .. 1 IGOTONEXTPAGE] Never 0 IGO TO NEXT PAGE] Please answer the next questions using number of times,nights, or days. (If no lifetime service use above,enter 0 in the respective row below.) MHTI M5. During the past 90 days,how many ... f. times have you had to go to the emergency room(for mental,emotional,behavioral or psychological problems)? I I I Times g. nights total did you spend in a hospital(for mental, emotional,behavioral or psychological problems)" I I I Nights h. times did you see a doctor in an office or outpatient clinic (for mental, emotional,behavioral or psychological problems)" I I I Times hl. days did you take prescribed medication for mental, emotional,behavioral or psychological problems? I I I Days j. Are you currently being treated for a mental, emotional, Yes No behavioral or psychological problem" 1 0 (IF NO,GO TO (If yes,where do you go?) NEXT PAGE] v. For Staff Use Only AGDM M8. DM Rating [MDM]:NONE❑ o SOME ❑ i MISUNDER 0 2 DENIAL ❑ 3 MISREP 0 4 GI 5 4.0 GPRA ART Core 40 12/1/2005 GAIN-I E.Environment and Living Situation The next set of questions is about places where you spend most of your time and the people you spend your time with.First we would like to ask some questions about where you live. El. What kind of housing do you currently live in? (Clarify and code response) A house,apartment or room you,your spouse,your partner or your parents rent or own 1 A foster home 2 A public housing or rent-subsidized apartment or house registered in your or your family's name 3 A friend's or relative's house, apartment or room 4 An unsupervised dormitory or quarters,such as at college, religious or military quarters or agriculture or other workers'quarters 5 A nursing home or any other kind of group home 6 Any kind of hospital, inpatient or residential facility for medical,mental, alcohol or drug-related problems 7 Jail,detention center,correctional halfway house or other correctional institution 8 Temporary or emergency shelter for people who are homeless,runaways,neglected or abused 9 Vacant buildings,public or commercial facilities,parks,cars or on the street because you do not have a place to stay 10 Any other housing situation(Please describe) 99 v. a. How long have you been living there? I ' 1+I I_I+ J+ Years Months Weeks Days Using Card A... RERI b. When was the last time(if ever)that you considered yourself to be homeless? (Circle one) Within the past two days 6 3to7daysago 5 1to4weeksago 4 1 to 3 months ago 3 4 to 12 months ago 2 More than 12 months ago 1 Never 0 Yes No Elc. Can you continue to stay where you are now? 1 0 El d. During the oast 90 days on how many days have you been homeless or had to stay with someone else to avoid being homeless? I I I Days GI 5 4.0 GPRA ART Core 41 12/12005 GAIN-I The next two questions are about alcohol and drug use at home or where you are living. RERI E2. During the past 90 days, on how many days did... Days d. otherpeople use alcohol where you were living9 I I I e. other people use drugs where you were living? I I REP] E2f. During thepast 90 days, on how many days did you live someplace where you were not free to come and go as you please- such as jail, an inpatient program,or hospital? 1 Days RERI E3. During the past 90 days, on how many days have you gotten into trouble at home or with your family for any reason9 I I I Days Please answer the following questions using yes or no. E3a1. During the past 12 months,have you lived with anyone Yes No other than yourself'? 1 0 [IF NO,GO TO E3b1l MENTIONED Who have you lived with?(Code or say,have you lived with...) Yes No 2. Spouse, significant companion or other sexual partner 1 0 3. Parents 1 0 4. Your biological or adopted children age 12 or less 1 0 5. Your biological or adopted children over 12 1 0 6. Your brothers or sisters age 12 or less 1 0 7. Your brothers or sisters over 12 1 0 8. Other relatives 1 0 9. Other children age 12 or less 1 0 10. Other children over the age of 12 1 0 11. Other adult roommates 1 0 12. Foster parents 1 0 13. Institutional staff 1 0 99. Other(Please describe) 1 0 v. E3b1. Have you ever been married or lived as married with Yes No someone9 1 0 [IF NO,CIRCLE 8 IN E3b2 AND GO TO E4] E3b2. What is your current marital status? (Clarify and circle one) Married 1 Remarried 2 Living with someone as married 3 Married but living apart 4 Divorced 5 Legally separated 6 Widowed 7 Never married 8 E4. How many children (if any) do you have(under the age of 21)? I Number GI 5.4.0 GPRA ART Core 42 12/1/2005 GAIN-I For the following questions,please do not count people iust because they are in the same building(e.g.,jail,detention, school),or because you only see them a few times. E5. During the past 12 months how many people would you say you have regularly lived with(including your parents or family)'? I I I (IP 0 GO TO Ml Using Card C... People LRI/ Of the people you have regularly lived with would ERS you say that none,a few,some,most or all of them... None A Few Some Most All a. were employed or in school or training full-time? 4 3 2 1 0 b. were involved in illegal activity? 0 1 2 3 4 c. weekly got drunk or had 5 or more drinks in a day'? 0 1 2 3 4 d. used any drugs during the past 90 days'? 0 1 2 3 4 e. shout,argue,and.fight most weeks? . 0 1 2 3 4 f. have ever been in drug or alcohol treatment'? 4 3 2 1 0 g. would describe themselves as being in recovery'? 4 3 2 1 0 E6. During the past 12 months,how many people would you say you spend most of your time with at work,a training program,or school? I I (I'0 GO TO E71 People Using Card C... VRI/ Of the people you have regularly worked or gone to ERS school with,would you say that none,a few,some,most or all of them... None A Few Some Most All a. were employed or in school or training full-time? 4 3 2 1 0 b. were involved in illegal activity? 0 I 2 3 4 c. weekly got drunk or had 5 or more drinks in a day? 0 1 2 3 4 d. used any drugs during the past 90 days? 0 1 2 3 4 e. shout,argue, and fight most weeks?._ _ _ 0_ 1 2 3 4 f. have ever been in drug or alcohol treatment? 4 3 2 1 0 g. would describe themselves as being in recovery'? 4 3 2 1 0 E7. During the past 12 months how many people would you say you spend most of your free lime with or hang out with? I I II (IF 0 GO TO E81 People Using Card C... SRI/ Of the people you have regularly socialized with or hung out with, ERS would you say that none,a few,some,most or all of them... None A Few Some Most All a. were employed or in school or training full-time? 4 3 2 1 0 b. were involved in illegal activity? 0 1 2 3 4 c. weekly got drunk or had 5 or more drinks in a day? 0 1 2 3 4 d. used any drugs during the past 90 days? 0 1 2 3 4 e. shout, argue, and fight most weeks? 0 1 2 3 4 f. have ever been in drug or alcohol treatment? 4 3 2 1 0 g. would describe themselves as being in recovery? 4 3 2 1 0 GI 5.4.0 GPRA ART Core 43 IVI/2005 GAIN-I No matter how hard people try,they sometimes have conflicts or disagreements. Below is a list of various ways people try to settle their differences. The first set of questions is about what you may have done. Using Card A... RERI E8. When was the last time(if ever)that during an argument with someone else yciki swore, cursed,threatened them,threw something, or pushed or hit them in any way? (Circle one)(Card A) Within the past two days 6 3to7daysago 5 1 to 4 weeks ago 4 I to 3 months ago 3 4 to 12 months ago .. ------------------... . _. 2 More than 12 months ago I IGO TO E9] Never 0 IGO TO E9I Please answer the following questions using yes or no. GCTS E8. During the vast 12 months have you had a disagreement in which you did the following things? Yes No a. Discussed it calmly and settled the disagreement. 1 0 b. Left the room or area rather than argue 1 0 c. Insulted,swore or cursed at someone. 1 0 d. Threatened to hit or throw something at another person 1 0 e. Actually threw something at someone 1 0 f Pushed,grabbed, or shoved someone 1 0 g. Slapped another person 1 0 h. Kicked,bit,or hit someone 1 0 j. Hit or tried to hit anyone with something(an object). 1 0 k. Beat up someone. 1 0 m. Threatened anyone with a knife or gun. 1 0 n. Actually used a knife or gun on another person 1 0 [IF 4 TO 12 MONTHS AGO REPORTED IN E8,GO TO E91 Please answer the following question using number of days. RERI p. During the vast 90 days, on how many days did you have an argument with someone else in which you swore,cursed, threatened them,threw something, or pushed or hit them in any way? I Days 615.4.0 GPRA ART Core 44 12/1/2005 GAIN-I The next questions are about things that other people may have done to ycs.Please answer the next questions using yes or no. GVS E9. Has anyone ever done any of the following things to you? Yes No a. Attacked you with a gun,knife,stick,bottle or other weapon.-_ 1 0 b. Hurt you by striking or beating you to the point that you had bruises,cuts, or broken bones or otherwise physically abused you 1 0 c. Pressured or forced you to participate in sexual acts against your will,including your regular sexual partner,a family member or friend 1 0 d. Abused you emotionally;that is,did or said things to make you feel very bad about yourself or your life. 1 0 [IF ALL OF ABOVE ARE NO,GO TO E9n BELOW' e. About how old were you the first time any of these things happened to you? I I 1 Age Yes No e 18. [IS E9e UNDER 18?] 1 0 Did any of the previous things happen.. . Yes No f. several times or over a long period of time'? 1 0 g. with more than one person involved in hurting you? 1 0 h. where one or more of the people involved was a family member close family friend,professional or someone else you had trusted? 1 0 j. where you were afraid for your life or that you might be seriously injured'? 1 0 k. and result in oral,vaginal or anal sex? 1 0 m. and people you told did not believe or help you? 1 0 Are you currently worried that someone might. . . Yes No n. attack you with a gun,knife,stick,bottle or other weapon? 1 0 p. hurt you by striking or beating or otherwise physically abuse you'/ 1 0 q. pressure or force you to participate in sexual acts against your will? 1 0 r. abuse you emotionally? 1 0 (If E9a-d and E9f-r are all No,circle No to E9s below and continue) Yes No E9s. Have you gotten the help you need to deal with these problems? 1 0 GI 5.4.0 GPRA ART Core 45 12/1/2005 • GAIN-I E9(continued) Using Card A... RERI E9t. When was the last time(if ever)you were attacked with a weapon, beaten,sexually abused or emotionally abused? (Circle one)(Card A) Within the past two days 6 3to7daysago 5 1 to 4 weeks ago 4 I to 3 months ago 3 4 to 12 months ago 2 ]GO TO El lb] More than 12 months ago 1 EGO TO Ellbl Never 0 EGO TO Ellbi Please answer the next question using number of days. RERI u. During the past 90 days,on how many days were you attacked I I with a weapon,beaten, sexually abused or emotionally abused" W Days Using CARD G,please answer the next questions using"not at all, somewhat, considerably or extremely." = , � -o E c t CSAT/ El lb.During the past 90 days ... O o x GPRA Z c " El lbl. how stressful have things been for you because of your use of alcohol or other drugs" 0 1 2 3 El1b2. how much has your use of alcohol or other drugs caused you to reduce or give up important activities" 0 1 2 3 El 1b3. how much has your use of alcohol and other drugs caused you to have emotional problems? 0 1 2 3 Please answer the next questions using number of days. RERI E14. During the past 90 days,on how many days have you been Days involved in a formal activity(sports,family event, club)where... I I a. no one was using alcohol or drugs" I IIII b. anyone was using alcohol or drugs" u For Staff Use Only AGDM E18.DM Rating[EDM]:NONE 0 SOME ❑ i MISUNDER ❑ 2 DENIAL ❑ 3 MISREP❑ J GI 5 4.0 GPRA ART Core 46 12/1/2005 • GAIN-I L. Legal(Civil and Criminal) This section deals with the legal system and behaviors that may get you into trouble or be against the law.Recall that your answers here are strictly confidential and will be used only for your treatment and to help us evaluate our program. Using Card A... IAS L3. When was the last time(if ever)that you did anything you thought might get you in trouble or be against the law besides using(alcohol or)drugs? (Circle one)(Card A) Within the past two days 6 3to7daysago 5 1 to 4 weeks ago 4 lto3monthsago 3 4 to 12 months ago 2 More than 12 months ago 1 IGO TO L4al Never 0 IGO TO L4al GI 5.4.0 GPRA ART Core 47 12/1/2005 GAIN-I Please answer the next questions using number of times. Times L3a. During the past 12 months,how many times have you... GCS/ 1. purposely damaged or destroyed property that did not belong to you? --I I PCS 2. bought, received,possessed or sold any stolen goods? I I I I 3. passed bad checks,forged(or altered)a prescription or took money from an employer? I I I 4. taken something from a store without paying for it? I I I I 5. other than from a store,taken money or property that didn't belong to you? I I 6. broken into a house or building to steal something or just to look around? I I I 7. taken a car that didn't belong to you? I I GCS/ 8. used a weapon,force, or strong-arm methods to get money ICS or things from a person? I I I I 9. hit someone or got into a physical fight? I I I I 10. hurt someone badly enough they needed bandages or a doctor? I I I I 11. used a knife or gun or some other thing(like a club)to get something from a person? I I I 12. made someone have sex with you by force when they did not want to have sex? I I I I 13. been involved in the death or murder of another person(including accidents)? I I 14. intentionally set a building, car or other property on fire? I I I I GCS/ 15. driven a vehicle while under the influence of alcohol or DCS illegal drugs? I I I I 16. sold, distributed or helped to make illegal drugs? I I I 17. traded sex for food, drugs, or money? I I I I 18. been a member of a gang? I I I 19. gambled illegally? I I I _I 99. done something else(other than drug use)that would have gotten you into trouble with the police if they had known about it? I I I (Please describe) v. [IF 4 TO 12 MONTHS AGO REPORTED IN L3,GO TO L4al Please answer the next questions using number of days. Days IAS L3d. During the past 90 days on how many days were you involved in any activities you thought might get you into trouble or be against the law(besides drug use)? I I I [IF 0,GO TO L4al L3e-g On how many of these days were you involved in these activities(you thought might get you into trouble or be against the law)... e. in order to support yourself financially? I I I f. in order to obtain drugs or alcohol? I I I g. while you were high or drunk? I I GI 5 4.0 GPRA ART Core 48 12/1/2005 GAIN-I Please answer the next questions using number of times. L4a. In your lifetime about how many times have you been picked up by the police for status offenses such as running away or truancy? I i I P Times L5. In your lifetime about how many times have you been arrested. charged with a crime and booked?(Please include all the times this happened, even if you were then released or the charges were dropped.) I I I lIF 0,GO TO L61 Times L5a. What were the"charges"?(Were there any other charges?) MENTIONED (If more than 5 arrests, ask all as:for which of the following offenses-have-you ever been arrested and charged with?) Yes No 1. Vandalism or property destruction 1 0 2. Receiving,possessing or selling stolen goods 1 0 3. Passing bad checks, forgery,or fraud 1 0 4. Shoplifting 1 0 5. Larceny or theft 1 0 6. Burglary or breaking and entering 1 0 7. Motor vehicle theft 1 0 8. Robbery 1 0 9. Simple assault or battery 1 0 10. Aggravated assault 1 0 11. Forcible rape 1 0 12. Murder,homicide or non-negligent manslaughter 1 0 13. Arson 1 0 • .14. Driving under the influence 1 0 15. Drunkenness or other liquor law violation 1 0 16. Possession,dealing, distribution or sale of drugs 1 0 17. Prostitution,pimping,or commercialized sex 1 0 18. Probation or parole violations 1 0 19. Illegal gambling 1 0 99. Status or other offenses(curfew,truancy,graffiti,gang involvement/activity, run away,domestic violence,disturbing the peace,disorderly conduct,paraphernalia) 1 0 (Please describe) v, L5ac. How many limes were you convicted or adjudicated? I J Times GI 5.4.0 GPRA ART Core 49 12/1/2005 GAIN-I Using Card A... L5b. When was the last time you were arrested, charged with a crime and booked? (Circle one)(Card A) Within the past two days 6 3to7daysago 5 l to 4 weeks ago 4 1 to 3 months ago 3 4 to 12 months ago 2 IGO TO L6] More than 12 months ago 1 IGO TO L6] Never 0 IGO TO L6] L5c. During the past 90 days how many times have you been arrested I I I I [IF 0,GO TO L6] and booked for breaking a law?(Please do not count minor traffic violations.) Times L5d. What were you arrested for in the past 90 days?(How many MENTIONED times?Was there anything else you were arrested for? How many times?) Times 1. Vandalism or property destruction I I 2. Receiving,possessing or selling stolen goods I 3. Passing bad checks,forgery,or fraud 4. Shoplifting I 5. Larceny or theft I 6. Burglary or breaking and entering I I 7. Motor vehicle theft I I 8. Robbery I I 9. Simple assault or battery I 10. Aggravated assault I 11. Forcible rape I 12. Murder,homicide or non-negligent manslaughter I 13. Arson I 14. Driving under the influence I 15. Drunkenness or other liquor law violation I 16. Possession,dealing, distribution or sale of drugs I 17. Prostitution, pimping, or commercialized sex I 18. Probation or parole violations ___ __ __. 19. Illegal gambling 99. Status or other offenses(curfew,truancy,graffiti,gang involvement/activity,running away,domestic violence,disturbing the peace,disorderly conduct,paraphernalia) I (Please describe) V. GI 5.4.0 GPRA ART Core 50 12/1/2005 GAIN-I Using Card A... CJSI L6. When was the last time you were on or in probation,parole, jail,detention,house arrest or electronic monitoring? (Circle one)(Card A) Within the past two days 6 3 to 7 days ago 5 I to 4 weeks ago 4 1 to 3 months ago 3 4 to 12 months ago 2 IGO TO L7l More than 12 months ago 1 IGO TO L71 Never 0 IGO TO L71 Please answer the next questions using number of days. a-f During the past 90 days how many days have you been... Days a. on probation? J b. on parole? I J c. in jail or prison? d. on house arrest9 I II I e. on electronic monitoring? f. in juvenile detention? I� I g. How many days of the days mentioned above(in L6a-f)did you get into trouble with your probation officer or parole officer?(How many days did you get caught doing things you were not supposed to do?) I I I Yes No h. Are you currently in jail,prison or detention? 1 0 IIIF NO,GO TO L71 j. How much longer do you think you will be U I there? � + � + � + I_i 1 [Use 99 years for rest of life] Years Months Weeks Days GI 5.4.0 GPRA ART Core 5 12/1/2005 GAIN-I Please answer the next questions using yes or no. L7. Are you currently involved with the criminal justice system in any of the following ways? Yes No 1. Awaiting a trial 1 0 2. Awaiting sentencing 1 0 3. Out on bail or released on own recognizance(ROR) 1 0 4. On probation 1 0 5. In jail/prison 1 0 6. On treatment release, work release or school release 1 0 7. On parole 1 0 8. In detention 1 0 9. Assigned to a sentencing alternative or treatment program(TASC) 1 0 10. Under house arrest 1 0 11. Under other forms of court supervision 1 0 12. Awaiting charges 1 0 99. Other involvement(Please describe) 1 0 v. For Staff Use Only AGDM L12. DM Rating [LDM]:NONE ❑o SOME 0 MISUNDER 02 DENIAL D 3 MISREP ❑ 4 GI 5.4.0 GPRA ART Core 52 12/1/2005 GAIN-I V.Vocational(School,Work,Financial) These next questions are about school, work and money. Vl. What is the last grade or year that you completed in school? (NOTE: You cart use 12 for high school,16 for a BA/BS and 17 for graduate school or more than 4 years of college) I I I Grade VI a. Did you receive any special education classes or services Yes No or go to any alternative school programs? 1 0 11F NO,GO TO Vlb] [If Yes,what kind of services or program did you go toil vl. v2. v3. V lb. During your last year in school,what was your average grade? (Circle one) A-to A+ 4 B-to B+ 3 C-to C+ 2 D-to D+ 1 F 0 Mixed/Other(Please describe) 99 v. V2. What kinds of diplomas,degrees, certificates or licenses MENTIONED have you received?(Any others?) [If none,circle all 0's] Yes No 1. High school diploma 1 0 2. Passed GED(general equivalency diploma) 1 0 3. Adult basic education(ABE)certificate 1 0 4. Junior college or associate's degree 1 0 5. Bachelor's degree 1 0 6. Advanced college degree(master's or doctorate) 1 0 7. Vocational/trade certificate 1 0 8. Trade license apprenticeship 1 0 99. Other degrees or licenses(Please describe) 1 0 v. GI 5.4.0 GPRA ART Core 53 iznnoos GAIN-I Using Card A... TAS V3. When was the last time you were in any kind of school or training program? (Circle one)(Card A) Within the past two days 6 3 to 7 days ago 5 1 to 4 weeks ago 4 1 to 3 months ago 3 4 to 12 months ago 2 [GO TO V6] More than 12 months 1 [GO TO V6] Never 0 ]GO TO V61 Please answer the next questions using number of days or times. TAS V3. During the past 90 days, on how many days... Days (NOTE:5 days per week in 90 days is equal to 64 days.) k. did you go to any kind of school or training'? I I I [IF 0,GO TO V6] m. did you go to school or training full time? U n. did you miss school or training for any reason') I p. did you get in trouble at school or training for any reason? U q. were you suspended from school or training for any reason?___ r. During the past 90 days how many times did you get expelled from school or training? I I I Times Using Card A... EmAS V6. When was the last time you worked at a(civilian)job or were self-employed? (Circle one)(Card A) Within the past two days 6 3 to 7 days ago 5 1 to 4 weeks 4 1 to 3 months ago 3 4 to 12 months ago 2 [GO TO V7] More than 12 months ago 1 [GO TO V7] Never 0 [GO TO V7] Please answer the next questions using number of days or times. EmAS V6. During the past 90 days, on how many days ... Days (NOTE:5 days per week in 90 days is equal to 64 working days.) k. did you work for money at a job or in a business? U [IF 0,GO TO V71 m. did you work full time(7 or more hours per day)? LLI n. did you miss work for any reason? U p. did you get in trouble at work for any reason? U q. were you suspended from work for any reason'? I I r. During the past 90 days how many times did you get fired from work' I I I Times GI 5.4.0 GPRA ART Core 54 12/1/2005 GAIN-I V7. Which of the following statements best describes your present work or school situation?(If more than one applies,code the one engaged in most often.) (Circle one) Working full-time, 35 hours or more a week 1 Working part-time, less than 35 hours a week 2 Have a job,but not at work because of treatment, extended illness,maternity leave, furlough or strike 3 Have a job but not at work because it is seasonal work 4 Unemployed or laid off and looking for work 5 Unemployed or laid off and not looking for work 6 Full-time homemaker 7 In school or training only 8 In school or training,but not currently going to classes 9 Retired 10 In jail,prison or detention 11 Too disabled for work(Please describe disability) 12 v. In the military 13 Doing volunteer work 14 Some other work situation(Please describe) 99 v. a. How lone have you been in this situation? I I I + I I I +I I VI I Years Months Weeks Days The next questions are about gambling.This includes betting on sports,playing the lottery,going to casinos or betting for money,drugs, sex or other things. Using Card A... FIS V9. When was the last time(if ever)you gambled for money, drugs,sex or other things? (Circle one)(Card A) Within the past two days 6 3 to 7 days ago 5 1 to 4 weeks ago 4 • 1 to 3 months ago 3 4 to 12 months ago 2 [GO TO Vlol More than 12 months ago 1 [GO TO Viol Never 0 [GO TO V101 Please answer the next question using number of days. FIS m. During the past 90 days, on how many days have you gambled for money,drugs,sex or other things? I I I Days GI 5.4.0 GPRA ART Core 55 12/1/2005 GAIN-I VI 0. What is your primary source of income? (Which of the following is your primary source of income?) (CLARIFY AND CODE ANSWER) (Circle one) None 0 Wages or a salary from a legitimate job or business Social Security or Railroad Retirement payments 2 Supplemental(Disability) Security Income(SSI or SSDI) 3 Other public assistance or welfare payments from the state or local welfare office such as general assistance 4 Temporary Assistance for Needy Families(TANF, formerly AFDC). 5 Interests,dividends,rent,royalties or inheritance 6 Income from spouse, family or friends (including child support,allowance or alimony). 7 Gambling(including a loss) 8 Hustling,dealing or other illegal activities 9 Unemployment compensation. 10 Some other source.(Please describe) 99 v. GI 5.4.0 GPRA ART Core 56 1?/12005 GAIN-I V11. During the past 90 days about how much did you receive all together from each of the following sources?[VERIFY THAT AMOUNT IS FOR PAST 90 DAYS.IF NONE,RECORD 0.1 90-Day Total a. Wages or salary from a legitimate job or business $I I I I , I I b. Spouse,family or friends $I I I I , I I I c. Alimony and child support $I I I I , I I d. SSI-Supplemental Security Income(that you qualify for because of low income) $I I I I , I I I e. Disability pay,such as SSDI, unemployment compensation of a work-related injury or income from a private disability plan. $I I 11 , 1 I f. Unemployment_compensation because of layoff $ - 1- I I g. Other retirement income, including military and private pensions $I I I I H I h. Welfare or public assistance programs such as TANF (Temporary Assistance for Needy Families),food stamps or housing assistance $I I I I , 1 I I j. Department of Veterans Affairs $I I I . I I I k. Criminal or possibly illegal activities,including hustling or dealing $I I I I . I I I m. Any other income not mentioned above(Please describe) $I I I I , I I v. n. So overall,you received about (add up&correct) from all these sources during the past 90 days $I I I I , I I p. How much did you spend on alcohol? $I I I I q. How much did you spend on drugs? $I I I , I I I I The next two questions are about your family's household.This may include people with whom you share your income and expenses(such as husband,wife, children,parents,relatives,and/or sexual partners). PoPI r. How many people are there in your family household? I I I People The next question is about the income of everyone in your'household together.We do NOT need an exact number.You can give your answer to the nearest hundreds or thousands of dollars if that is easier.(Put'DK'if you don't know) s. During the past 90 days,what was the total family income of everyone in your household together'? $I I I I , I I I I For Staff Use Only AGDM V14.DM Rating[VDM]:NONE O0 SOME 0 1 MISUNDER O 2 DENIAL ❑ J MISREP O 4 GI 5.4.0 GPRA ART Core 57 12/1/2005 GAIN-I CG. CSAT GPRA Supplement (for use with GAIN-I version 5.4) The following supplemental questions are being collected to support reporting requirements of our funder(the Center for Substance Abuse Treatment under the Government Performance and Results Act. The OMB No. is 0930-0208 with an expiration date of 1/31/2007. Comments can be directed to the SAMHSA Reports Clearance Officer, Room 7-1045, 1 Choke Cherry Road, Rockville, MD 20857.) Client Type: Treatment Client 1 (A client who is receiving substance abuse treatment by your agency and these treatment services are beingfunded by CSAT grant award) Client in Recovery 2 (A client who is receiving support services through your agency, and these recovery support services are being funded by CSAT grant award) [IF NO PAST MONTH ALCOHOL USE(S2a<4),GO TO CGS2] Earlier you reported using alcohol in the past month. CGS 1. During the past 30 days,how many days did you drink... a. Any kind of alcohol(such as beer,wine,whiskey,gin,scotch or mixed drinks)? . _ I I I Days b. 5 or more drinks of alcohol'? I I I Days c. 4 or less drinks of alcohol but still felt like you got high" Days [IF NO PAST MONTH DRUG USE(S2c-r ALL<4),GO TO CGB4] Earlier you reported using marijuana, cocaine, heroin or other drugs in the past month. CGS2. During the past 30 days,how many days did you use illegal I I drugs? �J Days [IF CGS1a=0 or skipped OR CGS2=0 or skipped,GO TO CGS4] Earlier you reported using both alcohol and other drugs in the past month. (Note:number of days cannot exceed value of CGS]a or CGS2, whichever is smaller) CGS3. In the past 30 days,how many days have you used both alcohol and drugs(on the same day)? I I Days GI 5.4.0 GPRA ART Core 58 12/1/2005 GAIN-I [IF NO PAST MONTH DRUG USE(S2c-r ALL<4),GO TO CGB4] In the past r.What was the most CGS4. Now we are going to go over your drug use in the past 30 days.The 30 days, severe route in which following questions will ask how many days you used a particular drug and dadays have many you used it? the most severe route in which you used it.The types of route from lowest to you u o highest severity are Oral,Nasal, Smoking,Intra-muscular injection,and IV. used... S Y E'. Dave �o z N 1 2 3 4 5 [IF NO PAST MONTH MARIJUANA USE(S2c<4),GO TO CGS4bl a. Marijuana,hashish;blunts or other-forms of THC ? J (herb,reefer;weed). 1 _2 3 q. .5 [IF NO PAST MONTH COCAINE USE(S2d-c BOTH<4),GO TO CGS4eJ b. Crack and/or other forms of cocaine? I I I 1 2 3 4 5 [IF NO PAST MONTH INHALANT USE(S2f<4),GO TO CGS4dJ c. Inhalants? I I I 1 2 3 4 5 [IF NO PAST MONTH HEROIN USE(S2g<4),GO TO CGS4eJ d. Heroin? I I I 1 2 3 4 5 [IF NO PAST MONTH NON-PRESCRIPTION METHADONE USE(S2h<4),GO TO e. CGS4II Non-prescription methadone? II 1 2 3 4 5 [IF NO PAST MONTH OPIOID USE(S2j<4),GO TO CGS4gi fl. Morphine? lIF 0,GO TOR] I I I i 2 3 4 5 f2. Diluadid? [IF 0,GO TO 13J I I I 1 2 3 4 5 D. Demerol? Dr 0,GO TO fit] I I I 1 2 3 4 5 f4. Percocet? [IF 0,GO TO fa] I I I 1 2 3 4 5 f5. Darvon? [IF 0,GO TO I6] I I I 1 2 3 4 5 f6. Codeine? [IF 0,GO TO nI 1 2 3 4 5 17. Tylenol 2,3,4? [IF 0,GO TO I8] I I I 1 2 3 4 5 f8. Oxycontin/Oxycodone? [IF 0,GO TO CGS4g1] I I I 1 2 3 4 5 GI 5.4.0 GPRA ART Core 59 12/1/2005 GAIN-I (CGS4. Continued) In the past r.What was the most 30 days, severe route in which how many you used it? days have you U 0CD j Y E O ,Qq1 O Z ti = > [IF NO PAST MONTH PCP,CLUB OR PHARMACEUTICAL DRUG USE(S2k-q<4), GO TO CGS4h] gl. Hallucinogens/psychedelics,PCP(Angel Dust,Ozone, Wack,Rocket Fuel),MDMA(Ecstasy,XTC,X,Adam), LSD(Acid,Boomers,Yellow Sunshine),Mushrooms or Mescaline? [IF 0,GO TO g2] I I I I 2 3 4 5 g2. Methamphetamine or other amphetamines(Meth, Uppers,Speed,Ice,Chalk,Crystal,Glass,Fire,Crank)? [IF 0,GO TO g3] I I I 1 2 3 4 5 g3. Benzodiazepines:Diazepam(Valium);Alprazolam (Xanaz);Triazolam(Halcion);and Estasolam(Prosom and Rohypnol-also known as rooties,roche,and cope)? ELF 0,GO TO g4] I I I 1 2 3 4 5 g4. Barbiturates:Mephobarbital(Mebacut);and pentobarbital sodium(Nembutal)? [IF 0,GO TO g5] I I 1 2 3 4 5 g5. Non-prescription GHB(known as Grevious Bodily Harm, Liquid Ecstasy,and Georgia Home Boy)? [IF 0,GO TO g6] I I I 1 2 3 4 5 g6. Ketamine(]mown as Special K or vitamin K)? [IF 0,GO TO g7] u__I 1 2 3 4 5 g7. Other tranquilizers,downers,sedatives or hypnotics? 0,GO TO CGS4h] I I I 1 2 3 4 5 h. [IF NO PAST MONTH OTHER DRUG USE(S2r<4),GO TO CGS4] Other illegal drugs? I I I 1 2 3 4 5 Please describe v. [IF NO PAST MONTH NEEDLE USE(Rl<4 AND ALL ROUTES IN CGS4a-h<4),GO TO CGF3.] Earlier you reported "needle use" in the past month. CGB4. During the past 30 days,how often did you use a syringe, cooker, cotton or water that someone else used? Would you say... Always ] Frequently 2 Half the time 3 Sometimes 4 Never 5 GI 5.4.0 GPRA ART Core 60 12/1/2005 GAIN-I [IF NO PAST MONTH SEXUAL ACTIVITY(R2<4),GO TO CGF4.] Earlier you reported having"sex" in the past month. CGF3. During the past 30 days, how many a sexual contacts(vaginal,oral or anal)did you have? I I I I [IF 0,GO TO CGF41 b. unprotected sexual contacts did you have? III I [IF 0,GO To CGF4] How many of these unprotected sexual contacts were with an individual who is or was... c. 1. HIV positive or has AIDS? I 2. an injection drug user? LI 3. high on some substance? I I CGF4. In-the past 30 days;not due to your use of alcohol or drugs,on how many days have you... a. experienced serious depression? W b. experienced serious anxiety or tension? c. experienced hallucinations? d. experienced trouble understanding,concentrating or remembering? e. experienced trouble controlling violent behavior? II f. attempted suicide? I I I [IF CGF4a-f ALL 0,GO TO CGC1] CGF4_a. How much have you been bothered by these psychological or emotional problems in the past 30 days? Would you say... Not at all? 1 Slightly? 2 Moderately? 3 Considerably? 4 Extremely? 5 CGCI. In the past 30 days,where have you been living most of the time? Shelter(safe havens,TLC,low demand facilities,reception centers,other temporary day or evening facility) 1 Street/outdoors (sidewalk, doorway,park,public or abandoned building) 2 Institution(hospital,nursing home,jail/prison) 3 Own/rent apartment,room or house 41 Someone else's apartment,room or house 42 Halfway house 43 Residential treatment 44 Other housed(Please describe) 99 v. GI 5.4.0 GPRA ART Core 61 12/1/2005 GAIN-1 [IF NO CHILDREN(E4 0),GO TO CGDh] Yes No CGC6b. Are any of your children living with someone else due to a child protection court order? 1 0 IIF NO,GO TO CGD1] CGC6c. How many of your children are living with someone else due to a child protection court order' I I I CGC6d. For how many of your children have you lost parental rights? [The client's parental rights were terminated] I I IIF NO PAST MONTH SCHOOL(V3<4 AND V7 o S or 9),GO TO CGD3] Earlier you reported going to or being enrolled in a"school or training program" in the past month. CGDI. Are you currently enrolled in school or ajob training program? (IF ENROLLED: Is that full time or part time?) Not enrolled 1 Enrolled, full time 2 Enrolled,part time 3 Other(Please describe) 99 v. CGD3. Are you currently employed?(Clarify by focusing on status during most of the previous week, determining whether client worked at all or had a regular job but was off work.) Employed full time(35+hours per week,or would have been) Employed part time 2 Unemployed,looking for work 3 Unemployed, disabled 4 Unemployed,volunteer work 5 Unemployed,retired 6 Unemployed,not looking for work 7 Other(Please describe) 99 v. For the following question, please include your drug use, (if UNDER 21: alcohol use), and any other activities you thought might be against the law. CGE4. In the past 30 days,how many times have you committed a crime, including any illegal (alcohol or) drug use9 GI 5 4.0 GPRA ART Core 62 12/1/2005 GAIN-I CGG. In the past 30 days,how many times have you attended... 1. Any voluntary self-help groups for recovery that were not affiliated with a religious or faith-based organization,such as Alcoholics Anonymous,Narcotics Anonymous,Oxford House, Secular Organization for Sobriety, Women of Sobriety,etc.? II II Times 2. Any religious or faith affiliated recovery self-help groups? . I I I I Times 3. Meetings of organizations that support recovery other than the organizations described above? II II Times CGG4. In the past 30 days,did you have interaction with family and/or Yes No friends that are supportive of your recovery9 1 0 CGG5. To whom do you turn when you are having trouble? (Select only one) No One 1 Clergy Member 2 Family Member 3 Friends 4 Other(Please describe) 99 v. GI 5.4.0 GPRA ART Core 63 12/I/2005 GAIN-I For Staff Use Only GPRA Records Management CGAI. Identify the services you plan to provide to the client during the client's course of treatment/recovery. A. Modality-Select at least one Yes No D. Medical Services Yes No 1. Case Management 1 0 1. Medical Care - 1 0 2. Day Treatment 1 0 2. Alcohol/Drug Testing I 0 3. Inpatient/Hospital(Other than Detox) 1 0 3. HIV/AIDS Medical Support& 4. Outpatient I 0 Testing 1 0 5. Outreach 1 0 4. Other Medical Services I 0 6. Intensive Outpatient 1 0 (Please describe) 7. Methadone 1 0 v. 8. Residential/Rehabilitation 1 0 9. Detoxification(Select Only One) E. After Care Services Yes No Hospital Treatment 1 1. Continuing Care 1 0 Free Standing Residential ____ 2 2. Relapse Prevention 1 0 Ambulatory Detoxification ... 3 3. Recovery Coaching 1 0 10. After Care 1 0 4. Self-Help&Support Groups 1 0 11. Recovery Support 1 0 5. Spiritual Support 1 0 12. Other(Please describe) 1 0 6. Other After Care Services 1 0 v (Please describe) v. B. Treatment Services Yes No 1. Screening 1 0 2. Brief Intervention 1 0 F. Education Services - Yes No 3. Brief Treatment 1 0 1. Substance Abuse Education 1 0 4. Referral to Treatment 1 0 2. HIV/AIDS Education 1 0 5. Assessment 1 0 3. Other Education Services 1 0 6. Treatment/Recovery Planning 1 0 (Please describe) 7. Individual Counseling 1 0 v. 8. Group Counseling 1 0 G. Peer-to-Peer Recovery Support Svcs. Yes No 9. Family/Marriage Counseling 1 0 10. Co-Occurring Treatment/Recovery 1. Peer Coaching or Mentoring 1 0 Services 1 0 2. Housing Support 1 0 3. Alcohol-&Drug-Free Social Activities.. 1 0 11. Pharmacological Interventions 1 0 4. Information&Referral 1 0 12. HIV/AIDS Counseling 1 0 5. Other Peer-to-Peer Recovery Support---- 1 0 13. Other Clinical Services(Please describe) 1 0 Svcs. v. (Please describe) C. Case Management Services Yes No v. I. Family Services(Including Marriage Education,Parenting,Child Dev.Svcs.) 1 0 2. Child Care 1 0 3. Employment Services a. Pre-Employment 1 0 b. Employment Coaching 1 0 CGTM. How many additional minutes did you spend on the 4. Individual Services Coordination 1 0 supplement CSAT GPRA questions? 5. Transportation ----- - 1 0 a. With the participant I I I minutes 6. HIV/AIDS Service 1 0 b. Answering additional staff 7. Supportive Transitional Drug-Free Housing Services 1 0 questions for records I I I minutes 8. Other Case Management Services 1 0 (Please describe) V. GI 5 4.0 GPRA ART Core 64 12/1/2005 GAIN-I Z. End Thank you! That is all of the questions we have for you at this time. Please write down the time below. If you went straight through,we will figure out how many minutes you took. If you took a break(s),please make sure you write in about how many minutes total it took you to do this assessment. Z1. What time is it now? I I I : 1 I I Time(HH:MM) b. Is it AM or PM) I I AM/PM c. How many breaks did you take to finish this9 I I I Breaks d. Not counting breaks,how long did it take you to finish this9 I I I Minutes Z2. Are there any other special issues we need to know about to help you(or help you come to treatment)? Do you have any additional comments or questions? vl. v2. v3. v4. You can now return this form to the person who gave it to you.This person will check it over to make sure everything is filled out and answer any questions you have. • GI 5.4.0 GPRA ART Core 65 12/12005 • GAIN-I For Staff Use ONLY XADM. Administration Please document the following aspects of how the interview was administered. If there are more detailed comments elsewhere in the document,please be sure to summarize them in the additional comments section below or at least say where we can find them. a. What was the primary mode of administration(MOA)? (Circle all that apply) Yes No 1. Self-Administered(SA) 1 0 2. Self-Administered with sound files (SAS) 1 0 3. Orally Administered by staff(ORS) 1 0 4. Orally Administered by others(ORA) 1 0 5. Done with Pen and Paper(PAP) 1 0 6. Done on Computer(COMP) 1 0 7. Done on Telephone(TEL) 1 0 99. Other(OTH)(Please describe) 1 0 v. b. What was the primary language in which it was conducted(LNG)? English(ENG) 1 Spanish(SPN) 2 Other(OTH) (Please describe) 99 v. c. Were there any indications that the client might have learning disabilities that would interfere with his or her ability to respond or participate in treatment or, in general,indications of developmental disabilities(IDD)? No/none(NO) 0 Minimal(MIN) 1 Moderate(MOD) 2 Major(MAJ) 3 d. Was there any evidence that the person could not place himself or herself in place or time or, in general,any evidence of cognitive impairment or dementia(ECD)? No/none(NO) 0 Minimal(MIN) 1 Moderate(MOD) 2 Major(MAJ) 3 GI 5 4.0 GPRA ART Core 66 12/1/2005 • GAIN-I For Staff Use ONLY e. Was there any evidence of the following observed participant behaviors(OPB)? Yes No 1. Depressed or withdrawn(DEP) 1 0 2. Violent or hostile(VIO) 1 0 3. Anxious or nervous(ANX) 1 0 4. Bored or impatient(BOR) 1 0 5. Intoxicated or high(INT) 1 0 6. In withdrawal(WIT) 1 0 7. Distracted(DIS) 1 0 8. Cooperative(COP) 1 0 f. Did the individual's appearance suggest...(APP) No problems/none(NO) 0 Poor hygiene?(PH) 1 Unkempt appearance?(UNK) 2 Inadequate clothing?(INA) 3 Not applicable?(NA) 4 g. What was the participant's location during the assessment?(LOC) Treatment unit(Tx) 1 Specialized intake unit(INT) 2 Correctional setting(COR) 3 School(SCH) 4 Employment or work setting(EMP) 5 Home(HOM) 6 Probation or Parole Office(PPO) 7 Welfare or Child Protection Agency(WCP) 8 Research Office or Setting(RES) 11 Other(OTH)(Please describe) 99 v. g1-5. Were there any problems providing a quiet,private environment?(PRI) Yes No 1. Noise or other frequent distractions(DIS) 1 0 2. Divided attention or frequent interruptions(DIV) 1 0 3. Other people present or within earshot(EAR) 1 0 4. Police,guards,social workers or other officials present(OFF)--.. 1 0 5. Speaker or telephone call monitoring(MON) 1 0 015.4.0 GPRA ART Core 67 12/1/2005 GAIN-1 For Staff Use ONLY h. What administration protocol was followed? FULL Interview(FUL) Initial CORE, followed by FULL interview(SPLIT) 2 Started FULL,then converted to CORE(CONY) 3 CORE only(including GPRA Core)(CORE) 4 Partial assessment/incomplete to date(PAR) 5 Other(OTH)(Please describe) 99 v. Yes No hl. Was administration done over multiple sessions/days?(MUL) 1 0 [IF NO,GO TO XADMj] a. What is the final revision date(mm/dd/yyyy)9 II I / I I I / I I I I Month Day Year b. What is the total number of breaks across all sessions? U (Include"1" for break in between multiple sesions.) c. What is the total number of minutes spent doing the interview across all sessions? I d. What is the staff id[XSID) of the person finishing the interview?I I I I I I j. Do you have any additional comments about the administration of the assessment or things that should be considered in interpreting this assessment(AC)? Be sure to document any critical collateral information that you think should be considered during interpretation (or cross-reference where it is documented). vl. v2. G15.40 GPRA ART Core 68 12/1/2005 GAIN-I For Staff Use Only(Collateral Supplemental Information) Yes No 1H NO, CYO. Do you want to enter additional collateral information? 1 O GO TO XDIAGI We would like to ask you a few questions about a participant named CY1. What is your relationship with the participant? Mother 1 Father 2 Brother 3 Sister 4 Other relative 5 Other legal-guardian6 Spouse 7 Living as married 8 Close friend 9 Professional working with participant 10 Other(Please describe) 99 v. CB5. Are the participant's medical expenses covered by any Yes No iIF NO, type of insurance,court,or health program? 1 0 GO TO CV11r1 CB5a. What is the name of the participant's insurance company or provider? v. CB5b. Is the participant's insurance publicly funded,privately funded,or both? Public(Medicare,Medicaid,publicly funded,VA,CHAMPUS, correctional authority) .1 Private(HMO,BCBS,from employer,employee assistance program) 2 Mixed(both public and private,public purchase of HMO) 3 For Staff Use Only: CB5c. Detailed Insurance Code: I IIIII The next two questions are about the participant's family household size and income. This includes people with whom he/she shares his/her income and expenses(such as husband,wife,children,parents,relatives, or sexual partners). CV11r. How many people are there in the participant's family household?.. I l I People For the next question,we do not need an exact number. You can give your answer to the nearest hundreds or thousands of dollars if that is easier. (Put"DK"if you do not know) CVl ls. During the past 90 days what was the total family income of everyone in his/her household together? SI HI III GI 5.4.0 GPRA ART Core 69 12/1/2005 GAIN-I Now we want to go over a list of common problems related to alcohol or drug use. After(hearing/reading)each of the following statements, we would like you to tell us E c the last time the participant had this problem by Using Card B and responding in the u past month,2-12 months ago, I or more years ago, or never. N + z CS9. When was the last time that... (Please answer questions using Card B) 3 2 1 0 SPS/O c. the participant tried to hide that he/she was using alcohol or drugs? 3 2 1 0 d. the participant's parents,family,partner, co-workers, classmates or friends complained about his/her alcohol or drug use? 3 2 I 0 e. the participant used alcohol or drugs weekly? 3 2 1 0 f. the participant's alcohol or drug use caused him/her to feel depressed, nervous,suspicious,uninterested in things,reduced his/her sexual desire or caused other psychological problems? 3 2 1 0 g. the participant's alcohol or drug use caused him/her to have numbness, tingling,shakes,blackouts,hepatitis,TB, sexually transmitted disease or any other health problems? 3 2 1 0 SPS/A h. the participant kept using alcohol or drugs even though he/she knew it was keeping him/her from meeting his/her responsibilities at work, school,or home?.. 3 2 1 0 j. the participant used alcohol or drugs where it made the situation unsafe or dangerous for him/her, such as when he/she was driving a car, using a machine,or where he/she might have been forced into sex or hurt? 3 2 1 0 k. the participant's alcohol or drug use caused him/her to have repeated problems with the law? 3 2 1 0 m. the participant kept using alcohol or drugs even after he/she knew it could get him/her into fights or other kinds of legal trouble? 3 2 1 0 SPS/D n. the participant needed more alcohol or drugs to get the same high or found that the same amount did not get him/her as high as it used to? 3 2 1 0 p. the participant had withdrawal problems from alcohol or drugs like shaking hands,throwing up,having trouble sitting still or sleeping,or that he/she used any alcohol or drugs to stop being sick or avoid withdrawal problems 3 2 1 0 q. the participant used alcohol or drugs in larger amounts,more often or for a longer time than he/she meant to? 3 2 1 0 r. the participant was unable to cut down or stop using alcohol or drugs? 3 2 1 0 s. the participant 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 t. the participant's use of alcohol or drugs caused him/her to give up,reduce or have problems at important activities at work,school, home or social events? 3 2 1 0 u. the participant kept using alcohol or drugs even after he/she knew it was causing or adding to medical,psychological or emotional problems he/she was having? 3 2 1 0 v. How old was the participant when he/she first got drunk or used any drugs? I I Age GI 5.4.0 GPRA ART Core 70 12/1/2005 GAIN-I For Staff Use ONLY(Optional Supplemental Diagnostic Impressions IXPIA6]) Yes No [IFXDIAG. Do you want Gto enter additional diagnostic information? 1 0 N GO TO XAS] 1. DSM Axis 1. Clinical Disorders/Focal Conditions DSM-IV Code Spec. Condition a. I I 1 . 1 I In 'I ' v b. I I 1 . 1 I L I I l v. c. 1 1 1 . 1 1 IIII v d. I I . 1 1 ! I I l v. e. I I 1 . 1 I I I I v f. I I I . 1 1 I I I I v h. 1 1 1 . 1 1 11 1 I v 2. Axis 2. Personality Disorders/Mental Retardation DSM-IV Code Spec. Condition a• 11 I I . I 1 I I 1 1 I v b. JI1I • IIIIIIIv c. I I 1 1 . 1 I I I 1 1 I v d• I 111 . 11 I ' ll Iv 3. Axis 3. General Medical Conditions DSM-IV Code Spec. Condition a• I I 1 1 . I I I1 1 I I v b. 11 I I . 1 1 II 1 I I v. c• 11 I 1 . 1 I II I I I v a. I I I 1 . 1. 1 1.1 _I 1 I v. 4.Axis 4. Psycho-social and Environmental Problems(Circle all that apply) a.Primary Support Group: Yes-1 No-0 f.Economic: Yes-1 No-0 b.Social Environment: Yes-1 No-0 g.Access to Treatment: Yes-1 No-0 c.Educational: Yes-I No-0 h.Legal: Yes-1 No-0 d.Occupational: Yes-1 No-0 j.Victimization/Abuse: Yes-1 No-0 e.Housing: Yes-1 No-0 z.Other:(v. ) Yes-1 No-0 5. Axis 5. Functional Assessment Ratings(Circle here if using CGAF in a/b ....Yes-1 No-0 ) a.GAF Past Year Average: I_Ljj b.GAF Past 90 Day Average. 1 1 c.GARF Past Year Average* I d.GARF Past 90 Day Average: e.SOFAS Past Year Average: LLL_I f. SOFAS Past 90 Day Average: I I 6. Additional Sources of Information Considered(will be reported as part of methods): vl. v2. v3. GI 5.4.0 GPRA ART Core 7 12/1/2005 GAIN-I For Staff Use ONLY(Optional Supplemental ASAM Impressions [XASJ) Yes No [IF NO, XAS. Do you want to enter additional placement information? - 1 0 GO TO XSS1] Al. Substance Use Disorder Diagnostic Severity: a. Lifetime Severity: 0-None 1 -Collateral 2 -Codependent 3 - Use 4 -Abuse 5 - Dependence b. Rating: 1-No problem 2 -Past problems 3 -Problems 4 -Problems w/past treatment 5- In Tx wino problems 6 -In Tx w/moderate severity 7- In Tx w/high severity Comment: v. Bl.Acute Intoxication and Withdrawal: a. Rating: 1-No problem 2-Past problems 3 -Problems 4 - Problems w/past treatment 5- In Tx-w/no problems 6-In Tx w/moderate severity 7-In Tx w/high severity Comment: v. B2. Biomedical Conditions and Complications: a.Rating: 1-No problem 2 -Past problems 3-Problems 4 -Problems w/past treatment 5- In Tx wino problems 6 -In Tx w/moderate severity 7-In Tx w/high severity Comment: v. B3.Emotional/Behavioral Conditions and Complications: a.Rating: 1-No problem 2 -Past problems 3-Problems 4-Problems w/past treatment 5-In Tx w/no problems 6-In Tx w/]moderate severity 7-In Tx w/high severity Comment: v. B4.Readiness for Change(formerly Treatment Acceptance/Resistance): a.Rating: 1-No problem 2-Past problems 3 -Problems 4-Problems w/past treatment 5-In Tx w/no problems 6-In Tx w/moderate severity 7-In Tx w/high severity Comment: v. B5.Relapse Potential: a. Rating: 1 -No problem 2 -Past problems 3 -Problems 4-Problems w/past treatment 5 -In Tx wino problems 6-In Tx w/moderate severity 7-In Tx w/high severity Comment: v. B6.Recovery Environment: a. Rating: I -No problem 2 -Past problems 3 -Problems 4-Problems w/past treatment 5- In Tx w/no problem 6 -In Tx w/moderate severity 7 - In Tx w/high severity Comment: v. C. Level of Care Placement Recommendation: a.Level: 0-None 0.5-EI 1 -OP 1.5-OMT 2.1 - IOP 2.5-PH 3.1 -HH/LIRT 3.5 -MIRT 3.6-LTR/TC 3.7-HIRT/IP 4-MM/IP 5-Detox 99- Other Comment: v1. v2. v3. GI 5.4.0 GPRA ART Core 72 12/1/2005 • GAIN-I For Staff Use ONLY(Optional Special Study Detail) Yes No [IF NO, XSS 1. Do you want to enter additional special study information? 1 0 END1 XSSN. Special Study Number: Name:v. aa. ba. ca. ab. bb. cb. ac. be. cc. ad. bd. ed. ae. be. ce. of bf cf_ -4 ag• bg. cg. aft. bh. ch. aj. bj. cj. ak. bk. ck. am. bm cm. an. bn. cn. ap. bp. cp aq. bq. eq. ar. br. Cr. as. bs. cs. at. bt. ct. au. bu. cu. ay. by. cv. aw. bw cw. ax. bx. Cx. ay. by. cy. az. bz. cz. O15.4.0 GPRA ART Core 73 12/1/2005 1 GAIN-I Recommendation and Referral Summary (G-RRS) Name: Evaluator: Ramos Evette Date of Birth: 05/28/1988 Screening Date: 03/03/2006; 120 min. Presenting Concerns and Identifying Information Client is a 17 year old, ; Caucasion female who has never been married and who has 1 child. She presented as a typically groomed individual with no apparent physical abnormalities. She was referred to Turning Point by he caseworker. Client stated that the reason for coming to Turning Point was because "I got in trouble". Client last attended school or training 3 to 7 days ago at Centennial High School and has completed through grade 11. Client reported no job history. Client was residing with her mother in Fort Collins, Colorado. Below is a five axis diagnostic summary of Client's problems. This is followed by a narrative summary of the evaluation procedures, a detailed substance use diagnosis and treatment history, an assessment of placement and service needs, and the evaluator's recommendations for specific services and level of care/program placement to best address them. DSM-IV/ICD-9 Diagnoses Assessor Comments <<Prompt-Enter additional comments or specify if none>> Current Treatment None reported. Current Medications Endorsed but not specified in P11 dv; PROZAC AND ZYPREXA. Current Allergies None reported. Axis I: Clinical Disorders/Focal Conditions 304.90 Substance Dependence, NOS - Sustained Full Remission (Overall) Substance Use Disorder Specifier: with physiological tolerance symptoms (Overall) Substance Use Disorder Specifier: with physiological withdrawal symptoms Axis H: Personality Disorders/Mental Retardation None reported Axis III: General Medical Conditions None reported Axis IV: Psychosocial and Environmental Problems 2 -- Illegal activity among peers -- Weekly fighting among peers -- High lifetime history of traumatic victimization Axis V: Average Clinical Functional Assessment Ratings None reported Evaluation Procedure As part of Client's evaluation, the Global Appraisal of Individual Needs (GAIN) was given. The evaluator reported no problems in providing a quiet, private environment and observed that Client appeared: bored or impatient; cooperative. Additional sources of information consulted during Client's evaluation include: Family Service Plan and caseworker interview. Substance Use Diagnoses and Treatment History (ASAM criteria A) Client reported first using alcohol or drugs at age 9 and liking to use "METH" the most. She thinks that treatment is most needed for ""METH", "ALCOHOL", and "COCAINE"" use. She reported last using: alcohol to intoxication; marijuana, hashis, blunts or other forms of THC; crack, smoked rock or free base cocaine; cocaine other than crack, smoked rock or free base cocaine; inhalants; heroin or heroin mixed with other drugs; nonprescription or street methadone; pain killers, opiates, or other analgesics; PCP or angel dust; acid, LSD, ketamine, special K, mushrooms or other hallucinogens; speed, uppers, amphetamines, methamphetamine, ecstasy, MDMA, or other stimulants; downers, sleeping pills, barbiturates, or other sedatives; "[Endorsed but verbatim response not provided]" over one year ago. During the evaluation, Client reported 7 lifetime symptoms related to substance dependence. In the past month, she reported: needing more alcohol or drugs to get the same high or found that the same amount did not produce the same as high as it used to; having withdrawal problems from alcohol or drugs like shaking hands, throwing up, having trouble sitting still or sleeping, or using any alcohol or drugs to stop being sick or avoid withdrawal problems; using alcohol or drugs in larger amounts, more often or for a longer time than intended; being unable to cut down or stop using alcohol or drugs; spending a lot of time either getting alcohol or drugs, using them, or feeling the effects of them (high, sick); giving up, reducing, or having problems at important activities at work, school, home, or social events because of alcohol or drug use; continuing to use alcohol or drugs even after knowing it was causing or adding to existing medical, psychological, or emotional problems. When asked about signs and symptoms related to substance abuse, she endorsed 4 lifetime problem(s) in this area. In the past month, she reported: continuing to use alcohol or drugs despite recognition that it interfered with meeting responsibilities at work, school, or home; using alcohol or drugs where it made the situation unsafe or dangerous; having repeated problems with the law due to alcohol or drug use; continuing to use alcohol or drugs even after knowing that it could lead to fights or other kinds of legal trouble. History of Substance Abuse Treatment Client reports a history of being in a detoxification program 0 times in her life, none in the past 90 daysShe reported a history of participating in self-help group 3 meetings, including 6 of the past 90 days. Client has a lifetime history (0 nights out of the past 90) of staying in a recovery home or sanctuary. The last time Client received any kind of substance abuse treatment was more than 12 months ago. She is not currently in treatment and is not taking medication for substance use problems. Below is her history of formal substance abuse treatment: Program Name Type of Treatment Approx Admit Date Approx Disch. Date TURNING POINT Inpatient/Residential/ 02/05/2002 02/25/2002 Halfway house (ST/ LT/HH) JEFFERSON HILLS Inpatient/Residential/ 04/14/2005 03/03/2006 Halfway house (ST/ LT/MI) TURNING POINT Inpatient/Residential/ 03/03/2006 Halfway house (ST/ LT/HH) Level of Care and Service Needs (ASAM Criteria B) Dimension B1 -Acute Alcohol and/or Drug Intoxication and/or Withdrawal Potential Client scored in the no/minimal range of the Current Withdrawal Scale. Client stated last using any substance more than 12 months prior to the evaluation. Based on this information, the evaluator recommends: Dimension B2 -Biomedical Conditions and Complications Overall Health and Pain Assessment: Client reported a history of pregnancy, with the most recent pregnancy ending in a live birth. Client reported no allergies to medicines, foods, pollen or other things. Client scored in the no/minimal range of the Health Distress Scale. Nutrition and Exercise. Client reported standing about 63 inches tall and weighing approximately 155 pounds without shoes. According to these statistics, Client's Body Mass Index (BMI) is 27.5, a score which suggests she is overweight. Sexual Activity and Orientation. Client reported last having any kind of sex with another person more than 12 months ago. Treatment History for Health Problems. Client reported a history of 2 emergency room admissions, I hospital admission and medication (INHALER) currently being taken for allergies or health problems. The last time she was seen by a doctor or nurse about a health problem was 3 to 7 days ago. During the 4 past 90 days, Client reported the following related to health problems: made 4 outpatient visit(s); took medication on 90 day(s). She is not currently being treated. Based on this information, the evaluator recommends: Dimension B3 -Emotional, Behavioral, or Cognitive Conditions and Complications Emotional Conditions. Client scored in the no/minimal range of the Internal Mental Distress Scale. She described experiencing the following significant problems over the past 12 months: sleep trouble, such as bad dreams, sleeping restlessly or falling asleep during the day; remembering, concentrating, making decisions, or having her mind go blank; feeling very shy, self-conscious, or uneasy about what people thought or were saying about her; feeling tired, having no energy, or like being unable to get things done; losing or gaining 10 or more pounds when not trying to; having to repeat an action over and over, or having thoughts that kept running over in her mind; having a lot of tension or muscle aches because of feeling worried; being unable or finding it difficult to control worrying. She reported last feeling significantly disturbed by any kind of nerve, mental, or psychological problems 4 to 12 months ago. Client did not report thinking about killing or hurting someone else. Behavioral Conditions. Client scored in the moderate range of the Behavior Complexity Scale. She reported last having problems paying attention, controlling behavior, or breaking rules 4 to 12 months ago. Arguing and Aggression. During a disagreement in the past 12 months, Client described: discussing it calmly and settling the disagreement; leaving the room or area rather than argue; insulting, swearing, or cursing at someone; actually throwing something at someone. She reported last swearing, cursing, threatening someone, throwing something, pushing or hitting someone in any way during an argument 3 to 7 days ago and that this behavior occurred on 0 out of the past 90 days. Illegal Activity and Juvenile Justice Systems Involvement. Client reported a lifetime history of 14 arrests. During the past 90 days she was not on probation, on parole, in detention, on house arrest, or under electronic monitoring. Client reported last being arrested more than 12 months ago. She reported that she was: assigned to a sentencing alternative or treatment program (TASC). She stated she last engaged in any behavior that might result in getting into trouble or be against the law (besides using alcohol or drugs) 4 to 12 months ago. Cognitive Conditions. Client scored in the no/minimal range of the Cognitive Impairment Screen at the time of the evaluation. The evaluator observed no indications of developmental disabilities and no evidence of cognitive impairment. Treatment History for Emotional, Behavioral, or Cognitive Problems. According to self-report, Client has not been diagnosed by a doctor, nurse or counselor with a mental, emotional or psychological problem. Client reports a history of the following: been admitted overnight to a hospital for mental, emotional, behavioral or psychological problems; currently taking medication ("PROZAC AND ZYPREXA") for mental, emotional, behavioral or psychological problems. Client stated that she last received treatment for a mental, emotional, behavioral, or psychological problem 1 to 4 weeks ago. 5 During the past 90 days, she reported: spending 90 nights in the hospital for mental, emotional, behavioral, or psychological problems; visiting a doctor in an office or outpatient clinic 1 times; taking prescribed medication for mental, emotional, behavioral, or psychological problems90 days. Client is currently receiving treatment from Turning Point, where treatment has been received for the past month. Based on this information, the evaluator recommends: Dimension B4—Readiness to Change At the time of the evaluation, Client acknowledged problems related to alcohol or drug use and currently felt there was no source of pressure to be in alcohol or drug treatment. Client's responses suggested moderate motivation for treatment, and no/minimal resistance to treatment. Based on this information, the evaluator recommends: Dimension B5—Relapse, Continued Use, or Continued Problem Potential Combined with the problems above and risks from the recovery environment below, the following conditions are possible influences on Client's risk of relapse or continued use. First used substances or got drunk under the age of 15 Based on this information, the evaluator recommends: Dimension B6 - Recovery Environment The following are features,of Client's environment that may be critical to recovery: Family/Home Environment. During the past year, Client reported living with the following: other. She also reported that there was active parental involvement in her life. Client stated that she has 1 child who has been in the legal custody of the following people or agencies during the past 12 months: Client reported living alone during the past year. School Environment. Client reported last attending school or training at Centennial High School 3 to 7 days ago and had completed through grade 11. During the last year of school, Client described earning the following pattern of grades: A- to A+. Of the 91 days that Client was supposed to be in school during the past 90 days, she reported missing 1 days, being in trouble on 0 days, and being suspended on 0 days. Work Environment. Client reported no work history. Social Network Environment. Client stated that of the people she had regularly worked or gone to school with during the past year: most were employed or in school or training full-time, most were involved in illegal activity, a few got drunk weekly, none used drugs during the past 90 days, none shouted, argued, and fought most weeks, some have been in drug or alcohol treatment, and a few would 6 describe themselves as being in recovery. She reported that of the people she had regularly socialized with during the past year: most were employed or in school or training full-time, some were involved in illegal activity, a few got drunk weekly, none used drugs during the past 90 days, a few shouted, argued, and fought most weeks, most have ever been in drug or alcohol treatment, and most would describe themselves as being in recovery. Sources of Social Support. Client reported the following sources of social support during the past year: Personal Strengths. Client identified the following as personal strengths during the past year: Spirituality. Client reported no affiliation with a religious group. Victimization. Client reported a lifetime history of emotional abuse and scored in the high range of the lifetime General Victimization Scale. She stated that the last time problems occurred was more than 12 months ago. She was not currently worried about being victimized. Client reported that help has been received related to these issues. Based on this information, the evaluator recommends Recommendations Given current involvement, treatment should be coordinated with: Mental Health Treatment; Legal System Involvement; School. Based on the completed evaluation, Client is recommended for the following level of care: Ramos Evette Evaluator Client/Patient Signature Date Evaluator Signature Date Clinical Supervisor Date Medical Staff Date Other Date Hector's Comprehensive Treatment plan Client Name: Hector Date of Birth: 8/20/88 Date of Intake: 3/9/06 Program: Emancipation Group Home Estimated Date of Discharge: 6/9/06 General Background Information Client is a 17 year old, Mexican male who has never been married and who has no children. He presented as a typically groomed individual with no apparent physical abnormalities. He was referred to Turning Point by Adams County Department of Human Services. Client stated that the reason for coming to Turning Point was because issues with stealing. Client last attended school or trainingl to 4 weeks ago and has completed through grade 10. Client reported no job history due to being school and not in the labor force. DCP/FSP 1. To improve survival skills for independent living. *Student will acquire skills needed for independent living by independent living skills assessment, measured by staff observation, documentation and completion of groups and classes. Target Date of Completion: 2006-01-05 2. To eliminate escapist behaviors *Student will make a commitment to develop a substance-free lifestyle and identity. Target Date of Completion: 2006-01-05 3. To resolve family problems *student will communicate during visits and family counseling; measured by staff observation and completion of groups/classes. Target Date of Completion: 2006-01-05 4. To deal honestly with others. *Student will act assertively with others, measured by staff observation and completion of groups/classes. Target Date of Completion: 2006-01-05 5. To resist negative influences. *Student will choose peers whose actions are positive and distance self from negative peers and influences, measured by staff observation. Target Date of Completion: 2006-01-05 6. To accept responsibility. *Student will decrease blame; use positive alternatives, measured by staff observation and completion of groups/classes. Target Date of Completion: 2006-01-05 7. To prepare for transition to the community. *Student will identify ways to have a realistic day to day life challenges associated with community transition. Target Date of Completion: 2006-01-05 8. To eliminate victim stance. *Student will increase appropriate responsibility taking for his own behavior when limits are set, measured by staff observation and completion of classes/groups. Target Date of Completion: 2006-01-05 Therapy Strengths 1. Hector has expressed a strong willingness to work through his program successfully. Deficits 1. Hector has struggled with the legal system in the past and not complied with expectations. Goals 1. Hector will work on issues related to how his thinking errors influenced him to come into contact with the legal system. Goal Status: Current Predicted Date of Achievement: 5/15/06 2. Hector will attend and participate in drug and alcohol groups, mental health groups, experiential groups; progress will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 6/9/06 Interventions 1. Hector will be offered at least one individual therapy session per week. Behavior Strengths 1. Hector is compliant with the requirements of the program. 2. Hector is friendly and easy to talk with. 3. Hector completes assignments in a timely manner. 4. Hector takes feedback appropriately and does not become escalated or disrespectful. 5. Hector is able to effectively communicate with staff and peers. 6. Hector would prefer to read a book then write an assignment. Deficits 1. Hector is very quiet and submissive with his peers. 2. Hector has a history of running away has shown by Hector being on run away status when he was arrested. 3. Hector's file reports that Hector has gang affiliations. 4. Hector's file reports that all of Hector's brothers are in out-of-home placements due to acting out behaviors. 5. Hector file reports that Hector blames his friends for all of his delinquent behaviors and does not take any responsibility for his actions. 6. Hector reports that he has a history of getting involved in trouble because he has gotten involved with negative peers. Goals 1. Hector will read, demonstrate understanding, and comply with the rules of the program. Goal Status: Current Predicted Date of Achievement: 2006-06-09 2. Hector will understand the rules and expectations of the Emancipation Group Home by reading and understanding the handbook. His understanding of the rules and expectations can be assessed by his score on the Emancipation Group Home test. Goal Status: Current Predicted Date of Achievement: 2006-04-01 3. Hector will meet with his case manager weekly to discuss progress and treatment as well as any problems that may arise. This will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-06-09 4. Hector will increase his ability to follow staff directives while a client at Turning Point. He will have less than 5 incident reports in his first month at the Emancipation Group Home. His compliance will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-04-20 5. Hector will identify new and positive peers to relate to, that will encourage him to make positive choices and changes. This will be measured by staff observation. This will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-06-09 transition: 6. Hector will develop positive outlets and activities that will fill time with constructive efforts geared to make positive changes. This will be measured by staff observation. This will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-06-09 7. Hector will learn how to be more accountable and responsible for behavior instead of resorting to escapist behaviors. This will be measured by staff observation. This will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-06-09 8. Hector will react to stressful situations in constructive ways through the completion of Quick-Skills. Goal Status: Current Predicted Date of Achievement: 2006-06-09 9. Hector will follow call in expectations while in the community. This will be measured by Hector calling on his way in and calling when he is changing locations. This will be documented in the sign in/out sheet and in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-06-09 10. Hector will comply with the rules of Turning Point. This will be measured by staff observation. This will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-09-09 Interventions 1. Hector will be offered time to read the manual and demonstrate and understanding of the rules of the program. 2. Hector will take and pass the Emancipation Group Home handbook test with a 95% or better to show that he understands the program. This will be completed by April 1, 2006. 3. Hector will meet weekly with his case manager to discuss his progress in the program. This will be documented in progress notes. 4. Hector will be held accountable for his behavior while a client at Turning Point. This will be documented in progress notes and incident reports. Hector will receive an incident report if he is not following staff directives. 5. Hector will be offered Quick-Skills group on time per week for twelve weeks. His participation will be documented in progress notes Comments 10 Day Staffing:Hector took and passed a manual test a couple of days into his stay. Hector has met with his case manager weekly to discuss progress in the program. Hector has only received one incident report during the last couple of weeks. Hector has his level one. Hector has been following call in exceptions while in the community. Hector has been attending Quick-Skills weekly. Hector really struggles with taking accountability for his part of the situation. Hector has decided to work on this. Chad would like Hector to work on developing his own set of internal rules. Family Strengths 1. Hector has identified his family's home as where he wants to return to after discharge. Deficits 1. Hector is not living in the home of his family as he is in placement. Goals Transition: 1. Hector will address barriers to a smooth transition back into his family's home with them in therapy. Goal Status: Current Predicted Date of Achievement: 2006-07-28 Interventions 1. Hector will be offered at least one family session per week. Education Strengths 1. Hector has strong academic skills and will willing to take academic risks. 2. Hector has strong math skills and is willing to learn new skills and concepts. Deficits 1. Hector struggles with reading phonics and comprehension skills. 2. Hector struggles with understanding verbal directions quickly and requires extended time to work through directions. Goals 1. Hector will take the entrance PIAT to determine educational skill. Goal Status: Current Predicted Date of Achievement: 2006-04-20 2. Hector will take all GED pre-tests before he begins to study for one particular test. Goal Status: Current Predicted Date of Achievement: 2006-04-20 3. Hector will begin to improve his reading and comprehension skills. Goal Status: Current Predicted Date of Achievement: 2006-05-20 Interventions 1. When Hector has completed his Post tests for his GED Turning Point staff will get a check for him to begin testing at the CSU testing center. Comments 10-Day Staffing:Hector has entered Turning Point's Waverly school working hard and following all expectations. He has not been a problem behaviorally and has always been polite and respectful toward staff and peers. Hector has begun to study for his GED and has begun talking the pre-tests. He should be encouraged to continue working hard. Medical Strengths 1. Hector appears to be in good physical condition and has no current medical complaints. 2. Hector has the ability to communicate his medical and dental needs. Deficits 1. Hector reports that he will not have medical insurance after he discharges from Turning Point. Goals 1. Hector will come to staff with any medical and dental needs that might arise. Goal Status: Current Predicted Date of Achievement: 2006-06-09 2. Hector will receive the resources and information necessary to obtain medical and dental insurance or assistance needed prior to discharging Goal Status: Current Predicted Date of Achievement: 2006-06-09 transition: 3. Hector will become familiar with the locations of medical and dental facilities in his transition. This will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-06-09 4. Hector will have his intake dental appointment by April 9, 2006. It will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-04-09 5. Hector will have his initial intake physical exam by April 9, 2006. This will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-04-09 6. Hector will have his initial Vision Eyeland appointment by April 9, 2006. This will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-04-09 Interventions 1. While at EGH Hector will receive on going medical and dental attention as needed. 2. Hector will have intake dental, vision and physical examinations by April 9, 2006. 4. Hector will receive the resources and information necessary to obtain medical/dental insurance or assistance. This will be completed by discharge. Comments 10 Day Staffing:Hector had an appointment at Vision Eyeland on the 24th but has Medicaid number was not working so he was not seen at this time. Chad was contacted about the Medicaid number and an appointment will be rescheduled when the number becomes active. Hector's mother reports that she may have his immunization records since Chad does not have them in his file. I will continue to follow up with Chad and Hector's mother about this. Life Skills Strengths 1. Hector practices good hygiene skills. 2. Hector is fluent in Spanish and English. 3. "I enjoy playing basketball, going to the park and skateboarding". 4. Hector reports that he would like to be a pilot. Deficits 1. Hector does not know what resources are available to him in the community. 2. Hector tries to minimize his problems as seen by talking to Hector about his family. 3. Hector owes restitution and court fees for his criminal offenses. 4. Hector has no previous job experience. Goals transition: 1. Hector will be provided resources by completing community resource checklist before discharging. This will be documented in progress notes. Goal Status: Current 2. Hector will be connected with the Cha£ee Foster Care Independence Program (CFCIP). The program focuses on encouraging the development of a support system within the community, education, employment, money management and health. This will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-04-15 3. Hector will identify needs, develop skills and utilize resources that will promote his desired independent living situation upon discharge. Goal Status: Current Predicted Date of Achievement: 2006-03-20 4. Hector will complete a LifeSkills test. The test will be used to assess what areas needs to address through LifeSkills classes. Goal Status: Current Predicted Date of Achievement: 2006-04-01 5. Hector will increase his knowledge of potential career options, training required and potential career choices based on interests and skills. This will be documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-05-25 6. Hector will increase his understanding of the impact of his crime on victims through the completion of victim empathy classes. His increased understanding can be assessed by comparing Hector's score on his pre and post victim empathy scale tests. Goal Status: Current Predicted Date of Achievement: 2006-06-09 7. Hector will identify his spending habits and gain knowledge about budgeting to promote his desired independent living situation after graduation. This will be offered weekly and documented in progress notes. Goal Status: Current Predicted Date of Achievement: 2006-10-20 Interventions transition: 1. Hector will complete a community resource checklist with staff by discharge. 2. Hector will be connected with the Chafee Foster Care Independence Program prior to discharging. 3. Hector will be offered transition group on a weekly basis. This will be documented in progress notes. 4. Hector will be offered one victim empathy class a week for a six week period. His participation will be documented in progress notes. 5. Hector will be offered a social/cultural event once a month. Hector will be offered LifeSkills groups only on sections where he needs improvement. Through LifeSkills groups Hector will learn independent living skills in order to emancipate. Comments 10 Day Staffing: Chad would like Hector to get involved in an apprenticeship during his time at Turning Point. Chad suggested that staff look into the Workforce Investment Act (WIA) through the Workforce Center. Chad was given paperwork that needs to be completed so that Hector can start his work with the Chaffee program. Hector has attended career and transition group weekly. Hector will begin victim empathy group in two weeks and the group will last twelve weeks. Initial Diagnosis Axis I 312.8 Conduct Disorder Axis II 71.09 No Diagnosis Axis III None Axis IV Arrest Axis V 60 Current Diagnosis Axis I 312.8 Conduct Disorder Axis II 71.09 No Diagnosis Axis III None Axis IV Difficulties with interpersonal relationships Arrest Axis V 60 Client Therapist Parent Case worker Licensed Professional Dustin's February 2006 Monthly Report Therapy Dustin is consistently meeting for weekly individual therapy. He always seeks me out to set up a time each week that fits his work schedule. He is continuing to make progress identifying his thinking errors and how they effect his behavior. He has had very few anger outbursts this past month and when he did he did not have the urge to run or use. This has been a significant change for Dustin as this was his typical response when feeling angry. We spend a lot of time discussing the tactics he uses to avoid his feelings and how feelings are something fairly unfamiliar to him. His mother and father have decided that he will not return home and Dustin will live independently. He has been approved to live with a fellow peer from EGH who will be paroling at the same time as Dustin. Client Manager has requested an April parole hearing for him. Dustin continues to attend 12 step meetings but still does not like to use this system as his means of support for his drug and alcohol issues. He has not had any positive UA's or BA's this past month. Behavior Dustin continues to attend required groups and to make arrangements when there is a conflict with his schedule. Dustin has completed the handbook test and passed. He continues to meet with me on a regular basis, we have begun to discuss and look for apartments for him to live in once he transitions. Dustin continues to attend Quick Skills group even though he thinks he has completed them; there is no documentation of him completing this group. Dustin has taken one home pass but has not gone home for several weeks. When Dustin signs out to use pass time or to go to work he has been successful at making sure he is filling out his sheet appropriately. Family During this past month there have been no family therapy sessions. The one session that was scheduled did not occur because Dustin's mother could not get here. She was in court with his brother. Dustin has exhibited resistive behavior when it comes to giving this therapist his work schedule for the week, so a session can be setup. Will continue to address this issue. Education Dustin has decided that he would like to put off going to school at this time as he is trying to work to save money for his transition. Dustin has visited the Education Opportunity Center and is familiar with the services they offer; he has the ability and knows how to access them when he is ready to do so. Medical Dustin was taken to the dentist to get a tooth repaired as it had a crack in it. Dustin continues to let staff know if he is in need of medical attention. Life Skills Dustin has brought in his time sheets when asked and has worked with his manager to make sure his work does not interfere with required groups. Dustin continues to maintain employment at Wendy's and has opened a savings account and has begun saving money for when he transitions. Dustin attends weekly Transition group as well as Career Exploration group. Diagnosis Axis I 313.81 Oppositional Defiant Disorder 296.2 x Major Depressive Disorder Single Episode 303.90 Alcohol Dependence 304.20 Cocaine Dependence 304.30 Cannabis Dependence 305.90 Phencyclidine Abuse Axis II 799.9 Deferred Axis III None Axis IV Death of a family member Removal from the home Arrest Incarceration Axis V 55 Client Therapist Caseworker Parent Licensed Professional Attachment D Turning Point Center for Youth and Family Development, Inc. } \ \ Co O § ■ ■ ' k 2 \ ; _ . _ ® \ ( ` a a O O \ I- a } Lu 0 z \ w 2 y 2 b Lu- 2 0 ( ILI$ _ ce LU 0. 2 ( k § \ / 5 < ( § ) ) La § (0 mow § § b f § \_ L11 uj I- < I- z O 0 � 0 r co 5 re O k U. k § ! Z K Ow § b 2 § ; § k 0 - 0 00 o 0 O k 0 / 2 - k k \ k § E 2 § °z ` 2 ) 6 2 � 0 2 0 - ? ] 0 • § ( 0 ) 6 0 0 § § 0 2 ` . 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( 000 } : . ) - / k a § P | 888888888888888888 8 8 8 ] .2a2#22#ekk■;#;a2# g g 2 08 8 §B|L . ) V | 0 ; 888888888888g88888 8 8 8 B| .11a000aokk#ka■g;■ g g g ci Ib 40 . 888888888888888888 8 8 8 § |{ ngng■k#;■#;#;##a g g 2 , |a 8 B| / . 2 2 o *888$$$$$$$$$$$$88 $ ; a kassaasaaasassa■;# ; ; s \ M\ . ! B| � §| o 4I- ; r 888888888888888888 8 8 8 ; §| .2k-k#k#a■;k■;■;■■ & ; g CO• -Jr. a E e K06 o §| 40 E 888888888888888888 8 8 8 §,2#■#2##e#2■#2#2■ e ) .. x3 » - `; . ! \ q tg 6 e K §' 000000000000000 O zzzzzzzzzzzzzzzzzz/zzzzzzzz\ z\/ $ $ $ -▪-- if II > . . I |$ Er 8 � [ a. ie | |f . . a. � \ o• O ( |K § IT z � � I 20 . \ \ ) i . fr5 , . Attachment E Turning Point Center for Youth and Family Development, Inc. Turning Point Center for Youth and Invoice Family Development, Inc. 1644 S. College Avenue DATE INVOICE# Fort Collins, CO 80525 2/1/2006 7225 (970)221-0999, FAX(970)221-2727 BILL TO Weld County DSS P.O.Box A Greeley,CO 80632 III SERVICED DESCRIPTION CLIENT N... QTY RATE CLASS AMOUNT 1/31/2006 Day Treatment Special Education Program- 23 91.00 Day Tx 2,093.00 23 days Admitted: 12/6/2005 Total $2,093.00 Attachment F Turning Point Center for Youth and Family Development, Inc. Alliance ALLIANCE OF NONPROFITS FOR INSURANCE CNonprofits RISK RETENTION GROUP P P.O. Box 8546, Santa Cruz, CA 95061 fn-Insurance P: (800) 359-6422 Rbk Retention Group F: (831) 459-0853 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS PRODUCER: POLICY NUMBER: 2005-11832 CANPO ASI 455 Sherman Street Ste 207 RENEWAL OF NUMBER: 2004-11832 Denver, CO 80203 NAME OF INSURED AND MAILING ADDRESS: Turning Point Center for Youth& Family Development 1644 South College Avenue Fort Collins,CO 80525 POLICY PERIOD: FROM 08/01/2005 TO 08/01/2006 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Mental Health Counseling IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. LIMITS OF COVERAGE: GENERAL AGGREGATE LIMIT(OTHER THAN PRODUCTS-COMPLETED OPERATIONS) $3,000,000 PRODUCTS- COMPLETED OPERATIONS AGGREGATE LIMIT $3,000,000 PERSONAL AND ADVERTISING INJURY LIMIT $1,000,000 EACH OCCURRENCE LIMIT $1,000,000 DAMAGE TO PREMISES RENTED TO YOU $100,000 any one premises MEDICAL EXPENSE LIMIT 10,000 anyone person ADDITIONAL COVERAGES: SOCIAL SERVICE PROFESSIONAL LIABILITY AGGREGATE LIMIT $3,000,000 EACH OCCURRENCE LIMIT $1,000,000 CLASSIFICATION(S) SEE ATTACHED SUPPLEMENTAL DECLARATIONS SCHEDULE G PREMIUM $19,892 FORMS AND ENDORSEMENTS APPLICABLE TO THIS POLICY ARE INCLUDED IN COMMERCIAL LINES COMMMON POLICY DECLARATIONS 08/03/2005 BY (AUTHORIZED REPRESENTATIVE) THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS,IF APPLICABLE,TOGETHER WITH THE COMMON POLICY CONDITIONS,COVERAGE FORM(S) ND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. "NOTICE :This Policy is issued by your risk retention group.Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI - RRG - GL (02258) Alliance ofALLIANCE OF NONPROFITS FOR INSURANCE C Nonprofits RISK RETENTION GROUP rinsurance Sa nta Box 8546, Santa Cruz, CA 95061 Risk Riteaban Group P: (800) 359-6422 F: (831) 459-0853 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS PRODUCER: POLICY NUMBER: 2005-11832 CANPO ASI 455 Sherman Street Ste 207 RENEWAL OF NUMBER: 2004-11832 Denver,CO 80203 NAME OF INSURED AND MAILING ADDRESS: Turning Point Center for Youth& Family Development 1644 South College Avenue Fort Collins, CO 80525 POLICY PERIOD: FROM 08/01/2005 TO 08/01/2006 AT 12:01 A.M.STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Mental Health Counseling IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. LIMITS OF COVERAGE: GENERAL AGGREGATE LIMIT(OTHER THAN PRODUCTS-COMPLETED OPERATIONS) $3,000,000 PRODUCTS- COMPLETED OPERATIONS AGGREGATE LIMIT $3,000,000 PERSONAL AND ADVERTISING INJURY LIMIT $1,000,000 EACH OCCURRENCE LIMIT $1,000,000 DAMAGE TO PREMISES RENTED TO YOU $100,000 any one premises MEDICAL EXPENSE LIMIT 10,000 anyone person ADDITIONAL COVERAGES: SOCIAL SERVICE PROFESSIONAL LIABILITY AGGREGATE LIMIT $3,000,000 EACH OCCURRENCE LIMIT $1,000,000 CLASSIFICATION(S) SEE ATTACHED SUPPLEMENTAL DECLARATIONS SCHEDULE G PREMIUM $19,892 FORMS AND ENDORSEMENTS APPLICABLE TO THIS POLICY ARE INCLUDED IN COMMERCIAL LINES COMMMON POLICY DECLARATIONS 08/03/2005 BY (AUTHORIZED REPRESENTATIVE) THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS,IF APPLICABLE,TOGETHER WITH THE COMMON POLICY CONDITIONS,COVERAGE FORMISI ND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. "NOTICE :This Policy is issued by your risk retention group. Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI- RRG - GL (02258) • Alliance., ALLIANCE OF NONPROFITS FOR INSURANCE RISK RETENTION GROUP Nonprofits P.O. Box 8546, Santa Cruz, CA 95061 ft-Insurance P: (800) 359-6422 Risk Retention Group F: (831) 459-0853 COMMERCIAL GENERAL LIABILITY EXTENSION OF DECLARATIONS Schedule G POLICY NUMBER: 2005-11832 Page 1 NAME OF INSURED: Turning Point Center for Youth& Family Development PREMISES PREMIUM *ADVANCED CODE/CLASS *LOC BASIS RATE PREMIUM 67017/Mission, Settlement or Halfway Houses-not 1 9,000 156.631 $1,410 church or office buildings-includes products and/or completed operations 67017/Mission, Settlement or Halfway Houses-not 2 3,800 156.631 $595 church or office buildings-includes products and/or completed operations 61227/Buildings or Premises-office-NFP 3 1,500 277.994 $417 "7017/Mission, Settlement or Halfway Houses-not 4 14,400 156.631 $2,255 nurch or office buildings-includes products and/or completed operations 67017/Mission, Settlement or Halfway Houses-not 5 1,500 156.631 $235 church or office buildings-includes products and/or completed operations 60010/Apartment Buildings-includes products 6 6 99.679 $598 and/or completed operations 67017/Mission,Settlement or Halfway Houses-not 7 3,000 208.126 $625 church or office buildings-includes products and/or completed operations 67017/Mission, Settlement or Halfway Houses-not 8 18,000 208.126 $3,747 church or office buildings-includes products and/or completed operations 67513/Schools- NOC-NFP 9 15,559 142.135 $2,211 *See Common Declarations for Total Advanced Premium and Schedule'L'for locations. Ce. 462 08/03/2005 BY (AUTHORIZED REPRESENTATIVE) 'NOTICE :This Policy is issued by your risk retention group. Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI - RRG - SCHEDULE G (02258) Allianceof ALLIANCE OF NONPROFITS FOR INSURANCE RISK RETENTION GROUP C Nonprofits P.O.Box 8546,Santa Cruz, CA 95061 s) 7°'1213UTance P:(800)359-6422 Risk RermHon Group F:(831)459-0853 BUSINESS AUTO COVERAGE PART DECLARATIONS PRODUCER: CANPO ASI POLICY NUMBER: 2005-11832 455 Sherman Street Ste 207 Denver,CO 80203 RENEWAL OF NUMBER: 2004-11832 Item One: NAME OF INSURED AND MAILING ADDRESS: Turning Point Center for Youth&Family Development 1644 South College Avenue Fort Collins, CO 80525 POLICY PERIOD: FROM 08/01/2005 TO 08/01/2006 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Mental Health Counseling IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THIS POLICY,WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. Item Two: SCHEDULE OF COVERAGES AND COVERED AUTOS. This policy provides only those coverages where a charge Is shown In the premium column below.Each of these coverages will apply only to those"autos" shown as covered"autos"."Autos"are shown as covered"autos"far a particular coverage by the entry of one or more of the symbols from the COVERED AUTOS Section of the Business Auto Coverage Form next to the name of the coverage. COVERED AUTOS LIMIT COVERAGES rom N":c demote ovVEREDAUTOOS Seaton o"the THE MOST WE WILL PAY FOR ANY PREMIUM B end m�'v„cornd;Sias ONE ACCIDENT OR LOSS LIABILITY CSL 1 $1,000,000 $17,270 PERSONAL INJURY SEPERATELY STATED IN EACH P.I.P. PROTECTION(or equivalent 5 ENDORSEMENT. N/A No-fault Coverage) ADDED PERSONAL INJURY -SEPERATELY STATED IN EACH P.I.P. PROTECTION(or equivalent N/A ENDORSEMENT. N/A added No-fault Coverage) HIRED AUTO INCLUDED INCLUDED $50 NONOWNED AUTO INCLUDED INCLUDED $50 AUTO MEDICAL PAYMENTS 2 $5,000 $2,004 UNINSURED MOTORIST 2 $1,000,000 $1,125 UNDERINSURED 2 $1,000,000 Incl. MOTORIST PHYSICAL DAMAGE COMPREHENSIVE/ N/A N/A N/A COLLISION ESTIMATED TOTAL PREMIUM $20,499 FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT THE TIME OF ISSUANCE: CA0305/4-01, CA9923/12-93, CA0001/10.01, CA0113/9-98, CA 99 11/12 93, CA 20 54/10 01, CA 21 50/06 03, CA2171/1-88, CA 99 03/07 97, CA 99 34/12 93, IL 01 69/07 02, IL0169/4-98, IL0228/9-00, THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS,IF APPLICABLE,TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S)AND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. C6708/03/2005 BY /62 - (AUTHORIZED REPRESENTATIVE) - "NOTICE :This Policy is issued by your risk retention group.Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI - RRG -AL ( 02258 DY Alliance f ALLIANCE OF NONPROFITS FOR INSURANCE RISK RETENTION GROUP Nonprofits P.O. Box 8546, Santa Cruz, CA 95061 for Insurance P: (800) 359-6422 Risk Retention Group F: (831)459-0853 BUSINESS AUTO COVERAGE FORM POLICY NUMBER: 2005-11832 SCHEDULE BA Page 1 NAME INSURED: Turning Point Center for Youth &Family Development Item Three: SCHEDULE OF COVERED AUTOS YOU OWN DESCRIPTION DEDUCTIBLES apply only If coverage CLASS is provided as indicated below. COVERED YEAR,MODEL,TRADE NAME, VIN TERR. STATE CODE OTHER THAN AUTO BODYTYPE,SERIAL NUMBER(S) COLLISION NO. COLLISION 1 1997 Dodge Ram Wagon 2B5WB35Z2VK519272 110 CO 6482 N/A N/A 2 1995 GMC G3500 Rally 1 GJGG39K4SF526317 110 CO 6482 N/A N/A 3 2001 Dodge Ram Wagon 2B5W835Z01 K545119 110 CO 6482 N/A N/A 4 1995 Ford E350 Wagon 1FBJS31G2SHC05663 110 CO 6482 N/A N/A 5 1999 Dodge Ram Wagon 2B5W835Z5XK527417 110 CO 6482 N/A N/A 6 1999 Toyota Sienna 4T3ZF13C7XU154938 110 CO 6481 N/A NIA 7 1994 Saturn S Series 1 G8ZH559XRZ237778 110 CO 7398 N/A N/A 8 1991 Ford Explorer 1FMDU34X6MUB26971 110 CO 6481 N/A N/A 9 1995 Pontiac Trans Sport 1GMDU06L7ST211233 110 CO 6481 N/A N/A 10 1998 Ford Windstar 2FMDA5142WBA55002 110 CO 6481 N/A N/A i 11 1989 Dodge Caravan 2B4FK45J5KR312480 110 CO 6481 N/A N/A 12 1997 Mitsubishi Diamante 6MMAP47P8VT000964 110 CO 7398 N/A N/A 13 1995 Chevrolet Suburban 1 GNFK16K85J344621 110 CO 6481 N/A N/A 14 1992 Ford Aerostar 1FMDA41X7NZA50946 110 CO 6481 N/A N/A 15 2004 GMC Savana 1GJHG39U741166840 110 CO 6482 N/A N/A 16 2001 Dodge Ram Wagon 285W825Z11K548038 110 CO 6482 N/A N/A 17 1992 Buick Park Avenue 1G4CW53L7N1608027 110 CO 7398 N/A N/A 18 1997 GMC Safari 1GKEL19W0VB500427 110 CO 6481 N/A N/A UQ 08/03/2005 (AUTHORIZED REPRESENTATIVE) Date ANI - RRG - SCHEDULE BA Alliance of ALLIANCE OF NONPROFITS FOR INSURANCE CH,......0) Non fits RISK RETENTION GROUP p P.O. Box 8546, Santa Cruz, CA 95061 �° InsnranCe P: (800) 359-6422 Risk Retention Group F: (831) 459-0853 BUSINESS AUTO COVERAGE FORM POLICY NUMBER: 2005-11832 SCHEDULE BA Page 2 NAME INSURED: Turning Point Center for Youth&Family Development PREMIUMS:COVERAGE IS PROVIDED ONLY IF A PREMIUM CHARGE IS INDICATED. COVERED PHYSICAL DAMAGE ADDITIONAL INSURED/LOSS PAYEE: AUTO NON- MED UM/ Exalt lined bSrms interesta w WI ahphysicalphysical da pJou lo parade to wtiwm NO. OWNED HIRED LIABILITY PIP PAY UIM COLL. COMP. in"°a Warms may appear time at lose.See attached 1 1,120 0 129 60 N/A N/A 2 1,120 0 129 60 N/A N/A 3 1,120 0 129 60 N/A N/A 4 1,120 0 129 60 N/A N/A 5 1,120 0 129 60 N/A N/A 6 980 0 129 60 N/A N/A 7 530 0 23 75 N/A N/A 8 980 0 129 60 N/A N/A 9 980 0 129 60 N/A N/A I 10 980 0 129 60 N/A N/A 11 980 0 129 60 N/A N/A 12 530 0 23 75 N/A N/A 13 980 0 129 60 N/A N/A 14 980 0 129 60 N/A N/A 15 1,120 0 129 60 N/A N/A 16 1,120 0 129 60 N/A N/A 17 530 0 23 75 N/A N/A 18 980 0 129 60 N/A N/A NO/H 50 50 v 4 er: /6• 08/03/2005 (AUTHORIZED REPRESENTATIVE) Date AM - RRG - SCHEDULE BA ACORD TI, CERTIFICATE OF LIABILITY INSURANCE DATE IMM/200YY) 09/21/2005 PRODUCER 303-894-0298 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION NONPROFIT RESOURCES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 455 SHERMAN STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. UITE 207 JENVER, CO 80203-4494 INSURERS AFFORDING COVERAGE NAIC# WSURED INSURER A: ALLIANCE OF NONPROFITS INSURANCE TURNING POINT CENTER FOR YOUTH&FAMILY INSURER S: PINNACOL ASSURANCE DEVELOPMENT INSURER C: NORTH AMERICAN ELITE INSURANCE 1644 SOUTH COLLEGE AVENUE FORT COLLINS, CO 80525 INSURER D: I _ INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'Ll POLICY EFFECTIVE POLICY EXPIRATION LTR IN9 TYPE OFINSURANLE POLICY NUMBER GATE IMM/ODIWI DATF IMMIDDIYV LIMITS GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 11832 8/01/05 8/01/06 DAMAGEN TED HE PREMISES corsnce) $ 100,000 I CLAIMS MADE X OCCUR MEDEXP(Any one person) $ 10,000 PERSONAL XADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS,COMP/OPAGG $ 3,000,000 7 POLICY n fa Ii LOC AUTOMOBILE LIABILITY. COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO 11832 8/01/05 8/01/06 (Ea accident) ALL OWNED AUTOS BODILY SCHEDULED AUTOS (err person)I URV $ X HIRED AUTOS BODILY INJURY X NON,OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per eceldent) $ GARAGE LIABILITY AUTO ONLY)EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ I OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ — $ WORKERS COMPENSATION AND X ITORY LIMITS I I FRt B EMPLOYERS'LIABILITY 4044167 10/01/04 10/01/05 E.L.EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? EL.DISEASE)EA EMPLOYEE $ 100,000 II yes.deecrme undr SPECIAL PROVISIONS below _ E.L.DISEASE,POLICY LIMIT $ 50Q000 OTHER C PROPERTY SPECIAL FORM CWB0001451-02-11832 8/01/05 8/10/06 BLANKET BUILDING $2,939,000 THEFT BLANKET BPP $ 285,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESI EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS _ - CITY OF FORT COLLINS IS NAMED ADDITIONAL INSURED RE 5K RUN ON 10/23/05. (LANDLORD) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF FORT COLLINS DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN ATTN:JIM O'NEALL NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL PO BOX 580 IMPOSE NO OBLIGATION OR LIABILIIITTY�OFFTANY)KIINNDyUPON THE INSURER,ITS AGENTS OR REPRESFORT COLLINS CO 80522 AUTHORIZED /ES. _ I AUTHORIZED REPRESENTATIVE I -� I w/L,n. ACORD 25(2001/08) 'AC ORD CORPORATION 1988 EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP FROM :TURNING POINT FAX NO. :9702212727 May. 24 2006 08:17AM P1 TURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENT , INC . FACSIMILE TRANSMITTAL SHEET TO: FROM: Stephanie Brown,LCSW COMPANY, DATE: W&DSS -2 -10 FAX NUMBER: TOTAL NO.OF PAGES INCLUDING COVPk: 4'1D - Mt. -M048 3 PHONE NUMBER: SENDER'S PHONE NUMBER: 221.0999 ext.34 n SENDER'S EMAIL ADDRESS: I rtO D►L sbrOWII@ unvngwnt,arg URGENT ❑FOR REVIEW ❑PLEASE COMMENT ❑PLEASE REPLY O PI.PASE RECYCLE NO7RS/COMMENTS: � /cla:4 1644 SOUTH COI.I.F.GE AVENUE FORT COLLINS, CO 80525 970.221-0999 , FROM :TURNING POINT FAX NO. :9702212727 May. 24 2006 08: 18AM P2 (9�t/ turning point Center for Youth and Family Development,Inc. May 23,2006 Elaine Furister Weld County Department of Social Services 315 North 11th Avenue Greeley,CO 80631 Re: Request of information related to Bid 06SAT03, Sex Abuse Treatment Dear Ms. Furister, Below is Turning Point Center for Youth and Family Development, Inc.'s response to your request for additional information pertaining to our bid to he a Sex Abuse Treatment pmvider for Weld County. I appreciate you allowing us to submit this information this morning instead of yesterday afternoon. Condition #1: You must clarify the services offered through your bid by defining your services for the Greeley area. Our services will be offered to youth who are transitioning from our existing Offense Specific Residential program back to the Greeley/Evans area. All services outlined in our proposal will be offered to these youth in their community either in their home or in one of our Greeley based facilities. These include: • Offense Specific Group Therapy • Individual Therapy • Family Therapy • Psycho-education • Ongoing Monitoring&Assessment Condition#2: You must define your staff,identifying the services provided by each staff member,and state their qualifications. Staff currently available to provide this service include: Melissa Jeffryes, LPC,CAC III Dennis Gardner, Ph.D. Yvonne Dunn,MSW Tin Rutherford, MA Jenna Miller,BA,CAC II Jon Carlson, BA Sarah Kcck,BS Christina Hulls, BSW Josh Leber, BA 1644 South College Avenue • Fort Collins,Colorado 80525 ' . �� ;VY•6"• Phone 970221.0999 • F. oar. "'..12 as 97(..22 L.2727 • Website:www.turningput.oug , FROM :TURNING POINT FAX NO. :9702212727 May. 24 2006 08:18AM P3 The staff assigned to the youth will he based on individual client needs and Turning Point's intention is to maintain the therapeutic relationship they established while in the residential setting,making the transition to the community seamless. Youth will receive Individual,Group and Family therapy from a Masters level clinician. Bachelor level staff may conduct educational groups and monitoring. Compliance item: You must provide the required letters under the Collaboration Section from Weld County/Greeley Housing Authority,employment/training partners,and other partners identified in the bidder's assessment of needs. You must identity the process you will utilize to facilitate Medicaid eligible clients receiving mental health services at North Range Behavioral Health. Due to the short notice of this item, we are unable to obtain the letters to attach to this document since they are dependent on others in the community to respond. However,we will have these in place if awarded the contract and provide the County with those letters. Upon planning for a youth's transition from the residential services to the Greeley community, the treatment team will identify the needs of the youth as they enter their home community. This team will include not only Turning Point's staff and the youth's residential therapist, but also the Weld County Department of Social Services Case Worker. If mental health services are recommended,we will make a referral to North Range Behavioral Health prior to discharge to plan for a smooth transition and to ensure Medicaid eligible clients are served by NBH. Hourly Rate for Court Testimony: You did not provide a rate for court testimony. For new bidden,the Department will use your approved rate for services of$31.79 to bill for any court testimony. Wo apologize for this omission from our hid and understand the rate we will he compensated for this service. If you have any further questions,plisse contact me at 970-567-0937. Thank you for considering our response to your conditions. Sincere) , lephanie Brown, SW Chief Operating Officer d DEPARTMENT OF SOCIAL SERVICES P.O. A BOX GREELEY, CO. 80632A Website:www.co.weld.co.us ' Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 C. COLORADO May 18, 2006 Stephanie Brown, LCSW,CEO Turning Point 915 10th Street,P. O. Box 758 Greeley, CO 80632 Re: Bid 06SAT03, Sex Abuse Treatment; RFP 06006: Bid 06DT04, Day Treatment; Bid 06LS15, Lifeskills; Bid 06MH08,Mental Health Services; 06FPC10 Foster Parent Consultation Dear Ms. Brown: The purpose of this letter is to outline the results of the Core Bid process for PY 2006-2007 and to request written information or confirmation from you by Monday, May 22,2006. A. Results of the Bid Process for PY 2006-2007 • The Families, Youth and Children(FYC) Commission recommended approval of your Bid# 06SAT03 (RFP 06007), Sex Abuse Treatment for inclusion on our vendor list. The score given to your bid was 75. The FYC Commission attached the following conditions and compliance item to your bid. Condition#1: You must clarify the services offered through your bid by defining your services for the Greeley area. Condition#2: You must define your staff,identifying the services provided by each staff member,and state their qualifications. Compliance Item: You must provide the required letters under the Collaboration Section from Weld County/Greeley Housing Authority, employment/training partners,and other partners as identified in the bidder's assessment of needs. You must identify the process you will utilize to facilitate Medicaid eligible clients receiving mental health services at North Range Behavioral Health. Hourly Rate for Court Testimony: You did not provide a rate for court testimony.For new bidders,the Department will use your approved rate for services of$31.79 to bill for any court testimony. Page 2 Turning Point/Results of RFP Process for PY 2006-2007 • The Families, Youth and Children(FYC) Commission recommended approval of your Bid# 06DT03 (RFP 06006),Day Treatment, for inclusion on our vendor list. The score given to your bid was 85.The FYC Commission attached the following conditions and compliance item to your bid. Condition#1: You must clarify the services offered through your bid by defining your services for the Greeley area. Condition#2: You must address your intention to hire staff to work with the Monolingual Spanish population. Compliance Item: You must provide the required letters under the Collaboration Section from Weld County/Greeley Housing Authority. Hourly Rate for Court Testimony: You did not provide a rate for court testimony. For bidders carrying over services to 2006, the Department will use last year's court testimony hourly rate. Court testimony will be billed at$80 per hour. • The Families, Youth, and Children(FYC)Commission did not recommend approval of your Bid#06005 for Lifeskills.The score given to this bid was 69. • The Families, Youth,and Children(FYC) Commission did not recommend approval of your Bid#006-00 for Mental Health services.The score given to this bid was 76. • The Families, Youth, and Children(FYC)Commission did not recommend approval of your Bid#006-00A for Foster Parent Consultation. The score given to this bid was 33. B. Required Response by FYC Bidders Concerning FYC Commission Conditions: All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award(NOFAA). If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld county Department of Social Services accept your mitigating circumstances. If you do not accept the condition, you must provide in writing reasons why. A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations. Please respond in writing to Gloria Romansik, Weld County Department of Social Services, P.O.Box A, Greeley, CO, 80632,by Monday, May 22, 2006,close of business. You may fax your response to us at 970.346.7698. If you have questions concerning the above,please call Gloria Romansik, 970.352.1551 extension 6230. Sincerely, dy A. ego, Di ctor cc: Juan Lopez, Chair, FYC Commission Gloria Romansik, Social Services Administrator Hello