chapter 4 overview of justice program treatment sites
DESCRIPTION
Chapter 4 Overview of Justice Program Treatment Sites. GAIN Coordinating Center (11/21/2012). Normal , IL: Chestnut Health Systems. November 2012 . Available from www.gaincc.org/slides. - PowerPoint PPT PresentationTRANSCRIPT
Chapter 4Overview of Justice Program
Treatment Sites
GAIN Coordinating Center (11/21/2012).Normal, IL: Chestnut Health Systems. November 2012.
Available from www.gaincc.org/slides
Created for: Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for
Substance Abuse Treatment (CSAT) under contract number 270-2012-00001
2
SAMHSA/CSAT Full GAIN Outcome Data Set
Sample: The 2011 SAMHSA/CSAT data set includes data on 29,782 clients from 230 local evaluations, recruited between 1997-2011 who were due for at least one follow-up and available in the last quarterly data set of 2011.
Levels of Care: Outpatient, Intensive Outpatient, Short-term & Moderate/Long-term Residential, Corrections-Based Treatment and Post-Treatment Continuing Care
Instrument: Global Appraisal of Individual Needs (GAIN) (see www.gaincc.org/gaini) Versions 3 (CYT & ATM) and 5.1 through 5.6
Follow-up: 89% with one or more follow-ups at 3, 6, 9 & 12 months post intake, and 66% with two or more
Funding: SAMHSA/CSAT contracts 270-07-0191 and 270-2012-00001 and 230 individual grants
(see Detailed Acknowledgement)
3
Risk and Protective Factors The following slides present information on
demographics, and risk and protective factors for clients at intake, including: Demographics Substance use Risk behaviors Victimization Mental health disorders Physical health problems Crime and violence Sources of stress and strengths Costs Summary indices (problem prevalence, quality of life, general
satisfaction) Non-client characteristics (program, level of care,
and type of treatment)
4
Age
18 -25 Years 21.7%
(n=1,719)
Under 15 Years (<15) 6.7%
(n=532)
15-17 Years 42.3%
(n=3,343)
26+ Years 29.2%
(n=2,312)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,906)
5
Gender
Males 70.6% (n=5,582)
Females 29.4% (n= 2,322)
Other 0.01%
(n=1)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,905)
6
Race
Multi-racial 11.6%
(n=918)
African American 17.3% (n=1,371)
Hispanic 33.7%
(n=2,660)
White 34.7% (n=2,744)
Other 2.7% (n=211)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,904)
7
12 to 14 Years Old
15 to 17 Years Old
18+ Years Old
African American
Other
Hispanic*
Caucasian
GLBTQ
Married
Female
0% 20% 40% 60% 80% 100%
7%
42%
51%
17%
14%
39%
35%
5%
8%
29%
Demographic Characteristics
*Any Hispanic ethnicity separate from race group
CSAT data dominated by male, minority, age 18+
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,843)
8
Environment
Single Parent Custody (ado-lescents only)
Any School in P90
Ever Homeless or Runaway
Not Housed in the Community
Mod-High Health Problems
Any Work in P90
Military History*
0% 20% 40% 60% 80% 100%
57%
54%
45%
44%
41%
21%
3%
*n = 5,442
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,860)
9
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,819)
Current Risk of Homelessness
At Risk 14.9%
(n=1,163)
Housed 58.5%
(n=4,578)
Group or Institution
20.1% (n=1,575)
Currently Homeless
6.4% (n=503)
10
Substance Problem Recognition
Can Give 1+ Reasons to Quit*
Client Believes Need
ANY Treatment
Acknowledges Having
an AOD Problem
0% 20% 40% 60% 80% 100%
93%
80%
34%
* n=5,252
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,895)
11
Substance Severity by Time Period
Lifetime Past Year Past Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
69%
47%
11%
Dependence
Abuse
Use
No Use
Source: CSAT 2011 Summary Analytic Data Set (n=7,821)
12
Marijuana 39.5%
(n=3,125)
Past 90 Day Primary Substance
Cocaine9.7%
(n=766)
Alcohol 26.9%
(n=2,130)
Amphetamines 11.5% (n=912)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,904)
Other Drugs 2.3%
(n=179)
Opioids10.0% (n=792)
13
3+ Years Use
First Use < Age 15
Any Past Year Diagnosis
Prior SA Treatment
Past Year Dependence
Any Lifetime Withdrawal
Weekly Use of AOD
Severe Past Week Withdrawal
Substance Use Problems*
0% 20% 40% 60% 80% 100%
80%
74%
68%
48%
47%
45%
36%
2%
23% 55% 22%
EAST
Low SU (0-2)
Moderate SU (3-5)
Substance Use Problems
*Count of 8 items
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,820)
14
Pattern of Weekly Use (13+/90 days)
Anything
Cannabis
Alcohol
Opioid
Other Drugs
Cocaine
Amphetamines
Controlled Environment
Tobacco
Any Needle Use*
0% 20% 40% 60% 80% 100%
36%
22%
11%
5%
3%
3%
3%
64%
45%
4%
*Not a weekly measure; any in past 90 days
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,885)
15
Marijuana
Alcohol
Amphetamine*
Opiates
Cocaine
Sed/hyp/anx
Other drugs
Hallucinogens
Inhalants
PCP
Tobacco **
Any SUD
0% 20% 40% 60% 80% 100%
17%
12%
10%
9%
7%
2%
35%
68%
Use
Abuse
Dependence
Series5
Substance Use Disorders in Past Year by Major Substances
*n=4,074**Not counted in Any SUD Diagnosis. Abuse is not an option for Tobacco.
Source: CSAT 2011 JP Summary Analytic Data Set (n=6,915)
16
Tobacco Diagnosis
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,803)
Never Used17%
(n=1,359)
Past Use10% (n=756)
Current PY Use38% (n=2,945)
Dependence/Daily Use
35% (n=2,743)
17
Recovery Environment - Peers
Social Peers Getting Drunk Weekly+
School/Work Peers Getting Drunk Weekly+
Others at Home Getting Drunk Weekly+
Social Peers Using Drugs
School/Work Peers Using Drugs
Others at Home Using Drugs
0% 20% 40% 60% 80% 100%
39%
27%
25%
46%
32%
21%
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,780)
18
Recovery Environment - Home
Family History of Substance Use
Weekly Alcohol Use at Home*
Weekly Family Problems*
Weekly Drug Use at Home*
0% 20% 40% 60% 80% 100%
71%
14%
9%
9%
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,799)
*Past 90 days
19
HIV Risk Scale* Past Year at Intake: Needle Use
Use a needle to shoot up drugs
Reuse needle you had used before
Let someone else inject you w/ needle
Skip cleaning needle after done
Let use water/cooker/cotton after you
Let someone else use needle
Reuse needle w/o cleaning first
Reuse water/cooker/cotton after
Use needle someone else used
0% 2% 4% 6% 8% 10%
6.1%
4.1%
3.7%
2.8%
2.7%
2.6%
2.5%
1.8%
1.6%
* Mean of 36 items from the next four slides. Intake only.
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,896)
20
HIV Risk Scale* Past Year at Intake: Sex
Sex in past year
Unprotected Sex
Sex w/you or partner high on AOD
2 or more sex partners in past year
Use AOD to make sex longer or hurt less
Sex involving anal intercourse
Sex with injection drug user
Pain during sex or after sex
Trade sex for drugs, gifts, or money
Sex with someone HIV positive**
Use drugs/gifts/money to purchase sex
Sex w/man who has sex with other men
0% 20% 40% 60% 80% 100%
75%
48%
40%
37%
10%9%
5%
4%
3%
1%
2%
1%
* Mean of 36 items. Intake only.
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,294)
**n=8,246
21
HIV Risk Scale* Past Year at Intake: Victimization
Is age first abused UNDER 18?**
Ever attacked you with a weapon
Ever hurt you by striking/beating you
Any several times or for long time
Any with more than one person involved
Abused you emotionally
Was person family member/trusted one
Were you afraid for your life/injury
People you told not believe you/help you
Forced sex against your will
Result in oral, vaginal, anal sex
0% 20% 40% 60% 80% 100%
84%
50%
46%
39%
38%
33%
31%
28%
14%
13%
11%
* Mean of 36 items. Intake only.
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,622)
**n=18,224
22
Currently worried someone attack you
Currently worried someone beat/hurt you
Currently worried someone abuse you emotionally
Currently worried someone force sex acts
HIV Risk Scale
0% 20% 40% 60% 80% 100%
10%
8%
7%
1%
24% 52% 24%
Series1
Low Risk(0-2)
Moderate Risk(3-9)
HIV Risk Scale* Past Year at Intake: Trauma
*Mean of 36 items. Available at intake only.
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,864)
23
HIV Risk Change Index* in Past 90 Days at Intake
Sexually active
Any unprotected Sex
Mulitple Sex partners
Current worries about being victimized
Victimized
Any needle use
Shared needles
HIV Risk Change Index* (P90 days)
0% 20% 40% 60% 80% 100%
56%
30%
21%
16%
11%
4%
1%
56% 36% 7%
East
Low Risk(0-1)
Moderate Risk (2-3)
*Count of 7 items listed. Can be used to measure change.
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,736)
24
Number of Sex Partners*
No Sex Partners
47% (n=3,500)
1-2 Sex Partners
42% (n=3,123)
3+ Sex Partners12% (n=884)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,507)
*In the past 90 days
25
Severity of Victimization Scale
Ever attacked w/ gun, knife, other weapon
Ever hurt by striking/beating
Ever abused emotionally
Ever forced sex acts against your will/anyone
Age of 1st abuse < 18*
Happened several times or for long time
By multiple people
By family member/trusted one
Victime afraid for life/injury
People you told not believe you/help you
Result in oral, vaginal, anal sex
Currently worried someone attack
Currently worried someone beat/hurt
Currently worried someone abuse emotionally
Currently worried someone force sex acts
General Victimization Scale**
0% 20% 40% 60% 80% 100%
50%
46%
33%13%
84%
39%
38%
31%
28%
14%
11%
10%8%
7%1%
29% 18% 53%
EAST
Low Severity (0)
Moderate Severity (1-3)
**Mean of 15 items
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,862)
*n=5,235
26
Past Year Mental Health Disorders
Internalizing Disorders
Only 13.8%
(n=1,087)
Externalizing Disorders
Only 15.5%
(n=1,222)
Both 27.8%
(n=2,192)
Neither 42.8%
(n=3,371)
Source: CSAT 2011 Summary Analytic Data Set (n=7,872)
27
Any Co-Occurring Psychiatric Problem
Mood Disorder NOS
Attention Deficit/Hyperactivity Disorder
Conduct Disorder
Traumatic Stress Disorder
General Anxiety Disorder
Ever Physical, Sexual or Emotional Victimization
High Severity Victimization (GVS>3)
Ever Homeless or Runaway
Any Homicidal/Suicidal Attempts/Thoughts PY
Any Self Mutilation*
Prior Mental Health Treatment
Count of Co-Occurring Psychiatric Diagnoses**
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
57%
35%
32%
31%
26%
17%
70%
53%
45%
14%
7%
42%
43% 17% 14% 11% 9% 5%
bar
None
One
Two
Three
Four
Co-Occurring Psychiatric Problems
*(n=7,704)** Count of Conduct Disorder, ADHD/ADD Major Depressive Disorder, Traumatic Stress Disorder, and Generalized Anxiety Disorder
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,875)
28
Homicidal/Suicidal Thoughts
Thought about killing/hurting someone
Thought about committing suicide
Had a plan to commit suicide
Attempted suicide
Gotten gun etc. to carry out plan
Homicidal Suicidal Thought Scale*
0% 20% 40% 60% 80% 100%
9%
7%
3%
3%
2%
86% 12%
2%
EAST
Low Severity (0)
Moderate Severity (1-3)
*Mean of 5 items
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,890)
29
Para-suicidal Index
Cut, burned, or hurt self on purpose - PY
Cut, burned, or hurt self on purpose - P90 days
Felt can't stop cut, burn, or hurt self - PY
Needed medical attention after cut, burn, or hurt self
Parasuicidal Index *
0% 20% 40% 60% 80% 100%
7%
3%
2%
2%
5%
2%
Series1
Moderate Severity (1-2)
*Sum of 4 items
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,701)
30
Family History of Health Problems
Problems with alcohol use
Problems with drug use
Diabetes
Heart or blood problems
Psychological problems
Other probs or in Tx a lot
Any Family History of Physical Health Problems
0% 20% 40% 60% 80% 100%
64%
56%
53%
50%
38%
31%
87%
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,690)
31
Past 90 Day Health Problems
High Problems
10.0% (n=781)
Low Problems
59.2% (n=4,625)
Moderate Problems
30.8% (n=2,410)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,816)
32
Quarterly Cost of Health Care Utilization
Using the GAIN, we are able estimate the quarterly cost to society of tangible services (e.g., hospital visits, emergency room visits, etc.) in 2011 dollars for the 90 days before intake.
For the 7,598 clients served in 58 sites between 1998-2011, the average Quarterly Cost of Health Care Utilization (HCU) per client:– in the quarter before they entered treatment, was $2,323 and
totaled $17,648,250 across clients.– in the year before they entered treatment, was $9,292 per
client and totaled $70,593,000 across clients.
33
HCU Cost to Society – 2011 Dollars
*Quarterly Health Care Utilization 2011 dollars w/ SA TX based on French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates and cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35, 462-469.
Description UnitCost 2011
dollars
Inpatient hospital day Days $ 2,202.87
Emergency room visit Visits $ 6,477.04
Outpatient clinic/doctor’s office visit Visits $ 68.58
Nights spent in hospital Nights $ 2,202.87
Times gone to emergency room Times $ 6,477.04
Times seen MD in office or clinic Times $ 79.77
How many days in detox Days $ 234.86
Times in ER for AOD use Times $ 270.51
Nights in residential for AOD use Nights $ 121.62
Days in Intensive outpatient program for AOD use Days $ 94.36
Times did you go to regular outpatient program Times $ 32.50
34
Health Care Utilization Cost
% of Total Dollars ($17,648,250; mean=$2,323)
% of Population (7,598)
0% 20% 40% 60% 80% 100%
30%
38%
74%
10%52% $0
$1 - $7,599
$7,600+
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,598)
35
Past Year Crime and Violence
High 30.4%
(n=2,396)
Low 49.6%
(n=3,910)
Moderate 20.0%
(n=1,581)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,887)
36
Any Violence or Illegal Activity
Physical Violence
Any Illegal Activity
Other Drug Related Crimes*
Any Property Crimes
Any Interpersonal/ Violent Crime
Lifetime Justice Involvement
Current Justice involvement
1+/90 days In Controlled Envi-ronment
0% 20% 40% 60% 80% 100%
75%
60%
56%
40%
37%
33%
99%
95%
81%
Past Year Crime & Justice Involvement
*Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,893)
37
Violent Crime*33%
(n=2,536)
Other Crime**17% (n=1,311)
Drug Use only50%
(n=3,907)
Type of Crime
* Violent crime includes assault, rape, murder, and arson.** Other crime includes vandalism, possession of stolen goods, forgery, and theft.
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,754)
38
Cost of Crime in the Past Year
Using the GAIN we are able estimate the cost to society associated with economic losses due to criminal activity (e.g., vandalism, forgery, theft, assault, arson, rape, murder) in 2011 dollars for the year prior to intake
Of the 7,906 clients served in 58 CJ sites between 1998-2011, the average Cost of Crime per client, in the year before they entered treatment, was $264,685 and totaled $2,058,982,855 across clients.
39
Cost of Crime – 2011 Dollars*
*Cost of Crime 2011 dollars w/ SA TX based on McCollister, K. E., French, M. T., & Fang, H. (2010). The cost of crime to society: New crime-specific estimates for policy and program evaluation. Drug and Alcohol Dependence, 108(2)(1-2), 98-109.
Description UnitCost 2011
dollars
Purposely damaged or destroyed property Times $5,095.64
Passed bad checks/forged a prescription/took money from employer Times $5,745.70
Taken money/property (not from a store) Times $8,360.63
Broken into a house/building to steal Times $6,775.32
Taken a car that didn't belong to you Times $11,294.29
Used a weapon, force, or strong-arm methods to get money or things from a person Times $44,361.43
Hurt someone badly enough they needed bandages or a doctor Times $112,208.95
Made someone have sex with you by force Times $252,450.22
Been involved in the death or murder of another person (including accidents) Times $9,418,450.51
Intentionally set a building, car, or other property on fire Times $22,126.20
40
Cost of Crime
% of Total Dollars ($2,058,982,855; mean=$264,685)
% of Population (7,779)
0% 20% 40% 60% 80% 100%
97%
18%64% 18%$0
$1 - $119,00
$120,000+
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,779)
41
Intensity of Justice System Involvement
Past year illegal activity/ SA use0.1%
Past arrest/JJ/CJ sta-tus1%
Other JJ/CJ status3% Other prob/
parole/ deten-tion10%
On prob/parole 14+ days w/ 1+ drug screens
11%
Drug Court40%
In detention/ jail 14-29 days
3%
In detention/ jail 30+ days
32%
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,891)
42
In S
ch
oo
l
PH
Tx
Arr
es
ted
At
Wo
rk
MH
Tx
SA
Tx
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
54%40%
29%21% 21% 24%
Past 90 days
More than 90 days ago
Never
Recency of System Involvement
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,852)
43
Count of Major Clinical Problems at Intake
Other drug disorder
Cannabis disorder
Alcohol disorder
Depression
ADHD
CD
Trauma
Anxiety
Violence/ illegal activity
Victimization
Suicide
Major Clinical Problems*
0% 20% 40% 60% 80% 100%
53%
41%
36%
35%
32%
31%
26%
17%
75%
70%
7%
3%8% 13% 16% 14% 46%
East
None
One
Two
Three
Four
*Based on count of self reporting criteria to suggest alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal activitySource: CSAT 2011 JP Summary Analytic Data Set (n=7,631)
44
GAIN-Initial Profile: Behavior Change Scales at Intake
Cu
rre
nt
Wit
hd
raw
al
(0/1
-11
/12
-22
)
Fin
an
cia
l*
(0-1
3/1
4-4
9/5
0-1
00
)
Wo
rk P
rob
lem
s
(0/1
0-7
5/7
6-1
00
)
Su
bs
tan
ce
Pro
ble
ms
(0
/1-9
/10
-16
)
He
alt
h P
rob
lem
s(0
-9/1
0-3
2/3
3-1
00
)
HIV
Ris
k
(0-1
/2-3
/4-7
)
Re
co
ve
ry E
nv
iro
nm
en
t...
Em
oti
on
al
Pro
ble
ms
(0
-13
/14
-50
/51
-10
0)
Ille
ga
l A
cti
vit
y
(0/1
-75
/76
-10
0)
Su
bs
tan
ce
Fre
qu
en
cy
...
Sc
ho
ol
Pro
ble
ms
(0
/10
-75
/76
-10
0)
0%10%20%30%40%50%60%70%80%90%
100% 2% 7% 7% 6% 10% 7% 7% 10%21% 24% 30%
High
Moderate
Low
* n =5,325
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,777)
45
Sources of Stress: Personal
Health problem of family/friend
Death of family member/close friend
Major change in relationships/divorce
Fights with boss/ teacher/coworkers
Other family changes/problems
Birth/adoption of new family member
0% 20% 40% 60% 80% 100%
29%
28%
21%
10%
10%
8%
Source: CSAT 2011 JP Summary Analytic Data Set (n=5,333)
46
Sources of Stress: Other
Major change/bad housing
Transportation problems
Interruption or loss of house/job/school
Something you saw
Threat of losing job/house/school/transportation
New job, position, or school
Hard work or school schedule
Discrimination in community/work/etc.
Other environmental demands
Sources of Stress Index*
30%
27%
18%
14%
14%
13%
10%
6%
5%
31% 30% 39%
East
Low Stress(0)
Moderate Stress (1-2)
*Sum of 15 items
Source: CSAT 2011 JP Summary Analytic Data Set (n=5,300)
47
Treatment Readiness
Can get help you need in Tx program
Need to be in Tx for at least a month
Need support from friends/ relatives
Old friends may try to get you drunk/high
A lot of pressure to be in Tx
Too many responsibilities to be in Tx
Being in Tx program too demanding
Will need to come back to Tx 1/more times
Be hard to resist AOD where you live
Treatment Readiness*
75%
68%
53%
34%
28%
22%
21%
16%
14%
54% 43% 4%
East
High Readiness (6-9)
ModerateReadiness (3-5)
*Sum of 9 items
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,845)
48
Self-Help Activities Scale
You understood othersOther people understood you
Prayed for helpAgreed with advice
Received advice from meetingRead recovery readings
Shared at meetingMeetings important part of life
Talked w/sponsor or others outside mtg.Help someone from meeting
Actively worked 12 stepsAsked for help
Member of a home groupHad a spiritual awakening
Performed service at meetingHad a sponsor
Talked to sponsor at meetingParticipated in group sponsored events
Sponsored someone elseSelf-Help Activities Scale*
0% 20% 40% 60% 80% 100%
42%38%37%
35%35%35%34%34%
26%23%22%20%17%16%
14%12%
10%8%1%
0.188 0.26 0.552
EAST
High Ac-tivity (12-19)
Moderate Activity (1-11)
*Mean of 19 items
Source: CSAT 2011 JP Summary Analytic Data Set (n=3,769)
49
Individual StrengthsListening, caring or communicating
with others
Doing well with your family
Doing well with close friends
Problem solving and figuring things out
Doing well at sports, exercise, physical activity
Doing well at school or training
Working or playing with computers
Doing well at work
Doing well at music, dancing, acting, other performing art
Drawing, painting, design or other art activities
Strength Self-Efficacy Index*
0% 20% 40% 60% 80% 100%
82%
81%
79%
75%
68%
58%
53%
46%
44%
39%
50% 44% 7%
EAST
High Strength (7-10)
Moderate Strength(3-6)
*Sum of 10 items
Source: CSAT 2011 JP Summary Analytic Data Set (n=5,315)
50
Family members/close partners
Someone to talk to about emotions
Someone to help cope with problems
Friends to hang out with
Legal hobby or activity
Professional counselor/health provider
People at work/school: day to day things
People at work/school: get assignments
Friends/colleagues from other com-panies/schools
General Social Support Index*
0% 20% 40% 60% 80% 100%
83%
78%
77%
77%
69%
58%
49%
47%
45%
72% 20% 8%
EAST
High Support(5-9)
Moderate Support (2-4)
General Social Support Strengths
*Sum of 9 items
Source: CSAT 2011 JP Summary Analytic Data Set (n=5,337)
51
Spiritual Social Support Index
Consider your beliefs to be very important to you?
Consider your beliefs to be very strong?
Beliefs often influence your de-cisions?
Religiously affiliated
Consider self a good member?
Regularly attend services or ceremonies?
Important that friends share your beliefs?
Spiritual Socual Support Index*
0% 20% 40% 60% 80% 100%
69%
61%
53%
51%
33%
23%
18%
0.202 0.394 0.403
EAST
High Support (6-7)
Moderate Support (3-5)
* Sum of 7 items
Source: CSAT 2011 JP Summary Analytic Data Set (n=5,287)
52
Potential Mentors in the Recovery Environment
None involved in illegal activity
Little shouting, arguing or fighting most weeks
Know anyone in treatment
Know anyone in recovery
Little shouting, arguing or fighting most weeks
None involved in illegal activity
Know anyone in treatment
Know anyone in recovery
Little shouting, arguing or fighting most weeks
None involved in illegal activity
Know anyone in treatment
Know anyone in recovery
Environmental Strengths Index*
0% 20% 40% 60% 80% 100%
78%66%
25%19%
75%70%
21%14%
65%58%
29%19%
46% 43% 12%
WEST High Strength (12-16) Moderate Strength (3-5)
Ho
me
Sch
oo
l or
Wo
rkS
oci
al
Pee
rs
*Sum of 12 items
Critical gap in
connection to recovery community
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,793)
53
Quarterly Cost to Society
Using the GAIN we are able estimate the cost to society of tangible services (e.g., health care utilization, days in detention, probation, parole, days of missed school) in 2011 dollars for the 90 days before intake
Of the 7,092 clients served in 58 sites between 1998-2011, the average Quarterly Cost to Society (QCS) per client:– in the quarter before they entered treatment, was $6,445 and
totaled $45,707,064 across clients.– in the year before they entered treatment, was $25,780 per
client and a total of $182,828,256 across clients.
54
Quarterly Cost to Society – 2011 Dollars*
*Quarterly cost to society 2011 dollars w/ SA TX based on Dennis, M. L., French, M. T., McCollister, K. E., & Scott, C. K. (2011). The economic costs of quarterly monitoring and recovery management checkups for adults with chronic substance use disorders. Journal of Substance Abuse Treatment, 41, 201-207.
Description Unit Cost 2011 dollars
Inpatient hospital day Days $ 2,202.87
Emergency room visit Visits $ 6,477.04
Outpatient clinic/doctor’s office visit Visits $ 68.58
Nights spent in hospital Nights $ 2,202.87
Times gone to emergency room Times $ 6,477.04
Times seen MD in office or clinic Times $ 79.77
Days bothered by any health problem Days $ 26.47
Days bothered by psych problems Days $ 10.72
How many days in detox Days $ 234.86
Times in ER for AOD use Times $ 270.51
Nights in residential for AOD use Nights $ 121.62
Days in Intensive outpatient program for AOD use Days $ 94.36
Times did you go to regular outpatient program Times $ 32.50
Days missed school or training for any reason Days $ 19.19
How many times arrested Times $ 2,192.92
Days on probation Days $ 5.94
Days on parole Days $ 19.30
Days in jail/prison/detention Days $ 84.15
55
Quarterly Cost to Society
% of Total Dol-lars
($45,707,064; mean=$6,445)
% of Population (7,092)
0% 20% 40% 60% 80% 100%
3%
27%
44%
57%
53%
16% $0-$1,999
$2,000 - $9,999
$10,000+
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,092)
56
Problem Prevalence Index
Summarizes days of problems across domains: substance use, internalizing disorders, externalizing disorders, physical health risk behaviors, criminal involvement, vocational problems, and environmental concerns.
Calculation: the average of the percent of days with problems (of past 90) on each of 23 items across 8 areas. The resulting score is multiplied by 100 to get an index score from 0 to 100.
Interpretation: continuous; where higher values represent more problems across multiple domains.
Triage groups: Low (0-5), Moderate (6-24) or High (25-100) based on roughly 50%, 40% and 10% of the clinical population.
57
Quality of Life
Summarizes quality of life represented by fewer reported problems during the past year in school problems, work problems, health problems, sources of stress, risk behavior, internal disorders, external disorders, substance disorders, and crime/violence.
Calculation: the sum of 9 screeners from the GAIN-Q version 3 (reversed to Low=2, Moderate=1, and High=0) divided by the range (18), and multiplied by 100 to get a score from 0 to 100.
Interpretation: continuous; where higher values represent greater quality of life.
Triage groups: Low (0-36), Moderate (37-69) or High (70-100) groups.
58
General Satisfaction Index
Summarizes life satisfaction in 6 areas (sexual relationship, living situation, family relationships, school/work, free time, and getting help with problems). This index is optional.
Calculation: sum of these dichotomous items Interpretation: continuous; where higher values represent
greater satisfaction with life situations. Triage groups: Low problems (5-6), Moderate problems (3-
4) or High problems (0-2) groups. High satisfaction corresponds to low problems.– However, for the purposes of this presentation, the groups are not
reversed, so in the following slides, low satisfaction scores (0-2) are in the low group, and high satisfaction scores (5-6) are in the high group.
59
Problem Prevalence
Index
Quarterly Cost to Society
Quality of Life Index
General Sat-isfaction In-
dex*
0%10%20%30%40%50%60%70%80%90%
100% 6%16% 0.2461015026
93507
0.178564593301435 Low
Mod
High
High
Mod
Low
Cross Validation of Four Summary Indices
Pro
ble
mat
icB
en
efic
ial
*GSI groups are usually reversed (low satisfaction scores (0-2) are in the high problem group); here low satisfaction scores are in the low group, and high satisfaction scores are in the high group (n=5,225)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,344)
60
General Satisfaction Index by Problem Prevalence Index
Low Prevalence
(0-5)
Moderate Prevalence
(6-24)
High Prevalence
(25-100)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%14% 20%
38% Low Satis-faction (0-2)
Moderate Satisfaction (3-4)
High Satis-faction (5-6)
Problems are subjectively
unpleasant and are associated with
lower satisfactionSource: CSAT 2011 JP Summary Analytic Data Set (n=5,223)
61
Low ($0-$1,999)
Moderate ($2,000-$9,999)
High ($10,000+)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%11%
20% 22%Low Satis-faction (0-2)
Moderate Satisfaction (3-4)
High Satis-faction (5-6)
General Satisfaction Index by Quarterly Cost to Society
Higher costs are subjectively
unpleasant and are associated with
lower satisfactionSource: CSAT 2011 JP Summary Analytic Data Set (n=4,676)
62
Low Quality(0-36)
Moderate Qual-ity
(37-69)
High Quality(70-100)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
29%19%
10%
Low Satisfac-tion (0-2)
Moderate Sat-isfaction (3-4)
High Satisfac-tion (5-6)
General Satisfaction Index by Quality of Life
Quality of life is subjectively
pleasant and is associated with
higher satisfactionSource: CSAT 2011 JP Summary Analytic Data Set (n=5,225)
63
FunderCSAT Criminal Justice (CJ) Adolescent: 59.7% (n=4,720; 32 grants)
CSAT CJ Adult:40.3%
(n=3,186; 26 grants)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,906)
64
Grant Program in Chronological Order of first grant cohort
• 2004-2010, Young Offender Reentry Program (YORP)• 2005-2010, Juvenile Treatment Drug Court (DC) • 2006-2009, Family Drug Court (FDC)• 2008-2011, Adult Treatment Drug Court (ATDC)• 2009-2011, Offender Re-entry Program (ORP)• 2011-2011, Juvenile Treatment Drug Court (JTDC)
65
Grant Program
DC: Drug Court (n=1,768; 11 grants)
YORP: Young Offender Re-entry Program
(n=2,278; 10 grants)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,906)
ATDC: Adult Treatment Drug Court (n=1,147; 11 grants)
ORP: Offender Re-entry Program (n=2,449; 21 grants)
FDC: Family Drug Court (n=193; 2 grants)
JTDC: Juvenile Treatment Drug Court
(n=71; 3 grants)
66
Level of CareM-LTR: Mid to
Long Term Residential 1.6%
(n=124)
STR: Short Term Residential
.03% (n=2)
OP: Outpatient
59.1% (n=4,465)
CC-OP: Continuing Care
– Outpatient 13.0%
(n=979)
IOP: Intensive
Outpatient 26.2%
(n=1,980)Source: CSAT 2011 JP Summary Analytic Data Set (n=7,550)
67
Type of Treatment
Local Tx Manual: Specific
Manualized Treatment 2.1%
(n=163)
MET/CBT: Motivational
Enhancement Therapy/Cognitive-Behavioral Therapy
22.1% (n=1,748)
Other: Non-manualized Treatment 33.0%
(n=2,609)
Other EBTx: Evidence Based Treatment 18.1%
(n=1,403)
A-CRA/ACC: Adolescent Community
Reinforcement Approach/ Assertive
Continuing Care 24.7% (n=1,956)
Source: CSAT 2011 JP Summary Analytic Data Set (n=7,906)
68
Outcomes
The following slides present information on the outcomes of substance abuse treatment, including: Abstinence Recovery GAIN change scales over time (SPSm, CWS, HPS, EPS, EmPS,
TPSl, IAS, TRI, SES, SATI, MHTI, PHTI, CJSI) GPRA outcomes (vocationally engaged, housed, no justice
system involvement, social consequences, abstinence, and social connectedness) and
NOMS outcomes (treatment initiation, engagement and continuing care; no problems with: health, mental health, family, illegal activity; abstinent, vocationally engaged and housed).
Data on follow up rates, months to last follow up, and number of follow ups per client are provided in the Methods Appendix
69
Pre-CE Intake 3 Month 6 Month 9 Month 12 Month
0
5
10
15
20
25
30
35
40
45
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
Mari-juana
Alcohol
To-bacco*
Amphet-amine
Cocaine
Opiates
Days of Use in the Past 90 Days by Substance
Source: CSAT 2011 SA Data Set subset to those with 1+ Follow ups
Da
ys
Us
ed
in P
as
t 90
–s
olid
lin
e
*There is no pre-ce information available for tobacco
Da
ys U
se
d in
Pa
st 90
– da
she
d lin
e
70
Percent Change in 6 Month Abstinence
Series10%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
22%
Source: CSAT 2011 SA Data Set subset to those with 6-Month Follow up (n=14,290)
• Percent change in 6 month abstinence is calculated as
• % abstinent at 6 month minus % abstinent at intake
• Abstinence increased 22% from 36% at intake to 58% at 6-months.
71
Relative Percent Change in 6 Month Abstinence
Series10%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
61%
• Relative percent change in 6 month abstinence is calculated as: • (% abstinent at 6 month minus %
abstinent at intake) divided by % abstinent at intake
• Relative percent of change can be large (i.e., greater than 100%) if baseline abstinence is low.
• Abstinence increased by almost two-thirds (61%) against the intake value. (22% increase/ 36% at intake).
Source: CSAT 2011 SA Data Set subset to those with 6-Month Follow up (n=14,290)
72
Past Month AOD Abstinence Over Time
Intake 3 Month 6 Month 9 Month* 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
*InterpolatedSource: CSAT 2011 AT SA Data Set subset to 1+ Follow ups
73
Recovery Over Time*
Intake 3 Month 6 Month 9 Month** 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
* Recovery defined as no past month use, abuse, or dependence symptoms while living in the community.
Source: CSAT 2011 AT SA Data Set subset to 1+ Follow ups **Interpolated
74
GPRA Outcomes Over Time
Intake 3 Month 6 Month 9 Month* 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Vocationally Engaged
Housing
No Justice Sys-tem Involvement
No Social Consequences
Abstinence
Socially Connected
*InterpolatedSource: CSAT 2011 SA Data Set subset to 1+ Follow ups
75
Change in GPRA Outcomes (Intake to Last Wave*)
Inta
ke
Las
t W
ave
Inta
ke
Las
t W
ave
Inta
ke
Las
t W
ave
Inta
ke
Las
t W
ave
Inta
ke
Las
t W
ave
Inta
ke
Las
t W
ave
0%
20%
40%
60%
80%
100%
Vocationally Engaged
Housing No Justice System
Involvement
No Social
Consequences
Abstinence Socially Connected
*Last wave is the last follow-up
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
76
NOMS Outcome: Number of Treatment Received Outcomes Met*
Initiation within 14 days of assessment
Engagement forat least 6 weeks
Any Continuing Care (91-180 days post intake)
Evidenced-Based Treatment
Number of Treatment Received Outcomes Met*
0% 20% 40% 60% 80% 100%
90%
82%
81%
64%
0.308 0.429 0.229 0.032
Total
Four
Three
Two
One
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups (n=5,906)
*Based on a count of initiation within 14 days, evidence based practice, engagement for at least 6 weeks, and any continuing care.
77
NOMS Outcome: Estimated Treatment Episode Cost by Treatment Modality
*Used in slides; ** Inter-quartile range of actual costs in 2006 dollarsSource: French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates and cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35, 462-469.
ModalitySAMSHA Episode
Cost (2004)*
French’s Estimated Episode Cost
(2008)**
Adolescent Early Intervention $200-$1,200 -
Adult Outpatient - $1,132 - $2,099
Adolescent Outpatient $1,000 - $5,000 $1,517 - $3,237
Intensive Outpatient/Continuing Care $1,000 - $7,000 $1,384 - $5,780
Adult Drug Court - $2,486 - $4,888
Adult Methadone Maintenance - $4,277 - $13,395
Adult Residential $3,000 - $10,000 $2,907 - $11,260
Adult Therapeutic Community/Residential $3,000 - $10,000 $14,818 - $32,361
Adult Therapeutic Community/In-Prison - $1,249 - $2,112
78
SAMHSA Outcome: Treatment Cost Bands
Below3% (n=101)
Within30%
(n=884)
Above 67% (n=1,993)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups (n=2,978)
79
Selected NOMS Outcomes Over Time
Intake 3 Month 6 Month 9 Month* 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%No Health Problems
No Mental Health Prob-lems
No Family Problems
Abstinence
No Illegal Ac-tivity
Vocationally Engaged**
Housed
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
*Interpolated **Past month
80
Change in Selected NOMS Outcomes (Intake to Last Wave)
Inta
ke
Las
t W
ave
Inta
ke
Las
t W
ave
Inta
ke
Las
t W
ave
Inta
ke
Las
t W
ave
Inta
ke
Las
t W
ave
Inta
ke
Las
t W
ave
Inta
ke
Las
t W
ave
0%10%20%30%40%50%60%70%80%90%
100%
Vocationally Engaged*
No Health Problems
No MH Problems
Past Month
Abstinent
No Illegal Activity
HousedNo Family Problems
*Past monthSource: CSAT 2011 SA Data Set subset to 1+ Follow ups
81
NOMS Outcomes: No Problems at Intake
UseAbuse/Dependence Sx*
Physical HealthMental Health
Nights of Psychiatric Inpatient Illegal Activity
Arrests Housed in Community Family/Home Problems
Vocational Problems*Social Support/Engagement Recovery Environment Risk
Quarterly Cost to SocietyIn Work/School
0% 20% 40% 60% 80% 100%
45%63%
28%9%
99%73%
79%19%
69%65%
2%55%
5%49%
* Variable measures the last 30 days. All others measure the past 90 days.
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
82
NOMS Outcomes: Outcome Status at Last Wave
UseAbuse/Dependence Sx*
Physical HealthMental Health
Nights of Psychiatric Inpatient Illegal Activity
Arrests Housed in Community**
Family/Home ProblemsVocational Problems*
Social Support/Engagement Recovery Environment Risk
Quarterly Cost to SocietyIn Work/School**
0% 20% 40% 60% 80% 100%
42%83%
34%
41%
82%
68%
81%67%
14%
62%43%
87%
28%79%19%12%99%79%87%54%75%67%4%62%8%59%
No Prob-lem
Reduced 50% or No Problem
*This variable measures the last 30 days. All others measure the past 90 days.**The blue bar represents an increase of 50% or no problem.
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
83
NOMS Outcomes: Count of Positive Outcomes* (Last FU– Intake)
Less than negative one11% (n=681)
Negative one7% (n=448)
None11% (n=666)
One12%
(n=753)
Two13%
(n=816)
Three13% (n=785)
Four11%
(n=660)
Five +23%
(n=1,426)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups (n=6,235)
*Based on count of reductions or no problem in the following variables: Substance use frequency, Abuse/Dependence Sx (past 30d), Physical Health (past 90d), Mental Health (past 90d), Nights of Psychiatric Inpatient (past 90d), Illegal Activity (past 90d), Arrests (past 90d), Housed in Community (past 90d), Family/Home Problems (past 90d), Vocational Problems (past 30d), SocialSupport/Engagement (past 90d), Recovery Environment Risk (past 90d), Quarterly Cost to Society (past 90d), In Work/School (past 90d) at last wave Minus No problems at intake with these variables.
42% have one or more
improved areas
84
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
63%77% 79% 80%
30%20% 18% 15%
6% 4% 3% 5%
High (10-16)
Moderate (1-9)
Low (0)
Past Month Substance Problems Scale Groups Over Time
Source: CSAT 2011 AT SA Data Set subset to 1+ Follow ups
85
Current Withdrawal Scale Groups Over Time
Baseline 3 Month 6 Month 12 Month82%
84%
86%
88%
90%
92%
94%
96%
98%
100%
88%
95%97% 96%
10%
5%3% 4%
2% 1% 1% 1%
High (12-22)
Moderate (1-11)
Low (0)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
86
Health Problems Scale Groups Over Time
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
59%50% 52% 50%
31%39% 38% 40%
10% 11% 10% 10%
High (33-100)
Moderate (10-32)
Low (0-9)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
87
Emotional Problems Scale Groups Over Time
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
43%50% 55% 59%
46%43% 39% 35%
11% 7% 6% 6%
High (51-100)
Moderate (14-50)
Low (0-13)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
88
Employment Problems Scale Groups Over Time
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
95% 98% 98% 99%
1% 2% 2% 2%
High (6-8)
Moderate (3-5)
Low (0-2)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
89
Employment Problems Scale Groups Over Time – Subset to Those Employed
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
82%96% 96% 97%
3% 4% 4% 3%
High (6-8)
Moderate (3-5)
Low (0-2)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
90
Training Problems Scale Groups Over Time
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
80%92% 94% 97%
8% 1% 1% 1%
High (6-8)
Moderate (3-5)
Low (0-2)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
91
Training Problems Scale Groups Over Time – Subset to Those in School/Training
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
58%
84% 87% 93%
26%
14% 11% 5%16%
2% 1% 2%
High (6-8)
Moderate (3-5)
Low (0-2)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
92
Illegal Activities Scale Groups Over Time
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12% 13% 13% 10%
67% 68% 71% 75%
21% 20% 17% 15%
High (11-100)
Moderate (1-10)
Low (0)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
93
Treatment Resistance Index Groups Over Time
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
43%51% 52% 58%
51%43% 40% 33%
6% 6% 8% 9%
High (3-4)
Moderate (1-2)
Low (0)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
94
Self-Efficacy Scale Groups Over Time
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
62%69% 70% 73%
29%24% 21% 18%
9% 8% 9% 9%
High Prob-lems (0-2)
Moderate Problems (3-4)
Low Prob-lems (5)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
95
Substance Abuse Treatment Index Groups Over Time
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
79%
34%
67%79%
8%
29%
15%
8%
13%
37%
18% 13%
High (14-100)
Moderate (1-13)
Low (0)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
96
Mental Health Treatment Index Groups Over Time
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
85% 80% 82% 83%
9%10% 9% 9%
7% 10% 9% 8%
High(14-100)
Moderate (1-13)
Low (0)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
97
Physical Health Treatment Index Groups Over Time
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
69% 67% 70% 73%
20% 22% 19% 17%
11% 12% 10% 10%
High (14-100)
Moderate (1-13)
Low (0)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups
98
Criminal Justice System Index Groups Over Time
Baseline 3 Month 6 Month 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
17% 17% 21%29%
25%10%
9%
9%
59%74% 70%
62%
High (14-100)
Moderate (1-13)
Low (0)
Source: CSAT 2011 SA Data Set subset to 1+ Follow ups