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THOMPSON, MANITOBA
3
Thompson, Manitoba
For more information, please contact:
Joanna Henderson, Ph.D.
Clinician Scientist
Gloria Chaim, MSW
Deputy Clinical Director
Child, Youth and Family Services
Centre for Addiction and Mental Health
80 Workman Way, Toronto, ON M6J1H4
Production of this report has been made possible through a financial contribution from Health Canada.
The views expressed herein do not necessarily represent the views of Health Canada
© 2013 CAMH
Thompson, Manitoba
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Acknowledgments
The National Youth Screening Project Team would like to acknowledge the commitment, dedication
and hard work of the many people representing agencies in Thompson, Manitoba, one of ten
participating communities across Canada. Sincere thanks are due to Fran Schellenberg, Mental
Health, Addictions and Spiritual Health Care and Beverley Pageau, Senior Policy Analyst, Mental
Health and Spiritual Care Branch, Manitoba Health for their interest and effort that resulted in the
Thompson, Manitoba network collaboration on this project; to John Donovan, the Thompson,
Manitoba network lead, for his enthusiasm and leadership; to Lynn Sauve for her assistance at the
outset of the project; to the agency leads who were prepared to commit to participate in a cross-
sectoral collaboration, explore ways to integrate consistent administration of a screening tool and
dedicate staff time to participate in the project; and to front-line service providers who were willing to
take the time to explore new practices, and to work on engaging youth in a screening process for
clinical and research purposes; and, most of all, to the youth who participated in completing the
screeners and consented to sharing them for project purposes. We would also like to thank Health
Canada for their commitment to capacity building, data collection and knowledge exchange,
demonstrated by providing the funding support that made this project and dissemination of the
findings possible.
National Youth Screening Project Partner Agencies: Thompson, Manitoba
The following agencies participated in one or more of the four key project activities: Network
Development, Capacity Building, Screening Implementation and Data Collection (Refer to Appendix A
for agency descriptions and Appendix B for key project activity descriptions)
Partner Agencies Agency Leads
Addictions Foundation of Manitoba
Northern Health Region (formerly BRHA)
Ma-Mow-We-Tak Friendship Centre
Manitoba Justice, Community and Youth Correctional Services
Marymound Inc
Nisichawayasihk Cree Nation
Sir John Hugh MacDonald Youth Services
School District of Mystery Lake
Thompson Boys and Girls Club Inc
John Donovan
Regina Newman Thorne
Dee Chaboyer
Allison Coles
Audrie Brooks
May Mossip
Jacquie Hopkins
Sharon Kent
Chris Sauvé
Thompson, Manitoba
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Network Leads
John Donovan, Thompson Lead, Addictions Foundation of Manitoba
Network Coordinator
Lynn Sauvé, Thompson Coordinator, Thompson Boys and Girls Club
Project Team: Centre for Addiction and Mental Health
Project Leads
Joanna Henderson
Gloria Chaim
Project Coordinator
Megan Anne Tasker
Administrative Support
Stephanie Schultz
Research Analysts
Andra Ragusila
Dave Summers
Carly Clifton
GAIN SS License
Chestnut Health Systems – Copyright holder for all Global Appraisal of Individual Needs instruments,
including Global Appraisal of Individual Needs - Short Screener (GAIN SS)
Thompson, Manitoba
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Table of Contents
List of Figures 7
National Youth Screening Project 9
Overview 9
Context 9
Objectives 12
National Youth Screening Project: Thompson, Manitoba 13
Summary 13
Development 13
Partners 14
Roles 15
Implementation Process 16
Materials 17
Findings 21
Background Information about Youth 23
Clinical Needs of Youth Based on the GAIN SS 36
Other Clinical Needs 45
Concurrent Substance Use and Mental Health Concerns 46
Service Provider Survey 52
Summary of Findings 54
Discussion 55
Recommendations 57
Appendix A: Thompson, Manitoba Network Member Agency Descriptions 61
Appendix B: Key Project Activity Descriptions 63
Appendix C: Agency Project Activity Participation 64
Appendix D: Project Timeline 65
Appendix E: Project Flow Chart 66
Appendix F: References 67
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List of Figures
Figure 1: Age Distribution of Participants 24
Figure 2: Age Distribution by Service Sector 25
Figure 3: Sex Distribution of Participants 26
Figure 4: Sex Distribution of Participants by Service Sector 27
Figure 5: Service History by Service Sector 28
Figure 6: Ethnicity Distribution of Participating Youth 29
Figure 7: Current Living Arrangements 30
Figure 8: Current Living Arrangements by Sex 31
Figure 9: Current Living Arrangements by Age Categories 32
Figure 10: Current Living Arrangements by Service Sector 33
Figure 11: Number of Concerns Endorsed by GAIN SS Domain 37
Figure 12: Recent Clinical Needs Using Moderate Threshold by Service Sector 38
Figure 13: Recent Clinical Needs Using High Threshold by Service Sector 39
Figure 14: Recent Internalizing Concerns by Age and Sex Categories 40
Figure 15: Recent Externalizing Concerns by Age and Sex Categories 41
Figure 16: Recent Substance Use Concerns by Age and Sex Categories 42
Figure 17: Recent Crime and Violence Concerns by Age and Sex Categories 43
Figure 18: Recent Suicide Concerns by Age and Sex Categories 44
Figure 19: Rates of Recent Additional Concerns by Sex Categories 45
Figure 20: Rates of Endorsement of Concurrent Disorders 46
Figure 21: Rates of Endorsement of Concurrent Disorders by Service
Sector and Sex 48
Figure 22: Rates of Endorsement of Concurrent Disorders by Age and Sex 49
Figure 23: Rates of Endorsement of Concurrent Disorders by Legal
System Involvement 50
Figure 24: Complexity of Needs 51
Thompson, Manitoba
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Thompson, Manitoba
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National Youth Screening Project
Overview
The National Youth Screening Project (NYSP), Enhancing Youth-Focused, Evidence-Informed
Treatment Practices through Cross-Sectoral Collaboration, was funded under Health Canada’s Drug
Treatment Funding Program (DTFP) to work collaboratively with youth-serving agencies in seven
communities across Canada to implement a common screening tool for youth substance use and
mental health concerns. Each network was to include a range of agencies representing three or more
sectors, including substance use, mental health, justice, child welfare, education, housing, outreach
and primary health care. Each of the agencies was to participate in one or more of four key project
activities: Capacity Building, Network Development, Screening Implementation and Data Collection
(see Appendix B). Through this process, the project would have the opportunity to examine rates of
co-occurring substance use and mental health concerns (frequently referred to as concurrent or co-
occurring disorders (CD)) in different service sectors, across the adolescent and emerging adulthood
age spectrum, and to examine the extent to which rates of CD are consistent with service provider
expectations. As well, the project aimed to explore service provider perceptions of interagency
referrals, perceived interagency collaboration and youth CD attitudes, knowledge, and practices at
different time points in the project.
The overall objective of the NYSP was to enhance service provider CD capacity, increase early
intervention opportunities and improve pathways to treatment for youth aged 12-24 years with
substance use concerns and CD. This was done through building sustainable stakeholder
collaborations and providing CD-related capacity development opportunities.
Context
Background
Youth with CD experience difficulties in many areas of functioning, resulting in vulnerability to
increased risk-taking behaviour, poor academic/vocational performance, increased suicide risk, and
adverse health effects, including increased risk for substance dependency and psychiatric disorders
continuing into adulthood (Rush, Castel, & Desmond, 2009). Unfortunately, effective,
developmentally-informed interventions have yet to be established. From a public health perspective
there is a desperate need to develop integrated models of service delivery across the continuum of
care to improve outcomes and reduce the high individual and societal costs associated with CDs
(Rush et al., 2009). Evidence suggests that universal screening for mental health and/or substance
Thompson, Manitoba
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use disorders should be a routine part of client care in adults (Rush et al., 2009). However, effective
and efficient screening, assessment and treatment approaches, especially for youth, are only
beginning to emerge. At the same time, concerns about co-occurring substance use and mental
health issues in youth have been identified in services across sectors including child welfare, youth
justice, mental health, addictions, education, health care, housing and other social service agencies
(Chaim & Henderson, 2009). There is a strong rationale for effective, consistent screening in youth
service delivery settings (Rush et al., 2009).
In Canada, there have traditionally been separate service delivery systems for health, mental health,
substance use treatment and social services rather than integrated or collaborative models of service
delivery. With recent calls to develop integrated models of service delivery in Canada (Health Canada,
2002), some agencies are beginning to offer integrated CD services, although little information is
available about types and accessibility of these services. Emerging evidence suggests that cross-
discipline collaborations may have particular benefits for improving access and meeting youth and
family needs (McElheran, Eaton, Rupcich, Basinger, & Johnson, 2004; Murphy, Rosenheck,
Berkowitz & Marans, 2005). There are many barriers, however, to cross-discipline approaches,
especially if the disciplines involved differ substantially in organizational culture, philosophy, values
and practices (Oliver & Dykeman, 2003; Robillard, Gallito-Zaparaniuk, Kimberly, Kennedy, Hammett,
& Braithwaite, 2003). It has been argued that these barriers can be addressed through
communication, relationship-building, joint educational opportunities and practice-based initiatives,
although the specific impacts of these strategies have not been established (McElheran et al., 2004;
Murphy et al., 2005; Oliver & Dykeman, 2003; Henderson, MacKay, & Peterson-Badali, 2010).
Although it is well known that youth presenting for service often have multiple co-occurring needs, the
fragmented system is generally not set up to address them. There are many challenges including
stigma, lack of resources, lack of knowledge and lack of attention to youth-specific needs, as well as a
frequent lack of collaboration and limited integration. The work of the Canadian Mental Health
Commission (2006) and the National Treatment Strategy Working Group (2008) highlighted these
issues and provided some fundamental principles to be considered and followed in planning new
initiatives. Themes and recommendations identified across these documents including “every door is
the right door,” the need to improve access, the importance of attending to population specific needs,
the need to collaborate within and across sectors, the importance of generating solid data to inform
investments and making knowledge exchange a priority, have informed this project as well as our
previous collaborative screening network projects (GAIN Collaborating Network, 2009; Concurrent
Disorders Support Services Screening Project, 2011).
Choosing a Screening Tool for Youth
The importance of screening for both mental health and substance use concerns across sectors has
been identified through a number of initiatives. From 2002 to 2006, the emphasis was primarily on the
identification of useful adult tools and practices (Health Canada, 2002; Centre for Addiction and
Mental Health, 2006).
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In 2006, Rush and colleagues initiated a process to identify youth screening tools and processes and
conducted a comprehensive review and synthesis of screening tools for substance use and mental
health disorders among children and adolescents (Rush, Castel, & Desmond, 2009).
Through these initiatives, the Global Assessment of Individual Needs Short Screener (GAIN SS) was
identified as an ideal first stage screening tool for substance use and mental health concerns for youth
and adults. In particular, it was recommended because it:
Screens for both substance use and mental health issues
Is reliable and valid
Is brief (five to seven minutes to complete)
Can be self-administered
Has been validated for individuals aged 10 years and older (including adults)
Is low cost
Can be used in different service settings (e.g., treatment, primary care, etc.)
Collaborative Screening Initiatives 2003 - 2010
In 2003, CAMH merged its children’s mental health and youth substance use services into the Child,
Youth and Family Program (CYFP) and in 2005 a project was initiated to identify and implement a
common screening tool for substance use and mental health concerns across the merged program.
Based on the work of Rush and colleagues, the GAIN SS was chosen and implemented. In addition,
substance use and mental health-related staff attitudes, knowledge and practices were measured and
staff feedback was gathered. Findings from that project demonstrated that many youth endorsed co-
occurring substance use and mental health concerns, regardless of “presenting problem” and initial
service request. As well, participating staff indicated that implementing a consistent substance use
and mental health screening tool was feasible across diverse services and provided clinically useful
information (Henderson, Chaim, & Rush, 2007; Skilling, Henderson, Root, Chaim, Bassarath, &
Ballon, 2007).
Discussion about this project at workshops, conferences and network meetings generated interest in
the Toronto-based Mental Health and Addiction Youth Network (MAYN) in replicating the project
within their own agencies. In 2008, a cross-sectoral network of 10 Toronto-based youth serving
agencies, all members of MAYN, led by Gloria Chaim and Joanna Henderson committed to
administer the GAIN SS, along with a standardised background information form to the youth (aged
12 – 24 years) seeking service at their agencies for a 6-month period. The GAIN Collaborating
Network research findings resulted in a report describing youth needs across sectors and about the
feasibility and utility of consistent screening and the GAIN SS in particular. Stakeholder discussion
about the findings generated a number of service, system and research initiatives and suggested that
the GAIN SS is a feasible and useful clinical instrument (Chaim & Henderson, 2009).
Upon completion of the GAIN Collaborating Network project, findings were presented to local
stakeholders including service providers, agency leaders and policy makers as well as at multiple
Thompson, Manitoba
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international, national and local conferences, meetings, and forums, most notably the Annual
Convention of the American Psychological Association (2009) and Issues of Substance (2009).
Through these knowledge sharing opportunities, interest in implementing the GAIN SS in youth
serving agencies and in participating in collaborative research was generated in communities across
Canada. In 2009, the Health Canada, Drug Treatment Funding Program had a call for proposals.
With interest and stakeholder support from several provinces, Chaim and Henderson submitted a
proposal to engage youth-serving agencies in participating in a national youth screening project.
In 2010, while awaiting acceptance of their DTFP proposal, Chaim and Henderson, in collaboration
with the Toronto Concurrent Disorders Support Services Network, supported by the Toronto Central
Local Health Integration Network, launched another screening project, working with a cross-sectoral
group of 10 Toronto-based health and social service agencies focused on youth and adults seeking or
receiving service at their agencies. Similar to the GAIN Collaborating Network Project, service
providers’ attitudes regarding feasibility and utility of the GAIN SS were positive and stakeholders
reported that the research results were useful in identifying gaps in service and training needs for staff
(Hillman et al., 2011).
The National Youth Screening Project: Enhancing Youth-Focused, Evidence-Informed Treatment
Practices through Cross-Sectoral Collaboration was granted DTFP funding in 2010.
Objectives
Promote, facilitate and evaluate implementation of evidence-based screening procedures and tools
in cross-sectoral youth-serving agencies
Establish network protocols for referral and intervention to improve pathways to care for youth
Promote and facilitate collaboration and knowledge exchange amongst service providers through
the establishment of local cross-sectoral networks of youth-serving agencies
Increase use of reliable and valid tools across agencies and sectors
Evaluate and compare youth service needs across jurisdictions
Evaluate and compare pre-post service provider capacity re: evidence-based practices for youth
substance use with or without co-occurring mental health concerns
Promote a standardised screening protocol for youth concurrent disorders
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National Youth Screening Project: Thompson, Manitoba
Summary
Discussion about collaboration in Manitoba started in August 2009 and discussion about collaboration
specifically with the Thompson, Manitoba Network began in September 2010. This was followed by
several meetings, resulting in nine agencies committing to participate in the project. All necessary
Research Ethics Board (REB) submissions were approved and agreements were signed by
September 2011.
Over a staggered six month period, commencing in September 2011, a cross-sectoral group of nine
youth-serving agencies in and around Thompson, Manitoba undertook this collaborative project to
administer the GAIN SS and a demographic information form to youth aged 12 – 24 years seeking
service at their agencies. Service providers participated in training about youth substance abuse and
CD, with an emphasis on evidence-based screening practices, clinical use of the GAIN SS and
implementation of the project protocol. Service providers completed pre/post surveys about their own
knowledge, attitudes and practices related to youth substance use and mental health concerns. They
also provided feedback about their perceptions of the feasibility and utility of implementing the
screening tool in their practices and the impact of screening in particular and project participation
more generally on their referral practices. Presented in this report are the background and service
needs of youth who participated in this study as well as service provider perceptions of the screening
tool and related processes.
Development
In August 2009, Health Canada linked the project team with representatives of Manitoba Health who
were exploring concurrent disorder capacity building opportunities. Following the project funding
announcement, a process was initiated through the Co-occurring Disorders Initiative Leadership
Committee, a provincial network of regional health authority mental health and addiction agency
representatives to identify a Manitoba community network to participate in the National Youth
Screening Project. In September, 2010 it was agreed that the Addictions Foundation of Manitoba
(AFM), Thompson, would initiate network development in Thompson. Under the leadership of John
Donovan, a cross-sectoral network of nine local agencies that serve youth was formed and the AFM
took on the role of “Lead Agency”. Similar to the pilot screening projects described previously, the
agencies expressed interest in participating in a project to build capacity to identify and address the
complex needs of the youth who access their services as well as in having the opportunity to
document the needs of youth seeking service in their respective agencies, sectors and community.
Thompson, Manitoba
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In June 2011, the Addictions Foundation of Manitoba formally agreed to lead and coordinate a local
collaborative network to implement the GAIN SS1 with youth seeking service at the participating
agencies. The project team held a one-day training workshop for service providers, repeated on two
consecutive days to allow for all agency staff to be trained, in Thompson, Manitoba March 2-3, 2011.
Service providers attended from all nine participating agencies. Prior to the training, the service
providers were surveyed regarding their attitudes, knowledge and practices related to youth
substance use, mental health and co-occurring concerns. In September, two of the agencies
launched the six-month data collection phase. Four agencies were unable to submit completed
contracts in time to be included in the data collection activity of the project. Ma-Mow-We-Tak
Friendship Centre, Nisichawayasihk Cree Nation and School District of Mystery Lake participated in
capacity building and network development but did not participate in the data collection due to not
completing the contracts required for the project. Northern Health Region was unable to participate in
the data collection activity of the project due to challenges with staff turn over, but continued to
participate in the other three key project activities, including the GAIN SS implementation.
The Thompson, Manitoba Network was established based on shared interests and concerns, and
were particularly interested in building service capacity for youth in their community. Participation in
this research-community collaboration offered an opportunity to bring training and support for new
practices to the community. Furthermore, the network members expressed a desire to lay the
groundwork for on-going partnerships and collaboration through their participation in the NYSP.
Some members of the network were also interested and committed to ensuring that knowledge
gained through this collaborative effort be shared locally, provincially and nationally.
Partners
The Thompson, Manitoba Network includes representation from the addictions, child welfare,
outreach, housing and support, education, justice, and health sectors (see Appendix A for agency
descriptions). Two agencies participated in all four key activities of the project, which include:
Capacity Building, Network Development, Screening Implementation, and Data Collection. Please
refer to Appendix B for a description of key project activities and Appendix C for description of the
respective agency participation.
1 Chestnut Health Systems granted a license to Addictions Foundation of Manitoba to use the GAIN SS (CAMH Version)
and gave permission to Addictions Foundation of Manitoba to include all the participating agencies in the network in its licensing agreement.
Thompson, Manitoba
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Roles
National Project Team:
Provide resources for and support meetings of youth-serving agencies to support all aspects of
project participation;
Provide training to staff in identifying and addressing substance use and/or CD concerns in youth,
implementing the GAIN SS and the data collection protocol;
Provide all necessary screening and project-related materials;
Provide templates and support for developing response, resource and referral guides customised
for each community;
Obtain ethics approval through Health Canada and CAMH and support each agency to comply with
their ethics approval processes.
Lead Agency: Addictions Foundation of Manitoba
Identify local organizations, representing a minimum of 3 sectors to participate in the project as a
participating agency;
Vet prospective participating agencies for suitability;
Act as a liaison between CAMH and participating agencies during the term of the project;
Identify and facilitate agency leads to obtain local REB approval for the project;
Obtain licenses from Chestnut Health Systems Inc. for use of the GAIN SS for participating
agencies;
Support training provided by the project leads and facilitate provision of consultation as needed
throughout the project;
Facilitate pre and post service provider surveys of staff attitudes, knowledge and practices to all
agency staff involved in the project;
Facilitate data collection by the participating agencies.
Participating Agencies:
Comply with the agreed upon protocol by obtaining participant and parental consents, administering
GAIN SS and submitting the data to the lead agency for review;
Ensure staff participation in project-related training;
Maintain and store original data from participants as per REB policies and in accordance with legal
requirements;
Ensure that as many eligible youth as possible have the opportunity to be included in the project
and that the rates of eligibility and consent are tracked.
Thompson, Manitoba
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Implementation Process
(See Appendix D for Project Timeline)
Prior to initiating project activities, two separate agreements were signed:
1. A two-party agreement between CAMH and the Addictions Foundation of Manitoba, the network
lead agency.
2. A three-party agreement between CAMH, Addictions Foundation of Manitoba and each of the
respective participating agencies.
Each agreement described the project, roles, responsibilities, activities and commitments, as well as
the data collection protocol. These agreements were developed and signed by five of the agencies.
Four of the agencies, Ma-Mow-We-Tak Friendship Centre, Nisichawayasihk Cree Nation, School
District of Mystery Lake and Northern Health Region were unable to complete the agreements in time
to be included in the research component.
A collaborative process was used throughout the project to develop joint goals, materials and
processes as well as research questions and data analyses. The lead agency, Addictions Foundation
of Manitoba, was involved with the project throughout each stage of the project from initiation to
completion. Once the agency level training was completed and data collection was underway, the
lead agency, along with the project team at CAMH, was involved in communicating with the
participating agencies to maintain engagement, momentum, and compliance with the project protocol,
problem-solving of issues arising.
Implementation Process
1. May - November, 2010 – Networking:
a. Identified interested agencies
b. Established cross-sectoral network
2. September, 2010 - September, 2011– Agreements and REB:
a. Developed 2-party agreement between CAMH and Addictions Foundation of
Manitoba
b. Developed 3-party agreement between CAMH, Addictions Foundation of
Manitoba and all participating agencies
3. March 2-3, 2011– Capacity building
a. Capacity building across sites was delivered using the package developed by
the project leads
b. Project leads administered service provider consents and the Service Provider
Survey at the beginning of training day
c. Each Agency identified a lead to act as a “point person” for communication with
Thompson, Manitoba
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the Network Lead, including receiving and distributing project packages to the
participating service providers in their respective agencies
4. September 2011 – Project launch:
a. Distributed project packages i.e. project instruction sheets, consent forms, GAIN
SS, Background Information forms, tracking sheets
5. September 2011 – June 2012 – Project actively underway:
a. Service providers obtained consent from youth seeking service at their
agencies, administered the GAIN SS and Background Information Form
b. Anonymous copies of the completed measures and tracking sheets were
submitted to the network coordinator on a monthly basis, and delivered to
CAMH
c. Consultation was provided as needed by the network coordinator and/or project
coordinator/project leads
d. Staff feedback forms were collected on completion of the data collection
6. September 19, 2012 – Preliminary data analysis meeting:
Discussed:
a. Data analysis questions
b. Preliminary findings
c. Fit with expectations and experiences of the community
d. Lessons learned, including staff feedback provided on utility and feasibility of
administering the GAIN SS to youth in their agencies
e. Feedback from network and agency leads
f. Potential recommendations based on findings
g. Report dissemination plan
Materials
Service Provider Project Package
Service Provider Consent Form
The consent form described the project, confidentiality and plans for data management. Service
providers’ initials only were required to ensure anonymity.
Service Provider Survey
The Service Provider Survey is a self-report questionnaire that combines measures of service
providers’ 1) service-related knowledge, attitudes and practices regarding youth substance use,
mental health, co-occurring disorders, and screening; 2) perceptions of co-occurring disorders-
Thompson, Manitoba
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informed practices; 3) estimates of current use of CD-informed practices; and 4) experiences with
inter-agency referrals and collaboration.
Project Flow Chart (See Appendix E)
A step-by-step project flow chart was developed for use by all service providers to facilitate
consistency across providers.
Instructions for GAIN SS Use
A step-by-step one page protocol was developed for use by all service providers to facilitate
consistency across providers.
Referral Resource Guide
Customised templates listing local resources for consultation and referrals for follow-up to
endorsement of concerns on the GAIN SS were provided to each participating service provider.
GAIN SS Tracking Sheet
Tracking sheets were used to document rates of youth eligibility for project participation, consent/non-
consent, participation/reasons for non-participation, and data collection completion and submission for
each youth seeking service in each agency.
Feedback Survey
The feedback survey was designed to gather information from participating service providers
regarding their perceptions of the feasibility and utility of administering the GAIN SS to youth in their
setting and about the impact of the screening process on their practices.
Youth Project Package
Youth Consent Form
The consent form described the project, confidentiality and plans for data management. Youth initials
only were required to ensure anonymity.
Parental Consent Form
The consent form described the project, confidentiality and plans for data management. Parental
consent in addition to youth consent was required only where parental consent was required to obtain
services for youth under 16 years of age. Parent’s initials only were required to ensure anonymity.
Background Information Form
The Background Information Form is a one-page questionnaire used to gather demographic
information about the participating youth. The questions seek information about the determinants of
health frequently cited in the literature as associated with youth substance use and mental health
Thompson, Manitoba
19
concerns including age, sex, education, employment, income support, housing, legal involvement,
ethno-racial identification, and language diversity.
GAIN SS (CAMH Version)
The GAIN SS is a brief screening tool validated for use with individuals aged 10 years and older to
quickly identify those who may be experiencing difficulties in one or more of four dimensions: 1)
internal mental distress (e.g., depression, anxiety); 2) behavioural complexity (externalizing
behaviours e.g., ADHD); 3) substance use problems; and 4) crime and violence (Denis, Chan, &
Funk, 2006). The tool was developed by Chestnut Health Systems and copyrighted in 2005. Chestnut
Health Systems permitted CAMH’s Child, Youth and Family Program to modify the GAIN SS in 2006,
by adding seven items (not part of the original validation) at the end to screen for: eating-related
issues, trauma-related distress, disordered thinking and gambling, gaming and internet misuse
concerns.
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Thompson, Manitoba
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Findings
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Thompson, Manitoba
23
Background Information about Youth
Who participated?
In total, 34 youth participated:
21 (62%) from housing, outreach, and support sector
13 (38%) from addictions sector
How representative is the sample of youth who participated in the project?
Service providers were asked to use tracking sheets to record each youth eligible to participate.
Information collected on the tracking sheets included sex, age, consent response, and any comments
on why individual youth may not have been approached or refused to consent. All participating
agencies used this approach to track participation rates.
According to the tracking sheets provided by the service providers from the housing, outreach and
support sector 22 youth presented for service to the participating over the course of the six-month
project timeframe. Of these youth 100% were eligible for the project. Of the youth who were eligible to
participate in the project, 100% were approached for participation. Of the youth who were
approached, 95% completed the GAIN SS (N = 21) and 5% of youth who were asked to complete the
GAIN SS refused (N = 1). Of the youth who completed the GAIN SS, 100% consented to have a copy
used for the purposes of this project.
Overall then, based on these tracking sheet numbers, 95% of eligible youth presenting for service to
the housing, outreach and support sector contributed screeners for this report. No tracking sheets
were provided by service providers in the addictions sector, so it is not known what proportion of
eligible youth presenting for service to the addictions sector participated. As a result, the
representativeness of the sample is unknown and caution should be exercised in generalizing the
findings beyond the participating youth.
Thompson, Manitoba
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What are the demographics of the youth who participated?
AGE
FIGURE 1: AGE DISTRIBUTION OF PARTICIPANTS
The project aimed to involve youth ages 12 to 24. In this community, given the mandates of the
agencies involved, the participants ranged in age from 12 to 19 years, with an average age of 15.2
years and a median age of 16 years. In Figure 1, the ages of participating youth are presented using
age categories commonly used in service provision. As can be seen, more youth were in the 12-15
years age range than the 16-24 age category.
44%
56%
12-15 years old
16-24 years old
Thompson, Manitoba
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FIGURE 2: AGE DISTRIBUTION BY SERVICE SECTOR
When youth are grouped by sector (see Figure 2), it can be seen that two thirds of the participating
youth who presented for service to the addictions sector were in the older age group, whereas
approximately half of participating youth presenting to the addictions sector were 12 to 15 years old.
52%
31%
48% 69%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Housing, Outreach & Support Addictions
Pro
po
tio
n o
f Y
ou
th
Sector
16-24years
12-15years
Thompson, Manitoba
26
Sex
FIGURE 3: SEX DISTRIBUTION OF PARTICIPANTS
Almost half of participating youth were female (47%), while 50% were male, and 3% identified as
trans. In order to protect the privacy of participants, only those who identified as male or female are
included in subsequent analyses related to sex.
50% 47%
3%
Male
Female
Trans
Thompson, Manitoba
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FIGURE 4: SEX DISTRIBUTION OF PARTICIPANTS BY SERVICE SECTOR
Comparing the male to female ratio across the two sectors reveals that two-thirds of the youth
presenting to the addictions sector were male while less than half (43%) of the youth presenting to the
housing, outreach and support sector were male.
43%
67%
57% 33%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Housing, Outreach & Support Addictions
Pro
po
rtio
n o
f Y
ou
th
Sector
Female
Male
Thompson, Manitoba
28
Service History
FIGURE 5: SERVICE HISTORY BY SERVICE SECTOR
Approximately one third of youth (30%) participating in the project had been involved with the
participating service for less than one month, although there were significant differences between the
two sectors. For example, the majority of youth (58%) from the addictions sector completed the GAIN
SS in the past month while the majority of youth who completed the questionnaire in the housing,
outreach and support sector had been involved with the service for more than 2 months.
8% 11%
50% 44%
33% 44%
8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Housing, Outreach & Support Addictions
Pro
po
rtio
n o
f Yo
uth
Sector
More thana year ago
2-12MonthsagoIn the pastmonth
Today
Thompson, Manitoba
29
Ethnicity
FIGURE 6: ETHNICITY DISTRIBUTION OF PARTICIPATING YOUTH
Three percent of participating youth endorsed more than one ethnicity. The most commonly endorsed
ethnicity across all youth was Aboriginal (83%), followed by White/Europe (14%) ‘and ‘Other’ (3%).
Birth Country and First Language
All participants reported being born in Canada. The majority of participating youth also reported that
English was their first language (94%), while 3% reported French as their first language and 3%
reported Cree as their first language.
83%
14%
3%
Aboriginal
White / Europe
Other
Thompson, Manitoba
30
Living Arrangements
FIGURE 7: CURRENT LIVING ARRANGEMENTS
Most participating youth (62%) reported living in supportive housing (e.g. “group home”, “treatment
facility”), 26% reported that they were living with parents, 6% were living with other family members
while 3% were living on their own or with friends, and 3% reported living in unstable housing (e.g.
“shelter”, “on street”, “couch surfing”).
26%
3%
6% 62%
3% Parental/Family Home
Own/With Friends
Other Family/Relative
Supportive Housing
Unstable
Thompson, Manitoba
31
FIGURE 8: CURRENT LIVING ARRANGEMENTS BY SEX
Examination of sex differences in living arrangements revealed that 75% female youth reported
supportive housing while 53% of male youth reported supportive housing. This high rate of supportive
housing is not surprising as a significant proportion of youth participating are from the housing,
outreach and support sector.
35%
19%
6%
12%
53%
75%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Male Female
Pro
po
rtio
n o
f Y
ou
th
Sex
SupportiveHousing
OtherFamily/Relative
Own/With Friends
Parental/FamilyHome
Thompson, Manitoba
32
FIGURE 9: CURRENT LIVING ARRANGEMENTS BY AGE CATEGORIES
The majority of both younger and older youth reported living in a supportive housing context, as would
be expected given that the majority of participating youth are involved in the project through the
housing, outreach and support sector.
20% 32%
5%
7%
5%
73% 53%
5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12 to 15 16 to 24
Pro
po
rtio
n o
f Y
ou
th
Age (years)
Unstable
Supportivehousing
Otherfamily/relative
Own/with friends
Parental/familyhome
Thompson, Manitoba
33
FIGURE 10: CURRENT LIVING ARRANGEMENTS BY SERVICE SECTOR
As would be expected, youth presenting for service to the addictions sector reported a wider variety of
housing arrangements than youth presenting to the housing, outreach and support sector who were
exclusively residing in supportive housing.
69%
8%
15%
100%
8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Housing,Outreach & Support Addictions
Pro
po
rtio
n o
f Y
ou
th
Sector
Unstable
SupportiveHousing
OtherFamily/Relative
Own/WithFriends
Parental/FamilyHome
Thompson, Manitoba
34
Legal Involvement
Many of participating youth reported never having had any legal involvement (47%), while the
remaining youth reported legal involvement in the past 12 months (32%), or more than a year ago
(21%).
Education, Employment and Income
Overall 59% of participating youth identified as students. Of those who did not identify as students,
93% indicated that they were unemployed, and 7% indicated their employment status was unknown.
Thompson, Manitoba
35
How do the demographics of male and female youth compare?
TABLE 1: DEMOGRAPHIC COMPARISON OF MALE AND FEMALE PARTICIPANTS
Male Female
Average Age 14.7 15.9*
Aboriginal
White / European
88%
12%
81%
19%
English First Language 100% 94%
Legal Involvement 59% 50%
*p<.05
In an examination of the similarities and difference in demographic characteristics of male and female
youth, it was revealed that female youth were significantly older than male youth. No other significant
differences were revealed.
Thompson, Manitoba
36
Clinical Needs of Youth Based on the GAIN SS
The GAIN SS is a well-validated and reliable screener for mental health and substance use concerns
in youth and adults. It has four 5-item subscreeners embedded within the overall measure to screen
across four domains: Internalizing (INT) disorders (e.g., mood, anxiety disorders), Externalizing (EXT)
disorders (e.g., attention deficit/hyperactivity disorder), Substance Use disorders (SUB), and
engagement in Crime/Violence (CV). In order to fully understand the findings presented in this report,
it is important to understand the scoring decisions that informed the analyses. The GAIN SS has been
shown to have excellent sensitivity and specificity. These rates change, however, depending on how
the GAIN SS is scored and analyzed.
Within each subscreener using a moderate threshold of at least one recent (2-12 months ago) or
current (past month) concern has excellent sensitivity (94-98%) for identifying youth who will meet
diagnostic criteria for disorder, but lower (71-76%) specificity, i.e. lower accuracy in ruling out youth
who will not meet diagnostic criteria for disorder. Using a high threshold of three or more recent or
current concerns within one domain improves the specificity to 96-100%, but results in decreases in
sensitivity (49-68%). Using a threshold of three or more current or recent concerns endorsed across
all domains (total) will identify 91% of youth who will meet diagnostic criteria for a disorder and will
rule out 90% of youth who will not have a disorder (Dennis, Chan, & Funk, 2006).
Depending on the service setting, use of each threshold may be more appropriate. For example, in
settings where the rates of clinically significant mental health and substance use problems are
expected to be low (e.g. primary care), use of the moderate threshold may be most appropriate. In
settings where individuals are seeking service for mental health and substance use concerns, use of
the high threshold may be more informative.
For this project, a modified version of the GAIN SS was used (GAIN SS CAMH Modified Version)
which includes 7 additional items following the original subscreeners. These additional items provide
information about eating behavior, thinking-related issues, traumatic distress, and gambling, gaming
and internet overuse. Sensitivity and specificity data for these items are not yet available and these
items are not scored.
Thompson, Manitoba
37
FIGURE 11: NUMBER OF CONCERNS ENDORSED BY GAIN SS DOMAIN
As can be seen in Figure 11, two-thirds of participating youth endorsed 3 or more recent internalizing
concerns, suggesting that with a full diagnostic assessment they may meet criteria for a diagnosis in
the internalizing domain (e.g. mood disorder, anxiety disorder, etc.). In the externalizing domain
almost half of youth endorsed 3 or more recent externalizing concerns. Similarly, approximately half
(49%) of participating youth reported 3 or more recent indications of problematic substance use. In the
area of crime and violence 29% of youth reported 3 or more crime/violence concerns.
12% 9% 21% 24%
3%
21%
50% 30%
47%
8%
67%
41% 49%
29%
89%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
INT EXT SUB CV total
Pro
po
rtio
n o
f Y
ou
th
GAIN SS Domain
3+ recentconcerns
1-2 recentconcerns
No recentconcerns
Thompson, Manitoba
38
How do the needs of youth differ across sectors?
FIGURE 12: RECENT CLINICAL NEEDS USING MODERATE THRESHOLD (1+ ENDORSEMENTS) BY SERVICE SECTOR
In Figure 12, the needs of youth by service sector are presented. Using the threshold of 1
endorsement to identify youth who screen positive, the majority of youth, regardless of sector,
screened positive in each area of concern.
86% 86%
71% 67%
92%
100%
92% 92%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
INT EXT SUB CV
Pro
po
rtio
n o
f Y
ou
th
GAIN SS Domain
Housing,Outreach &Support
Addictions
Thompson, Manitoba
39
FIGURE 13: RECENT CLINICAL NEEDS USING HIGH THRESHOLD (3+ ENDORSEMENTS) BY SERVICE SECTOR
Using a threshold of three or more recent or current concerns within one domain improves the
specificity (i.e. fewer false positives) of the GAIN SS screener and allows identification of youth with
higher severity of needs.
As can be seen in Figure 13, the majority of youth presenting for service from both sectors have high
internalizing concerns. Youth presenting for service to the addictions sector had particularly high rates
of endorsement with 85% of youth indicating that they had experienced 3 or more internalizing
symptoms in the past year. Similarly, within the externalizing domain, just over 60% of youth from the
addictions sector reported they had experienced high severity externalizing difficulties, although fewer
(29%) youth from the housing, outreach and support sector reported similar difficulties.
In the substance use domain, youth in the addictions sector had higher rates of endorsement of
problematic substance use with just over two thirds of participating youth indicating that they had
experienced 3 or more symptoms of problematic substance use in the past year. Though lower, a
substantial proportion (38%) of youth presenting for service to the housing, outreach & support sector
also indicated that they had experienced 3 or more symptoms of problematic substance use in the
past year.
In the area of crime and violence, rates of endorsement were substantially lower than other domains,
although still 1 in 4 to 1 in 3 youth endorsed 3 or more crime and violence problems.
57%
29%
38%
24%
85%
62%
69%
39%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
INT EXT SUB CV
Pro
po
rtio
n o
f Y
ou
th
GAIN SS Domain
Housing,Outreach &Support
Addictions
Thompson, Manitoba
40
How do the needs of youth differ across age and sex categories?
FIGURE 14: RECENT INTERNALIZING CONCERNS BY AGE AND SEX CATEGORIES
Older youth (16-24 years) were more likely to endorse internalizing concerns than younger youth.
There were no differences between male and female participants.
44%
88%
33%
90%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12 to 15 16 to 24
Pro
po
rtio
n o
f Y
ou
th
Age
Male
Female
Thompson, Manitoba
41
FIGURE 15: RECENT EXTERNALIZING CONCERNS BY AGE AND SEX CATEGORIES
As shown in Figure 15, male youth aged 16 to 24 were more likely to endorse externalizing concerns
than other male or female youth.
22%
75%
17%
40%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12 to 15 16 to 24
Pro
po
rtio
n o
f Y
ou
th
Age
Male
Female
Thompson, Manitoba
42
FIGURE 16: RECENT SUBSTANCE USE CONCERNS BY AGE AND SEX CATEGORIES
Male youth aged 12 to 15 were more likely to endorse problematic substance use concerns than
same aged female youth. Older female youth were also more likely to endorse substance use
concerns than younger female youth.
56%
75%
0%
50%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12 to 15 16 to 24
Pro
po
rtio
n o
f Y
ou
th
Age
Male
Female
Thompson, Manitoba
43
FIGURE 17: RECENT CRIME AND VIOLENCE CONCERNS BY AGE AND SEX CATEGORIES
Crime and violence problems were more commonly endorsed by male than female youth, especially
male youth in the oldest age category.
22%
75%
0% 10% 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12 to 15 16 to 24
Pro
po
rtio
n o
f Y
ou
th
Age
Male
Female
Thompson, Manitoba
44
FIGURE 18: RECENT SUICIDE CONCERNS BY AGE AND SEX CATEGORIES
Given the clinical importance of suicide-related concerns, the single item related to suicide-related
thinking and behavior from the internalizing subscreener was examined. Overall, 6% of participating
youth indicated that they had thought about suicide in the past month, with an additional 9% reporting
having thought about suicide in the past 2 to 12 months and 18% more than 12 months ago. Sixty-six
percent of youth indicated they had never thought about suicide. When we examined rates of
endorsement by sex and age category it was revealed that male youth aged 16 to 24 had the highest
rates of suicide concerns (25%).
11% 25%
0% 10% 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12 to 15 16 to 24
Pro
po
rtio
n o
f Y
ou
th
Age
Male
Female
Thompson, Manitoba
45
Other Clinical Needs
How many youth endorsed additional areas of concern?
As part of the process of meeting the needs of service sector stakeholders, and with the permission of
Chestnut Health Systems, the copyright holders of the GAIN SS, we added 7 items to the end of the
GAIN SS. The items that were added were not part of the original GAIN SS nor the validation study
(Dennis et al., 2006), and as a result their reliability, validity, and utility are unknown. Nevertheless, it
was identified by stakeholders that it would be important to ask about other areas of concern expected
to be important for the youth participants so that these areas could be explored further if youth
indicated any concerns. The items were from the areas of eating concerns (2 items), traumatic stress
(1 item), disordered thinking concerns (2 items), gambling concerns (1 item) and gaming/internet
concerns (1 item).
FIGURE 19: RATES OF RECENT ADDITIONAL CONCERNS BY SEX CATEGORY
As can be seen, the distressing memories/dreams (traumatic distress) item was endorsed by
approximately half of youth and was the most commonly endorsed additional item. Youth were least
likely to endorse concerns about gambling.
24% 18%
53% 41%
18%
41%
12% 6%
31%
44%
27%
6% 0% 0%
0%10%20%30%40%50%60%70%80%90%
100%
Pro
po
rtio
n o
f Y
ou
th
Additional Concerns
Male
Female
Thompson, Manitoba
46
Concurrent Substance Use and Mental Health Concerns
This project used the GAIN SS to identify youth who are likely to have concurrent disorders (i.e., co-
occurring substance use and mental health concerns). Youth who endorsed at least three recent
concerns in the substance use domain as well as at least three recent concerns in either the
internalizing or externalizing domain were identified as endorsing a concurrent disorder.
How many youth endorsed both substance use and mental health concerns?
FIGURE 20: RATES OF ENDORSEMENT OF CONCURRENT DISORDERS
INT
SUD
9%
0% 9%
0%
9%
32%
24% Did not screen positive for INT, EXT, or
SUD
18%
EXT
Thompson, Manitoba
47
Overall, 50% of youth screened positive for more than one area of concern, and 41% of participating
youth screened positive for possible concurrent (substance and mental health) disorders. As can be
seen in the Figure 20, approximately one third (32%) of all participating youth screened positive for
co-occurring internalizing, externalizing and substance use concerns, and 9% endorsed concurrent
internalizing and substance use concerns. No youth indicated concurrent externalizing and substance
use concerns without co-occurring internalizing concerns.
Thompson, Manitoba
48
How similar were rates of Concurrent Disorder endorsement across service sectors?
FIGURE 21: RATES OF ENDORSEMENT OF CONCURRENT DISORDERS BY SERVICE SECTOR AND SEX
Female youth from the addictions sector had the highgest rates endorsement of concurrent disorders
with three quarters of female youth screening positive for concurrent disorders. The lowest rates of
concurrent disorders were found in female youth receiving service in the housing, outreach and
support sector.
44% 50%
17%
75%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Housing, Outreach, & Support Addictions
Pro
po
rtio
n
of
Yo
uth
Sector
Male
Female
Thompson, Manitoba
49
What factors are related to endorsing both mental health and substance use concerns?
Age and Sex
FIGURE 22: RATES OF ENDORSEMENT OF CONCURRENT DISORDERS BY AGE AND SEX
Older male and female youth were more likely to endorse concurrent concerns than younger youth.
Living Arrangements
For the purposes of the following analyses living arrangements were reduced to two categories: 1)
parental/family home and 2) living outside of the parental/family home. Youth who live outside of the
parental/family home were no more likely to endorse concurrent disorders than youth living in the
parental/family home (56% vs 36% respectively); although with a larger sample size this difference
may have become statistically significant.
22%
75%
0%
50%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12 to 15 16 to 24
Pro
po
rtio
n
of
Yo
uth
Age
Male
Female
Thompson, Manitoba
50
Legal Involvement
FIGURE 23: RATES OF ENDORSEMENT OF CONCURRENT DISORDERS BY LEGAL SYSTEM INVOLVEMENT
For the purposes of the following analyses, legal involvement was reduced to two categories: 1) no
legal involvement and 2) previous legal involvement. Youth who reported past legal involvement were
no more likely to endorse concurrent disorders (39%) than youth who reported no previous
involvement with the legal system (33%).
Educational Status
When we compared youth who identified as students to those who did not, it was revealed that 45%
of students endorsed concurrent substance use and mental health concerns, and just over one third
(36%) of non-students screened positive for concurrent disorders.
43% 47%
25% 31%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
No legal involvement Previous legal involvement
Pro
po
rtio
n o
f Y
ou
th
Legal Involvement
Male
Female
Thompson, Manitoba
51
How many participants endorsed multiple areas of concern in their lives?
FIGURE 24: COMPLEXITY OF NEEDS
In order to understand how many participants experience multiple areas of concern we also examined
the following social determinants of health, along with mental health and substance use concerns: 1)
housing (unstable or supportive), 2) education/occupation (under 18 and not a student or 18 and older
and not a student and not employed), 3) legal involvement (past or current legal involvement), 4)
internalizing concerns (high severity), 5) externalizing concerns (high severity), and 6) substance use
problems (high severity). As can be seen, approximately two thirds of participants reported having 3
or more factors and almost a fifth of participants reported experiencing 5 or more of the 6 factors.
Results did not differ for male and female youth. These findings highlight the complexity of the needs
of the individuals who are presenting for service and participated in this project.
29%
53%
18%
38%
50%
13%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0-2 3-4 5-6
Pro
po
rtio
n o
f Y
ou
th
Number of Significant Needs
Male
Female
Thompson, Manitoba
52
Service Provider Survey
This project included a survey about service providers’ attitudes, knowledge, and practices regarding
youth substance use, mental health, and concurrent disorders. Questions about interagency
collaboration and interagency referral practices were also included in the survey. In addition, the
project included a feedback survey that gathered information regarding the feasibility, utility, and
impact of using the GAIN SS.
Service providers in Thompson, Manitoba (n = 43) completed the service provider survey prior to
participating in the project’s capacity building training event, but few completed the feedback survey (n
= 3) at the end of data collection. As a result, findings from this component of the project are not
presented here. Instead the information from Thompson service providers will be included in the
National Youth Screening Project national report. We have provided here, however, some anecdotal
comments about service providers’ experiences.
Service provider comments about administering the GAIN SS:
“GAIN was doable; youth were willing to complete; it didn’t drive them away, easy
to do, created a good discussion with young people.”
“GAIN SS screener was easy to apply and led to questioning.”
“GAIN SS has an easy format to open up dialogue.”
“I do not use the GAIN-SS on any of the youth I come into contact with, but I
would like to start.”
Thompson, Manitoba
53
Service provider comments about the feasibility and utility of the GAIN SS in their
practices
“I hope this can be used for advocacy purposes for more mental health
resources, and to put in place a new practice of mental health assessments for
all people who screen positively on the GAIN.”
“Very helpful to have local data on our youth. We can do planning based on who
we actually are seeing.”
Thompson, Manitoba
54
Summary of Findings
Youth presenting for services from addictions and housing, outreach, & support service sectors
contributed information to this report.
Based on information provided by service providers, approximately 95% of eligible youth presenting
to housing, outreach and support services completed the GAIN SS and 100% of youth completing the
GAIN SS consented to have their information included in this report. Information about the
representativeness of the youth sample for the addictions sector, however, is not available. As a
result, caution should be exercised in generalizing the findings beyond the participating youth.
Youth aged 12-19 years participated, with differences in age being apparent across service sectors.
Participants yielded an almost 50/50 split of male and female youth (50% male, 47% female, and
3% trans), and the addictions sector had significantly more male participants than the housing,
outreach, & support sector.
The majority of participants identified their ethnicity as Aboriginal, all reported being born in Canada
and most reported having English as their first language.
The majority of participating youth screened positive for significant internalizing or externalizing
mental health concerns and/or problematic substance use. Moreover, substantial numbers of youth
from each sector endorsed significant difficulties. Of particular note are the high rates of mental health
concerns among youth presenting to the addictions sector.
Rates of endorsement across domains differed for male and female youth and for younger and
older youth.
Fifteen percent of participating youth reported significant suicide-related concerns in the past year.
Half of participating youth screened positive for more than one disorder and 41% of youth screened
positive for co-occurring mental health and substance use concerns. Notably, approximately one third
of participating youth endorsed high severity concerns in both mental health domains (internalizing
and externalizing) and problematic substance use.
Thompson, Manitoba
55
Discussion
Youth Needs
The findings of this project in Thompson, Manitoba suggest that many youth presenting for service,
regardless of which sector they present to, are experiencing significant substance use and/or mental
health concerns. Moreover, half of participating youth endorsed significant concerns in more than one
domain, and over 40% of youth screened positive for co-occurring substance and mental health
concerns. In addition, the vast majority of youth presenting to the addictions sector had significant co-
occurring mental health concerns. These findings suggest that recent efforts to improve capacity to
address co-occurring substance use and mental health problem are warranted and that the need for
mental health services for youth with problematic substance use is high.
The findings of this report also support the need for gender-sensitive and developmentally-informed
approaches with youth. The concerns and needs of male and female youth differed, as did the needs
and concerns of younger and older youth. For example, 16 to 24 year old male youth were more likely
to report externalizing difficulties than same-aged female youth and younger youth. Also older female
youth were more likely to endorse problematic substance than younger female youth but problematic
substance use by male youth did not differ significantly by age.
These, and other findings from the project, have implications for service delivery, both in terms of
thinking about issues such as access, but also in terms of what services might be most applicable at
different ages and for male and female youth. Unfortunately the number of youth who identify as trans
who participated was too small to allow for meaningful analyses. Future projects should aim to better
understand the needs of this often overlooked group of youth.
Project and Implementation Processes
As described in this report there were several essential steps required to initiate, carry out and
complete this project. First and foremost, local leadership was required to build a network through
identifying, engaging and supporting partners from various youth service sectors. Addictions
Foundation of Manitoba, Thompson Office, took a strong leadership role, embracing the “Lead
Agency” role after being identified through a provincial process facilitated by the Mental Health and
Spiritual Care Branch of Manitoba Health. The interest and enthusiasm of the network lead and the
initial support of the network coordinator resulted in the engagement of agencies representing six
sectors (addictions, health, justice, child welfare, outreach, housing and support, and education),
exceeding the four sectors they initially agreed to enlist. Service providers from all six sectors
participated in the network development and capacity building activities. Ultimately, due to
Thompson, Manitoba
56
administrative challenges including staff turnover, agencies representing only two sectors, addictions
and outreach, housing and support, participated in all the project activities (See Appendix C).
Providing more than one capacity building event, including teleconference training options for those
who could not attend the “live” events, provided greater opportunity for all agency staff to receive
training directly from the project leads. This helped to ensure that all aspects of the protocol were
clearly and consistently communicated. Agencies decided to send staff who would participate in the
full project, staff who might use the screening tool with populations that were not part of this project
(e.g., adults older than 24 years), as well as staff who would not be administering the screener, given
their role in the agency but might receive youth who had been screened. As such, the capacity
building component of the project had a broader reach than initially anticipated.
Following completion of data collection, through the Thompson network lead, the project team learned
that GAIN SS administration has continued in at least one agency beyond the six month project data
collection phase. In addition, Youth At Risk North (YARN) is a recently funded program that works
with youth who are accessing services through multiple agencies, including those that were part of the
NYSP. YARN is administered by the Thompson Boys and Girls Club; its Steering Committee is
chaired by the NYSP Thompson lead (AFM) and it has received funds to provide GAIN SS training to
other agencies, particularly justice and schools. As well, as noted above, some of the agencies that
didn’t participate in the formal data collection portion of the project, nonetheless, had implemented the
GAIN SS in their agencies. This highlights the importance of considering unanticipated
consequences and suggests that an initiative such as this project may have the potential to
significantly impact agency practice.
Limitations
The findings of this project are limited by a few important factors. The system to capture the extent to
which the sample is representative of youth typically presenting to the participating services (service
provider completed tracking sheets) has limitations and the data indicate that some tracking sheets
were not completed, although the extent of the problem is not clear. As a result, the relevance of the
findings to youth who did not participate is not clear. Secondly, the screening tool is a high level
screening tool intended to identify youth who would be likely to have a diagnosis with a full
assessment and who thus would benefit from assessment and service planning. As a result, it does
not provide detailed information about the areas of concern that are identified. Lastly, different service
providers and services engaged with the project to differing extents which may have impacted the
findings in unknown ways.
Thompson, Manitoba
57
Recommendations
Gender-informed and gender-specific services should be considered to ensure that links to all
necessary services are available where male and female youth are more likely to present for service
and to ensure that once accessed, the services that are delivered are designed to address the
different types of difficulties male and female youth experience. Further research is needed to
address the needs of youth who identify as trans or other youth who do not identify as solely male or
female.
Developmentally informed and responsive services are indicated in order to meet the needs of
transitionally aged youth (16 to 24 years), especially those who are seeking and/or receiving
services in the adult service sector.
Continued capacity building regarding concurrent disorders across sectors is warranted given that
almost half of participants endorsed significant co-occurring mental health and substance use
concerns. In particular, given the high rate of mental health concerns amongst youth with substance
use concerns, ensuring access to mental health services (or “concurrent disorder” services) for
youth with problematic substance use concerns is critical. This project aimed to improve early
identification and pathways to care through evidence-based practice in the form of screening using
a standardized tool. Subsequent projects should consider the importance of capacity building
regarding interventions to address concurrent disorders.
Building capacity for trauma-informed care across sectors is also suggested, given that
approximately half the youth endorsed concerns related to traumatic distress.
While this project examined youth needs at one point in time in service delivery, consideration
should be given to the potential utility of repeating administration of the screening tool at subsequent
points in the service delivery process for the purposes of monitoring within treatment progress and
post-treatment outcomes.
Further study is also recommended to examine the relative impacts of training, agency policy,
protocols, monitoring, supervision and administrative support on implementation of new practices,
such as the implementation of a consistent screening tool and process, as was examined in this
project.
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Appendices
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Appendix A: Thompson, Manitoba Network Member Agency Descriptions
Addictions Foundation of Manitoba (AFM) – Lead agency
The Addictions Foundation of Manitoba is a crown agency responsible for addictions services across
the province of Manitoba. The services include residential treatment for substance abuse and also
one center, which provides residential problem gambling programs. AFM also provides community
based services in almost all non First Nations communities, some on an itinerant basis. The AFM
does Impaired Driver assessments on all drivers charged with a DUI. School based counseling is
provided in a little over 50 school in Manitoba, with some schools having a fulltime substance abuse
counselor. AFM provides prevention and education services across the province on issues related to
substance abuse and problem gambling. Work place services and employee assistance training is
offered in each of the three regions in Manitoba. The AFM in Thompson also provides counselling for
out of school youth as well as referral to the youth residential program at Southport.
Boys and Girls Club
Boys and Girls Club of Thompson operates a youth drop in centre for youth 10 to 18 with after school
programs, weekend and evening programs for youth in the club house, along with street outreach.
Workers funded under the Sexually Exploited Youth funding and also one funded by the AFM, provide
street outreach during the evenings and until four in the morning on weekends to address the needs
of youth at risk in the community at agency off-hours. The Boys and Girls Club also operates “Youth
Build” which is school basics and work skills training program for 20 youth per year. The youth apply
from across the province to participate; they receive a wage dependent on attendance and progress
in both the academic and vocational training aspects of the program. The youth receive life skills
training and social supports to assist in making them successful in and out of the project. The Youth
At Risk North program is managed by the Boys and Girls Club, providing supports and integrated
case management to the youth and families of 30 youth who are involved in multiple agencies.
Marymound
Marymound is a provincial wide organization founded by the Grey Nuns, to offer support and
assistance to youth and families. The provision of foster care, group homes and support programs is
the primary role in Thompson. Marymound also operates a live in and day school in Winnipeg for
female youth who are experiencing behavior and family problems. Marymound operates the only
youth drug stabilization unit in Manitoba, located in Winnipeg, under the “support for parents act”
which provides a seven day apprehension setting for youth unwilling to seek help with their substance
abuse. Marymound has been operating in Thompson since the mid seventies and has a residential
facility which houses youth from infants to youth aging out of care.
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Macdonald Youth Services
Sir Hugh John Macdonald Youth Services, locally referred to as Macdonald Youth Services, is a
provincial organization which provides living supports, both foster and group homes as well as
independent living, to youth in care. The services include recruiting, training and supporting foster
parents in communities across the province with a large number in the north to maintain children close
to their families and culture. The group homes range from intake and assessment, short term respite
environments to long term homes for male or female youth across the province. MYS also hosts the
Street Outreach services for youth substance abuse. The services for youth support include school
programs, wilderness camp, work programs and independent living situations.
Probation Services
Probation Services in Thompson is a regional base for all communities both on and off reserve in the
north east portion of Manitoba. The staff work with youth in all communities and access the youth via
northern and/ or winter roads, fly in and train access. The programs in Thompson address the needs
of youth from court, in the Intensive Support and Supervision Program as well as those in the
alternative justice initiatives. The Addictions Foundation has a worker in the probation office twice
weekly to work with youth referred and or, ordered to counseling by the judge. The youth have often
been in custody at the youth correctional facilities in southern Manitoba and on probation for a period
following.
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Appendix B: Key Project Activity Descriptions
Network Development
Member agencies that participated in the Network Development activity played a foundational role in
building a collaborative network, starting with preliminary discussions regarding project participation.
These agencies participated in several meetings with the project team, in addition to network specific
meetings and training. The agency leads and broader network membership also collaborated with the
project team to carry out the project.
Capacity Building
Service providers and agency leads from interested agencies participated in a half-day evidence-
based youth co-occurring disorders capacity building session and a half-day screening and
intervention protocol training session. During this session, where agencies had committed to full
project participation and had obtained research ethics approval, service providers also completed the
Service Provider Survey. Some agencies that participated in the Capacity Building activities were
interested in participating in the full project but were not able to due to resource or administrative
challenges, such as difficulties completing legal and/or ethics processes in the required network
timeframe.
Screening Implementation
Member agencies that participated in the full project implemented the GAIN SS with youth seeking
services at their agencies. Some agencies chose to implement the GAIN SS with the youth seeking
service for clinical purposes, but did not participate in the full data collection component of the project
(see below).
Data Collection
Member agencies that participated in the full project participated in a six month data collection period.
During this time, the GAIN SS and Background Information Form were administered to youth seeking
service at their agencies and, with consent, a copy was sent to the project team. The data was
prepared by the project team and a local community report was generated through a collaborative
process between the project team and the participating agencies.
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Appendix C: Agency Project Activity Participation
SECTOR Agency name
Project activity
Network Development
Capacity Building
Screening Implementation
Data Collection
Addictions Addictions Foundation of Manitoba ● ● ● ●
Child welfare Nisichawayasihk Cree Nation ● ●
Education School District of Mystery Lake ● ●
Justice Manitoba Justice ● ●
Mental health Northern Health Region ● ●
Outreach, housing & support
Thompson Boys and Girls Club Inc ● ●
Marymound Inc ● ●
Ma-Mow-We-Tak Friendship Centre ● ●
Sir John Hugh MacDonald Youth Services ● ● ● ●
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Appendix D: Project Timeline
Year 1 Year 2 Year 3
2010 2011 2012 2013
Apr - Jun
July - Sept
Oct - Dec
Jan - Mar
Apr - Jun
July - Sept
Oct - Dec
Jan - Mar
Apr - Jun
July - Sept
Oct - Dec
Jan - Mar
Networking: Introduce project to
potential participating agencies
Establish cross-sectoral network:
REB Approval & Signing of MOU
Training for participating agencies
Project launch
Project actively underway
Preliminary findings presented
Report to stakeholders
Legend
Thompson, Manitoba timeline
National Youth Screening Project Timeline
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Appendix E: Project Flow Chart
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Appendix F: References
Centre for Addiction and Mental Health. (2006). Navigating screening options for concurrent disorders.
Toronto, ON: Author.
Chaim, G. & Henderson, J. (2009). Innovations in collaboration: Findings from the GAIN Collaborating
Network Project. Toronto, ON: Centre for Addiction and Mental Health.
Dennis, M.L., Chan, Y.F., & Funk, R.R. (2006). Development and validation of the GAIN Short Screener
(GSS) for internalizing, externalizing and substance use disorders and crime/violence problems
among adolescents and adults. American Journal on Addictions, 15, 80-91.
Health Canada (2002). Best practices: Concurrent mental health and substance use disorders. Ottawa,
ON: Author.
Henderson, J., Chaim, G., & Rush, B. (2007). Knowledge, skills and tools: Addressing the mental health
and addiction needs of youth. Symposium presentation, Issues of Substance 2007 Conference,
Edmonton, AB.
Henderson, J., Chaim, G., & Goodman, I. (2009, August). Evaluating youth concurrent disorders across
youth-serving agencies in Toronto, Canada. Paper presentation, 117th Annual Convention of the
American Psychological Association, Toronto, ON.
Henderson, J., MacKay, S., & Peterson-Badali, M. (2010). Interdisciplinary knowledge translation: Lessons
learned from a mental health - fire service collaboration. American Journal of Community
Psychology, 46, 277-288.
Hillman, L., Chaim, G., & Henderson, J. (2011). Cross-sector collaboration in action: Findings from the
Concurrent Disorders Support Services Screening Project. Toronto, ON: Authors
McElheran, W., Eaton, P., Rupcich, C., Basinger, M., & Johnston, D. (2004). Shared mental health care:
The Calgary model. Families, Systems & Health. 22(4), 424–438.
Murphy, R. A., Rosenheck, R. A., Berkowitz, S. J., & Marans, S. R. (2005). Acute service delivery in a
police-mental health program for children exposed to violence and trauma. Psychiatric Quarterly,
76(2), 107-201.
National Treatment Strategy Working Group (2008). A systems approach to substance use in Canada:
Recommendations for a National Treatment Strategy. Ottawa, ON: National Framework for Actions
to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada.
Oliver, C., & Dykeman, M. (2003). Challenges to HIV service provision: The commonalities for nurses and
social workers. AIDS Care, 15(5), 649-663.
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Reid, G.J., Evans, B., Brown, J.B., Cunningham, C.E., Lent, B., Neufeld, R., Vingilis, E., Zaric, G., &
Shanley, D. (2006). Help – I need somebody: The experiences of families seeking treatment for
children with psychosocial problems and the impact of delayed or deferred treatment. Ottawa, ON:
Canadian Health Services Research Foundation.
Robillard, A.G., Gallito-Zaparaniuk, P., Arriola, K. J., Kennedy, S., Hammett, T., & Braithwaite, R. L.
(2003). Partners and processes in HIV services for inmates and ex-offenders. Facilitating
collaboration and service delivery. Evaluation Review, 27, 535-562.
Rush, B., Castel, S., & Desmond, R. (2009). Screening for concurrent substance use and mental health
problems in youth. Toronto, ON: Centre for Addiction and Mental Health.
Skilling, T., Henderson, J., Root, C., Chaim, G., Bassarath, L., & Ballon, B., (2007). Who are our clients?
Comparing the mental and addiction needs of adolescent clients across two CAMH programs.
Poster Presentation, Annual Convention of the Canadian Psychological Association, Ottawa, ON.
