Incorporating the GAIN-SS into a tablet-based self-reported assessment for use in an integrated youth health centre


Authors: Gabrielle Chartier, MD-MSc (1); Javiera Pumarino (2,3,4) ; Steve Mathias, MD (1,2,3) ; Chris Richardson, PhD (2,3,4)

1. Department of Psychiatry, UBC; 2. Inner City Youth Program, Providence Health Care; 3. Centre for Health Evaluation & Outcome Sciences (CH.OS), Providence Health Care; 4. School of Population and Public Health, UBC


Quality improvement evaluation of a tablet-based waiting room assessment implemented in a youth-oriented integrated primary care centre, which:

  1. Captures clients’ (a) psychosocial functioning and (b) sociodemographic characteristics.
  2. Generates real-time report with clinical profile of youths' mental health and substance use for clinicians to review immediately prior to clinical encounter.

These assessments can improve the quality of care by:

  1. Reducing time devoted to data-gathering.
  2. Helping orient encounters according to youths' priorities.
  3. Acting as a "patient-activation" tool.

Real-time clinical report may help clinicians to:

  1. Identify and address mental health and substance use problems in early stage.
  2. Show more empathy and engagement during encounter.

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Presented at: 22nd International Association for Child and Adolescent Psychiatry and Allied Professions World Congress. Calgary, AB; Sep 18–22, 2016.



• Design and implement tablet-based CAHPS administration in a safety net setting. 
• Conduct formative qualitative work to create shorter, lower literacy patient experience items. 
• Explore broader concepts of & preferences for reporting patient experience among vulnerable patients. 

 Fig 1: Question Module

Fig 1: Question Module




1. Tablet-based waiting-room survey (n=465):

  • Completed between Aug. 2015 and Aug. 2016 at the Granville Youth Health Centre in Vancouver, BC.
  • HEADSS and GAIN-SS, plus Q.I. indicators: youth's perceptions of the tablet system.
  • $5 gift card as honorarium.

2. Anonymous exit survey (n=625):

  • Clients were invited to complete survey on the tablet-based system after their clinical encounter (Aug. 2015 to Aug. 2016.)
  • Included: (a) perceptions of pre-visit survey and (b) whether they felt it improved their clinical experience.
  •  $5 gift card as honorarium.

3. Staff survey and interviews (n=15):

  • Staff completed survey of perceptions of the tablet-based health survey and report between Sep. and Oct. 2015.
  • They were also interviewed to get feedback on the system and identify potential short-term improvements.

Tablet Interface

Developed through a process of co-creation with youth, health care professionals and administrators.

 Fig 2: Tickit Survey Interface

Fig 2: Tickit Survey Interface

  • Gamification, pictograms, and icons:
    • Increased youth engagement and appreciation.
    • Decreased level of literacy.
    • Reduced cultural biases.
    • Higher self-disclosure of stigmatized behaviours.


  • Assessment content is organized into HEADSS blocks:
    • Home and Demographics
    • Sex
    • Education
    • Eating
    • Activities
    • Emotions (GAIN-SS)
    • Safety
    • Drugs
    • Health

GAIN-SS (Global Appraisal of Individual Needs Short Screener)

 Fig 3: Tickit Dashboard

Fig 3: Tickit Dashboard

  • Mental health and substance use screening tool for youth.
  • 5 minutes, 23 items, 4 subscales:
    • Internalizing Disorder
    • Externalizing Disorder
    • Substance Disorder
    • Crime & Violence


  • Produced in real-time for clinicians to review prior to clinical encounter.
  • Can be reviewed online, printed, or downloaded as pdf.
  • Provides overview of patient's situation:
    • GAIN-SS summary
    • Alerts
    • All responses

Results: Clients


 Fig 4: Client Results Acceptability

Fig 4: Client Results Acceptability

  • Female: 54%
  • Mean Age: 21.3, Range 12-30
  • Aboriginal: 23%, Caucasian 60%
  • Graduated high school: 57%
  • Homeless or Couch Surfed in the past month: 39%
 Fig 5: Client Results Comprehension

Fig 5: Client Results Comprehension

Today I am here to discuss (pick up to 3):

  1.  My Feelings (59%)
  2.  Physical Health (35%)
  3. Alcohol/Drugs (25%)
  4. Sexual health (22%)
  5. School/work issues (18%)
  6. Eating/nutrition (15%)
  7. Family issues (11%)
  8. Relationship issues (11%)
  9. My Safety (9%)
Source: Waiting room survey
 Fig 6: Client Results Ease of Use

Fig 6: Client Results Ease of Use

 Fig 8: Client Results in appointment

Fig 8: Client Results in appointment

 Fig 7: Client Results Patient Buy-In

Fig 7: Client Results Patient Buy-In

 Fig 9: Client Results Prepardeness

Fig 9: Client Results Prepardeness


 Results: Staff

Staff Interviews

 Fig 10 : Staff Surveys

Fig 10 : Staff Surveys

  • Majority of the staff was satisfied with training. Suggested to complete Health Survey before training.
  • Staff did not feel familiar with the GAIN-SS, which is most often used in research; would have liked more training.
  • Alerts were appreciated by the staff, helped to identify rapidly what was relevant. Provided suggestions to improve alerts' clinical relevance.
  • Some Feedback
    • “I was able to hone some of my questions into a specific area more quickly”
    • “Provided more in depth information” 
    • "Survey helps her feel more focused during the interview and get to the point faster.
    • "Overall this is an excellent tool. I sometimes find it challenging with time management of booked appointments (...)"
    • "Great work! I like it a lot"
    • "This has been a lot easier than expected"

 Fig 11: Staff Interviews tool usefulness

Fig 11: Staff Interviews tool usefulness

 Fig 12: Staff Interviews efficiency

Fig 12: Staff Interviews efficiency



  • Encouraging results! One year after implementation:
    • Youth are satisfied and seem comfortable with the survey platform.
    • Youth think survey helps prepare them for visit and helps staff provide better care.
  • One month after implementation:
    • Staff are using the reports and finding them to be a useful tool to support their clinical practice.
    • Staff have a quick access to demographic data, which is thought to reduce the time allowed to data-gathering and help them focus the sessions on identified priorities.
    • Survey makes encounter more efficient for most staff, although reviewing the reports reduced efficiency in some cases


In partnership with Silver Wheaton, The Canadian Institute of Health Research and the Centre for Health Evaluation & Outcome Sciences


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