The Calculating an Adequate System Tool (CAST) was created in 2016 when JG Co-Owner and Principal Researcher Brandn Green was working for the Substance Abuse and Mental Health Services Administration (SAMHSA). Brandn and fellow researchers at SAMHSA determined there was a technological gap in the reporting process when measuring the capacity of behavioral health care systems – and this process could be more streamlined with the use of technology. Enter CAST: the Calculating an Adequate System Tool. CAST was created as a tool for evaluating the capacity of the substance abuse care system within a given geographic area. In order to do this, quantitative risk scores are combined with secondary data and mixed methods data collection to provide users with a risk assessment of substance abuse treatment needs across the given geographic area.
The first version of the CAST tool was piloted in Chicago and Newaygo County MI. The successful pilot led to the introduction of CAST published in Preventing Chronic Disease: A Tool for Assessing a Community’s Capacity for Substance Abuse Care. Since its publication, CAST has been updated and a handbook for use created. The handbook describes the tool as follows:
“CAST was created as a method for evaluating the capacity of the substance abuse care system within a defined geographic area. CAST provides users with both a risk assessment of county-level social and community determinants of substance abuse, and an assessment of local service need across the continuum of care […] CAST uses social determinants of behavioral health and social disparities in behavioral health outcomes to provide insight into the chronic social conditions that may be contributing to behavioral health outcomes in your community. Most often, CAST has been used to estimate need for a county as the geographic unit, but it can be used for smaller or larger areas, as long as data at those geographic levels is available or could be produced at that scale.”
The CAST tool fills a very unique gap in the reporting process for behavioral health care systems and has now been used in several states (Delaware, Pennsylvania, Montana, Nevada, Oregon, and Ohio), as well as in Missoula County, MT and Sussex County, DE. As of February 2023 the CAST tool has been converted into a web based application for ease of use and broader utilization, with Kate Salemo (formerly of JG) as lead developer. There is nothing comparable to this service; CAST’s distinctive proprietary algorithms do the estimating for the need for services and reflect the unique characteristics of the given population. Now that the CAST tool exists on the internet it allows users to run and refine assessments and estimates themselves – from anywhere.
The CAST tool and has been highlighted in the popular press (Washington Post) and a federal review of Needs Assessment Methodologies in Determining Treatment Capacity for Substance Use Disorders for promising approaches to estimating system capacity. To dive in and look at how the tool is used we will look at the following contemporary cases of CAST in action in Nevada, Oregon and Ohio.
In 2019 CAST was used by the Nevada Substance Abuse Prevention and Treatment Agency for the Regional Capacity Assessment Report: Southern Rural Region. The tool was used to estimate the entirety of the state’s substance use by adjusting for the large variation in population density within Nevada’s counties. The results produced were able to help inform legislation and decision making for the benefit of Nevada residents.
For the state of Oregon CAST was used in the 2022 Oregon Substance Use and Disorder Services Inventory and Gap Analysis report. Kate and Brandn worked closely with the project leads at Oregon’s Health and Science University to understand gaps in the state’s prevention, treatment, and recovery services. CAST was used to estimate risk and service capacity needs which then informed statewide planning efforts to improve the substance use case system. In order to do this assessment, the tool drew on data from a needs assessment, literature reviews, and Oregon specific utilization of services data to calculate the estimate of services needed.
In Ohio, the app has been used for recovery residents across the state. This is one of the most exciting and contemporary uses of the CAST tool.
The future of CAST looks like continued use of the tool as well as expansion of the methodology into other realms of public health. Plans for development include expanding into the mental health system and care systems for youth. If you have interest in learning more about CAST, please contact brandn@jgresearch.org.