2012 Client-Level Data Analysis Webinar

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1 2012 Client-Level Data Analysis Webinar Ted Lutterman Data Analysis by Craig Colton, Neal DeVorsey, Glorimar Ortiz Special Thanks to Azeb Berhane September 24, 2013

2 Agenda Process & Methods Data Sets Overview National Outcome Measures Access to Services/Capacity: Client Characteristics Stability in Housing Adult Employment Criminal Justice Involvement School Attendance in Children Readmission to State Hospitals Data Issues 2013 Data Submissions

3 PROCESS & METHODS

4 MH CLD Files: Basic Client Information (BCI) Data Files BCI = Master file (all clients served) Contains all clients who received services funded by the SMHA during the reported period From all treatment settings: community, state hospital, residential treatment centers, other psychiatric facilities, jail/correctional facilities Both types of clients: new and continuing Regardless of treatment status at the end of the reporting period: discharged or continuing 4

5 MH CLD Files: State Hospital Readmission (SHR) Data Files Contains all clients who received services and have at least one discharge episode from the state hospital during the reporting period Excluded: transfers or discharges that constitute a transfer (e.g. transfer to a different ward within the same state hospital or to a medical facility to receive a temporary medical care) 5

6 Relationship Between BCI and SHR BCI and SHR are linkable files Use the same unique client ID of the person All persons in the SHR should have been reported in the BCI; and At least one of their service setting is state hospital Difference between BCI and SHR An individual reported in the BCI should have only one record. An individual reported in the SHR may have as many records as the number of times the person was discharged from the state hospital. 6

7 NRI File Review Process Make sure transaction code is changed when resubmitting files Corrective action Edit Report Data file NRI Server Test DB Table Production DB Table Processed records are stored unless deleted.

8 MH CLD Data Review Process When files are processed, they are checked against the CLD edits Fatal errors: Will cause the data file or the record to be rejected All errors that occur in the header record are considered fatal errors and will result in the data file being rejected Non-fatal errors: Errors will be flagged but the data will be processed and saved in the database

9 Analysis Methods Labeling variables and values Identifying missing and invalid values New variable creation Defining diagnostic groups Identifying changes in employment, housing, or arrests Simplifying variables Creating data set for longitudinal analysis between-years (2011 &2012) Matching client ID s

10 Diagnostic Groupings Schizophrenia 295.* Delusional & Other Psychoses 297*, 298* Anxiety Disorders 300, 300.0*, , 300.2*, 300.3*, 300.6*, 300.7*, , 308.3*, , , , Depressive Disorders 296.2*, 296.3*, 300.4*, 311*, 309.0*, Bipolar Disorders 296.0*, 296.4*-296.8*, Intellectual Disability 317*-319* Personality Disorders 301.0*, , , 301.2*-301.9*, 312.3*, V71.01, V71.02 ADHD 314* Conduct Disorders 312.8*, 312.9* Oppositional Defiance Disorder

11 Basic Client Information & State Hospital Readmission Data Sets OVERVIEW

12 2012 Submitting States WA BCI & SHR Data BCI Data Only No 2012 BCI or SHR Data New Hampshire Montana ND Minnesota VT Maine Oregon California NV ID UT WY Colorado South Dakota NE KS Iowa MO WI Illinois Michigan IN KY OH West Virginia Pennsylvania VA NY Massachusetts RI CT NJ DE AZ NM OK AR TN North Carolina SC MD Mississippi Alabama Georgia TX LA Alaska FL Guam HI Puerto Rico Virgin Islands

13 Basic Client Information (BCI) & State Hospital Readmission (SHR) 2012 Data Sets 2012 BCI Data 31 States, 1 Territory 3,280,900 Clients 2012 SHR Data 29 States, 1 Territory 82,641 Discharge Records 67,449 Unique Clients

14 2012 BCI: Number of Clients Reported by State

15 2012 SHR: Number of Discharges Reported by State

16 Between Years Analysis Client-Level Data For 2011 & 2012 WA New Hampshire MT ND Minnesota VT Maine Oregon California NV ID UT WY CO South Dakota NE KS Iowa MO WI Illinois Michigan IN KY OH West Virginia Pennsylvania VA NY Massachusetts RI CT NJ DE AZ NM OK AR TN North Carolina SC MD Mississippi Alabama Georgia TX LA Alaska FL Guam HI 2011 only 2011 & only Puerto Rico Virgin Islands

17 Between Years Analysis 17 States with 2011 & 2012 BCI Data Total Unique Clients Over Two Years 2,614,193

18 National Outcome Measure ACCESS TO SERVICES/CAPACITY: SERVICE CHARACTERISTICS

19 Treatment Status in 2012 by Age Group Status at End of Reporting Period (T2) Age Group Status Discharged Continuing Total Status at Start of Reporting Period (T1) Children (0-17) N=904,286 (27.6%) Adults (18-64) N=2,246,293 (68.5%) Elderly (65+) N=127,249 (3.9%) All Clients N=3,280,900 New 25% 28% 53% Continuing 16% 31% 47% Total 41% 59% 100% New 25% 20% 45% Continuing 14% 41% 55% Total 39% 61% 100% New 19% 11% 30% Continuing 14% 56% 70% Total 33% 67% 100% New 25% 22% 46% Continuing 15% 39% 54% Total 39% 61% 100%

20 Between Years Analysis Treatment Status of Clients Over Two Years, Only Clients with Two Years of BCI Data T2 in 2012 Discharged Continuing T1 in 2011 Total 53.6% 46.4% New Client 42.3% 24.6% 17.7% Continuing Client 57.7% 21.3% 36.5%

21 N=1,287,926; missing=0 Discharge Reasons 2012, Excludes clients Continuing at the end of 2012

22 Service Dates, Single or Multiple 2012 Percent of Clients With One Service Date Average State Median State Min. State Max. Children (0-17) 15.4% 11.0% 0.5% 73.4% Adults (18-64) 14.8% 13.6% 0.4% 47.7% Elderly (65+) 13.6% 13.7% 0.4% 66.6% Al Clients 14.9% 12.9% 0.4% 49.5% No Missing Service Events Data

23 No Missing Service Settings Data Service Settings 2012

24 National Outcome Measure ACCESS TO SERVICES/CAPACITY: DEMOGRAPHIC CHARACTERISTICS

25 Valid N=3,278,516 (99.9%); missing=2,384 (0.1%) Gender 2012

26 N=3,277,828 (99.9%); missing=3,072 (0.1%) Gender by Age 2012

27 Mental Health Client Age Distribution vs. United States Population 2012

28 Race 2012 Ethnicity N=3,157,040 (96.2%); missing=123,860 (3.8%) N=2,812,827 (85.7%); missing=468,073 (14.3%)

29 N=1,590,242 (67.0%); missing=784,911 (33.0%) Marital Status 2012 BCI, Ages 18+

30 National Outcome Measure ACCESS TO SERVICES/CAPACITY: DIAGNOSTIC CHARACTERISTICS

31 Diagnostic Groups for Adults & Children 2012 Clients may have multiple diagnoses Total percentages for each age group add up to more than 100% Total* N=2,101,112 (88.5%); missing=274,041 (11.5%)

32 Diagnostic Groups for Adults: Gender 2012, Ages 18+ Clients may have multiple diagnoses Total percentages for each gender add up to more than 100% Total* N=2,101,112 (88.5%); missing=274,041 (11.5%)

33 Diagnostic Groups for Children: Gender 2012, Ages <18 Clients may have multiple diagnoses Total percentages for each gender add up to more than 100% Total* N=803,130 (88.8%); missing=101,570 (11.2%)

34 Total N=1,414,676 (59.6%); missing=960,477 (40.4%) Diagnostic Groups: Marital Status 2012, Ages 18+

35 Single vs. Multiple Diagnoses 2012

36 Anxiety & Depression Comorbidity 2012

37 Selected Comorbidities 2012

38 Between Years Analysis Changing Diagnoses from 2011 to 2012

39 Substance Abuse Problems 2012, Ages 12+ State Variance in % of Clients with Substance Abuse Problem State Median State Min. State Max. 26.5% 1.7% 99.99% N=2,363,284 (83.1%); missing=479,542 (16.9%)

40 N=2,363,284 (83.1%); missing=479,542 (16.9%) Substance Abuse Problems by Age 2012, Ages 12+

41 Total N=2,193,589 (77.2%); missing=649,237 (22.8%) Substance Abuse Problems by Diagnostic Group 2012, Ages 12+

42 N=2,450,514 (74.7%); missing=830,386 (25.3%) Substance Abuse Diagnoses 2012

43 SED & SMI Reported 2012 Severe Emotional Disturbance (SED) in Children (Ages <18) Severe Mental Illness (SMI) in Adult Clients (Ages 18+) Total missing=227,627 (6.9%)

44 National Outcome Measure STABILITY IN HOUSING

45 N=1,614,038 (68.0%); missing=761,115 (32.0%) Residential Status for Adults 2012, At Start of Reporting Period, Ages 18+

46 Gender & Homelessness 2012, Ages 18+, at Start of Reporting Period Percent of Clients that are Homeless State Variance in % Homeless Male Female State Median State Min. State Max. 6.1% 3.0% 0.5% 0.4% 45.5% 44.4%

47 Homelessness Rate: Age & Gender 2012, At Start of Reporting Period Male: N=1,070,796 (68.0%); missing=503,423 (32.0%) Female: N=1,143,532 (69.0%); missing=512,679 (31.0%)

48 Homelessness Rates 2012, At Start of Reporting Period, Ages 18+ Race Ethnicity Male: Total N=698,488 (65.3%); missing=370,878 (34.7%) Female: Total N=879,786 (67.5%); missing=42,439 (32.5%) Male: Total N=573,246 (53.6%); missing=496,120 (46.4%) Female: Total N=732,019 (56.1%); missing=572,157 (43.9%)

49 Homelessness Rates: Selected Diagnostic Groups 2012, At Start of Reporting Period, Ages 18+ Total N=1,508,607 (63.6%); missing=864,935 (36.4%)

50 Male: N=510,367 (47.7%); missing=558,999 (52.3%) Female: N=633,162 (48.5%); missing=671,014 (51.5%) Homelessness Rates: Substance Abuse Diagnosis 2012, At Start of Reporting Period, Ages 18+

51 Homelike Residence: Diagnostic Groups 2012, At Start of Reporting Period, Ages 18+ Total N=1,509,203 (63.5%); missing=865,950 (36.5%)

52 Residence Data at T1 & T Residential Status at T1 Residence Status at T2 Updated Residence Status & Multiple Service Events only N=1,054,951 N=2,252,229

53 Data Exclusion Process: T1-T2 Residence Change Within State Variance in % Included State Median State Min. State Max. 26.9% 0% 84.6%

54 Total N=1,054,951 Residence Change within 2012 from T1 to T2 Clients with a valid residence update flag and multiple service dates only

55 Between Years Analysis Data Exclusion Process: Residence Change From T to T State Variance in % Included State Median State Min. State Max. 37.6% 1.1% 91.6%

56 Between Years Analysis Residence Change from T1 in 2011 to T2 in 2012 Only clients with valid residence update flags and multiple service dates in both years

57 National Outcome Measure ADULT EMPLOYMENT

58 N=1,427,729 (63.5%) ; missing=819,832 (36.5%) Adult Employment Status 2012, At Start of Reporting Period, Ages 18-64

59 Adult Employment: Race & Ethnicity 2012, At Start of Reporting Period, Ages Race Ethnicity Race: Total N=1,409,241 (62.7%); missing=838,320 (37.3%) Ethnicity: Total N=1,191,756; (53.0%) missing=1,055,805 (47.0%)

60 Total N=1,344,579 (59.8%); missing=902,982 (40.2%) Adult Employment: Diagnostic Group 2012, At Start of Reporting Period, Ages 18-64

61 Employment Data at T1 & T2 2012, Ages Employment Status at T1 Employment Status at T2 Updated Employment Status & Multiple Service Events only N=755,030 N=1,427,729

62 Data Exclusion Process: T1-T2 Employment Change within 2012 State Variance in % Included State Median State Min. State Max. 25.7% 0% 83.7%

63 Total N=701,581 Employment Change within 2012 from T1 to T2 Ages 18-64; Clients with an updated employment status and multiple service dates only

64 N=701,581 Employment Change within 2012 from T1 to T2 Ages 18-64; Clients with an updated employment status and multiple service dates only

65 Between Years Analysis Employment Change from T1 in 2011 to T2 in 2012 Only clients with multiple service events, valid employment update flags, and aged in both years

66 National Outcome Measure CRIMINAL JUSTICE INVOLVEMENT

67 Arrested in 30 Days Prior to Start of Reporting Period: Age 2012 Total N=1,333,850 (40.7%); missing=1,947,050 (59.3%)

68 Arrested in 30 Days Prior to Start of Reporting Period: Race 2012 Race Ethnicity Male: Total N=618,886 (38.6%); missing=984,867 (61.4%) Female: Total N=668,269 (39.9%); missing=1,006,494 (60.1%) Male: Total N=614,637 (38.3%); missing=989,116 (61.7%) Female: Total N=662,458 (39.6%); missing=1,012,305 (60.4%)

69 Arrested in 30 Days Prior to Start of Reporting Period: Diagnostic Group 2012 Male: Total N=603,832 (37.7%); missing=999,921 (62.3%) Female: Total N=661,099 (39.5%); missing=1,013,664 (60.5%)

70 Arrested in 30 Days Prior to Start of Reporting Period: Substance Abuse (SAP) & Severe Mental Illness (SMI) 2012, Ages 18+ Male: Total N=319,315 Female: Total N=428,229

71 Data Exclusion Process: T1 to T2 Arrest Change Within 2012

72 Arrested in Prior 30 Days: Start and End of Reporting Period Clients with multiple service dates only State Variance in % Arrested State Median State Min. State Max. Start of Reporting Period End of Reporting Period 2.9% 2.6% 0.0% 0.0% 9.5% 7.3%

73 Arrested in Prior 30 Days: Change from T1 to T2 within 2012 Clients with multiple service events only

74 National Outcome Measure SCHOOL ATTENDANCE IN CHILDREN

75 School Attendance Data Overview 2012, Ages 3-17 School Attendance in Children

76 Student Age: Grade Level and Diagnostic Group 2012, Ages 3-17, Attending School

77 School Attendance Among Children 2012, Ages 3-17 Race Ethnicity Race: Total N=150,544 (16.9%); missing =742,599 (83.1%) Ethnicity: Total N=153,271 (17.2%); missing =739,872 (82.8%)

78 National Outcome Measure READMISSION TO STATE HOSPITALS

79 N=82,641; missing=0 Discharges from State Psychiatric Hospitals 2012 SHR Data Set

80 N=67,449; missing=0 Days Until Readmission 2012 SHR Data Set, First discharge records only

81 Readmission Legal Status First discharge records only; Clients with readmissions only 2012 SHR Data Set State Variance in Legal Statuses Voluntary Involuntary Average 17.5% 82.5% State Median State Min. State Max. 10.7% 89.3% 0% 25.9% 74.1% 100% N=14,979 (95.1%); missing=773 (4.9%)

82 N=58,747 (87.1%); missing=8,702 (12.9%) Discharge Reason 2012 SHR Data Set, First discharge records only

83 Readmission Rates Within 30 & 180 Days: Diagnostic Group 2012 SHR Data Set, First discharge records only Total N= 64,795 (96.1%); missing=2,654 (3.9%)

84 DATA ISSUES

85 Data Issues Incomplete data Various invalid entries Changes in employment/residence with single service event 30+ arrests in prior 30 days Children under 13 in college/grad school or married/widowed/divorced

86 Valid data Missing Data Missing data for Selected Variables 2012, States not submitting specific data excluded from % missing

87 2013 DATA SUBMISSIONS

88 Timeline for 2013 CLD Submission September: State Data Crosswalk Upon crosswalk approval: Test Files Submit only the recommended file size December 2, 2013: BCI Production Files After successful test file submission March 3, 2014: SHR files Within completion of the 6-month observation window

89 MH CLD Data Edits NRI is finalizing the development of an edit program that allows states to check data for quality/edit issues before submission. More information on the data edit program

90 Reporting of URS Tables by States Submitting MH CLD in 2013 States Submitting a second year of MH CLD do not need to submit these URS Tables that can be calculated from MH CLD: Table 2: Total Clients Served by Age, Gender, Race Table 3: Total Clients Served by Setting Table 4: Employment Table 14: SMI/SED Clients by Age, Gender, Race Table 14a: SMI/SED Clients by Setting Table 15: Living Situation States Submitting MH CLD information on Arrests, School Attendance and/or Readmissions do not need to submit these URS tables: Table 19a: Criminal Justice Involvement Table 19b: School Attendance/Grade Level Tables 20a/b: State Hospital Readmissions

91 Technical Support Forward your queries to: Copies of the Manual and Data Crosswalk Template and future announcements, please check: 91

92 Contact Information NASMHPD Research Institute, Inc Fairview Park Dr. Suite 650 Falls Church, VA Ted Lutterman (Fax)

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