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

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

PROCESS & METHODS

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

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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)

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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.

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NRI File Review Process

Test DB Table

Production DB Table

Edit Report

Corrective action

Data file

NRI Server

Make sure transaction code is changed when resubmitting files

Processed records are stored unless deleted.

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

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

Diagnostic Groupings

• Schizophrenia – 295.* • Delusional & Other Psychoses – 297*, 298* • Anxiety Disorders – 300, 300.0*, 300.11-300.19, 300.2*,

300.3*, 300.6*, 300.7*, 300.81, 308.3*, 309.81, 309.89, 309.21, 309.24

• Depressive Disorders – 296.2*, 296.3*, 300.4*, 311*, 309.0*, 309.28

• Bipolar Disorders – 296.0*, 296.4*-296.8*, 301.13 • Intellectual Disability – 317*-319* • Personality Disorders – 301.0*, 301.1-301.12, 301.14-

301.19, 301.2*-301.9*, 312.3*, V71.01, V71.02 • ADHD – 314* • Conduct Disorders – 312.8*, 312.9* • Oppositional Defiance Disorder – 313.81

OVERVIEW

Basic Client Information & State Hospital Readmission Data Sets

2012 Submitting States

Alabama

Alaska

California

Georgia

Illinois

Iowa

Maine

Massachusetts

Michigan

Minnesota

Mississippi

New Hampshire

North Carolina

Oregon

Pennsylvania

South Dakota

West

Virginia

Puerto Rico Virgin Islands

Guam

Colorado

Montana

AR AZ

FL

IN

KS KY

LA

MO

NV

OK

RI

SC

TX

UT

WA

WI

WY

CT

DE

HI

ID

MD

ND

NE NJ

NM

NY

OH

TN

VA

VT

BCI & SHR Data

BCI Data Only

No 2012 BCI or SHR Data

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

2012 BCI: Number of Clients Reported by State

2012 SHR: Number of Discharges Reported by State

Between Years Analysis

Client-Level Data For 2011 & 2012

Alabama

Alaska

California

Georgia

Illinois

Iowa

Maine

Massachusetts

Michigan

Minnesota

Mississippi

New Hampshire

North Carolina

Oregon

Pennsylvania

South Dakota

West

Virginia

Puerto Rico Virgin Islands

Guam

CO

MT

AR AZ

FL

IN

KS KY

LA

MO

NV

OK

RI

SC

TX

UT

WA

WI

WY

CT

DE

HI

ID

MD

ND

NE NJ

NM

NY

OH

TN

VA

VT

2011 only 2011 & 2012 2012 only

Between Years Analysis

17 States with 2011 & 2012 BCI Data

Total Unique Clients Over Two Years

2,614,193

ACCESS TO SERVICES/CAPACITY: SERVICE CHARACTERISTICS

National Outcome Measure

Treatment Status in 2012 by Age Group

Status at End of Reporting Period (T2)

Status at Start of Reporting Period

(T1)

Age Group Status Discharged Continuing Total

Children (0-17) N=904,286 (27.6%)

New 25% 28% 53%

Continuing 16% 31% 47%

Total 41% 59% 100%

Adults (18-64) N=2,246,293 (68.5%)

New 25% 20% 45%

Continuing 14% 41% 55%

Total 39% 61% 100%

Elderly (65+) N=127,249 (3.9%)

New 19% 11% 30%

Continuing 14% 56% 70%

Total 33% 67% 100%

All Clients N=3,280,900

New 25% 22% 46%

Continuing 15% 39% 54%

Total 39% 61% 100%

Between Years Analysis

Treatment Status of Clients Over Two Years, 2011-2012

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%

Discharge Reasons 2012, Excludes clients ‘Continuing’ at the end of 2012

N=1,287,926; missing=0

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

Service Settings 2012

No Missing Service Settings Data

ACCESS TO SERVICES/CAPACITY: DEMOGRAPHIC CHARACTERISTICS

National Outcome Measure

Gender 2012

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

Gender by Age 2012

N=3,277,828 (99.9%); missing=3,072 (0.1%)

Mental Health Client Age Distribution vs. United States Population

2012

Race Ethnicity

2012

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

Marital Status 2012 BCI, Ages 18+

N=1,590,242 (67.0%); missing=784,911 (33.0%)

ACCESS TO SERVICES/CAPACITY: DIAGNOSTIC CHARACTERISTICS

National Outcome Measure

Total* N=2,101,112 (88.5%); missing=274,041 (11.5%)

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%)

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=803,130 (88.8%); missing=101,570 (11.2%)

Diagnostic Groups for Children: Gender 2012, Ages <18

Clients may have multiple diagnoses Total percentages for each gender add up to more than 100%

Diagnostic Groups: Marital Status 2012, Ages 18+

Total N=1,414,676 (59.6%); missing=960,477 (40.4%)

Single vs. Multiple Diagnoses 2012

Anxiety & Depression Comorbidity 2012

Selected Comorbidities 2012

Between Years Analysis

Changing Diagnoses from 2011 to 2012

Substance Abuse Problems 2012, Ages 12+

N=2,363,284 (83.1%); missing=479,542 (16.9%)

State Variance in % of Clients with

Substance Abuse Problem

State Median

26.5%

State Min.

1.7%

State Max.

99.99%

Substance Abuse Problems by Age 2012, Ages 12+

N=2,363,284 (83.1%); missing=479,542 (16.9%)

Substance Abuse Problems by Diagnostic Group

2012, Ages 12+

Total N=2,193,589 (77.2%); missing=649,237 (22.8%)

Substance Abuse Diagnoses 2012

N=2,450,514 (74.7%); missing=830,386 (25.3%)

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%)

STABILITY IN HOUSING

National Outcome Measure

Residential Status for Adults 2012, At Start of Reporting Period, Ages 18+

N=1,614,038 (68.0%); missing=761,115 (32.0%)

Gender & Homelessness 2012, Ages 18+, at Start of Reporting Period

Percent of Clients that are Homeless State Variance in % Homeless

Male Female

State Median

6.1% 3.0%

State Min.

0.5% 0.4%

State Max.

45.5% 44.4%

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%)

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%)

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%)

Homelessness Rates: Substance Abuse Diagnosis 2012, At Start of Reporting Period, Ages 18+

Male: N=510,367 (47.7%); missing=558,999 (52.3%) Female: N=633,162 (48.5%); missing=671,014 (51.5%)

Homelike Residence: Diagnostic Groups

2012, At Start of Reporting Period, Ages 18+

Total N=1,509,203 (63.5%); missing=865,950 (36.5%)

Residence Data at T1 & T2 2012

Residential Status at T1 Residence Status at T2 Updated Residence Status & Multiple Service Events only

N=2,252,229

N=1,054,951

Data Exclusion Process: T1-T2 Residence Change Within 2012

2012

State Variance in % Included

State Median

26.9%

State Min.

0%

State Max.

84.6%

Residence Change within 2012 from T1 to T2

Clients with a valid residence update flag and multiple service dates only

Total N=1,054,951

Between Years Analysis

Data Exclusion Process: Residence Change From T1 2011 to T2 2012

State Variance in % Included

State Median

37.6%

State Min.

1.1%

State Max.

91.6%

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

ADULT EMPLOYMENT

National Outcome Measure

Adult Employment Status 2012, At Start of Reporting Period, Ages 18-64

N=1,427,729 (63.5%) ; missing=819,832 (36.5%)

Race Ethnicity

Adult Employment: Race & Ethnicity 2012, At Start of Reporting Period , Ages 18-64

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%)

Adult Employment: Diagnostic Group

2012, At Start of Reporting Period , Ages 18-64

Total N=1,344,579 (59.8%); missing=902,982 (40.2%)

Employment Data at T1 & T2 2012, Ages 18-64

Employment Status at T1 Employment Status at T2 Updated Employment Status & Multiple Service Events only

N=1,427,729

N=755,030

Data Exclusion Process: T1-T2 Employment Change within 2012

State Variance in % Included

State Median

25.7%

State Min.

0%

State Max.

83.7%

Employment Change within 2012 from T1 to T2

Ages 18-64; Clients with an updated employment status and multiple service dates only

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

N=701,581

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 18-64 in both years

CRIMINAL JUSTICE INVOLVEMENT

National Outcome Measure

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%)

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%)

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%)

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

Data Exclusion Process: T1 to T2 Arrest Change Within 2012

Arrested in Prior 30 Days: Start and End of Reporting Period

Clients with multiple service dates only

State Variance in % Arrested

Start of Reporting

Period

End of Reporting

Period

State Median

2.9% 2.6%

State Min.

0.0% 0.0%

State Max.

9.5% 7.3%

Arrested in Prior 30 Days: Change from T1 to T2 within 2012

Clients with multiple service events only

SCHOOL ATTENDANCE IN CHILDREN

National Outcome Measure

School Attendance Data Overview 2012, Ages 3-17

School Attendance in Children

Student Age: Grade Level and Diagnostic Group

2012, Ages 3-17, Attending School

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%)

READMISSION TO STATE HOSPITALS

National Outcome Measure

Discharges from State Psychiatric Hospitals

2012 SHR Data Set

N=82,641; missing=0

Days Until Readmission 2012 SHR Data Set, First discharge records only

N=67,449; missing=0

Readmission Legal Status First discharge records only; Clients with readmissions only

2012 SHR Data Set

N=14,979 (95.1%); missing=773 (4.9%)

State Variance in Legal Statuses

Voluntary Involuntary

Average 17.5% 82.5%

State Median

10.7% 89.3%

State Min.

0% 25.9%

State Max.

74.1% 100%

Discharge Reason 2012 SHR Data Set, First discharge records only

N=58,747 (87.1%); missing=8,702 (12.9%)

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%)

DATA ISSUES

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

Missing Data for Selected Variables

2012, States not submitting specific data excluded from % missing

Valid data

Missing data

2013 DATA SUBMISSIONS

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

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

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

Technical Support

• Forward your queries to:

cldta@nri-inc.org

• Copies of the Manual and Data Crosswalk Template and future announcements, please check: http://www.nri-inc.org/projects/SDICC/urs_forms.cfm

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NASMHPD Research Institute, Inc. 3141 Fairview Park Dr. Suite 650 Falls Church, VA 22042 www.nri-inc.org

Ted Lutterman 703-738-8164 703-738-8185 (Fax) ted.lutterman@nri-inc.org

Contact Information