04/24/02 1 Cross-system Utilization using Three Years of Data Paul Stiles, J.D., Ph.D.Diane Haynes, M.A. 813) [voice] (813) [voice] Policy & Services Research Data Center Department of Mental Health Law & Policy Louis de la Parte Florida Mental Health Institute University of South Florida Bruce B. Downs Blvd. Tampa, FL Pinellas Data Collaborative

04/24/02 2 PDC Background Established under F.S. 163 Several organizations in county participating including: –BOCC-- DJJ –DSS-- JWB –Courts/Sheriff-- DCF –EMS--FMHI (repository)

04/24/02 3 Data Sets Criminal Justice [CJIS] Dept of Social Services [DSS] DCF/ADM [IDS] Medicaid [AHCA] Juvenile Welfare Board [JWB] Child Welfare [CW] Emergency Medical Services [EMS] Baker Act [BA]

04/24/02 4 On-going Questions/Analyses Use and cost of Acute Care (Baker Act) services in the county Use of Acute Care (Baker Act) by children Overlap of identified population (PEMHS) in JWB that are in Medicaid Network Analysis on Individuals Dealing with Substance Abuse Continuity of Care Study (GPW Closing) How many kids being served by JWB are also involved in the Child Welfare system?

04/24/02 5 Cross Systems Utilization: Initial Questions What is the measure/degree to which adults and children in the 8 systems have caseload overlap for over a three year period ( )? What is the measure/degree to which high users in the systems have caseload overlap over a three year period ( )?

04/24/02 6 Overview The Eight Systems The Statistical Method used in this study Findings

04/24/02 7 Eight Systems Included in this Study Criminal Justice [CJIS] Dept of Social Services [DSS] DCF/ADM [IDS] Medicaid [AHCA] Juvenile Welfare Board [JWB] Child Welfare [CW] Emergency Medical Services [EMS] Baker Act [BA]

04/24/02 8 CJIS 35% DSS 34% EMS 24% IDS 58% MMH 77% JWB 19% CW 24% BA 21% CJIS35% DSS36% EMS24% IDS51% MMH79% JWB15% CW15% BA15% Between 1998 and 1999Between 1999 and 2000Between 1998 and 2000 CJIS25 % DSS21 % EMS 19 % IDS44% MMH64% JWB34% CW13% BA13 % Overlap within each system across years - All

04/24/02 9 CJIS 28% DSS 33% EMS 18% IDS 55% MMH 56% JWB 8% CW 65% BA 38% CJIS26% DSS29% EMS19% IDS41% MMH57% JWB3% CW58% BA18% Between 1998 and 1999Between 1999 and 2000Between 1998 and 2000 CJIS14% DSS13% EMS11% IDS21% MMH40% JWB0% CW53% BA13% Overlap within each system across years - HH

04/24/02 10 Statistical Method Probabilistic Population Estimation (PPE) Caseload Segregation/Integration Ratio (C-SIR) This process relies on information in existing databases and the agencies do not have to share unique person identifiers. It avoids the expense of case-by-case matching and sensitive issues of client-patient confidentiality.

04/24/02 11 Probabilistic Population Estimation (PPE) A statistical method for determining the number of people represented in a data set that does not contain a unique identifier. The estimation is based on a comparison of information on the distribution of Date of Birth and Gender in the general population with the distribution of Date of Birth and Gender observed in the data sets. The number of distinct birthday/gender combinations that occurred in each data subset are counted. The number of people necessary to produce the observed number of birthday/gender combinations are then calculated.

04/24/02 12 Caseload Segregation/Integration Ratio (C-SIR) C-SIR = C-SIR is a rating between 0 and 100 which indicates the amount of overlap of clients between agencies. Zero being no overlap at all and 100 being total overlap. Duplicated Count Unduplicated Count - 1 Duplicated Count Largest Undup. Count - 1  * 100

04/24/02 13 One year Overlap/C-Sir (44) IDS MMH 7,447 3,996 3,131 Unique ID Count PPE Count Population Cross MMH 7,104 7, % IDS 11,640 11, %

04/24/02 14 Findings from last year’s analysis There is very little overlap in users between the systems that were looked at. The caseload integration/segregation rating in this study varied from 5 to 44 on a scale of 0 to 100. The greatest overlap is between IDS and MMH, the mental health systems It is the non-high users that are more likely to cross multiple systems, not the high users. If an individual is a high user in one system, they probably are not in the other systems.

04/24/02 15 Three Year Overlap/C-Sir-Adults Total Population

04/24/02 16 Three Year Overlap/C-Sir-Kids Total Population

04/24/02 17 Three Year Overlap/C-Sir-Adults “Heavy Hitters”

04/24/02 18 Three Year Overlap/C-Sir-Kids “Heavy Hitters”

04/24/02 19 Overlap/C-Sir JWB & CW JWB Child Welfare 48,639 23,720 17,563

04/24/02 20 Overlap/C-Sir EMS & IDS/MMH/BA (All Age Groups)

04/24/02 21 We need your help!! Help with what systems to cross Help with predicted pathways (so that we can look at service use patterns over time) Help selecting other systems to include (e.g., Education?) Help with interpretation

04/24/02 22 Demographics (ALL-Adults)

04/24/02 23 Demographics (ALL-Kids)

04/24/02 24 Reference Banks, S. & Pandiani, J. (1998). The use of state and general hospitals for inpatient psychiatric care. American Journal of Public Health, 99(3), Banks, S., Pandiani, Gauvin, L, Readon, M.E., Schacht, L., & Zovistoski, A. (1998). Practice patterns and hospitalization rates. Administration and Policy in Mental Health, 26(1), Banks, S, Pandiani, J. & James, B (1999). Caseload segregation/integration: A measure of shared responsibility for children & adolescents. Journal of Emotional & Behavioral Disorders, 7(2), p Banks, S, Pandiani, J., Bagdon, W., & Schacht, L. (1999). Causes and Consequences of Caseload Segregation/Integration. 12 th Annual Research Conference (1999) Proceedings, Research and Training Center for Children’s Mental Health. Pandiani, J., Banks, S., & Gauvin, L. (1997). A global measure of access to mental health services for a managed care environment. The Journal of Mental Health Administration, 24(3),