1. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov The Integrated Database Project IDB Combining Mental Health and Substance Abuse Data From State Agencies A Federal/State Collaboration Delaware, Oklahoma, Washington January 24, 2003

2. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov History of the Project SAMHSA Project Officers: –Joan Dilonardo, CSAT –Jeff Buck, CMHS Contractor: The Medstat Group Subcontractors: –National Association of State Alcohol and Drug Abuse Directors, Inc. (NASADAD) –National Association of State Mental Health Program Directors Research Institute (NASMHPD) Contract Period: 1996-2001, 2001-2004

3. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov History of the Project Collaborative Effort Between CSAT/CMHS and Three States: –Delaware –Oklahoma –Washington

4. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Building the Database: Five Not-So-Easy Steps Select States to Participate Design Structure of the Database Acquire Confidential Data Build the Files Make the Information Available

5. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Step 1. Select Three States Four Questions We Asked: –Was the State willing to be part of the study (time and resources)? –Did the State provide SA and MH services from Medicaid and another State agency? –Was electronic data available from each source? –Were there common data elements across agencies?

6. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Step 2. Design the Integrated Database (IDB) Total of Eleven Files That Link Together Mix of Client/Service Data –Client/Demographic Files Static Information (e.g., age, gender, race) Change across time (e.g., employment, drug use, marital status) Medicaid (e.g. eligibility status, months of enrollment)

7. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Step 2. Design IDB Files, (cont.) Medicaid Service Files –Inpatient –Long term care –Pharmacy –All the rest – outpatient services

8. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov State Agency Service Files –Outpatient SA services –Community mental health services –Institutional or residential services Step 2. Design IDB Files, (cont.)

9. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Levels of Data Aggregation Client Level Medicaid Eligibility or MH/AOD Program Level Service Level

10. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov How are the Files Linked Together? –Clients are linked within agencies –Clients are linked across agencies –Clients and services are linked by assigned identifiers Step 2. Design IDB Files, (cont.)

11. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Confidential Data Personal Identifiers Needed For Linking –Something to Identify Individuals Directly –Name, Address, Telephone Number, DOB –Identification Numbers Such as SSN Helpful –All Confidential Information

12. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Step 3. Data Acquisition Each State Had Requirements for Confidentiality Common Requirements: –Signed confidentiality agreement/non-disclosure statements –Guaranteed security of the data –Limited activities to approved research –Removal of identifiers and identifying information

13. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Step 4. Build The Files Final Products: –Three years of data: 1996-1998 –Database with demographics, MH/SA services plus medical services for Medicaid clients –One client-level file with summary costs and services –One client-level file with more detail about services and diagnostics

14. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Step 5. Make The Information Available Gave The State-Specific Database To Each State and SAMHSA Posted Information on the SAMHSA Website including: –Linking routines that other states can adapt –Sample code –Reports Participate at conferences

15. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Analysis of the IDB Questions We Can Answer About People –What are the demographics of persons receiving publicly-funded MH/SA services (age, race, gender)? –What percent of clients have MH disorders, SA disorders, or co-occurring disorders? –What are the most frequent diagnoses?

16. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Analysis of the IDB (cont’d) Questions We Can Answer About Utilization: –What types of providers give treatment to MH/SA clients? –What kinds of services do MH/SA clients receive? –How often and for how long do they receive services? –What are the costs of services? –Are services provided by Medicaid? State Agencies? Both?

17. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Data Analysis To Date Seven Analyses –Two completed –Three close to completion –Two in planning stage

18. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Data Analysis: Completed Reports #1. Linking Client Records from Substance Abuse, Mental Health, and Medicaid State Agencies –Describes various concepts behind record linking –Strengths and weaknesses of different techniques relative to the IDB –Describes specific method used for linking clients in the integrated database

19. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Data Analysis: Completed Reports #2. Mental Health and Substance Abuse Treatment: Results from a Study Integrating Data from State Mental Health, Substance Abuse and Medicaid Agencies –1996 data –Age groups 0-17 and 18-64 –Who provides services for: Clients with mental disorders only Clients with substance abuse disorders only Clients with co-occurring disorders

20. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov A Few Key Findings About 4 percent of the population of each State was treated for primary MH and/or SA disorders in 1996 under the auspices of State MH/SA agencies and or Medicaid Youth clients were predominately males, whether they had MH, SA, or co-occurring disorders. Adult MH-only clients were more likely to be female. Adult MH clients treated under Medicaid only were less likely to have schizophrenia, major depression, and psychoses – the most serious mental illnesses.

21. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov More Findings

22. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov More Findings

23. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Data Analysis: Reports Underway #1. Public Mental Health Services Utilization by Adults with Serious Mental Illness –Subset of adult IDB MH population, ages 21-64 –What are the demographic characteristics of clients? –Where are they mostly likely to receive services? –What mental health services did they receive? –Did they also receive substance abuse services?

24. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Data Analysis: Reports Underway (cont’d) #2. Utilization of Public Mental Health Services by Children with Serious Emotional Disturbance –Subset of MH clients, ages 0-17 –What are the demographic characteristics of clients? –What is their hospital utilization? –What other MH services did they receive? –Did they also receive substance abuse services? –What psychotropic drugs are prescribed?

25. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Data Analysis: Reports Underway (cont’d) #3. Utilization of Psychotropic Medication Under Medicaid in Three States, 1998 –MH population, age groups 0-17, 18-64 –REDBOOK® Drug Classification Scheme –What are the patterns of use of psychotropic medications for consumers of Medicaid mental health (MH) services? By specific drug By major drug class By MH category By age group

26. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Data Analysis: Reports in Beginning Stage #1. Continuity of Publicly Funded Coverage for Mental Health and Substance Abuse Treatment Services –MH and SA population, ages 0-17 and 18-64 –What is the length of time clients receive services and how often? –Does the length of time in service differ by: Diagnosis? Agency?

27. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Data Analysis: Reports in Beginning Stage #2. Expenditure Analysis for Treating Co-Occurring Clients Focus on Understanding: Expenditures for Co-Occurring MH/SA Disorders Expenditures for MH-Only and SA-Only High-cost Clients Within the Three Client Groups Factors That May Affect Spending Among States: –demographics –clients covered –availability and use of services –managed care

28. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Overview of Potential Analysis Topics, 2003 Variations in Treatment Utilization by Provider Classification Interactions Between Medicaid and State Agencies in Providing Services (under discussion) MH/SA Treatment Utilization Among MH/SA Patients with HIV/AIDS (under discussion)

29. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Technical Assistance Help Other States Build and Maintain an Integrated MH/SA Database Share With Other States What We’ve Learned From Working with the Three State Databases Describe a Framework for Changing State MH/SA Databases

30. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Technical Assistance: Original Scope For Four New States –2 on-site visits per year –Conference calls –Focus on integrating data For Three Incumbent States –1 on-site visit per year –Conference calls –Focus on data analysis, using and maintaining IDB

31. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Initial Activity: Introduction Packet Sent to all States + District of Columbia –MH Commissioner/Agency Director –SA Commissioner/Agency Director –Medicaid Director Packet Included: –Letter of Introduction –Description of IDB project –“Letter of Interest” for more information

32. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Letters of Interest Received by Medstat 25 New States and the District of Columbia Expressed Interest in Receiving Technical Assistance Six States Had Less than Three Sources of MH/SA Data –i.e., no substance abuse or no Medicaid –Follow-up contacts made to verify information Twenty Potential States for Technical Assistance

33. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov States That Returned Letter of Interest = less than 3 sources of data

34. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Information Gathering Calls Scheduled with Remaining Twenty States –Included key staff from: Mental Health Agencies Substance Abuse Agencies Medicaid Agencies Other (umbrella agencies, IT staff) Team “interview” to Gather Information from States

35. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Topics of Discussion With States Organizational Relationships Between Participating Agencies Ongoing Data Projects Integration Efforts Data Sharing Agreements Technical Assistance Needs Resource Availability

36. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov What We Learned from the States Each State has Different Needs –Planning stage of integrating data –Beginning-middle stage –Advanced stage – well on their way States Would Like Information from Other States Going Through the Same Process

37. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov What We Learned from the States (cont’d) State Budget and Resources Are In Short Supply Level of Service Detail Available Differs State to State Memorandums of Understanding (MOU) to Share Data are Necessary States are Receiving More Demands for Information Regarding Their MH/SA Population

38. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov How Should We Accomplish This? On-site Visits as Originally Planned Possibility of Workshops To Make Information Available to Additional States –A National Meeting or Regional Meetings? –Follow-up Meetings?

39. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Center for Mental Health Services www.samhsa.gov Discussion/Questions