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
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
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
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
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?
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)
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
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.)
•
State Agency Service Files
– Outpatient SA services
– Community mental health services
– Institutional or residential services
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
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.)
•
How are the Files Linked Together?
– Clients are linked within agencies
– Clients are linked across agencies
– Clients and services are linked by assigned identifiers
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
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
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
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
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?
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?
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
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
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
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.
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
Figure 1: MH-Only Clients Are Treated Mainly by the
MH Agency or Medicaid, Not Usually Both
Percent of MH Clients
by State Organization
100%
80%
31
51
59
MH Agency Only
60%
40%
52
26
29
20%
17
13
State 1
State 2
0%
22
State 3
Source: CSAT /CMHS IDB Project, 1996 data.
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
Medicaid Only
Both Auspices
More Findings
Percent of Dual MH+SA Clients
by State Organization
Figure 2: Clients with Co-Occurring Disorders Are Less
Likely To Be Treated under Medicaid Alone
100%
16%
80%
38%
9%
70%
60%
M H/S A Age nc ie s Only
M e dic a id Only
25%
B o th Aus pic e s
40%
20%
75%
8%
38%
22%
0%
State 1
State 2
State 3
Source: CSAT /CMHS IDB Project, 1996 data.
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?
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?
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
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?
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
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)
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
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
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
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
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







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
= less
than 3
sources
of data
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
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
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
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
•
Memorandums of Understanding (MOU) to Share
Data are Necessary
•
States are Receiving More Demands for
Information Regarding Their MH/SA Population
Level of Service Detail Available Differs State to
State
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?
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
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