***DRAFT***
September 3, 1998
Client Periodic
Data Elements
III. CLIENT PERIODIC DATA ELEMENTS
[Data collected at specified intervals (Admission, every 6 months, annually, and/or discharge)]:Item |
FN-11 |
Source |
Other |
¬ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ Committee Recommendation ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ® |
|
# |
Data Element |
Document |
Name |
Definition |
Workgroup Comments |
1 |
Education | EE #90 FN-10 p.48 CC p.24 |
Years of Schooling; Currently in school/ special education; Education at time of Admission | Identifies the highest grade level completed by the client. Never attended school Preschool/kindergarten Total number of years of school |
Outcome Indicator |
2 |
Employment Status | EE #98 FN-10 p.48 CC p.24 |
Employment; Current or most recent occupation/ industry | Employed Part-time employed Unemployed (Laid off or looking for work) In the Armed Forces Not in labor force (homemaker, student, retired, resident of institution) Other (volunteer, disabled) |
Outcome Indicator |
3 |
Type of Employment | Workgroup |
Competitive Supported Volunteer None |
Outcome Indicator | |
4 |
Residential Arrangement | EE #86 FN-10 p.45 CC p.22 |
Living/residential arrangement; residential arrangement; admission, most current or updated, and discharge | Homeless (On the street,
in a shelter, transient) Private residence/household Other residential setting (group home, half-way house, supported living) Jail or correctional facility (detention center, institution/training school) Other institutional setting (Psychiatric hospital, residential treatment center, Nursing Home) Boarding school |
States may want to add additional codes for this category to better discern differences in cost and independence |
Item |
FN-11 |
Source |
Other |
¬ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ Committee Recommendation ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ® |
|
# |
Data Element |
Document |
Name |
Definition |
Workgroup Comments |
5 |
Household Composition | EE #86 FN-10 p.45 CC p.23 |
Living arrangement; admission, most current or updated, and discharge | Client lives alone Client lives with relatives (relationship, plus biological, step, or adoptive) Client lives with non-related persons (foster parents and other foster children, professional child care staff and other children in group care) Client lives with same age peers (adolescents) Other |
States may want to add additional codes on residential arrangement; Indicator if needed; Level of Support |
6 |
Residence (two variables)? | EE #85 FN-10 p.42 |
Current coded area of residence | Zip Code and county code
where the client lives No fixed address |
Resource allocation |
7 |
Functional Status | EE #89 FN-10 p.43 CC p.22 |
Severity of condition, or level of functioning at admission | The functioning level rating of the client as defined by Axis V/GAF, or other level of functioning instrument | Needs a lot of work |
8 |
Self-reported Health Status | EE #88 |
The client’s self-reported health status | Outcome Indicator | |
9 |
Custody/ guardianship/ Conservator-ship | CC p.23 |
The custody/guardianship/conservatorship of the client. Parents (jointly, or separate; biological or adoptive) Other relative(s), specify Non-relative(s), specify Independent/emancipated minor State agency, specify |
Outcome Indicator | |
10 |
Legal Status | FN-10 p.151 |
The legal status of the client at time of service Voluntary Involuntary civil Involuntary criminal |
Outcome Indicator | |
Item |
FN-11 |
Source |
Other |
¬ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ Committee Recommendation ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ® |
|
# |
Data Element |
Document |
Name |
Definition |
Workgroup Comments |
11 |
Inter-agency participation in assessment and provision of services | CC p.24 |
Inter-agency participation in assessment/ service planning; Interagency participation in provision of services, per plan | Indicates the level of interagency coordination and other
agencies involved in care: (check all that apply) or allow a specific number? Mental Health Substance abuse DD Education CPS Social Services (other than protective) Police Court Juvenile justice/correction Public/School Health Vocational rehabilitation Community support agency (e.g.YMCA) |
Performance Indicator |
12 |
Marital Status | EE #87 FN-10 p.150 |
Current marital status | The client’s current marital status: Never married Now married Living as married Separated Divorced Widowed |
Target population, actuarial analysis |
13 |
Place of Birth | Workgroup |
Country, if not in US State, if in US |
||
14 |
Citizenship (Alien Status) | Workgroup |
|||
15 |
Year of Entry | Workgroup |
Year client came to the Untied States (yyyy) | ||
16 |
Residence Five Years Ago | Workgroup |
Country/State where client lived 5 years ago | ||
17 |
Informed Consent for Treatment | Workgroup |
Yes/No | Consumer Choice | |
Item |
FN-11 |
Source |
Other |
¬ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ Committee Recommendation ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ® |
|||
# |
Data Element |
Document |
Name |
Definition |
Workgroup Comments |
||
18 |
Informed consent for Data Sharing (Release of Information) | Workgroup |
Yes/No | Consumer Choice | |||
19 |
Primary Presenting Problem(s) at Time of Admission | EE #45, 94 FN-10 p.42, 151 CC p. 22 |
Client’s Stated Reason for Visit; Requested Service | Marital/family
problem Social/interpersonal (other than family problem) Coping with daily roles and activities (i.e. job, housework, daily grooming, financial management, etc.) Medical/somatic Depression or mood disorder Attempt, threat, or danger of suicide Alcohol or Drugs Involvement with criminal justice system Eating disorder Thought disorder Abuse/assault/rape victim Runaway behavior |
Risk rating, resource allocation, appropriateness of care) | ||
20 |
Referring Source | EE #37, 62 FN-10 p.44 CC p.22 |
Source of Referral; Referring Provider | The Provider Identifier or source that referred
the client for services. Self, family, or friend Police Court or correction agency School system or education agency Social Service agency Inpatient/residential organization (Mental Health Program Identifier) Probation Other referral source (indicate specific type) |
Planning, linkage, outreach, resource allocation | ||
Item |
FN-11 |
Source |
Other |
¬ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ Committee Recommendation ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ® |
||
# |
Data Element |
Document |
Name |
Definition |
Workgroup Comments |
|
21 |
Principal Mental Health Diagnosis | EE #40, 42, 46, 47 FN-10 p.151 |
Principal Behavioral Health Diagnosis; Diagnosis Chiefly Responsible for Services Provided; Physician’s Tentative Diagnosis (ambulatory); Primary Diagnosis (inpatient); Diagnosis-admission, most current or updated, and discharge | The principal mental health diagnosis from DSM-IV or ICD-9CM used to indicate the primary reason for treatment. | Risk rating, resource allocation, care appropriateness | |
22 |
Second Mental Health Diagnosis | EE #43 |
Second Behavioral Health Diagnosis; Other Diagnosis (inpatient) | The secondary mental health diagnosis from DSM-IV or ICD-9CM | ||
23 |
Additional Mental or Physical Health Diagnosis (1) | EE #44 FN-10 p.156 |
Other Diagnosis (ambulatory); Handicaps/impairments (other than mental illness) at time of admission | Additional mental or physical health diagnoses which may be
from DSM-IV or ICD-9CM. Developmental disability/mental retardation. Organically based problem in expressive communication Blindness or severe visual impairment Deafness or severe hearing loss Nonambulation or major difficulties in ambulation Moderate to severe medical problems |
||
24 |
Primary Care Physician/ Clinician/ Case Manager | EE #75 FN-10, p.47 |
Current primary therapist or case manager | Name or identification of organization staff who is currently the client’s primary therapist, case manager, or advocate | Link to staff demographic data | |