Sixteen State Performance Indicator Study

February 7, 2000 Conference Call

Minutes reported by Ellen Sparks, South Carolina

Olinda González convened the meeting and called roll in Ron Manderscheid=s absence.

1. Discussion was held related to barriers to producing data for the indicators in which work is currently proceeding.

Consumer Survey

Judy Hall reported that she has nine states reporting consumer survey data. Barriers to reporting include some states not using the MHSIP survey, and some just now starting to use the survey. Washington State is still exploring issues regarding the survey and Connecticut is in the process of starting, expecting data in another 12 months. Illinois has hospital based data and will want to include community data. Judy will contact Vijay regarding the data from Texas.

Level of Functioning

Mary Smith reported on the MHSIP policy group (meeting agenda is on the MHSIP website)subcommittee that will be developing general guidelines vis a vis the MHSIP survey. Discussions toward that end in the next meeting will include the different surveys being used, scoring, and administration (self administered/consumer to consumer etc.). Also being discussed is the child and adolescent survey. Results of the discussions will be incorporated into Vijay=s paper (MHSIP Website) and disseminated to the field.

Mary is organizing a committee of experts to meet for scale development of the level of functioning indicator-the meeting will be held in the next two months.

Penetration Rates

Melinda Murtaugh reported that Vermont has heard from about half the states for the more recent data request on hospital utilization and that some follow up is needed.

Contact within 7 Days

Steve Davis has data from 3 states. Judy Hall noted there was not a column to report totals for states; Steve will change the layout. Olinda has talked with one state that cannot report this indicator. John Whitbeck reported that they are taking more time to understand the data than they thought. Eva is checking the quality of data in Connecticut. They are using a new system and expect data to be available by fall. They may be able to provide a sample. Arizona is working on getting it collected. Each state is to contact Steve as to their status on this indicator.

Readmission within 30 Days

Al Volo has heard from 8 states. Other states were also asked to report to Al about their status.

Children=s Survey

Discussion was held by Randy Koch on the Children=s survey and a group that will convene in April to discuss policy issues around child surveys. The group will include representatives from committees and groups that are working on child outcome issues including the Outcomes Roundtable on Children. Areas to be addressed include access, family instruments, cultural competence, outcome, primary health care, and criminal justice issues. Questions were posed as to whether states piloting the children=s survey (Chair-Molly Brunk) should proceed with initial piloting of the survey given this development. O. González will refer to R. Manderscheid for comment on this. Randy noted that Virginia will be going ahead with their pilot as with field testing there are likely to be revisions anyway.

2. Guest Speaker Bruce Dembling from the University of VA, Southeast Rural Service Research Center spoke on Health Status and Mortality. He will be working with Craig Colton to further develop this indicator. He referred to two sources, the August >99 issue of Psychiatric Services on the Massachusetts Methodology Study and Steve Leff=s published toolkit. He noted that it is a sizable undertaking to download vital statistics mortality data but once it=s done is can be very valuable. One difficulty is the interpreting of data and attributing outcomes. Specifically for Measure 2 the comparison is number of deaths to the number expected in the general population or a group of peers. Craig noted that many states are linking to vital statistics data and they may be willing to participate in a workgroup. Some items to work on include how to interpret, what are the best indicators, and what is the population. Oklahoma, Texas, Vermont, DC, and AZ are interested in participating in the workgroup, and Craig Colton will be the Chair. Bruce will e-mail Bruce=s references on the Onelist and the sub-group on this indicator will meet by conference call.

Per Member Per Month

Nancy Callahan wants feedback from states regarding where they are with this indicator. She has e-mailed information on this indicator to participants. She noted that Total Dollars could be defined as total MH expenditures as defined by NASMHPD, total MH budget, and medicaid and not medicaid. Total number of unduplicated mental health clients requires that states have the ability to unduplicate the total number of clients across service systems. The next level is cost by service, inpatient, crisis, outpatient and day treatment. Costs for inpatient services can be calculated different ways as described in the proposal. VT, AZ, CO, WA, UT, and CN have access to these costs and will begin with fiscal year >97-98 and >98-99. Definitions are needed for example for inpatient, state hospital, unit of service, days etc. Nancy wants to work on some preliminary numbers. Olinda will inform Ron and the administrative group. States are asked to send definitions and/or comments to Nancy.

Employment

John Whitbeck reported that he has been able to match social security numbers with employment security data. Not all states have access to this data. He used the Office of Research as a go-between as one way to address the issue of confidentiality. Oklahoma has an interagency agreement. John reported that he gets data about 3-6 months out. John will send out a brief questionnaire to discern where States are at in terms of collecting employment security data. John will chair this group and Ted will be included in the group to coordinate with NASMHPD employment indicator. Steve and Nancy will also join. John discussed the indicator as an adjunct to the Supported Employment indicator.

Administrative Costs

Linda Frisman noted three areas of discussion:

(1) Develop common definitions and categories as a way to have a common measure.

(2) How might cost data be collected. There may be an administrative component to unit costs and per person costs.

(3) Develop common service categories, inpatient, crisis, day treatment, residential, and other outpatient services.

Expectation may be to develop general guidelines for states to look at their own administrative costs. Olinda will call Linda this week to discuss Ron=s comments about this indicator. Linda anticipates that it will take 5-6 months work to develop guidelines. John Whitbeck noted that Washington tried to have contract agencies have 85% of funds go to direct care but the question of exactly what can be called direct care arises.

3. Discussion of Indicators to be Tested in Year 2

Consumers Linked to Primary Health Services

Mary Smith will present the possibility of linking this to the MHSIP survey on the MHSIP agenda next week. Illinois tested this as part of the MHSIP report card. Judy Hall noted that some states might get this data from surveys which would be self report and some might utilize medicaid data.

Family Involvement in Treatment for Children and Adolescents

Molly Brunk has a pilot questionnaire. Judy will check the similarity with NASMHPD. Will defer to Ron as to changes.

Employment

John Whitbeck is working on this indicator as reported.

Mortality

Craig Colton is working on this indicator as reported.

Living Situation

Nancy will present more at the next meeting.

Criminal Justice

John Whitbeck, John McGrew, Steve Reeves, Laurie Stone, Lucille Schact, and Randy Koch will be working on this indicator and will try to meet soon.

4. Indicators to be developed in Year 2: Time frames for getting data by September

Q5 and Q6 Assertive Community Treatment and Supportive Employment: Will be utilizing checklist and pilot. Estimate one year. Olinda and John will talk regarding John=s suggestion for a pilot as a next step.

O4 and O5 Functioning and Symptoms: There were five states interested in the Technical Workgroup which may be too many to be accommodated. A conference call will be considered to connect with a broader group of participants. This group recognizes need to crosswalk the instruments possibly using the RCI to for measurement..

O10 Recovery: Vijay is working on this indicator. He is not available today.

O11 Reduced Substance Abuse: Staff from Connecticut is unable to participate in the development of this indicator.

S1 Consumer/Family Involvement: Ted will discuss this at next meeting.

5. Discussion of Indicators to be worked on in coordination with ORYX.

Ted was not able to make the call but NASMHPD will be able to send some data to the states- specifically risk adjustment and case mix data. Steve and Ted will work on this further.

Amy Elliott reported on the Atypical Medications indicator. She has six states so far that have returned her survey. There was a question regarding measure 1 being just for 295 diagnoses. It was noted that use of atypical medications was not in the best practice guidelines for those who did not have 295 diagnosis so it was agreed to keep the measure to those with that diagnosis. It was also noted that ACT is supposed to be for 295 diagnosis according to best practice guidelines as well.

6. Marie Danforth and the state planners will be having a meeting to discuss stakeholder participation and involvement. She will report to us next time.

7. The next conference call will be held on Tuesday, March 14, 2000 at 1:00 EST.

The meeting was adjourned.