State Indicator Pilot Conference call 3/14/00

Roll call- Dr. Ron Manderscheid

Present: AZ, CO, CT, MO, OK, RI, VA, UT, VT, WA, TX, NY, Marie Danforth, Kelly Hannah, Mattie Cheek & Dr. Joyce Berry.

Not Present: IL, SC

Minutes-Victor Ingurgio, OK

Dr. Berry thanked all involved for what has been done on behalf of the states. She also announced that the State Block Grant has received a $57 million increase which is the first increase in at least 10 years. This will mean that states will get increased dollars, and it will help zero in on the need for greater reporting, accountability and uniformity with respect to what is shown to Congress in regard to the manner in which Block Grant dollars are being used.

She also stated she had asked NASMHPD and the NRI to play a coordinated role with CMHS along with the 16-state project in working toward uniformity in reporting. She also encouraged the bridging between planners and data.

A1 Penetration Rates (John Pandiani)

John summarized the 1999 status as follows: data is reported on 11 states, 4 more states should have data available in the next couple of weeks and 1 state (IN) is unlikely to have data available in time for the statistics conference, due to changing computer systems. Community data is coming along nicely; there is data available from 4 states, 5 states can report in a relatively short period of time, 2 that are working with/from partial data and 5 are unknown but believed to be making good progress.

Ron stressed the importance of this information because it will allow us to get an unduplicated count.

John Whitbeck, WA asked the following question: We're working with penetration rates, 1 with a denominator that goes towards the adjusted and estimated census by year and the other with the Medicaid eligible population to the Medicaid eligible persons. Aren't we doing it that way, or what's our denominator?

John responded that as of now, they're working on taking the larger number and comparing it against the general population. There's at least 1 state that can report on Medicaid now but not the rest of it. We may want to look at breaking those out into the future but for now we're looking for the larger number.

WA: So we have a footnote on that then?

John: Yes, we'll do the same thing as last time. We'll have footnotes for the information.

A2 Q1 Q4 O1 Consumer Survey (Judy Hall)

Judy reported having data on the MHSIP survey submitted by 10 states, and TX has joined them. She also reported that 3 states are now piloting the survey (CT being one). Per the 16-state work group conference call, the survey subcommittee is looking to see if they can include non-MHSIP items from the 2 states that are using non-MHSIP surveys for the indicators. They're also beginning to collect the second wave of data from states that implemented the survey more than once. Risk adjustment work is just beginning on the 1^st wave of data and may be available by the national statistics conference. The MHSIP Work Group came up with a list of recommendations that will be presented for approval, and then disseminated to the larger community.

Q3 Contact within 7 Days Following Hospital Discharge (Steve Davis)

Victor reported having received data from 4 states. He stated he would like to re-send the listserve message so everyone can link to the MHSIP page and receive the information on how to submit the data. He stated he hasn't heard anything yet from TX, IL or UT. He also stated he needed to follow-up with states that have provided implementation dates that have passed.

A discussion followed regarding how consumers are being handled who come into the hospital through involuntary commitment, but because of private insurance are lost to the count when they leave as they would not show up on the outpatient data base. It was determined that the scope of this analysis would need to be clarified in the future as we move toward more uniform reporting across the states.

Q11 Readmission within 30 Days - State Hospital (Chip Felton)

Sudha Mehta, NY reported having received data from 8 states and is waiting on data from the rest of the states. A discussion followed regarding clarification of whether this should be for subsequent episodes or any admission to a state hospital and if it should include readmissions to other hospitals as well. Most agreed that all readmissions to any hospital (state or local) should be tracked. It was then suggested that a separate number be added to track readmission to hospitals other than state hospitals, as not all states are able to track information outside the state hospitals. It was also mentioned that the NY spreadsheet needs to be amended to separate clients with a diagnosis from those with no diagnosis as previously discussed.

S3 Per Member per Month Average Resources Spent for Mental Health (Nancy Callahan)

Nancy stated she has 5 states who are trying to put together their cost dollars similar to the model she'd projected across the 4 treatment areas and has had good progress on that complicated issue. She stated she would like to get at least the total number of clients (possibly from John Pandiani's penetration rate) and the total number of mental health dollars per state so they could do the top level analysis of looking at dollars per client and then try to separate that out by Medicaid clients.

B. Indicators to be Tested in Year 2

Q2 Consumers Linked to Primary Health Services (Deb Kupfer, CO)

Deb stated they're planning to add/modify a couple of questions to the MHSIP consumer survey (following in RI's footsteps): 1) Is there a physical health provider that you usually use when you have a physical health problem? 2) Have you had a physical exam in the last 12 months? She would like for any other states to get in touch with her if interested in working on this in that same avenue or in a different way.

Q10 Family Involvement in Treatment for Children/Adolescence (Molly Brunk / Randy Koch, VA) (to be included in children's survey to be piloted)

Molly reported their workgroup has finalized the survey for consumers' parents and has another version for children and adolescents which a couple of states are piloting this spring. Molly stated they're hoping to do a factor analysis and be able to report on it at the conference. The children's survey was designed to hopefully tap 4 factors; 1) overall satisfaction, 2) family involvement, 3) provider availability and 4) cultural sensitivity. They will be trying to do a confirmatory factor analysis to see if those factors hold up. (Molly had mailed a copy of the Youth Services Survey to the listserve, possibly in December.)

O2 School Days Attended By Children (Molly Brunk will be asking members of the children's consumer survey group if any person is interested in this indicator)

Molly stated that on the above listed survey, there are a number of items looking at outcome, such as school days attended. The survey asks if the child was absent from school in the last month and if so, how many days? Molly said they're hoping the Children's Workgroup will take the lead with this data.

Ted Lutterman, NASMHPD, suggested that some members of the 16 state project sit in on a meeting, April 26^th, in Washington with the Round Table on Children's and Adolescent's Mental Health Outcomes group which is addressing performance indicators for children. Anyone interested in attending should contact Ted.

O3 Employment (John Whitbeck, WA)

John stated that this is new in the sense that the approach is employment in states with unduplicated utilization data which can match with the FICA or Employment Security data to obtain those measures. Currently he has surveyed the states and will be contacting the 6 states or entities (consisting of NASMHPD, WA, OK, VA, AZ & VT) to schedule a conference call to review this information.

O9 Mortality (Craig Colton)

Craig reported he is currently contacting states to find out what they are doing, what they have done and what they are capable of doing. He is also working on ways to develop links between death records and the Mental Health Client data. One possibility is a universal identification number across the states to tie into the identification numbers of the death records. They will also need to find the right software to do the matching.

O12 Living Situation (Nancy Callahan)

Nancy reported having sent out a new proposal based on existing NASMHPD indicator to determine independent living situation. This had been whittled down to 3 options: 1) living in a house or apartment, 2) living in some other facility, and 3) homeless. During the ensuing conversation, the consensus seemed to be that there should be 2 separate indicators, 1 for where the person is living and 1 for the level of support the person receives (as those living in a home or apartment may not be living independently).

O13 Involvement in the Criminal Justice System (Lucille Schacht)

Lucille reported that the subcommittee is pulling together what has already been reported and assessing what the current rates are looking like based on the different ways of measuring it. The indicators are currently set up with the option of client self-import or linking administrative data, which will produce different results.

S2 Proportion of Expenditures Accounted for by Administrative Costs and Profit (Linda Frisman)

Linda reported the subcommittee has not made a huge amount of progress since the last conference call. To date they've determined that they will not be able to collect costs related to administrative costs in a standard way across all the sites. Currently they are working with Nancy Callahan on the total cost indicator and feel some will be able to break out administrative costs from that total cost but it will not be able to be defined in a similar way.

C. Indicators to be developed in Year 2

Q5 Adults Receiving Assertive Community Treatment (John McGrew)

John reported that he has developed a 1 page checklist based on the CARF Standards while still including the PACT model-the checklist is more in line with the academic standards. He has circulated this checklist before and will be circulating it again; everyone is asked to review it and forward any feedback to John.

Q6 Adults in Supported Employment (John McGrew)

John reported that he has developed a 1 page checklist based on the CARF Standards (although somewhere in the middle of CARF AND PACT), which he feels is more in line with the academic standards. He has circulated this checklist before and will be circulating it again; everyone is asked to review it and forward any feedback to John.

Q7 Adults in Supported Housing (no chairperson)

O4 Level of Functioning (Mary Smith)

Mary was not in attendance.

O5 Symptom Relief (Mary Smith)

Mary was not in attendance.

O10 Recovery/Hope/Personhood (Vijay Ganju, TX)

Vijay reported that he is forming a group of people who had worked on recovery to develop a plan of action in terms of how they're going to develop and test the measure. Vijay proposed possibly meeting in Austin in early May and asked if funds would be available to do so. It was also pointed out that there is a parallel initiative under the MHSIP umbrella in terms of the development of the next generation report card, which this could feed into.

O11 Reduced Substance Abuse (no chairperson)

There was discussion on getting a group together to work on this. John Whitbeck stated he'd like to be involved, as he's been doing related work at Harbor View, but cannot lead the group. It was suggested that John see if Rick Reeves, who is also involved in the Harbor View Project, would like to participate in the group. It was then pointed out that Randy Koch (who was not present) has been the most involved person in this within the NASMHPD framework and it was suggested that me might also be included. Denny Geertsen, Cindy Hopkins and Bernadette Phalen stated they would also like to be involved. Bernadette stated Dr. Minkhoff had also expressed an interest in joining the group.

S1 Consumer/Family Member Involvement in Policy, Quality Assurance, and Planning (Planner committee) (Marie Danforth)

Marie reported the planners have discussed stakeholder involvement and have decided to try to document the involvement. The planners have also decided to take responsibility for this indicator and have selected co-chairs for the group.

D. Indicators to be worked on in coordination with the ORYX project in year 2 (Q12, Q13, Q14, O6, 07) (Ted Lutterman)

Ted reported that NASMHPD is not permitted to share the information they receive from reporting state hospitals in ORYX. John Whitbeck pointed out that in the state of WA the mental health authority already has that information and there is no prohibition on the use of the data, so this data is available to him. It was then suggested that all states consider the possibility of providing this data to Ted, if it would be possible to do without duplicating the information. It was decided that they would discuss having a year 2 report at the next face to face meeting.

Q8 Adults receiving new generation atypicals/medications (Amy Elliott)

Amy stated they are still waiting to get surveys (regarding how to collect information and whether or not they can provide unduplicated counts) back from some of the states. So far, they have received information from 7 states and 2 other states have said they're working on it.

2. NASMHPD's new role in project.

The proposed new partnership consists of the state data people, the state planning people, the CMHS planning group and the CMHS data group. They are currently looking at adding NRI and NASMHPD to the existing partnership to form a joint partnership among all. There have been extensive discussions regarding putting together a website at CMHS and the NASMHPD site that would contain existing state-level information. Information would be provided from the 16 state pilot project, the activity which will be address how states have spent the additional $66 million in block grant funds, the direction of the block grant effort, and it's relationship to the mental health system.

Marie highlighted the February 7^th meeting with commissioners, and some planner and data people. She stated that their main topic of discussion was whether states are ready to report uniform information given the importance of meeting accountability requirements for the block grant. There will be a follow up on this on their next meeting, April 6^th. It was pointed out that the purpose is not only to report to OMB and Congress but also to initiate a pro-active, energetic movement to bump the block grant up to a billion dollars a year.

3. Face to face meeting to be held this year: 1) should it be held April 27, 28 or at a different time, 2) things to be accomplished at the meeting, 3) status of meeting year 2 goals and developing of goals for year 3.

Ron postponed the April 27-28 meeting until mid June or mid July, at which time the new partners could attend. He also scheduled the next conference call for April 27^th, from 1:00-3:00pm. Ron also asked for, and received, volunteers to participate in a couple of conference calls to put together a proposal for the group for the National Conference meeting, May 30 - June 2^nd at the Renaissance Mayflower Hotel.

Marie stated the planners meeting will be July 29^th - August 1^st. The planners and the planning council people will be meeting together. She stated she does not have the agenda at this time.

4. There was an announcement to call Victor Ingurgio at 405-522-3909 for those who are not on the 16 State list serve, being on the list serve will ensure that one gets all logistic and indicator subgroup messages for the project.

The meeting was adjourned.