Attendance: All States were represented at the conference call with the exception of Texas.

Minutes taken by Steve Davis and Olinda González

Ron Manderscheid convened the meeting and presented the agenda items to be covered: Sub-Committee data collection reports, Ted Lutterman=s report on the ORYX initiative and the 16 State/ORYX Indicators, and a presentation by Ruth Ralph on the Recovery Model.

John Pandiani reported that he is working to broadly define community utilization including all people served regardless of funding stream, and analyses by age, race, gender, and other categories such as relation between utilization in hospitals versus community. The definition will emerge but we need to use the data that people currently have. He is referring to unduplicated counts. Nancy Callahan suggested using a Medicaid population sunset as it would be an easier population base from which to draw. The HCFA database has data for all states on line, including data on anti psychotic medications-the site address will be forwarded to the workgroup.

Mary Smith plans to meet with the workgroup at the Southern Regional meeting in Charleston, SC, Nov1-3.

Judy Hall is continuing to receive data from additional states including Arizona and New York. She is assessing methodologies as related to the indicators. Of interest is that States are collecting data for inpatient and outpatient services and there may be a difference in results of the two levels of services. She will be comparing and analyzing this. Ron stated that A2, Q1, Q4, and O1 are the indicators in to be reported in the 2^nd year. Judy responded that all but one are in the 21 item survey, so that some states do not have data on the indicator, participation in treatment planning. AZ will send their survey analyses for Judy to review, and NRI is assessing appropriateness of items for inpatient surveys. HSRI is also working on Illinois= automated inpatient survey to distribute broadly.

Assertive Community Treatment and Supported Employment

John McGrew reported that there is a need to identify a 7 to 10 checklist that would define these indicators for state data collection. Developmental work is needed in the form of an expert panel to complete this task. John will identify the task group with the help of Gloria Masa of Rhode Island. Ted Lutterman suggested that Greg Teague would be an appropriate person for the work group. It was suggested that Peggy Clark of HCFA be contacted for a new initiative on Assertive Community Treatment models. Nancy (CT) has experience with ACT and offered to provide input to the effort.

Al Volo had sent out a survey to the 16 States on readmissions and subsequently received feedback. He will now ask for FY= data, actual numbers, and diagnosis on discharge; there is also a need to decide on life table intervals using the definition from NASMHPD=s President=s Task Force with Ted=s clarifications. It was agreed that we need to look at more than 30 days, but unclear as to what other intervals or numbers to use. Denny Geertsen indicated that Nancy Callahan had suggested a 6-month interval. Nancy agreed to send out data to the states which revealed uses and value for specific intervals used in her work in California-one option would be to collect 1-3 months, 3-6 months, 6-12 months etc. Craig Colton suggested that collecting data at six months would be useful for planning. Ted indicated that the NASMHPD purpose had been to look at what happens in the first few weeks after discharge. More discussion ensued in terms of additional time frames to apply. This issue will be addressed in the next month by Al Volo. Ron Manderscheid indicated that we need to be consistent with John Pandiani=s denominators for percentages. It was clarified that one indicator is for discharges, and one is for people. The need is also to explain the relationship between people hospitalized and discharges, and community contacts, i.e., which is unduplicated and which is duplicated. The discussion then moved to the area of hospital referrals. For South Carolina, referrals from hospitals to CMHCs are a continuity of care issue. Ted Lutterman indicated that the language in the 5 State study focused on referrals only. Mary Smith indicated that different States have different policies regarding referrals. Vermont indicated that in the state, everyone who leaves the hospital is counted for this indicator. Virginia and Colorado only track centers in the state system. Following additional discussion regarding this issue, Jack Wackwitz suggested that we consider having two indicators: one for those referred to CMHC=s and one for those not referred to CMHC (do all discharges - the not referred would make the difference). Others agreed with this idea. Finally, Ted Lutterman indicated that the contact definition presented in Al=s survey is different from the NASMHPD definition; it should be a face to face contact with a provider anywhere (i.e., case manager), not just a provider at a CMHC. The definition will be corrected on the web site.

Nancy Callahan has been working on calculations re: PMPY in California; she will send data out via Power point to the states and also review chapter 12 in Mental Health US for comparisons. An outline of what she will be addressing for the indicator includes separate services, cost per unit, and cost per client, and total dollars for main service categories.

Eva Jakuba reported that the conference call with CO and AZ on September 24 addressed, (1) different definitions, and (2) that which could be considered to be administrative cost among workgroup states. Discussed were the variables that affect cost, who provides services, urban/rural states, and kinds of services which apply. Discussed was the need to start small then to expand because of political influences. The workgroup will meet at the end of October to address discussions with fiscal staff regarding definitions and financial reports that show administrative costs. Ron Manderscheid received a l997 report from HCFA on Medicaid national administrative costs and will send the document to workgroup members.

Amy Elliott reported that the subgroup had met last month, developed guidelines, and hospital and community questionsCthese are being revised and will be discussed at the conference call next month to finalize before sending out to states.

Ted Lutterman presented information on the status of Oryx indicators in the 16 States. Currently 11 States are participating in Oryx, Texas will be joining, and New York, Rhode Island, and Vermont are not participating. The total number of state hospitals involved is 54 hospitals (64 when Texas joins). The Oryx indicators are: readmissions at 30 days, seclusion and restraint, elopements, atypical meds, medical errors, and injuries to clients. Data is now being reported by individual hospitals. The data most reported by the >16' state grantees are the 30 days readmit rates. Eight states are reporting seclusion and restraint, five are reporting atypical medications and two are reporting medication errors. In the readmitted rate, data is being collected on individual level data, so life table analysis will be possible. Oryx is looking at individual hospitals and the >16 states= are looking at the entire public mental health system, so Oryx only counts readmits to the same hospital, while we are counting readmits to the systemBso the Oryx rate will always be equal to (when a state has only one hospital) or less than the 16 state indicator. In terms of readmits, states will have a rolling average three month rates - a rate each month and the average across each month. South Carolina is interested in the Seclusion and Restraint data collection, and Ron M suggested that they work with Paolo del Vecchio regarding definitions. In Colorado, state hospitals are separate from the SMHA, but both hospitals are contributing to the NASMHPD Oryx system. Ted Lutterman is getting data from 8 State Indicator Pilot States at this time; data will be returned to hospitals and commissioners. Ted will find out how many hospitals are reporting directly and how many are going through a central state system; he will then report the information to the 16 states. Current Oryx data will be reported at the end of October.

Ruth Ralph of the Edmund Muskie School of Public Service, the University of Southern Maine, presented an overview of her work which has been supported by CMHS, NTAC, and HSRI. Ruth stated that consumers have not reached consensuses on what recovery or being recovered is. Products which have been developed to date include a recovery model, a compendium of eight recovery instruments, three of which include objective measures. One of the three models (Jeanne Dumont) has been tested with the crisis hostel project. It is important to look for change over time in measurement of recovery. Ruth stated that if you cannot demonstrate change over time (improvementBindependent, employed, in good housing, sense of well-being, and empowerment), then the measure is not useful. The Ohio recovery attitude scale, crisis hostel healing scale, the Illinois scale, and the Ohio dissertation scale on vision of recovery all measure change over time. Another product in process is the review of recovery literature as a follow up to the SG report review; this includes reporting of personal accounts, how to information, and opinions. Ruth Ralph strongly supported that consumers participate in the development of instruments on recovery. A proposal at this time is the development and piloting of a recovery instrument; Ruth would participate with consumers possibly in coordination with the state of Texas. States can give names of consumers who may be interested in participation in the recovery model to Ruth via email or phone (ruthr@usm.maine.edu. or (207) 780-4525). Another resource is Steve Leff who has a compendium of instruments at HSRI. The recovery model information described by Ruth can be found on the mhsip web site - www.mhsip.org. Ruth again emphasized to the group that if recovery is going to be addressed, >you need to have consumers involved=.

The next conference call meeting was scheduled for Friday, November l9 at 1:00pm EST. A part of the agenda will include addressing the group of indicators to be tested in year two.