Tracking and Measuring Outcomes in King County, WA Mental Health and Substance Abuse Services Division
King County Mental Health, Chemical Abuse, and Dependency Services Division manage publicly funded mental health, substance abuse services, and co-occurring disorders. They prioritize interventions, job readiness, homelessness prevention, and reducing emergency medical and criminal justice involvement and costs. The division has been building a routine data collection process for supported housing and treatment programs over a 10-year period, improving evaluation efficiency. Data sources include MH Service Data, Community Psychiatric Hospital Data, and Crisis Data. The initiative was enhanced in 2003 through the Criminal Justice Initiative, funding new services and evaluation resources, leading to a Data Sharing Agreement for improved evaluation capabilities.
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Tracking and Measuring Outcomes in King County, WA Genevieve Rowe Mental Health, Chemical Abuse and Dependency Services Division genevieve.rowe@kingcounty.gov
King County Mental Health, Chemical Abuse and Dependency Services Division Manages publically funded mental health & substance abuse services and services for co-occurring disorders. Situated within the Department of Community and Human Services. Coordinates with regional human services partners via King County Human Services Framework Policies. King County's priorities for human service investments will be programs and services that help to stabilize and improve people's lives, and prevent or reduce emergency medical and criminal justice system involvement and costs. Human Services Priority Areas 1. Effective intervention and prevention strategies 2. Job readiness and employment to increase self-sufficiency 3. Prevention and elimination of homelessness 4. Services that reduce the growth of emergency medical and criminal justice system involvement and costs
Building a routine data collection process for evaluating supported housing and treatment programs - Has taken 10 years Isn t finished Still includes some manual entry and cleanup Has considerably improved evaluation efficiency
In the beginning we had data for MHCADSD funded services - MH Service Data Community Psychiatric Hospital Data Crisis Data (included civil commitments to state hospitals admit date only)
In the late 1990s the county jails were reaching capacity. Many frequent users were enrolled in public MH/SA treatment services but were not really engaged in those services. King County Jail Booking Data was provided daily to help locate clients for service engagement. MH Service Data Community Psychiatric Hospital Data Crisis Data (included civil commitments to state hospital admit date only)
The 2003 Criminal Justice Initiative funded new services and added evaluation resources. A new Data Sharing Agreement allowed use of the daily jail booking data for evaluations and added - Detailed KC Jail Booking Data a quarterly file of all bookings since 2001. Includes charges, flag if booking involved psychiatric housing, detention vs. EHD. Note: this added PHI. Many data sources are available retroactively. There is time to work things out. Daily King County Jail Booking Data MH Service Data Community Psychiatric Hospital Data Crisis Data (included civil commitments to state hospital admit date only)
Additional data sources were added for a few small programs - Municipal jail booking data (manual collection and entry process) Emergency Department data from one major hospital (clients signed Release of Information forms) Monthly logs with data for clients not in MH system Substance Use assessment forms (faxed hard copy) Quarterly Detailed KC Jail Booking Data Daily King County Jail Booking Data MH Service Data Community Psychiatric Hospital Data Crisis Data (included civil commitments to state hospital admit date only)
A 2007 grant funded the FACT program and a .6 FTE evaluator. IRB approval and Confidentiality Agreements allowed collection of additional data - Detailed State Psychiatric Hospital Data (including forensic admissions) for FACT population only Detailed Prison Datafor FACT population only Municipal Jail Booking Data Partial Emergency Department Data Quarterly Detailed KC Jail Booking Data Daily King County Jail Booking Data MH Service Data Community Psychiatric Hospital Data Crisis Data (included civil commitments to state hospital admit date only)
FACT demonstrated the importance of complete state hospital data for this population. An agreement was reached to provide - Detailed state psychiatric hospital data for civil admissions and flips (early 2011). Detailed state psychiatric hospital data for forensic admissions (mid 2011). Detailed State Psychiatric Hospital Data Prison Data Municipal Jail Booking Data Partial Emergency Department Data Quarterly Detailed KC Jail Booking Data Daily King County Jail Booking Data MH Service Data Community Psychiatric Hospital Data Crisis Data (included civil commitments to state hospital admit date only)
In 2008 the Mental Illness and Drug Dependency Action Plan, funded by a one-tenth of one cent sales tax increase, was enacted. The MIDD brought additional evaluation resources and began the long process of negotiating for complete jail data - Complete Municipal Jail Data from all five jails available in December 2011. Complete Detailed State Psychiatric Hospital Data Prison Data Municipal Jail Booking Data Partial Emergency Department Data Quarterly Detailed KC Jail Booking Data Daily King County Jail Booking Data MH Service Data Community Psychiatric Hospital Data Crisis Data (included civil commitments to state hospital admit date only)
After 10 years - Complete Municipal Jail Data Complete Detailed State Psychiatric Hospital Data Prison Data Partial Emergency Department Data Quarterly Detailed KC Jail Booking Data Daily King County Jail Booking Data MH Service Data Community Psychiatric Hospital Data Crisis Data - and monthly logs, other data forms
Where we are now - Complete KC Jail and Municipal Jail data Complete Community and State Psychiatric Hospital data Mental Health Service and Crisis data No Prison data (discontinued) Partial ED data for some programs (expanding to larger programs)
How Data Is Transferred In the Beginning Secure FTP Password protected disks Faxed forms and spreadsheets Now Secure FTP Encrypted thumb drives Encrypted email Faxed forms
You will be asked .. How much did we save? Can you do a cost benefit analysis? What are the cost offsets? A cost benefit analysis is not an extra step in a program evaluation.
Jail Days Are Not All Equal Acute Psychiatric Housing Surcharge (including Psych Care) 1:1 Daily Infirmary Care Surcharge Psychiatric Care Surcharge Guarding Surcharge (per hour) Booking Fee Maintenance Charge WER Charge $95.00 $125.00 $184.00 $227.00 $55.00 $93.00 $58.00
What about a comparison group? Whenever the number eligibles exceeds program capacity there is an opportunity for a comparison group. In a non-research setting it is very difficult to execute a randomized experimental evaluation design; but it can happen. Randomization or any limits to access to public services probably requires IRB approval. In reality you have no control over a control group.
How to begin Start small and simple: who, what, when, why Look for opportunities to build capacity Be aware of what others have the capacity for Be patient electronic records usually don t disappear Address data security, confidentiality, and HIPAA Have participants sign an ROI if there is any question about permission to access data
Sample Data Collection Sheet Coding Instructions This workbook is used to collect and report individually identified demographic, program and service data to MHCADSD. This version is designed for manual entry of data into the "Demographics_Program" and "Services_Outcomes" worksheets. The "DemoValues" tab has codes and descriptions that are used for some of the data elements (columns) in the worksheets. These are used to control values entered for variables noted below. See the "Data_Dictionary_Generic_09012010" PDF for more information about data formats, values, and definitions. Demographics_Program Client ID Surname (Last Name) Given Names (First Name) Site Gender DOB SSN Race1 Race2 Race3 Race4 Hispanic Origin Primary Language "Other Language" Interpreter Required Immigrant/Refugee Military Status Family Military Status Zip Code Disability1 Disability2 Disability3 Start Date End Date Exit Reason Exit Disposition Services_Outcomes Client ID Month Year Support Services Hrs {see list on DemoValues tab} F/M/U MM/DD/YYYY (If unknown enter 01/01/1900) (If unknown enter 999999999) {see list on DemoValues tab} {see list on DemoValues tab} {see list on DemoValues tab} {see list on DemoValues tab} {see list on DemoValues tab} {see list on DemoValues tab} See Data Dictionary N/Y/U N/Y/U N/Y/U {see list on DemoValues tab} {see list on DemoValues tab} {see list on DemoValues tab} {see list on DemoValues tab} {see list on DemoValues tab} {see list on DemoValues tab}
Sample Data Collection Sheet Code Values Code XYZ Site {Name of housing program} Code AE AA AAR AI ASI CAM CHI FIL GUA JAP KOR LAO NHI OAS SAM THA OPI VIE API CAU ME UK OTH Race Rollup Group MH Code CD Code 871 040 African - Ethnic Black, African American or Negro African American (general - use more specific if known) American Indian or Alaska Native Asian Indian Cambodian Chinese Filipino Guamanian or Chamorro Japanese Korean Laotian Native Hawaiian Other Asian Samoan Thai Other Pacific Islanders Vietnamese Asian/Pacific Islander (general: use more specific if known) White / Caucasian Middle Eastern Not Reported / Unknown/Refused to Answer Other Race (general: use more specific if known) Other Race/Unknown African American African American African American American Indian Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Asian/Pacific Islander Caucasian Other Race/Unknown Other Race/Unknown 2 021 031 604 605 608 660 611 612 613 032 034 695 618 033 619 600 010 13 8 12 3 5 6 9 10 11 7 23 16 17 22 19 20 24 999 050 15, 21 14 Code CUB MEX PR OSH OTH NOT UK Hispanic Origin Rollup Group MH Code CD Code 709 722 727 799 Cuban Mexican/Mexican-American/Chicano Puerto Rican Other Spanish/Hispanic Hispanic (general: use more specific if known) Not Spanish/Hispanic Unknown/Refused to answer Hispanic Hispanic Hispanic Hispanic Hispanic NotHispanic NotHispanic 1 2 5 4 998 999 3 6,7
Sample Data Collection Sheet More Code Values Code Family Military Status Drop Down Choices Dependent child of a person who served in the U.S. military Spouse or domestic partner of a person who served in the U.S. military Neither the dependent child, or the spouse or domestic partner of a person who served in the U.S. military Not asked - the question was not asked or client refused to answer. Unknown - this information is not available at present. 01 Dependent child 02 Spouse 03 Neither 08 Not asked 09 Unknown Code CX RO PV MA DI OTH Exit Reasons Completed program Needed more/different services Violation of policy (ex: nonpayment, broke rules) Moved out of area Died Other Code LS MS SS FF MHT CDT INC HOS NH NA Exit Disposition Move to less supportive housing Move to more supportive housing Return to streets/Sobering/shelter Move in with friends/family Move for mental health treatment Move for chemical dependency treatment Incarcerated or jailed Hospitalized Moved to nursing home Not applicable
Sample Data Collection Sheet More Code Values Code NOD DD SCD MPD OTH MUL UK Disability None - No disability Developmental disability Sensory or communication disability Medical/physical disability Other disabilities not listed Multiple disabiliites Unknown Code if learning disability {only allowed in Disability1} Code ASL AMH ARA BOS CAM CAN CZE DUT ENG FAR FIN FRE GER GRE GUJ HIN HMO HUN ILO IND ITA JAP KOR LAO MAL MAN MAR MIE NOR ORO OAF OAS OCM Primary Language Rollup Group MH Code CD Code 15 23 51 52 6 16 26 American Sign Language Amharic Arabic Bosnian Cambodian Cantonese Czech Dutch English Farsi Finnish French German Greek Gujarati Hindi Hmong Hungarian Ilocano Indian(General) Italian Japanese Korean Laotian Malay Mandarin Marathi Mien Norwegian Oromo Other African Other Asian Other communication methods (e.g., lip-reading, finger-spelling, letterboard, cued speech) 3 1 2 7 5 8 9 13 25 24 12 14 21 10 11 12 13 14 15 17 16 18 19 20 21 22 23 24 27 29 30 28 31 53 8 17 10 60 1 2 5 7 27 34 54 81 85 87
Sample Data Collection Sheet Master List and Demographics Given Names T Hispanic Origin Primary Language "Other Language" Interpreter required Client ID 123 Surname Test Site Gender DOB SSN Race1 Race2 Race3 Race4 Immigrant /Refugee Military Status Family Military Status Zip Code Exit Disability1 Disability2 Disability3 Start Date End Date Exit Reason Disposition
Sample Data Collection Sheet Monthly Service Hours Client ID 123 Month Year Support Services Hrs IDValidationFormulas FALSE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE Surname Given Names Test T #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A If the Client ID entered here is not found on the "Demographics_Program" sheet, an alert to check the Client ID will be displayed in Column D-E. If the Client ID is correct, the name will be displayed under "Surname" and "Given Names"
One page does it all Monthly Reporting Spreadsheet Date Medical or Psych Hospitalization: Since Enrollment: Incarcerations: ER Visits: Housing Changes (where TO) Days homeless in last month Prgram Start Date Visit Start Date Visit End Date Hospit al Name Date of Move Jail Name Booking Date Release Date ER Name Admit Date D/C Date Name DOB
