Project on Consumer Satisfaction

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					                                                                                                                                                     Data
#    Dimension           Domain        Subdomain    Indicator              Measures             Target Pop   Rationale                               Source   Measure Source
    1 CAPACITY           Resource       Financial   Adequacy of                                 Total        The capacity to develop and                      Kamis-Gould and
                         base                       Financial resources                         population   maintain a full array of services,               Hadley
                                                                                                             meet the service needs of all
                                                                                                             enrollees, and ensure prompt
                                                                                                             response, regardless of services
                                                                                                             desired, requires significant financial
                                                                                                             resources, i.e., average annual
                                                                                                             dollars per enrollee, will enable
                                                                                                             public entities to compare potential
                                                                                                             plans, select endowed plans, and
                                                                                                             develop norms for required financial
                                                                                                             resources.

    2 CAPACITY           Resource       Financial   % of federal dollars                                                                                      PI interviews
                         base                       coming into state
                                                    increases (Would
                                                    like to know how CT
                                                    stacks up against
                                                    other states in this
                                                    regard)

    3 CAPACITY           Resource       Human       Adequacy of human      Total direct service Total        Data on the ratio of available direct            Kamis-Gould and
                         base                       resources              full-time-equivalent population   service staff per enrollee reflect the           Hadley
                                                                           staff (FTEs) / #                  plan's capacity and potential to
                                                                           enrollees                         respond to needs and to deliver
                                                                                                             required services. Low ratios will
                                                                                                             suggest that clients will have to wait
                                                                                                             for services or receive services less
                                                                                                             frequently than desired. Public
                                                                                                             entities could use the data to
                                                                                                             compare competing plans and to
                                                                                                             develop norms.




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                                                                                                                                                         Data
#    Dimension           Domain        Subdomain    Indicator               Measures           Target Pop       Rationale                                Source       Measure Source
    4 CAPACITY           Resource       Human       Percent of              Ratio of providers                                                           Administrati Outcomes
                         base                       psychiatrists who are   with documented                                                              ve           Roundtable
                                                    Board Certified         training and
                                                                            experience
                                                                            qualifying them as
                                                                            knowledgeable
                                                                            about mental
                                                                            health
                                                                            development and
                                                                            the diagnosis and
                                                                            treatment of
                                                                            mental health
                                                                            problems in
                                                                            children and youth
                                                                            to the number of
                                                                            children and youth
                                                                            served




     CAPACITY            Resource       Human       Percent of Providers    # providers who                                                              Administrati IBH
                         base                       who are                 are recredentialed                                                           ve
                                                    recredentialed          annually / total #
                                                    annually                providers


    5 CAPACITY           Resource       Human       Shortage of child                                                                                                PI interviews-
                         base                       psychiatrists is                                                                                                 Wait lift of
                                                    addressed                                                                                                        evaluation of med
                                                                                                                                                                     evaluation
    6 CAPACITY           Resource       Human       Independently           board certified/       Total        Independently qualified clinicians,                  Kamis-Gould and
                         base                       qualified clinicians    licensed FTEs /        population   i.e., those certified or licensed to                 Hadley
                                                                                                                provide unsupervised services, are
                                                                            total FTEs                          those who have demonstrated
                                                                                                                relevant requirements and clinical
                                                                                                                skill. A high proportion of clinicians
                                                                                                                so certified would be an indication of
                                                                                                                highly qualified, direct service
                                                                                                                providers.

    7 CAPACITY           Resource       Human       Availability of                                                                                      Administrati DS 200+
                         base                       appropriate                                                                                          ve
                                                    services/specialists




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                                                                                                                              Data
#    Dimension           Domain        Subdomain      Indicator                Measures              Target Pop   Rationale   Source       Measure Source
    8 CAPACITY           Resource       Human         Provider Turnover                                                       Administrati Hedis 3.0; AMBHA-
                         base                         (HEDIS); Change in                                                      ve           PERMS 2.0
                                                      Provider availability
                                                      (AMBHA-PERMS)
    9 CAPACITY           Management     Leadership    Degree of consumer       # consumers who                                Enrollment   CARF performance
                         Capacity                     involvement in the       are involved in the                            data,        indicators for
                                                      planning, design,        service delivery                               consumer     behavioral health
                                                      delivery, and            system (e.g.,                                  survey
                                                      evaluation of services   planning, design,
                                                                               design, and/or
                                                                               evaluation of
                                                                               services) / total #
                                                                               consumers

10 CAPACITY              Management     Innovations   Degree of integration # children using                                               HSRI
                         Capacity                     of new services       newly created                                                  Recommendation
                                                                            services: EMPS,
                                                                            Care Coordination,
                                                                            Multisystemic
                                                                            Therapy,
                                                                            Wraparound
                                                                            services

11 CAPACITY              Management     Innovations   % of kids with care                                                                  PI Interviews-
                         Capacity                     coordination                                                                         Over % of kids who
                                                                                                                                           need care
                                                                                                                                           coordination
12 CAPACITY              Management     Innovations   Degree of physician      # clinicians                                                HSRI
                         Capacity                     training                 receiving system                                            Recommendation
                                                                               of care training




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                                                                                                                                                          Data
# Dimension           Domain        Subdomain           Indicator                Measures             Target Pop   Rationale                              Source   Measure Source
13 CAPACITY           Management     Networking/        Networking and           # agencies           Total        The best health and mental health               Kamis-Gould and
                      Capacity      systems integration integration with other   referring at least   population   services are provided by an                     Hadley
                                                        systems                  one client / #                    integrated system of care; i.e., a
                                                                                 potential referral                network of agencies and service
                                                                                 agencies in area                  systems-including primary care,
                                                                                                                   behavioral health, and generic
                                                                                                                   services- that ensures prompt
                                                                                                                   response to all service needs
                                                                                                                   through open communication,
                                                                                                                   referrals, and consultation. A high
                                                                                                                   proportion of area agencies referring
                                                                                                                   clients will suggest networking and
                                                                                                                   interaction, while a low proportion
                                                                                                                   might signal that agencies are
                                                                                                                   isolated and less likely to be able to
                                                                                                                   meet individualized service needs.



14 CAPACITY           Management     Networking/        Outreach and             Consultation &       Total        The proportion of an agency's staff             Kamis-Gould and
                      Capacity      systems integration networking effort        education +          population   devoted to 1- outreach to the public            Hadley
                                                                                 information &                     and to enrollees who might need,
                                                                                 referral FTEs /                   but do not avail themselves t of,
                                                                                 total FTEs                        services, and 2- networking with
                                                                                                                   other agencies and service systems
                                                                                                                   is a reflection of a desired public
                                                                                                                   health perspective and a willingness
                                                                                                                   to invest in the improvement of care.
                                                                                                                    A low ratio might suggest either
                                                                                                                   inadequate human resources and
                                                                                                                   inability to perform networking
                                                                                                                   functions, or a lack of recognition of
                                                                                                                   the importance of those functions.
                                                                                                                   Accumulated data might also
                                                                                                                   contribute to empirical development
                                                                                                                   of norms that could be later be built
                                                                                                                   into contractual requirements.




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                                                                                                                            Data
# Dimension           Domain        Subdomain           Indicator              Measures            Target Pop   Rationale   Source         Measure Source
15 CAPACITY           Management     Networking/        Linkage to primary     Percentage of                                Primary        Outcomes
                      Capacity      systems integration services               children/adolescent                          data           Roundtable
                                                                               s who have used                              collection     Reduced list
                                                                               behavioral health                            (self-report
                                                                               services, who                                survey)
                                                                               have had at least
                                                                               one health care
                                                                               visit with a
                                                                               physician during
                                                                               the past year
16 CAPACITY           Management     Networking/        Co-occurring           Number of                                                   Outcomes
                      Capacity      systems integration disorders              children/adolescent                                         Roundtable
                                                                               s diagnosed with                                            Reduced List-
                                                                               both mental health                                          Performance
                                                                               and substance use                                           measures currently
                                                                               per 1000 of the                                             being defined,
                                                                               eligible population                                         and/or
                                                                               who have a care                                             developmental
                                                                               plan that reflects                                          measures to be
                                                                               coordinated/integra                                         defined for possible
                                                                               ted services for                                            pilot testing in
                                                                               both disorders in a                                         response to policy
                                                                               calendar year                                               changes in
                                                                               (independent of                                             behavioral heath
                                                                               whether these                                               services.
                                                                               service systems
                                                                               are separate
                                                                               agencies).




17 CAPACITY           Management     Networking/        Getting medical care                                                               PI interviews- 1)
                      Capacity      systems integration in a timely way                                                                    Coordination of
                                                                                                                                           PCP Coordination
                                                                                                                                           for multiple complex
                                                                                                                                           needs, 2) Know
                                                                                                                                           who PCP is, 3) %
                                                                                                                                           have PCP visit vs.
                                                                                                                                           non-BH, 4) % have
                                                                                                                                           a PCP coordination




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                                                                                                                                                            Data
# Dimension           Domain        Subdomain            Indicator               Measures               Target Pop   Rationale                              Source   Measure Source
18 CAPACITY           Management     Capacity for        Capacity for service    # non-inpatient        Total        The provision of appropriate                    Kamis-Gould and
                      Capacity      service substitution substitution            beds                   population   services in the least restrictive               Hadley
                                                                                 (residential/crisis) /              setting requires a full array of
                                                                                  # enrollees                        services, as well as the ability to
                                                                                                                     "step down" clients from inpatient to
                                                                                                                     less restrictive, yet still intensive,
                                                                                                                     services. Commonly, the most
                                                                                                                     inadequate service segment is
                                                                                                                     residential services, with a lack of
                                                                                                                     both total number of beds and range
                                                                                                                     of types. A low ratio of non-inpatient
                                                                                                                     (i.e., residential and crisis beds)
                                                                                                                     would be a poor indicator,
                                                                                                                     suggesting an inability either to
                                                                                                                     stabilize crises without
                                                                                                                     hospitalization, or to discharge
                                                                                                                     hospitalized clients who need
                                                                                                                     intensive supervision and care but
                                                                                                                     who would best be served in
                                                                                                                     residential settings.

19 CAPACITY           Management     Capacity for        Decreased LOS in                                                                                            PI interviews
                      Capacity      service substitution residential treatment


20 CAPACITY           Management     Capacity for        Caregivers are          Measured by team                                                                    Dawn Project
                      Capacity      service substitution committed to plan       meeting                                                                             Outcome measures
                                                                                 attendance
21 CAPACITY           Management     Capacity for        Inpatient                                                                                                   PI Interviews
                      Capacity      service substitution administrative days
                                                       decline
22 CAPACITY           Management     Capacity for        Fewer kids in ERs                                                                                           PI interviews
                      Capacity      service substitution

23 CAPACITY           Management     Capacity for        Number of referrals                                                                                         PI interviews
                      Capacity      service substitution to ERs from EMPS
                                                       declines

24 CAPACITY           Management     Capacity for        LOS in ERs                                                                                                  PI Interviews
                      Capacity      service substitution decreases

25 CAPACITY           Management     Capacity for        Number of re-                                                                                               PI interviews-
                      Capacity      service substitution admissions to ERs                                                                                           Track frequent users

26 CAPACITY           Management     Capacity for        ER admissions                                                                                               PI interviews
                      Capacity      service substitution decrease



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                                                                                                                                                              Data
# Dimension           Domain        Subdomain            Indicator                 Measures             Target Pop   Rationale                                Source      Measure Source
27 CAPACITY           Management     Capacity for        System responds to                                                                                               PI interviews
                      Capacity      service substitution crises more
                                                         appropriately (i.e. no
                                                         police)
28 CAPACITY           Management     Capacity for        Choices given to                                                                                                 PI interviews-
                      Capacity      service substitution families                                                                                                         Satisfaction survey

29 CAPACITY           Management     Capacity for        Availablility of the                                                                                 Administrati NAMI
                      Capacity      service substitution most effective                                                                                       ve
                                                         medications,
                                                         rehabilitative
                                                         services, alternatives
                                                         to hospitalization and
                                                         rehabilitative services



30 CAPACITY           Management    Dispute              Prevalence of             % of enrollees       Total        Enrollees challenge utilization and                  Kamis-Gould and
                      Capacity      management           disputes                  who appeal           population   managed care when they disagree                      Hadley
                                                                                   decisions                         with decisions about the medical
                                                                                                                     necessity, choice of, or financial
                                                                                                                     coverage of services. A high
                                                                                                                     frequency of disputes, and a level
                                                                                                                     that is out of line in comparison with
                                                                                                                     other, similar situation, would
                                                                                                                     suggest a plan that over-
                                                                                                                     emphasizes cost containment,
                                                                                                                     probably at the expense of quality
                                                                                                                     care.
31 CAPACITY           Management    Dispute              Dispute Resolution        Average time to      Total        Delays in handling and resolving                     Kamis-Gould and
                      Capacity      management                                     resolution of        population   disputes about choices and financial                 Hadley
                                                                                   appeals                           coverage of services could reflect
                                                                                                                     an attempt to discourage enrollees
                                                                                                                     from challenging utilization and
                                                                                                                     managed care decisions. A high
                                                                                                                     average time to resolve appeals
                                                                                                                     would be a negative indicator.




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                                                                                                                                                             Data
# Dimension           Domain        Subdomain            Indicator                Measures              Target Pop   Rationale                               Source       Measure Source
32 CAPACITY           Management    Dispute              Number of patient                                                                                   Complaints/ IBH
                      Capacity      management           complaints and/or                                                                                   appeals/grie
                                                         greivances and                                                                                      vance
                                                         timeliness of review                                                                                records




33 CAPACITY           Clinical                           Comprehensiveness        % of model array      Total        Appropriate services and continuity                Kamis-Gould and
                      Capacity      Comprehensivenes of array of services         of services           population   of care require a comprehensive                    Hadley
                                    s of service array and potential for a        provided either                    array of services. It is, therefore,
                                                         seamless service         directly or through                incumbent upon public systems to
                                                         system                   existing (i.e., not                develop a model array of services
                                                                                  just promised)                     against which plans could be
                                                                                  service contracts                  assessed. The more complete the
                                                                                                                     range of services a plan offers, that
                                                                                                                     higher the likelihood that enrollees
                                                                                                                     will have access to all the services
                                                                                                                     they need and desire. Conversely,
                                                                                                                     a low proportion might suggest that
                                                                                                                     such a plan should not be
                                                                                                                     considered for public system clients.




34 CAPACITY           Clinical                           More services are                                                                                              PI Interviews- Off
                      Capacity      Comprehensivenes available in                                                                                                       hours access to
                                    s of service array afternoons,                                                                                                      clinic services;
                                                     evenings, and                                                                                                      School-based clinic
                                                     weekends.                                                                                                          care
35 CAPACITY           Clinical                       Access to full array                                                                                               PI interviews- With
                      Capacity      Comprehensivenes of services is insured                                                                                             more specificity
                                    s of service array

36 CAPACITY           Clinical                           Increased availability                                                                                         PI interviews-
                      Capacity      Comprehensivenes of hospital beds                                                                                                   Reduced ED stays -
                                    s of service array                                                                                                                  need to modify

37 CAPACITY           Clinical                           More crisis beds                                                                                               PI interviews-
                      Capacity      Comprehensivenes available immediately                                                                                              Non-hospital, level
                                    s of service array                                                                                                                  of care needed,
                                                                                                                                                                        EMPS
38 CAPACITY           Clinical                           Increased availability                                                                                         PI interviews
                      Capacity      Comprehensivenes of staffing for small
                                    s of service array group homes


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                                                                                                                                                          Data
# Dimension           Domain        Subdomain          Indicator              Measures             Target Pop   Rationale                                 Source   Measure Source
39 CAPACITY           Clinical                         Increase in                                                                                                 PI interviews
                      Capacity      Comprehensivenes residential slots,
                                    s of service array group homes

40 CAPACITY           Clinical       Clinical         Quality Assurance       QA FTEs / total      Total        Quality assurance activities are                   Kamis-Gould and
                      Capacity      soundness/QA                              FTEs                 population   essential to ensure that the right                 Hadley
                                                                                                                services are provided to the right
                                                                                                                clients, by the right providers, at the
                                                                                                                right time. Because such efforts do
                                                                                                                not generate revenues, however, it
                                                                                                                is important to monitor the level of
                                                                                                                quality assurance efforts. Public
                                                                                                                entities might opt to develop
                                                                                                                empirical norms about desired
                                                                                                                levels and encourage quality
                                                                                                                assurance by including this type of
                                                                                                                indicator in incentive structures and
                                                                                                                rewards.


41 CAPACITY           Clinical       Clinical         Congruence with         # reviewed cases Total            Most area of mental health services                Kamis-Gould and
                      Capacity      soundness/QA      clinical guidelines     within guidelines / population    do not have standards against                      Hadley
                                                      accepted by the field            #                        which to assess care, but a large
                                                                              examined                          and growing number have clinical
                                                                                                                guidelines for practice. Despite the
                                                                                                                fact that assessing congruence with
                                                                                                                guidelines may involve labor-
                                                                                                                intensive record reviews, this type of
                                                                                                                evaluation is desirable because
                                                                                                                compliance with guidelines is likely
                                                                                                                to maximize high quality care and to
                                                                                                                minimize liability.




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                                                                                                                        Data
# Dimension           Domain        Subdomain      Indicator               Measures            Target Pop   Rationale   Source       Measure Source
42 CAPACITY           Clinical       Clinical      Use of scientifically   Percentage of                                Administrati Outcomes
                      Capacity      soundness/QA   up to date and          children receiving                           ve           Roundtable
                                                   comprehensive           active services
                                                   treatment guidelines    who are treated
                                                                           within approved
                                                                           practice guidelines
                                                                           [i.e., American
                                                                           Psychiatric Assoc.,
                                                                           American
                                                                           Academy of Child
                                                                           and Adolescent
                                                                           Psychiatry,
                                                                           American
                                                                           Academy of
                                                                           Pediatrics --
                                                                           depression,
                                                                           Pervasive
                                                                           Developmental
                                                                           Disorders (PDD),
                                                                           ADHD, Tic
                                                                           Disorders and
                                                                           Stereotypic
                                                                           Movement
                                                                           Disorder, Mental
                                                                           Disorders Due to a
                                                                           General Medical
                                                                           Condition,
                                                                           Schizophrenia and
                                                                           Other Psychotic
                                                                           Disorders, Mood
                                                                           Disorders, Eating
                                                                           Disorders, etc.]




43 CAPACITY           Clinical       Clinical      Use of scientifically   Percentage of                                Administrati Outcomes
                      Capacity      soundness/QA   up to date and          clinical staff who                           ve           Roundtable
                                                   comprehensive           have received
                                                   treatment guidelines    training and
                                                                           certification in
                                                                           evidence-based,
                                                                           supported-
                                                                           supported
                                                                           treatments (CBT,
                                                                           MST, IPT, etc.)



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                                                                                                                        Data
# Dimension           Domain        Subdomain      Indicator             Measures              Target Pop   Rationale   Source         Measure Source
44 CAPACITY           Clinical       Clinical      Medication            Percentage of                                  Administrati   Outcomes
                      Capacity      soundness/QA   management            those prescribing                              ve/            Roundtable
                                                                         medication within                              Claims/MIS     Reduced list
                                                                         the service system
                                                                         who have been
                                                                         trained to use
                                                                         established,
                                                                         empirically based
                                                                         guidelines
                                                                         (American
                                                                         Academy of Child
                                                                         and Adolescent
                                                                         Psychiatry,
                                                                         American
                                                                         Psychiatric
                                                                         Association,
                                                                         American
                                                                         Academy of
                                                                         Pediatrics, etc.) for
                                                                         prescribing
                                                                         medications for
                                                                         behavioral health
                                                                         conditions


45 CAPACITY           Clinical       Clinical      Evidence based                                                                      PI interviews
                      Capacity      soundness/QA   practices are
                                                   implemented
46 CAPACITY           Clinical       Clinical      Medication            Percentage of                                  Administrati Outcomes
                      Capacity      soundness/QA   management            children/adolescent                            ve/          Roundtable
                                                                         s receiving                                    Claims/MIS Reduced list
                                                                         medications that
                                                                         also receive
                                                                         medication-
                                                                         monitoring
                                                                         services.
47 CAPACITY           Clinical       Clinical      Percentage and        # clients receiving                            Claims and     NASMHPD 16
                      Capacity      soundness/QA   penetration of        atypical psychotics                            case           State, APA
                                                   persons recieving      / total # clients                             records
                                                   atypical
                                                   antipsychotics; APA
                                                   has a very specific
                                                   set of diagnosis
                                                   related measures




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                                                                                                                       Data
# Dimension          Domain        Subdomain      Indicator               Measures            Target Pop   Rationale   Source       Measure Source
48 CAPACITY          Clinical       Clinical      Antidepressant          Percentage of                                Administrati Outcomes
                     Capacity      soundness/QA   Medication              children treated                             ve claims    Roundtable
                                                  Management.             within the service                           data
                                                  SUGGESTION: add         system who
                                                  atypical medications,   receive medication
                                                  as well as other uses   monitoring
                                                  of antidepressants,     services for
                                                                          antidepressants
                                                                          prescribed for
                                                                          serious
                                                                          depression, school
                                                                          phobias and other
                                                                          serious anxiety
                                                                          disorders, bed
                                                                          wetting, some
                                                                          bulimic-type eating
                                                                          disorders, and
                                                                          attention deficit-
                                                                          hyperactivity
                                                                          disorder. Anti
                                                                          psychotics ("major
                                                                          tranquilizers"),
                                                                          such as Haldol,
                                                                          Stelazine, or
                                                                          Thorazine
                                                                          prescribed for the
                                                                          reduction of
                                                                          irrational beliefs,
                                                                          hallucinations,
                                                                          related panic,
                                                                          sense of loss of
                                                                          control.
                                                                          Lithium/anti-
                                                                          convulsants such
                                                                          as carbamazepine
                                                                          (Tegretol) and




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                                                                                                                                                  Data
# Dimension           Domain        Subdomain      Indicator               Measures             Target Pop   Rationale                            Source   Measure Source
49 CAPACITY           Clinical       Clinical      Access: Second          # persons who                     The MI mental health code provides            MI Dept. of
                      Capacity      soundness/QA   opinions                received a service                a potential recipients of public              Community Health
                                                                           as a result of a                  mental health services the means to
                                                                           second opinion                    request a second opinion if their
                                                                                                             request for any non-emergent
                                                                                # persons who                CMHSP service is denied. This
                                                                           requested a                       indicator measures the proportion
                                                                           second opinion                    of persons receiving services as a
                                                                           following the                     result of a second opinion following
                                                                           denial of CMHSP                   an initial denial of service.
                                                                           service or a
                                                                           referral elsewhere
                                                                           during a
                                                                           professional
                                                                           assessment.



50 CAPACITY           Clinical       Clinical      Interventions for       Percentage of                                                        Survey     Outcomes
                      Capacity      soundness/QA   Family                  survey                                                                          Roundtable
                                                   Members/Significant     respondents who
                                                   Others of AOD           report using AOD
                                                   Clients in Treatment.   services and who
                                                                           also report that
                                                                           their family
                                                                           member/significant
                                                                            other received
                                                                           preventive
                                                                           interventions.




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                                                                                                                          Data
# Dimension           Domain        Subdomain      Indicator                 Measures            Target Pop   Rationale   Source       Measure Source
51 CAPACITY           Clinical       Clinical      Number and                Percentage of                                Administrati Outcomes
                      Capacity      soundness/QA   percentage of             children (by                                 ve - Claims Roundtable
                                                   patients or               medication class)
                                                   prescriptions for anti-   treated within the
                                                   psychotic                 service system
                                                   medications for           who receive
                                                   patients not having       medication
                                                   an Axis 1 psychotic       monitoring
                                                   disorder                  services
                                                   (SUGGESTION:              [Stimulants,
                                                   expand medication         dexedrine or
                                                   classification beyond     methylphenidate
                                                   anti-psychotics).         (e.g., Ritalin) --
                                                                             prescribed for the
                                                                             treatment of
                                                                             ADHD,
                                                                             Antidepressants
                                                                             prescribed for
                                                                             serious
                                                                             depression, school
                                                                             phobias and other
                                                                             serious anxiety
                                                                             disorders, bed
                                                                             wetting, some
                                                                             bulimic-type eating
                                                                             disorders, and
                                                                             attention deficit-
                                                                             hyperactivity
                                                                             disorder. Anti
                                                                             psychotics ("major
                                                                             tranquilizers"),
                                                                             such as Haldol,
                                                                             Stelazine, or
                                                                             Thorazine
                                                                             prescribed for the
                                                                             reduction of
52 CAPACITY           Clinical       Clinical
                      Capacity      soundness/QA
53 CAPACITY           Clinical       Clinical      Caregiver/child/          Percentage of                                Primary        Outcomes
                      Capacity      soundness/QA   adolescent/               families/caregivers                          data           Roundtable
                                                   involvement in            who report active                            collection     Reduced list
                                                   treatment                 participation in                             (self-report
                                                                             determining their                            survey)
                                                                             child’s treatment




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                                                                                                                     Data
# Dimension           Domain        Subdomain      Indicator             Measures           Target Pop   Rationale   Source       Measure Source
54 CAPACITY           Clinical       Clinical      Consumer/family       % of consumers                              State Report NASMHPD 16
                      Capacity      soundness/QA   involvement in policy on planning boards                                       State, DS 2000+
                                                   development, QA
                                                   and Planning

55 CAPACITY           Clinical       Clinical      Adverse drug                                                      Clinical       NAPHS
                      Capacity      soundness/QA   reactions                                                         Records
56 CAPACITY           Clinical       Clinical      Medication Errors                                                 Clinical       NASMHPD 16 State
                      Capacity      soundness/QA                                                                     Records
57 CAPACITY           Clinical       Clinical      Caregiver/child/     Percentage of                                Primary        Outcomes
                      Capacity      soundness/QA   adolescent/          youth (11 years                              data           Roundtable
                                                   involvement in       and older) who                               collection     Reduced list
                                                   treatment            report active                                (self-report
                                                                        participation in                             survey)
                                                                        determining their
                                                                        own treatment

58 CAPACITY           Clinical       Clinical      Family involvement   # ambulatory                                                Annie E. Casey
                      Capacity      soundness/QA                        treatment                                                   Children's
                                                                        encounters for                                              Benchmarking
                                                                        children less than                                          Project
                                                                        or equal to 12
                                                                        years of age who
                                                                        also have a family
                                                                        claim visit within
                                                                        the same 12
                                                                        month period / #
                                                                        ambulatory
                                                                        treatment
                                                                        encounters for
                                                                        children less than
                                                                        or equal to 12
                                                                        years of age




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                                                                                                                       Data
# Dimension          Domain        Subdomain      Indicator              Measures             Target Pop   Rationale   Source   Measure Source
59 CAPACITY          Clinical       Clinical      Seclusion and          To be defined in                                       Outcomes
                     Capacity      soundness/QA   restraint requirements accordance with                                        Roundtable
                                                                         JCAHO, etc.                                            Reduced List-
                                                                         Current status:                                        Performance
                                                                         Restraint/seclusion                                    measures currently
                                                                          provisions                                            being defined,
                                                                         enacted in the                                         and/or
                                                                         Children’s Health                                      developmental
                                                                         Act of 2000, P.L.                                      measures to be
                                                                         106-310. Many of                                       defined for possible
                                                                         the provisions and                                     pilot testing in
                                                                         definitions in these                                   response to policy
                                                                         regulations are                                        changes in
                                                                         conflicting                                            behavioral heath
                                                                         (JCAHO, HCFA,                                          services.
                                                                         etc.) — working to
                                                                         have the under-21
                                                                         RCT/hospital rules
                                                                         modified. Goal is
                                                                         to advocate for
                                                                         national standards
                                                                         that will be
                                                                         consistent across
                                                                         treatment settings.
                                                                             Measures
                                                                         include the
                                                                         following:
                                                                         1. Behavior
                                                                         requiring
                                                                         restraint/seclusion
                                                                         2. Documentation
                                                                         of less restrictive
                                                                         alternative failure
                                                                         3. Type: restraint,
                                                                         seclusion
                                                                         4. Qualification of




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                                                                                                                                                  Data
# Dimension           Domain        Subdomain      Indicator               Measures            Target Pop   Rationale                             Source         Measure Source
60 CAPACITY           Clinical       Clinical      Continuity of care      Percentage of                                                          Administrati   Outcomes
                      Capacity      soundness/QA                           children/adolescent                                                    ve/            Roundtable
                                                                           s discharged from                                                      Claims/MIS     Reduced list
                                                                           a psychiatric
                                                                           hospital who have
                                                                           a behavioral
                                                                           health service
                                                                           contact within 7
                                                                           days and 30 days
                                                                           of the hospital
                                                                           discharge




61 CAPACITY           Clinical       Clinical      Follow-Up after         Percent of children                                                    Administrati Outcomes
                      Capacity      soundness/QA   hospitalization for     and adolescents                                                        ve claims    Roundtable
                                                   substance abuse -       who had an                                                             data
                                                   within 30 days (7       ambulatory or
                                                   days for state          day/night mental
                                                   hospital); Rate of      health visit within
                                                   persons served who      seven days and 30
                                                   receive a timely face   days of hospital
                                                   to face follow-up       discharge
                                                   after leaving 24 hour
                                                   care (ACMHA)


62 CAPACITY           Clinical       Clinical      Least restrictive care (UOS inpatient &                  Appropriate substitution of                          Kamis-Gould and
                      Capacity      soundness/QA                          emergency/UOS                     residential and ambulatory care for                  Hadley
                                                                          residential &                     inpatient and emergency services
                                                                          ambulatory); this                 can produce the same results at
                                                                          year vs. last year                lower levels of restrictiveness.
                                                                                                            While this may involve the creation
                                                                                                            of new community services to fill
                                                                                                            gaps in care, this indicator should
                                                                                                            be monitored over time to ensure
                                                                                                            desired trends.


63 CAPACITY           Clinical       Clinical      Various quality                                                                                Clinical       Rand, AR Quality
                      Capacity      soundness/QA   indicators for                                                                                 Records        Indicators
                                                   different clinical
                                                   conditions for
                                                   children - ADHD,
                                                   Depression




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                                                                                                                                                       Data
# Dimension           Domain        Subdomain        Indicator               Measures             Target Pop   Rationale                               Source       Measure Source
64 CAPACITY           Clinical       Clinical        Rate of involuntary                                                                               Authorizatio SAMHSA EW
                      Capacity      soundness/QA     commitment                                                                                        n data       system, AMBHA -
                                                                                                                                                                    PERMS 2.0

65 CAPACITY           Clinical       Clinical        Use of peer review                                                                                Policies      NAPHS
                      Capacity      soundness/QA

66 CAPACITY           Technical     MIS & turn-around MIS downtime                                Total                                                              Kamis-Gould and
                      Capacity      of reports                                                    Population                                                         Hadley
67 CAPACITY           Technical     Monitoring and   Provider inclusion in   # providers who      Total                                                              Kamis-Gould and
                      Capacity      evaluation       quality monitoring      are members of       providers                                                          Hadley
                                                     activities              the BHO's quality
                                                                             monitoring
                                                                             committee /
                                                                                          total
                                                                             # providers

68 CAPACITY           Technical     Monitoring and   More Capacity at the                                                                                            PI Interviews- Use
                      Capacity      evaluation       regional level to                                                                                               of Data
                                                     analyze and interpret
                                                     data
69 CAPACITY           Technical     Monitoring and   Percent of Clients    # clients with post-                                                        Self-Report   IBH
                      Capacity      evaluation       who have post-        treatment follow-                                                           or clinical
                                                     treatment follow-up   up / total # clients                                                        records
                                                     to evaluate outcomes


70 CAPACITY           Financial                      Days in accounts        net accounts         Total        This measure is a common financial                    Kamis-Gould and
                      Viability                      receivable              receivable / net     population   ratio used by accountants and                         Hadley
                                                                             service revenue                   financial officers to assess how well
                                                                                                               an entity puts its money to work or
                                                                                                               brings money in to minimize the
                                                                                                               need to borrow. In industry, this
                                                                                                               ratio might be 30, 60, or 90 days. In
                                                                                                               indemnity healthcare, it is likely to
                                                                                                               be longer because insurance, e.g.,
                                                                                                               Medicaid, often takes loner to pay
                                                                                                               (i.e., creates a float).




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                                                                                                                                                            Data
# Dimension           Domain        Subdomain          Indicator              Measures         Target Pop        Rationale                                  Source     Measure Source
71 CAPACITY           Financial                        Operating margin       revenue-expenses Total             This measure reflects a profit                        Kamis-Gould and
                      Viability                        ratio                   / revenue       population        margin. To ensure that a large                        Hadley
                                                                                                                 proportion of capitated dollars are
                                                                                                                 spent on services rather than, for
                                                                                                                 example, dividends, a limit on this
                                                                                                                 ratio must be negotiated up front
                                                                                                                 and closely monitored.

72 CAPACITY           Financial                        Current ratio          current assets        Total        This measure is a common financial                    Kamis-Gould and
                      Viability                                                                     population   ration used by accountants and                        Hadley
                                                                              current liabilities                financial officers to ensure the
                                                                                                                 financial viability of any organization.
                                                                                                                  In industry, this measure should not
                                                                                                                 fall below 1.5:1.0.

73 RESPONSIVENESS Market                               Access: penetration    # children under                   This indicator addresses the degree                   MI Dept. of
                      Penetration   Admissions/populat rate                   18 served / #                      to which children under 18, typically                 Community Health
                                    ion                                       children under 18                  an underserved population, are
                                                                              in the area                        receiving public mental health
                                                                              population                         services. The county population
                                                                                                                 census is used as the denominator
                                                                                                                 since all residents are eligible for
                                                                                                                 public metal health services.

74 RESPONSIVENESS Market                               Percentage of                                                                                        Administrati HEDIS, AMBHA-
                      Penetration   Admissions/populat children/adults                                                                                      ve claims    PERMS 2.0
                                    ion                receiving day/night                                                                                  data
                                                       mental health
                                                       services; percentage
                                                       receiving inpatient
                                                       and outpatient
                                                       services
75 RESPONSIVENESS Market                               Percentage of                                                                                        Administrati HEDIS, AMBHA-
                      Penetration   Admissions/populat children receiving                                                                                   ve claims    PERMS 2.0
                                    ion                Inpatient mental                                                                                     data
                                                       health services
76 RESPONSIVENESS Market                               Percentage of                                                                                        Administrati HEDIS, AMBHA-
                      Penetration   Admissions/populat children receiving                                                                                   ve claims    PERMS 2.0
                                    ion                ambulatory mental                                                                                    data
                                                       health services




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                                                                                                                                                              Data
# Dimension       Domain            Subdomain          Indicator           Measures                     Target Pop     Rationale                              Source       Measure Source
77 RESPONSIVENESS Market                               Percentage of                                                                                          Administrati HEDIS
                      Penetration   Admissions/populat children receiving                                                                                     ve claims
                                    ion                any chemical                                                                                           data
                                                       dependency services


78 RESPONSIVENESS Market                                 Percentage of                                                                                        Administrati HEDIS, AMBHA-
                      Penetration   Admissions/populat children receiving                                                                                     ve claims    PERMS 2.0
                                    ion                Inpatient chemical                                                                                     data
                                                         dependency services


79 RESPONSIVENESS Market                                 Percentage of                                                                                        Administrati HEDIS, AMBHA-
                      Penetration   Admissions/populat children receiving                                                                                     ve claims    PERMS 2.0
                                    ion                ambulatory chemical                                                                                    data
                                                         dependency services


80 RESPONSIVENESS Market                                 Percentage of                                                                                        Administrati HEDIS
                      Penetration   Admissions/populat children receiving                                                                                     ve claims
                                    ion                day/night chemical                                                                                     data
                                                         dependency services


81 RESPONSIVENESS Market                                 Percentage of            # with SED in                                                               MIS        NASMHPD 16 State
                      Penetration   Admissions/populat children and               therapeutic foster                                                          systems,
                                    ion                adolescents with           care / total # with                                                         claims
                                                         SED served by the        SED
                                                         MH authority in a 24
                                                         hour setting who are
                                                         in therapeutic foster
                                                         care
82 RESPONSIVENESS Market             Active              Accessibility to youth   # SED clients / #     Population 0- Because of the level of disability in              Kamis-Gould and
                      Penetration   clients/population   with serious             estimated SED         18            children with SED, it is incumbent                 Hadley
                                                         emotional                children in                         upon public entities to develop
                                                         disturbances (SED)       population                          estimates of the prevalence of SED
                                                                                                                      in the general population, and to
                                                                                                                      monitor outreach to ensure that this
                                                                                                                      indicator is as close as possible to
                                                                                                                      1.0.




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                                                                                                                            Data
# Dimension       Domain            Subdomain            Indicator             Measures            Target Pop   Rationale   Source       Measure Source
83 RESPONSIVENESS Market             Active              Penetration rates of  Percent of children                          Administrati Outcomes
                      Penetration   clients/population   therapeutic foster    and adolescents                              ve claims    Roundtable
                                                         care. SUGGESTION:     who receive any of                           data
                                                         Expand categories to  the following
                                                         all behavioral health services: inpatient
                                                         services.             mental health
                                                                               services,
                                                                               residential mental
                                                                               health services,
                                                                               therapeutic foster
                                                                               care, day
                                                                               treatment or
                                                                               intensive
                                                                               outpatient mental
                                                                               health services,
                                                                               outpatient mental
                                                                               health services
                                                                               within a clinic
                                                                               setting, school-
                                                                               based mental
                                                                               health services,
                                                                               home-based
                                                                               mental health
                                                                               services, other
                                                                               community-based
                                                                               mental health
                                                                               services, inpatient
                                                                               chemical
                                                                               dependency,
                                                                               services,
                                                                               residential
                                                                               chemical
                                                                               dependency
                                                                               services, day
                                                                               treatment or
                                                                               intensive chemical
84 RESPONSIVENESS Market             Active              Number of cases per Percent of                                     Administrati Outcomes
                      Penetration   clients/population   1,000 members who child/adolescent/fa                              ve           Roundtable
                                                         were diagnosed with mily population
                                                         AOD abuse or          diagnosed with
                                                         dependence or who AOD abuse or
                                                         received AOD-         dependence who
                                                         related plan services received any AOD
                                                         on an annual basis.   services in a year.




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                                                                                                                                                          Data
# Dimension       Domain            Subdomain            Indicator               Measures            Target Pop   Rationale                               Source         Measure Source
85 RESPONSIVENESS Market             Active              Use of self-help/ self-                                                                          Policies or    Outcomes
                      Penetration   clients/population   management/ family                                                                               program        Roundtable
                                                         support                                                                                          description
86 RESPONSIVENESS Market             Active              Number and                                                                                       Administrati   AMBHA-PERMS 2.0
                      Penetration   clients/population   percentage of                                                                                    ve- claims
                                                         patients remaining in
                                                         professional
                                                         chemical
                                                         dependency
                                                         rehabilitation
                                                         treatment between
                                                         60 and 90 days from
                                                         admission to
                                                         inpatient, alternative
                                                         or intensive
                                                         outpatient settings


87 RESPONSIVENESS Market             Outreach            Outreach to increase annual outreach $      total        According to data compiled in the                      Kamis-Gould and
                      Penetration                        service accessibility / total budget        population   epidemiological Catchment Area                         Hadley
                                                                                                                  (ECA) projects, only about one-fifth
                                                                                                                  of persons with behavioral health
                                                                                                                  diagnoses used any mental health
                                                                                                                  services. It is important, therefore,
                                                                                                                  for providers to conduct outreach to
                                                                                                                  ensure that the level of treated
                                                                                                                  prevalence is as close as possible to
                                                                                                                  the prevalence of mental health
                                                                                                                  disorders.



88 RESPONSIVENESS Market             Outreach            Utilization of non-   Percentage of all                                                          Administrati Outcomes
                      Penetration                        traditional service   child/adolescent/fa                                                        ve/          Roundtable
                                                         settings              mily behavioral                                                            Claims/MIS Reduced list
                                                                               health service                                                             and/or
                                                                               contacts that                                                              other
                                                                               occur in home,                                                             primary
                                                                               school, or other                                                           data
                                                                               non-traditional                                                            collection
                                                                               service settings                                                           (self-report
                                                                                                                                                          survey)




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                                                                                                                           Data
# Dimension       Domain            Subdomain       Indicator              Measures               Target Pop   Rationale   Source      Measure Source
89 RESPONSIVENESS Market             Outreach       Families and                                                                       PI interviews-
                      Penetration                   providers have                                                                     Satisfaction survey
                                                    knowledge of what's
                                                    available regardless
                                                    of payer.

90 RESPONSIVENESS Market             Outreach       Penetration rates of                                                   Administrati Outcomes
                      Penetration                   early intervention                                                     ve claims    Roundtable
                                                                                                                           data

91 RESPONSIVENESS                  Locally unique   Geographic Analysis    Percent of                                      Administrati Outcomes
                      ACCESSIBILIT groups           of population to       population                                      ve           Roundtable
                      Y TO                          provider distance      (children/adolescen
                      UNDERSERVE                    and travel times.      ts/families)
                      D GROUPS
                                                                           residing within 30
                                                                           miles or 30
                                                                           minutes of location
                                                                           of service
                                                                           providers (this is
                                                                           the distance/travel
                                                                           time defined as
                                                                           reasonable by ------
                                                                           --)




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                                                                                                                           Data
# Dimension       Domain           Subdomain          Indicator              Measures             Target Pop   Rationale   Source         Measure Source
92 RESPONSIVENESS Accessibility to Locally unique     Proximity of service    Percentage of                                Administrati   Outcomes
                       Underserved   groups           providers              population                                    ve/            Roundtable
                       Groups                                                (children/adolescen                           Claims/MIS     Reduced list
                                                                             ts/families) who
                                                                             reside within, or
                                                                             have access to
                                                                             services within
                                                                             specified
                                                                             distances or travel
                                                                             times. (For
                                                                             example,
                                                                             urban/suburban:
                                                                             30 miles or 30
                                                                             minutes of location
                                                                             of service
                                                                             providers, rural: 60
                                                                             miles or 60
                                                                             minutes of location
                                                                             of service
                                                                             providers, and/or
                                                                             frontier: 120 miles
                                                                             or 120 minutes of
                                                                             location of service
                                                                             providers)




93 RESPONSIVENESS Accessibility to   Locally unique   Proximity of service   Percentage of                                 Administrati Outcomes
                       Underserved   groups           providers              population                                    ve/          Roundtable
                       Groups                                                (children/adolescen                           Claims/MIS Reduced list
                                                                             ts/families) living
                                                                             beyond specified
                                                                             service distances
                                                                             (see above) with
                                                                             access to Internet,
                                                                             tele-medicine,
                                                                             other electronic
                                                                             service/treatment
                                                                             supports




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                                                                                                                               Data
# Dimension       Domain           Subdomain          Indicator                  Measures             Target Pop   Rationale   Source     Measure Source
94 RESPONSIVENESS Accessibility to Locally unique     Convenience of             # positive                                    Consumer   CARF performance
                       Underserved   groups           Service locations for      consumer                                      survey     indicators for
                       Groups                         consumers                  responses to a                                           behavioral health
                                                                                 survey question
                                                                                 regarding location

                                                                                      total #
                                                                                 responses (e.g.
                                                                                 The location of
                                                                                 services was
                                                                                 convenient)


95 RESPONSIVENESS Accessibility to   Locally unique   Convenience of             # positive                                    Consumer   CARF performance
                       Underserved   groups           appointment times          consumer                                      survey     indicators for
                       Groups                         for consumers              responses to a                                           behavioral health
                                                                                 survey question
                                                                                 regarding location
                                                                                 /
                                                                                            total #
                                                                                 responses
                                                                                              (e.g.
                                                                                 Services are
                                                                                 available at times
                                                                                 that were good for
                                                                                 me)


96 RESPONSIVENESS Accessibility to   Locally unique   Bringing other voices                                                               PI interviews-
                       Underserved   groups           to the Collaboratives'                                                              Level of
                       Groups                         tables- schools,                                                                    Participation or %
                                                      HMOs                                                                                of collaboratives

97 RESPONSIVENESS Accessibility to   Locally unique   Community                                                                           PI interviews-
                       Underserved   groups           involvement and                                                                     Individual service
                       Groups                         support increases                                                                   plans; Non-
                                                                                                                                          Partnership vs.
                                                                                                                                          Private funding
98 RESPONSIVENESS Accessibility to   Locally unique   More kids being                                                                     PI interviews-
                       Underserved   groups           served in their district                                                            Prior zip
                       Groups                         schools                                                                             code/current zip
                                                                                                                                          code




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                                                                                                                                                     Data
# Dimension       Domain           Subdomain        Indicator           Measures              Target Pop     Rationale                               Source   Measure Source
99 RESPONSIVENESS Accessibility to Locally unique   Schools are more                                                                                          PI interviews
                       Underserved     groups       involved and there
                       Groups                       are DCF and Dept of
                                                    Ed liaisons. School
                                                    personnel have
                                                    regular involvement
                                                    in teams around
                                                    children's needs in
                                                    school.


100 RESPONSIVENESS Congruence                       Congruence with       active caseload /   population 0- The prevalence of mental disorders                Kamis-Gould and
                       with Assessed                need and expected     assessed need       18            varies from one location to another,              Hadley
                       Need                         demand for service.                                     often due to poverty and other
                                                                                                            population characteristics. Public
                                                                                                            entities should, therefore, conduct or
                                                                                                            sponsor needs assessment
                                                                                                            initiatives and ensure that the
                                                                                                            number of service recipients is as
                                                                                                            close as possible to the estimated
                                                                                                            number of people needing services.



101 RESPONSIVENESS Congruence                       Attention to mental   % enrollees       Population 0-    Primary healthcare providers often               Kamis-Gould and
                       with Assessed                health needs of       screened for need 18               are ill-equipped to identify and/or              Hadley
                       Need                         enrollees             for mental health                  treat mental disorders, and
                                                                          services and/or                    managed care systems tend to limit
                                                                          referred to a                      access to the specialty mental
                                                                          mental health                      health system in order to contain
                                                                          specialist.                        costs. Public entities must,
                                                                                                             therefore, monitor the level of
                                                                                                             screening for mental disorders and
                                                                                                             the number of referral to the
                                                                                                             specialty system, and develop
                                                                                                             normative data for future monitoring.


102 RESPONSIVENESS Congruence                       Do parents get                                                                                            PI interviews-
                       with Assessed                assessed and are                                                                                          Satisfaction survey
                       Need                         their needs being
                                                    met.




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                                                                                                                                                        Data
 # Dimension       Domain                 Subdomain   Indicator               Measures             Target Pop   Rationale                               Source       Measure Source
103 RESPONSIVENESS                                    Percentage of                                                                                     chart review Outcomes
                                                      children with                                                                                     or clinician Roundtable
                                                      following risk factors:                                                                           survey
                                                      inadequate prenatal
                                                      care; low birth
                                                      weight; difficult
                                                      temperment; poverty;
                                                      abuse/neglect; family
                                                      history of substance
                                                      abuse; history of
                                                      medical illness;
                                                      exposure to violence;
                                                      family discord




104 RESPONSIVENESS Cultural                           Access: penetration    % of the caseload                  This indicator addresses the degree                 MI Dept. of
                       Sensitivity &                  rate for minorities    comprised of                       to which ethnic minorities, typically               Community Health
                       Accessibility to                                      ethnic minorities /                an underserved population, are
                       Minorities                                                                               receiving public mental health
                                                                             % of persons who
                                                                             are ethnic                         services.
                                                                             minorities in the
                                                                             area population.

105 RESPONSIVENESS Cultural                           Cultural sensitivity   For the most                                                               Administrati Outcomes
                       Sensitivity &                  (language need         prevalent non-                                                             ve/          Roundtable
                       Accessibility to               awareness)             English language                                                           Claims/MIS Reduced list
                       Minorities                                            spoken in the                                                              and/or
                                                                             service area, the                                                          other
                                                                             proportion of                                                              primary
                                                                             providers speaking                                                         data
                                                                             that language                                                              collection
                                                                             compared to the                                                            (self-report
                                                                             proportion of                                                              survey)
                                                                             individuals
                                                                             residing in the
                                                                             service area
                                                                             speaking that
                                                                             language as their
                                                                             primary language.




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                                                                                                                                                          Data
 # Dimension       Domain                 Subdomain   Indicator              Measures             Target Pop     Rationale                                Source     Measure Source
106 RESPONSIVENESS Cultural                           Degree to which        # positive                                                                   Consumer   CARF performance
                       Sensitivity &                  linguistic             consumer                                                                     survey     indicators for
                       Accessibility to               accommodations are     responses to                                                                            behavioral health
                       Minorities                     made                   survey question
                                                                             regarding staff
                                                                             language / total #
                                                                             responses
107 RESPONSIVENESS Cultural                           Degree to which        # positive                                                                   Consumer   CARF performance
                       Sensitivity &                  consumers report       consumer                                                                     survey     indicators for
                       Accessibility to               that staff are         responses to                                                                            behavioral health
                       Minorities                     sensitive to their     survey question
                                                      cultural, ethnic, or   regarding personal
                                                      linguistic             dignity / total #
                                                      backgrounds            responses

108 RESPONSIVENESS Selection                          Responsiveness to      # admissions with Total             Persons with low levels of                          Kamis-Gould and
                                                      low-functioning        low level of        admissions 0-   functioning due to mental disorders                 Hadley
                                                      persons in need of     functioning (LOF) / 18              have high levels of need for
                                                      services                total admissions                   services, but they can be difficult to
                                                                                                                 treat and less appealing to
                                                                                                                 providers. Therefore, public entities
                                                                                                                 should monitor plans and systems
                                                                                                                 of care to ensure that each admits
                                                                                                                 as many low-functioning people as
                                                                                                                 the rest, and they should develop
                                                                                                                 normative data for future monitoring.




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                                                                                                                                                       Data
 # Dimension       Domain             Subdomain   Indicator             Measures               Target Pop      Rationale                               Source         Measure Source
109 RESPONSIVENESS Response                       Response              Average time from      Total           Delayed response to needed              Based on a     Kamis-Gould and
                      Promptness/Se               promptness            first urgent/routine   population 0-   services can discourage service         sample of      Hadley
                      lection                                           contact to first       18              utilization and, in emergency           records
                                                                        service                                situations, can be harmful or
                                                                                                               dangerous. To prevent delay,
                                                                                                               emergency care should be provided
                                                                                                               within one hour, and routine
                                                                                                               services should be offered within
                                                                                                               one week, from the time of contact
                                                                                                               or request for service. Because
                                                                                                               these types of data are rarely
                                                                                                               captured in automated MIS,
                                                                                                               monitoring the promptness of
                                                                                                               response to service requests could
                                                                                                               be accomplished through a sample
                                                                                                               survey of providers' service logs and
                                                                                                               recipients' clinical records.


110 RESPONSIVENESS     Response                   Consumer               Percent of families                                                           Self-report,   Outcomes
                      Promptness/Se               perception of access; who report they                                                                survey         Roundtable
                      lection                     wait time for 1st appt were seen for a
                                                                         first appointment
                                                                         in a timely manner.

112 RESPONSIVENESS     Response                   Length of time to     total # days                                                                   Administrati CARF performance
                      Promptness/Se               schedule first        between initial call                                                           ve records indicators for
                      lection                     appointment           and first                                                                                   behavioral health
                                                                        appointment /
                                                                        total # new
                                                                        admissions (adjust
                                                                        between types)




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                                                                                                                                                  Data
 # Dimension       Domain             Subdomain   Indicator               Measures            Target Pop   Rationale                              Source      Measure Source
113 RESPONSIVENESS Response                       Access: Timeliness      # persons who                    Quick, convenient entry into the                   MI Dept. of
                      Promptness/Se                                       received a face-to-              mental health system is a critical                 Community Health
                      lection                                             face meeting with                aspect of accessibility to services.
                                                                          a professional                   Delays can result in inappropriate
                                                                          within 14 calendar               care or exacerbation of distress.
                                                                          days of a non-                   The time it takes to have face-to-
                                                                          emergent request                 face contact with a mental health
                                                                          for service /                    professional and start services is a
                                                                                                           critical component of appropriate
                                                                                   total #                 care.
                                                                          persons who
                                                                          received a face-to-
                                                                          face assessment
                                                                          with a professional
                                                                          during the
                                                                          reporting period.




114 RESPONSIVENESS     Response                   Successful initiation   Percentage of                                                           Administrati Outcomes
                      Promptness/Se               of services             children/adolescent                                                     ve/          Roundtable
                      lection                                             s who received a                                                        Claims/MIS Reduced list
                                                                          diagnosis of a
                                                                          mental health
                                                                          disorder or
                                                                          received a mental
                                                                          health service visit
                                                                          and received any
                                                                          additional mental
                                                                          health service
                                                                          within 14 days.




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                                                                                                                       Data
 # Dimension       Domain             Subdomain   Indicator               Measures            Target Pop   Rationale   Source         Measure Source
115 RESPONSIVENESS Response                       Successful initiation   Percentage of                                Administrati   Outcomes
                      Promptness/Se               of services             children/adolescent                          ve/            Roundtable
                      lection                                             s who received a                             Claims/MIS     Reduced list
                                                                          diagnosis of an
                                                                          AOD disorder or
                                                                          received an AOD
                                                                          service visit who
                                                                          received any
                                                                          additional AOD
                                                                          service within 14
                                                                          days.

116 RESPONSIVENESS     Response                   length of time from     total # of days                              Administrati CARF performance
                      Promptness/Se               first to second         between first                                ve records indicators for
                      lection                     appointment             appointment and                                           behavioral health
                                                                          second
                                                                          appointment /
                                                                          total # second
                                                                          appointment
                                                                          (adjust between
                                                                          types)
117 RESPONSIVENESS     Response                    Rate of persons                                                     Survey         ACMHA
                      Promptness/Se               reporting timeliness
                      lection                     from first
                                                  appointment to
                                                  second appointment
118 RESPONSIVENESS     Response                   Percent of patients                                                  Survey         IBH
                      Promptness/Se               satisfied with access
                      lection                     to care
119 RESPONSIVENESS     Response                   Treatment               Percentage of                                Administrati Outcomes
                      Promptness/Se               engagement              children/adolescent                          ve/          Roundtable
                      lection                                             s diagnosed with                             Claims/MIS Reduced list
                                                                          serious emotional
                                                                          disorders who
                                                                          received three
                                                                          mental health
                                                                          services within 30
                                                                          days of the
                                                                          initiation of care.




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                                                                                                                                                   Data
 # Dimension       Domain             Subdomain   Indicator              Measures            Target Pop      Rationale                             Source       Measure Source
120 RESPONSIVENESS Response                       Treatment              Percentage of                                                             Administrati Washington Circle
                      Promptness/Se               engagement             children/adolescent                                                       ve           Group
                      lection                                            s diagnosed
                                                                         withAOD disorders
                                                                         who received
                                                                         three plan-
                                                                         provided AOD
                                                                         services within 30
                                                                         days of the
                                                                         initiation of care.


121 RESPONSIVENESS     Response                   Percentage of          Percent of                                                                Claims,      Outcomes
                      Promptness/Se               children at risk for   children/adolescent                                                       Clinical     Roundtable
                      lection                     psychiatric disorder   s/families in the                                                         records
                                                  who are screened for   eligible population
                                                  substance abuse        that are
                                                  disorders.             screened/evaluate
                                                                         d for AOD abuse
                                                                         or dependence.



122 RESPONSIVENESS     Response                   Sensitivity            # refused service/    Total         Consumers are and should be           Based on a   Kamis-Gould and
                      Promptness/Se                                      assigned against      population 0- active participants in decisions      consumer     Hadley
                      lection                                            preference / #        18            about treatments and services and,    opinion
                                                                         surveyed                            unless contraindicated, decisions     survey
                                                                                                             should be responsive to clients'
                                                                                                             desires and preferences. Because
                                                                                                             there are no norms about the
                                                                                                             proportion of requests that are
                                                                                                             clinically inappropriate,
                                                                                                             contraindicated, or financially
                                                                                                             unjustified, public entities should
                                                                                                             monitor plans and systems of care
                                                                                                             to develop comparative data and
                                                                                                             norms.




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                                                                                                                                                     Data
 # Dimension       Domain             Subdomain   Indicator                Measures             Target Pop    Rationale                              Source     Measure Source
123 RESPONSIVENESS Response                       Percentage of            Percentage of                                                             MIS        Outcomes
                      Promptness/Se               children with SED        children and youth                                                        systems    Roundtable
                      lection                     who receive services     who are living at
                                                  in their own homes,      home and receive
                                                  in school settings or    all their treatment,
                                                  other community          services, and
                                                  settings                 supports in their
                                                                           own homes,
                                                                           schools, and other
                                                                           settings in their
                                                                           community.


124 RESPONSIVENESS     Response                   Complaints, appeals,
                      Promptness/Se               and grievances
                      lection                     decrease and those
                                                  that occur are
                                                  handled satisfactorily



125 RESPONSIVENESS     Response                   Rate of service                                                                                    Authorizatio SAMHSA EW
                      Promptness/Se               denials by service                                                                                 n data       system, IBH
                      lection                     type

126 RESPONSIVENESS     Response                   % of PCPs know                                                                                                PI interviews
                      Promptness/Se               how to refer within
                      lection                     the system
127 RESPONSIVENESS     Response                   Cost Shifting            Proportion of        Total         Due to limited financial resources,               Kamis-Gould and
                      Promptness/Se                                        enrollees in state   population 0- providers are often tempted to avoid              Hadley
                      lection                                              hospitals, jails,    18            responding to especially difficult
                                                                           child welfare, or                  consumers by intentionally or
                                                                           juvenile justice                   unintentionally pushing them toward
                                                                           service systems.                   other systems. The proportion of
                                                                                                              any plan's enrollees in all systems
                                                                                                              where mental health service costs
                                                                                                              will be incurred should be
                                                                                                              minimized. Public entities should
                                                                                                              monitor plans and service systems
                                                                                                              and compile empirical data to
                                                                                                              develop acceptable levels and
                                                                                                              norms.




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                                                                                                                                                          Data
 # Dimension       Domain              Subdomain   Indicator               Measures           Target Pop       Rationale                                  Source       Measure Source
128 RESPONSIVENESS Response                        Percentage of           # children placed                                                              Administrati Outcomes
                       Promptness/Se               children placed in 24   in 24 hour                                                                     ve           Roundtable
                       lection                     hour treatment          treatment
                                                   programs                programs / total #
                                                                           children served

129 RESPONSIVENESS      Response                   Telephone access to calls answered in                                                                  Administrati SAMHSA EW
                       Promptness/Se               managed care        greter than 30                                                                     ve-          system, IBH
                       lection                     organization.       seconds / total                                                                    telephone
                                                                       calls                                                                              data
130 RESPONSIVENESS      Response                   Percent of phone        Calls placed                                                                   Administrati IBH
                       Promptness/Se               calls placed on hold    onhold / total calls                                                           ve-
                       lection                                                                                                                            telephone
                                                                                                                                                          data
131 RESPONSIVENESS      Response                   Telephone call          # calls abandoned                                                              Administrati IBH
                       Promptness/Se               abandonment rate        / total calls                                                                  ve-
                       lection                                                                                                                            telephone
                                                                                                                                                          data
132 EFFICIENCY         Productivity                Clinical case load for # clients / #           Total        The measure of the average                              Kamis-Gould and
                                                   a select group of      direct staff FTEs       population   number of clients served by direct                      Hadley
                                                   providers                                                   service full-time-equivalent staff, or
                                                                                                               clinical case load, is a key measure
                                                                                                               of productivity. Low ratios might
                                                                                                               indicate low productivity. Very high
                                                                                                               ratios, on the other hand, might
                                                                                                               reflect thinly spread clinical staff and
                                                                                                               an inability to provide appropriate
                                                                                                               service intensity. Empirical norms
                                                                                                               should be developed over time by
                                                                                                               meaningful client groups (e.g.,
                                                                                                               children, people with SMI, tec.) and
                                                                                                               by program elements (e.g., intensive
                                                                                                               case management, partial care,
                                                                                                               supervised residential services, etc.).




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                                                                                                                                                        Data
 # Dimension           Domain         Subdomain   Indicator                Measures             Target Pop     Rationale                                Source   Measure Source
133 EFFICIENCY         Productivity               Staff productivity for   total # units of                    The average number of units of                    Kamis-Gould and
                                                  a select group of        service (UOS) /                     service provided by clinical staff is             Hadley
                                                  providers                                                    the most important measure of
                                                                            # direct service                   productivity. Data and norms
                                                                           FTEs                                should be compiled and developed
                                                                                                               by program elements or cost
                                                                                                               centers, i.e., separately for inpatient,
                                                                                                               outpatient, residential services, etc.

134 EFFICIENCY         Cost                       Service cost             total $ / total                     This indicator of average cost per                Kamis-Gould and
                       Containment                                         units of service                    unit of service is the single most                Hadley
                                                                                                               important measure of cost
                                                                                                               containment and efficiency, as long
                                                                                                               as it is produced by program
                                                                                                               element (inpatient, outpatient, case
                                                                                                               management, emergency,
                                                                                                               residential, etc.) or cost center. This
                                                                                                               indicator is also useful for detailing
                                                                                                               program commitments in
                                                                                                               performance contracts. To prevent
                                                                                                               undue pressure to reduce costs, this
                                                                                                               indicator is best used in conjunction
                                                                                                               with outcome measures.



135 EFFICIENCY         Cost                       Cost per client          total $ / # clients Total         The average cost per client is a                    Kamis-Gould and
                       Containment                                         served              Population 0- useful descriptor of costs of services              Hadley
                                                                                               18            across programs or populations and
                                                                                                             a prevailing basis for capitation. It is
                                                                                                             also often the type of information
                                                                                                             requested by politicians and budget
                                                                                                             officers. Sound systems might best
                                                                                                             be defined enrollee groups (adults,
                                                                                                             children, SMI, etc.), and by
                                                                                                             multiplying those costs by the size of
                                                                                                             the respective groups to arrive at
                                                                                                             total expected costs.



136 EFFICIENCY         Cost                       Child and family       Measured by                                                                             Dawn Project
                       Containment                receive cost effective service utilization                                                                     Outcome measures
                                                  services               data




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                                                                                                                                                     Data
 # Dimension           Domain        Subdomain    Indicator                Measures             Target Pop   Rationale                               Source      Measure Source
137 EFFICIENCY         Cost                       Child and family         Measured by                                                                           Dawn Project
                       Containment                receive cost effective   average cost per                                                                      Outcome measures
                                                  services                 child- separated
                                                                           by grant and non-
                                                                           grant populations

138 EFFICIENCY         Cost                       Medicaid direct          Direct service                                                                        Annie E. Casey
                       Containment                service expenditures     expenditures for                                                                      Children's
                                                  per Medicaid child       Medicaid mental                                                                       Benchmarking
                                                  served                   health services /                                                                     Project

                                                                             # children
                                                                           enrolled in
                                                                           Medicaid who
                                                                           received at least
                                                                           one mental health
                                                                           service
139 EFFICIENCY         Cost                       Total direct services    Direct service                                                                        Annie E. Casey
                       Containment                expenditures per         expenditures for                                                                      Children's
                                                  child served             Medicaid and non-                                                                     Benchmarking
                                                                           Medicaid mental                                                                       Project
                                                                           health services /
                                                                           # children, both
                                                                           Medicaid and non-
                                                                           Medicaid, who
                                                                           received at least
                                                                           one mental health
                                                                           service


140 EFFICIENCY         Cost                       Revenues generated 1st + 3rd party $ /                     This measure of funds generated                     Kamis-Gould and
                       Containment                                    total $                                from client fees and third party                    Hadley
                                                                                                             insurance is most useful in
                                                                                                             assessing the degree to which a
                                                                                                             program, system, or plan taps
                                                                                                             potentialresources and collects fees,
                                                                                                             as compared with reliance on
                                                                                                             municipal and other government
                                                                                                             support.
141 EFFICIENCY         Cost                       Administrative                                                                                     Administrati Casey
                       Containment                Spending                                                                                           ve           Benchmarking; DS
                                                                                                                                                                  2000+; NASMHPD
                                                                                                                                                                  16 State




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                                                                                                                                                Data
 # Dimension           Domain         Subdomain   Indicator               Measures           Target Pop   Rationale                             Source        Measure Source
142 EFFICIENCY         Service Mix/               Occupancy rate/use      average # active                Mental health services involve both                 Kamis-Gould and
                       Occupancy                  of capacity             clients / capacity              fixed and variable costs, and                       Hadley
                                                                                                          occupancy data reflect the level to
                                                                                                          which fixed costs are put to the best
                                                                                                          use. Thus, full use of capacity will
                                                                                                          result in much lower costs per unit
                                                                                                          of service than a low occupancy;

                                                                                                          maximized.


143 EFFICIENCY         Service Mix/               Turnover/use of         annual # of                     Turnover is a measure of efficient                  Kamis-Gould and
                       Occupancy                  capacity                admissions / total              use of resources, facilities, and                   Hadley
                                                                          annual # served                 capacity; the higher the turnover,
                                                                                                          the higher the efficiency. Thus, high
                                                                                                          turnover in inpatient beds reflects
                                                                                                          efficient use because these beds
                                                                                                          can be used to serve more clients
                                                                                                          per year. This measure must be
                                                                                                          considered very carefully, and
                                                                                                          norms should be developed
                                                                                                          accordingly, because an extremely
                                                                                                          high turnover (e.g., through
                                                                                                          premature discharges) could
                                                                                                          compromise treatment effectiveness.


144 EFFICIENCY         Service Mix/               Duration of service     average length of               The average length of stay is also a                Kamis-Gould and
                       Occupancy                                          stay                            measure of efficiency. Because                      Hadley
                                                                                                          given fixed capacity, the shorter the
                                                                                                          length of stay, the higher the
                                                                                                          efficiency and the lower the costs.
                                                                                                          Again, premature discharges would
                                                                                                          produce low length of stay but would
                                                                                                          be likely to reduce effectiveness.
                                                                                                          This measure, therefore, should be
                                                                                                          examined in conjunction with
                                                                                                          effectiveness indicators, and norms
                                                                                                          should be developed accordingly.



145 EFFICIENCY         Service Mix/               Average number of                                                                               Administrati IBH
                       Occupancy                  sessions/days for                                                                               ve claims
                                                  intensive outpatient.                                                                           data
                                                  Residential and
                                                  outpatient care


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                                                                                                                                                     Data
 # Dimension           Domain         Subdomain   Indicator                 Measures             Target Pop   Rationale                              Source       Measure Source
146 EFFICIENCY         Service Mix/               Average length of         total # days of                                                          Administrati HEDIS; AMBHA-
                       Occupancy                  stay in days for          chemical                                                                 ve claims    PERMS 2.0
                                                  chemical                  dependency                                                               data
                                                  dependency                hospitalization /
                                                  hospitalization of        total # hospitalized
                                                  children                  for chemical
                                                                            dependency


147 EFFICIENCY         Service Mix/               Days per thousand in                                                                               Administrati Casey
                       Occupancy                  residential treatment                                                                              ve           Benchmarking



148 EFFICIENCY         Service Mix/               Mental health                                                                                      Administrati HEDIS, Casey
                       Occupancy                  discharges per 1000                                                                                ve claims    Benchmarking, IBH,
                                                  children                                                                                           data         AMBHA-PERMS 2.0


149 EFFICIENCY         Service Mix/               Chemical                                                                                           Administrati HEDIS; AMBHA-
                       Occupancy                  dependency                                                                                         ve claims    PERMS 2.0
                                                  discharges per 1000                                                                                data
                                                  children

150 EFFICIENCY         Service Mix/               Utilization per                                                                                    Administrati IBH
                       Occupancy                  thousand of Intensive                                                                              ve claims
                                                  outpatient, residential                                                                            data
                                                  and Outpatient
                                                  services
151 EFFICIENCY         Service                    Proportion of costly      inpatient +                       Inpatient and emergency services                   Kamis-Gould and
                       Substitution               services                  emergency costs /                 are the most expensive types of                    Hadley
                                                                                                              care, and, as long as clinically
                                                                             total services                   indicated, should be minimized.
                                                                            costs                             The ratio of these expensive
                                                                                                              services to the total services costs
                                                                                                              reflects both the level of financial
                                                                                                              management and the degree to
                                                                                                              which a plan employs innovative
                                                                                                              and less expensive services, such
                                                                                                              as crisis residential care and case
                                                                                                              management.




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                                                                                                                                                         Data
 # Dimension           Domain         Subdomain   Indicator             Measures               Target Pop      Rationale                                 Source      Measure Source
152 EFFICIENCY         Service                    Crisis response       Unduplicated #         Total           To assure a crisis response system        Crisis      TennCare Partners
                       Substitution                                     regional users who     population 0-   that provides alternatives to             response    Performance
                                                                        were diverted by       18              unnecessary psychiatric                   reports,    Measures
                                                                        crisis response                        hospitalization and provides a            Encounter
                                                                        services during the                    service that adequately meets the
                                                                        quarter /                              needs of those served.

                                                                        Unduplicated #
                                                                        regional users
                                                                        served during the
                                                                        quarter


153 EFFECTIVENESS      Client                     Service impact on     (average LOF at                        A major objective of mental health                    Kamis-Gould and
                       Outcomes/                  clients' level of     service                                services is to raise recipients' levels               Hadley
                       Functional                 functioning (LOF)     termination) -                         of functioning. Thus, the average
                       Level                                            (average LOF at                        increase between start and end of
                                                                        start of service)                      service is a measure of program
                                                                                                               effectiveness; the higher the
                                                                                                               increase, the better, as long as data
                                                                                                               are compiled by meaningful and
                                                                                                               comparable groups.
                                                                        or


                                                                        (LOF at service
                                                                        termination)-(LOF
                                                                        at start of service)
                                                                        for all clients /

                                                                        total # clients


154 EFFECTIVENESS      Client                     Average client's      (average LOF at                        The difference between average                        Kamis-Gould and
                       Outcomes/                  functional level 6    follow-up) -                           functional level at discharge and                     Hadley
                       Functional                 months following      (average LOF at                        follow-up is a measure of the degree
                       Level                      service termination   service                                to which program effects have been
                                                                        termination)                           sustained. A loss might mean
                                                                                                               premature service discontinuation,
                                                                                                               and such results should be
                                                                                                               minimized.




       e01d0856-fe15-4925-ae70-9ae43bf2207c.xls                                    39 of 56                                                                              7/14/2011
                                                                                                                      Data
 # Dimension           Domain        Subdomain    Indicator              Measures            Target Pop   Rationale   Source     Measure Source
155 EFFECTIVENESS      Client                     Percentage of          Percentage of                                Survey or  Outcomes
                       Outcomes/                  patients with          patients in an                               Clinical   Roundtable
                       Functional                 improved,              active intervention                          Assessment
                       Level                      maintained and         setting with                                 Instrument
                                                  reduced levels of      improved,
                                                  functioning            maintained and
                                                                         reduced levels of
                                                                         functioning based
                                                                         on a nationally
                                                                         accepted clinical
                                                                         assessment
                                                                         survey instrument.




156 EFFECTIVENESS      Client                     Degree to which        The proportion of                            Consumer CARF performance
                       Outcomes/                  consumers              children and                                 surveys,    indicators for
                       Functional                 experience an          adolescents who                              Case record behavioral health
                       Level                      increased level of     report to have
                                                  functioning            increased level of
                                                                         functioning in the
                                                                         CAFAS

157 EFFECTIVENESS      Client                     Improved records for   # of youth with
                       Outcomes/                  community              arrests in first year
                       Functional                 supervision for        after disenrollment
                       Level                      Department of
                                                  Corrections youth
158 EFFECTIVENESS      Client                     Improved records       % of children with                                      Dawn Project
                       Outcomes/                  with the juvenile      no further                                              Outcome measures
                       Functional                 justice system         incidences of
                       Level                                             delinquency,
                                                                         runaway or
                                                                         truancy charges,
                                                                         or violation of
                                                                         terms of probation,
                                                                         which results in
                                                                         placement failure
                                                                         for a period of six
                                                                         and twelve months
                                                                         from disenrollment.




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                                                                                                                       Data
 # Dimension           Domain        Subdomain    Indicator               Measures            Target Pop   Rationale   Source       Measure Source
159 EFFECTIVENESS      Client                     Decrease in arrests     Percentages of                               Survey -     Outcomes
                       Outcomes/                                          children and youth                           Self-report, Roundtable
                       Functional                                         whose encounters                             Clinician
                       Level                                              with law                                     report or
                                                                          enforcement                                  Juvenile
                                                                          decreased while                              Justice/Cour
                                                                          receiving services.                          t record
                                                                                                                       match

160 EFFECTIVENESS      Client                     Change in legal         Change in the                                Administrati Outcomes
                       Outcomes/                  encounters/arrests      average number                               ve/          Roundtable
                       Functional                                         of arrests for                               Claims/MIS Reduced list
                       Level                                              children/                                    and/or
                                                                          adolescents                                  other
                                                                          served by                                    primary
                                                                          behavioral health                            data
                                                                          systems from 30                              collection
                                                                          days preadmission                            (self-report
                                                                          to 30 days post                              survey)
                                                                          discharge


161 EFFECTIVENESS      Client                     Juvenile justice        # children who                                           Annie E. Casey
                       Outcomes/                  system involvement      received at least                                        Children's
                       Functional                                         one mental health                                        Benchmarking
                       Level                                              service and also                                         Project
                                                                          had at least one
                                                                          encounter with the
                                                                          juvenile justice
                                                                          system at any time
                                                                          during the year /
                                                                          total # children
                                                                          served


162 EFFECTIVENESS      Client                     Kids remain out of                                                               PI interviews- Aso
                       Outcomes/                  the JJ system                                                                    % of JJ served in
                       Functional                                                                                                  residential LOC
                       Level

163 EFFECTIVENESS      Client                     Reduction in criminal                                                            PI interviews
                       Outcomes/                  activity and
                       Functional                 substance abuse
                       Level




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                                                                                                                      Data
 # Dimension           Domain        Subdomain    Indicator              Measures            Target Pop   Rationale   Source        Measure Source
164 EFFECTIVENESS      Client                     Change in school       Percentage of                                Self-report   Outcomes
                       Outcomes/                  attendance             children and youth                           or school     Roundtable
                       Functional                                        whose school                                 records
                       Level                                             performance
                                                                         improved while
                                                                         receiving services.



165 EFFECTIVENESS      Client                     Change in school       Percentage of                                Administrati Outcomes
                       Outcomes/                  attendance             children/adolescent                          ve/          Roundtable
                       Functional                                        s whose                                      Claims/MIS Reduced list
                       Level                                             unexcused                                    and/or
                                                                         absences from                                other
                                                                         school or an                                 primary
                                                                         approved home                                data
                                                                         school program                               collection
                                                                         have decreased                               (self-report
                                                                         while receiving                              survey)
                                                                         services.
                                                                         (Unexcused
                                                                         absences do not
                                                                         include absence
                                                                         due to illness,
                                                                         hospitalization,
                                                                         treatment, etc. —
                                                                         unexcused
                                                                         absence is
                                                                         essentially truancy)


166 EFFECTIVENESS      Client                     Fewer school                                                                      PI interviews
                       Outcomes/                  suspensions and
                       Functional                 expulsions
                       Level
167 EFFECTIVENESS      Client                     Improved school        The Clinical                                               Dawn Project
                       Outcomes/                  functioning            Manager Tx Plan                                            Outcome measures
                       Functional                                        level rating.
                       Level
168 EFFECTIVENESS      Client                     Educational            The proportion of                            Case         CARF performance
                       Outcomes/                  attainment for those   children and                                 record,      indicators for
                       Functional                 who are in school      adolescents for                              school       behavioral health
                       Level                                             whom there is an                             record,
                                                                         increase in                                  follow-up
                                                                         educational                                  with teacher
                                                                         attainment                                   referrals



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                                                                                                                       Data
 # Dimension           Domain        Subdomain    Indicator               Measures            Target Pop   Rationale   Source          Measure Source
169 EFFECTIVENESS      Client                     Level of satisfaction   -The proportion of                           Case            CARF performance
                       Outcomes/                  with school             children and                                 record,         indicators for
                       Functional                                         adolescents for                              follow-up       behavioral health
                       Level                                              whom there is an                             with children
                                                                          increase after 3
                                                                          months on the
                                                                          CAFAS School
                                                                          Performance
                                                                          subscale
                                                                                     -Average
                                                                          rating of school
                                                                          satisfaction on the
                                                                          QOLQ


170 EFFECTIVENESS      Client                     For those receiving                         16-18                    survey, self- Outcomes
                       Outcomes/                  vocational or work                                                   report        roundtable
                       Functional                 readiness services,
                       Level                      the change in the
                                                  number of days of
                                                  paid work from
                                                  admission




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                                                                                                                    Data
 # Dimension           Domain        Subdomain    Indicator            Measures            Target Pop   Rationale   Source     Measure Source
171 EFFECTIVENESS      Client                     Completed suicide;    Rate: number of                             Facility   Outcomes
                       Outcomes/                  attempted suicide    deaths by suicide                            records    Roundtable
                       Functional                                      per 100,000
                       Level                                           (consistent with
                                                                       CDC
                                                                       Mortality/morbidity
                                                                       statistics. Age-
                                                                       adjusted rates are
                                                                       strongly suggested
                                                                       -- age-adjusted
                                                                       refers to weighting
                                                                       rates by a
                                                                       population
                                                                       standard to allow
                                                                       for comparisons
                                                                       across time and
                                                                       among risk
                                                                       groups). No data
                                                                       are collected on
                                                                       suicide attempts.
                                                                       SUGGESTION:
                                                                       rate of suicide
                                                                       attempt reported
                                                                       in the CDC Youth
                                                                       Risk Behavior
                                                                       Surveillance
                                                                       Survey (YRBSS)




172 EFFECTIVENESS      Client
                       Outcomes/
                       Functional
                       Level




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                                                                                                                      Data
 # Dimension           Domain        Subdomain    Indicator              Measures            Target Pop   Rationale   Source       Measure Source
173 EFFECTIVENESS      Client                     Adverse Outcomes:      Percentage of                                Self/Family Outcomes
                       Outcomes/                  client injuries,       children/adolescent                          reporting;   Roundtable
                       Functional                 elopement, suicide,    s who experience                             Clinical
                       Level                      homicide,              adverse outcomes                             records; law
                                                  unexpected deaths      including injuries,                          enforcement
                                                                         elopement from 24                             records;
                                                                         hour programs,                               Facility
                                                                         adverse drug                                 reporting
                                                                         reactions and
                                                                         unexpected
                                                                         deaths.




174 EFFECTIVENESS      Client                     Mortality                                                           State MIS     NASMHPD 16
                       Outcomes/                                                                                      or link ot    State; ACMHA
                       Functional                                                                                     public
                       Level                                                                                          health
                                                                                                                      death
                                                                                                                      records
175 EFFECTIVENESS      Client                     Change in frequency    Percent change in                            Self-report   Outcomes
                       Outcomes/                  of use of              frequency of use                                           Roundtable
                       Functional                 alcohol/other drugs    as a primary or
                       Level                      in past 30 days from   secondary drug of
                                                  admission to AOD       choice at
                                                  treatment setting to   admission to a
                                                  discharge.             treatment setting
                                                                         as compared to
                                                                         the frequency of
                                                                         use as a primary
                                                                         or secondary drug
                                                                         of choice at
                                                                         discharge.




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                                                                                                                                           Data
 # Dimension           Domain        Subdomain    Indicator               Measures            Target Pop   Rationale                       Source         Measure Source
176 EFFECTIVENESS      Client                     Adverse outcomes        The number of                                                    Administrati   Outcomes
                       Outcomes/                                          children/adolescent                                              ve/            Roundtable
                       Functional                                         s per 1,000 in                                                   Claims/MIS     Reduced list
                       Level                                              behavioral heath                                                 and/or
                                                                          treatment who                                                    other
                                                                          experience                                                       primary
                                                                          adverse outcomes                                                 data
                                                                          including injuries,                                              collection
                                                                          elopement from 24                                                (self-report
                                                                          hour programs,                                                   survey)
                                                                          adverse drug
                                                                          reactions,
                                                                          unexpected
                                                                          deaths, and
                                                                          suicide within a
                                                                          calendar year.




177 EFFECTIVENESS          Client                 Percentage of           Percentage of                    Survey or clinical assessment   outcomes
                         Outcomes/                patients experiencing   patients                                                         Roundtable
                         Symptom-                 symptom relief or       experiencing
                          atology                 reduction               symptom relief or
                                                                          reduction based
                                                                          on a nationally
                                                                          accepted
                                                                          instrument and
                                                                          through a
                                                                          nationally
                                                                          accepted self-
                                                                          reporting survey


178 EFFECTIVENESS          Client                 Inpatient readmission   Percent of children              Administrative claims and       Outcomes
                         Outcomes/                rates within 30 days    and adolescents                  authorization data              Roundtable
                         Symptom-                 (and 180 days for       who are
                          atology                 NASMHPD) and 90         readmitted to a
                                                  and 365 days (for       psychiatric
                                                  AMBHA)                  inpatient setting
                                                                          within 30 days of
                                                                          discharge (and
                                                                          subsequent time
                                                                          periods)




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                                                                                                                                               Data
 # Dimension           Domain        Subdomain    Indicator           Measures            Target Pop   Rationale                               Source          Measure Source
179 EFFECTIVENESS          Client                 Readmission rates   # of persons                     For some persons with serious           MI Dept of
                         Outcomes/                                    readmitted to an                 mental illness, the occasional use of   community
                         Symptom-                                     inpatient                        psychiatric inpatient care is           Health
                          atology                                     psychiatric unit                 essential. However, a rapid
                                                                      within 15 days of                readmission following a discharge
                                                                      discharge / Total #              may suggest that persons were
                                                                      of persons                       prematurely discharged or that the
                                                                      discharged from                  post-discharge follow-up was not
                                                                      inpatient                        timely or sufficient. This indicator
                                                                      psychiatric units                assesses whether CMHSPs are
                                                                      during the                       meeting the department's standard
                                                                      reporting period                 of no more than 15% of persons
                                                                                                       discharged from inpatient units
                                                                                                       being readmitted within 15 days.


180 EFFECTIVENESS          Client                 Rate of hospital                                                                             PI
                         Outcomes/                readmissions is                                                                              interviews -
                         Symptom-                 reduced                                                                                      Institutional
                          atology                                                                                                              LOC




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                                                                                                                                             Data
 # Dimension           Domain        Subdomain    Indicator             Measures            Target Pop   Rationale                           Source     Measure Source
181 EFFECTIVENESS          Client                 completed suicide;    Rate: Number of                  Facility records                    outcome
                         Outcomes/                attempted suicide     deaths by suicide                                                    Roundtable
                         Symptom-                                       per 100,000
                          atology                                       (consistent with
                                                                        CDC
                                                                        Mortality/Morbidity
                                                                        statistics. Age
                                                                        adjusted rates are
                                                                        strongly
                                                                        suggested. Age-
                                                                        adjusting refers to
                                                                        weighting rates by
                                                                        a population
                                                                        standard to allow
                                                                        for comparisons
                                                                        across time and
                                                                        among risk
                                                                        groups.) No data
                                                                        are collected on
                                                                        suicide attempts
                                                                        reported in the
                                                                        CDC Youth Risk
                                                                        Behavior
                                                                        Surveillance
                                                                        Survey (YRBSS)


182 EFFECTIVENESS          Client                 Adverse outcomes:     Percentage of                    Self/family reporting; clinical     Outcomes
                         Outcomes/                client injuries,      children/adolescent              records; Law enforcement records;   Roundtable
                         Symptom-                 elopement, suicide,   s who experience                 Facility reporting
                          atology                 homicide,             adverse outcomes
                                                  unexpected deaths     including injuries,
                                                                        elopement from
                                                                        24-hour programs,
                                                                        adverse drug
                                                                        reactions and
                                                                        unexpected deaths




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                                                                                                                                                      Data
 # Dimension           Domain        Subdomain    Indicator               Measures              Target Pop   Rationale                                Source     Measure Source
183 EFFECTIVENESS          Client                 Change in frequency     Percent change in                  Self-report                              Outcomes
                         Outcomes/                of use of               the frequency of                                                            Roundtable
                         Symptom-                 alcohol/other drugs     use as a primary
                          atology                 in past 30 days from    or secondary drug
                                                  admission to AOD        of choice at
                                                  treatment setting to    admission to a
                                                  discharge               treatment setting
                                                                          as compared to
                                                                          the frequency of
                                                                          use as a primary
                                                                          or secondary drug
                                                                          of choice at
                                                                          discharge


184 EFFECTIVENESS          Client                 Safety of                                                                                                       PI interviews-
                         Outcomes/                environments                                                                                                    Satisfaction survey
                         Symptom-                 improve
                          atology
185 EFFECTIVENESS          Client                 Residential stability   % clients in same                  Residential stability is an important                Kamis-Gould and
                         Outcomes/                                        residence > 1                      component of consumers' quality of                   Hadley
                         Symptom-                                         year; this year vs.                life. The change in average
                          atology                                         last year                          residential stability over time is one
                                                                                                             way of monitoring improvements, at
                                                                                                             least until empirical norms are
                                                                                                             developed.

186 EFFECTIVENESS          Client                 Community tenure        average                            Community tenure is another aspect                   Kamis-Gould and
                         Outcomes/                                        community tenure                   of consumers' quality of life and                    Hadley
                         Symptom-                                         in months; this                    should be monitored and
                          atology                                         year vs. last year                 maximized. This indicator also can
                                                                                                             reveal situations where mental
                                                                                                             health plans and systems push
                                                                                                             disabled and expensive enrollees to
                                                                                                             the state hospital system.

187 EFFECTIVENESS          Client                 Length of time spent    Number of days                                                              Consumer CARF performance
                         Outcomes/                in the community        spent in the                                                                survey/repor indicators for
                         Symptom-                                         community /                                                                 t            behavioral health
                          atology
                                                                          total number of
                                                                          days in the index
                                                                          period




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                                                                                                                         Data
 # Dimension           Domain        Subdomain    Indicator                Measures             Target Pop   Rationale   Source      Measure Source
188 EFFECTIVENESS          Client                 Proportion of children   # children who                                            Annie E. Casey
                         Outcomes/                served who were in       received at least                                         Children's
                         Symptom-                 out-of-home              one mental health                                         Benchmarking
                          atology                 placements during        service and were                                          Project
                                                  the year                 in foster care or
                                                                           other out-of-home
                                                                           placement- under
                                                                           the purview of the
                                                                           child welfare
                                                                           agency- at any
                                                                           time during the
                                                                           year / total #
                                                                           children served

189 EFFECTIVENESS          Client                 Kids are at home                                                                   PI interviews
                         Outcomes/
                         Symptom-
                          atology
190 EFFECTIVENESS          Client                 Percentage of            # children living                             Chart       Outcomes
                         Outcomes/                children living          independently /                               review; new Roundtable
                         Symptom-                 independently            total # children                              data
                          atology                                          receiving services                            required

191 EFFECTIVENESS          Client                 Length of            # days in a                                       Administrati CARF performance
                         Outcomes/                hospitalization      hospital / total #                                ve data      indicators for
                         Symptom-                                      days in the index                                              behavioral health
                          atology
                                                                       period
192 EFFECTIVENESS          Client                 Change in number of Compare at                                         Administrati NASADAD
                         Outcomes/                hospital admissions admission to AOD                                   ve- Clinical
                         Symptom-                 during past 6 months treatment setting                                 Record
                          atology                                      and 6 months post-
                                                                       admission


193 EFFECTIVENESS          Client                 Change in ER visits      Compare at                                    Administrati NASADAD
                         Outcomes/                for psychiatric          admission to AOD                              ve- Clinical
                         Symptom-                 purposes in past 6       treatment setting                             Record
                          atology                 months                   and 6 months post-
                                                                           admission




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                                                                                                                                                    Data
 # Dimension           Domain        Subdomain    Indicator                 Measures           Target Pop   Rationale                               Source       Measure Source
194 EFFECTIVENESS          Client                 Change in number of       Compare at                                                              Administrati NASADAD
                         Outcomes/                hospital admissions       admission to AOD                                                        ve- Clinical
                         Symptom-                 to a psychiatric          treatment setting                                                       Record
                          atology                 hospital during past 6    and 6 months post-
                                                  months                    admission


195 EFFECTIVENESS          Client                 Quality of life: living   # children served               Use of this indicator is based on the                  MI Dept. of
                         Outcomes/                situation                 living with their               assumption that, in general, the                       Community Health
                         Symptom-                                           family / total #                quality of life for children will be
                          atology                                                                           higher where they live with their own
                                                                            children receiving
                                                                            CMHSP services                  family instead of in an out-of-home
                                                                                                            placement.
196 EFFECTIVENESS          Client                 Fewer kids in                                                                                                    PI interviews-
                         Outcomes/                shelters and lower                                                                                               With behavioral
                         Symptom-                 LOS                                                                                                              health needs
                          atology
197 EFFECTIVENESS          Client                 Change in quality of      Percentage of                                                           Primary        Outcomes
                         Outcomes/                life                      children/adolescent                                                     data           Roundtable
                         Symptom-                                           s in behavioral                                                         collection     Reduced list
                          atology                                           health services,                                                        (self-report
                                                                            whose quality of                                                        survey)
                                                                            life (i.e., changes
                                                                            in stress, strain,
                                                                            etc.) has
                                                                            decreased,
                                                                            remained the
                                                                            same, or
                                                                            increased.



198 EFFECTIVENESS          Client                 Maintanenece of           # clients who                                                           Survey         Washington Circle
                         Outcomes/                treatment effects         report specific                                                                        Group
                         Symptom-                                           services provided
                          atology                                           and/or monitored
                                                                            by the plan to
                                                                            promote and
                                                                            sustain positive
                                                                            treatment
                                                                            outcomes post-
                                                                            discharge / total
                                                                            # clients
                                                                            discharged




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                                                                                                                         Data
 # Dimension           Domain         Subdomain   Indicator              Measures               Target Pop   Rationale   Source        Measure Source
199 EFFECTIVENESS          Client                 Caregiver strain       Measured by                                                   Dawn Project
                         Outcomes/                questionnaire          Questionnaire at                                              Outcome measures
                         Symptom-                                        intake, every 6
                          atology                                        months until
                                                                         discharge, and 12
                                                                         months after
                                                                         discharge
200 EFFECTIVENESS          Client                 Percent of patients    # of patients with                              Clinical      DMA MMC
                         Outcomes/                with anorexia who      anorexia who are                                Records       Benchmarking
                         Symptom-                 are able to maintain   able to maintain a                                            Project
                          atology                 a normal weight        normal weight
                                                  within 6 months of     within 6 months of
                                                  receiving diagnosis    receiving
                                                                         diagnosis / total #
                                                                         patients with
                                                                         anorexia

201 EFFECTIVENESS          Client                 Effectiveness with                                                     Survey,       Summit 2001; DS
                         Outcomes/                which presenting                                                       Self-Report   2000+
                         Symptom-                 problems were
                          atology                 addressed;
                                                  Improvement in
                                                  problem resolution;
                                                  quality of life

202 EFFECTIVENESS      Client                     Patient satisfaction   Percentage of                                   Survey        Outcomes
                       Outcomes/                  with quality of care   patients “satisfied”                                          Roundtable
                       Consumer                                          with their
                       Satisfaction                                      professional
                                                                         treatment services
                                                                         based on a
                                                                         nationally
                                                                         accepted self-
                                                                         report survey
                                                                         instrument three
                                                                         months from first
                                                                         documented
                                                                         encounter




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                                                                                                                         Data
 # Dimension           Domain         Subdomain   Indicator               Measures              Target Pop   Rationale   Source        Measure Source
203 EFFECTIVENESS      Client                     Degree to which         # consumers who                                Consumer      CARF performance
                       Outcomes/                  consumers feel good     feel good about                                surveys,      indicators for
                       Consumer                   about themselves        oneself / total #                              Case record   behavioral health
                       Satisfaction
                                                                          consumers;
                                                                          based on scales
                                                                          from, e.g.,

                                                                                 -
                                                                          Rosenberg Self-
                                                                          Esteem scale
                                                                               -SLOF

                                                                                    -Client
                                                                          Satisfaction (CSQ-
                                                                          8)                -
                                                                          NACBHD -
                                                                          Respect and
                                                                          Dignity


204 EFFECTIVENESS      Client                     Families become                                                                      PI interviews-
                       Outcomes/                  their own advocates                                                                  Satisfaction survey
                       Consumer
                       Satisfaction
205 EFFECTIVENESS      Client                     Parents are true                                                                     PI interviews-
                       Outcomes/                  partners                                                                             Satisfaction survey
                       Consumer
                       Satisfaction
206 EFFECTIVENESS      Client                     Comfort level of                                                                     PI interviews-
                       Outcomes/                  families increases in                                                                Satisfaction survey
                       Consumer                   the collaboratives.
                       Satisfaction               Families feel
                                                  comfortable voicing
                                                  opinions.

207 EFFECTIVENESS      Client                     Degree to which         # positive                                     Consumer      CARF performance
                       Outcomes/                  consumers believe       consumer                                       survey        indicators for
                       Consumer                   they were respected     responses to                                                 behavioral health
                       Satisfaction               by the staff            survey question
                                                                          regarding
                                                                          consumer respect
                                                                           / total #
                                                                          responses




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                                                                                                                        Data
 # Dimension           Domain         Subdomain   Indicator           Measures                 Target Pop   Rationale   Source         Measure Source
208 EFFECTIVENESS      Client                     Consumer received                                                     Survey         Outcomes
                       Outcomes/                  the services                                                                         Roundtable
                       Consumer                   consumer/family
                       Satisfaction               thought were needed



209 EFFECTIVENESS      Client                     Perception of          Percentage of                                  Primary        Outcomes
                       Outcomes/                  appropriateness of     children/adolescent                            data           Roundtable
                       Consumer                   services               s or families who                              collection     Reduced list
                       Satisfaction                                      report they                                    (self-report
                                                                         received the                                   survey)
                                                                         services that they
                                                                         needed
210 EFFECTIVENESS      Client                     Satisfaction of                                                                      PI interviews
                       Outcomes/                  families increases
                       Consumer
                       Satisfaction
211 EFFECTIVENESS      Client                     Services meet the      Measured by                                                   Dawn Project
                       Outcomes/                  real needs of the      biennial, narrative                                           Outcome measures
                       Consumer                   child and family       report of
                       Satisfaction                                      successes and
                                                                         barriers based on
                                                                         Service
                                                                         Coordinator focus
                                                                         groups

212 EFFECTIVENESS      Client                     Degree of active       # positive                                     Consumer       CARF performance
                       Outcomes/                  consumer               consumer                                       survey         indicators for
                       Consumer                   participation in       responses to                                                  behavioral health
                       Satisfaction               decisions concerning   survey question
                                                  their treatment        regarding
                                                                         treatment /

                                                                         total # responses

213 EFFECTIVENESS      Client                     Availability of                                                       Administrati DS 2000+
                       Outcomes/                  consumer choice in                                                    ve
                       Consumer                   plan, treatment,
                       Satisfaction               family involvement




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                                                                                                                           Data
 # Dimension           Domain         Subdomain   Indicator                  Measures             Target Pop   Rationale   Source        Measure Source
214 EFFECTIVENESS      Client                     Degree to which            # positive                                    Consumer      CARF performance
                       Outcomes/                  consumers receive          consumer                                      survey        indicators for
                       Consumer                   information to make        responses to                                                behavioral health
                       Satisfaction               informed choices           survey question
                                                                             regarding
                                                                             adequate
                                                                             information /
                                                                             total # responses

215 EFFECTIVENESS      Client                     Adequacy of                                                              Survey        Summit 2001
                       Outcomes/                  information about:
                       Consumer                   Assessment results;
                       Satisfaction               treatment incl. risks
                                                  and benefits; self-
216 EFFECTIVENESS      Client                     help; patient rights,
                                                  Recovery/Hope                                                            Survey,       Outcomes
                       Outcomes/                                                                                           Self-Report   Roundtable;
                       Consumer                                                                                                          NASMHPD 16
                       Satisfaction                                                                                                      State; DS 2000+
217 EFFECTIVENESS      Client                     Rate people report                                                       Survey        ACMHA, Summit
                       Outcomes/                  they feel safe in                                                                      2001
                       Consumer                   treatment and also in
                       Satisfaction               community
218 EFFECTIVENESS      Client                     Consumer's (family)                                                      Survey,       Summit 2001
                       Outcomes/                  comfort to refuse                                                        Self-Report
                       Consumer                   treatment; confort to
                       Satisfaction               complain; experience
                                                  of harmful
                                                  medication side
                                                  effects; safety in their
                                                  relationship with
                                                  provider


219 EFFECTIVENESS      Client                     Kids feel that they                                                                    PI interviews-
                       Outcomes/                  are heard                                                                              Satisfaction survey
                       Consumer
                       Satisfaction




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                                                                                                                                                 Data
 # Dimension           Domain         Subdomain   Indicator             Measures             Target Pop   Rationale                              Source        Measure Source
220 EFFECTIVENESS      Client                     Parent/family reports                                                                          Survey,       CAHPS - NCQA,
                       Outcomes/                  on experience with                                                                             Self-Report   APA
                       Consumer                   care: How well Drs.
                       Satisfaction               Communicate;
                                                  timeliness of care;
                                                  getting needed care;
                                                  respectfulness and
                                                  helpfulness;
                                                  customer service;
                                                  getting needed drugs
                                                  and specialized
                                                  services; family
                                                  centered care;
                                                  coordination
                                                  of care (APA refers
                                                  to Perceptions of
                                                  care)




221 EFFECTIVENESS      Provider                   Providers' (e.g.,      % providers                      Dissatisfied and unhappy providers     Provider      Kamis-Gould and
                       Outcomes/                  behavioral health      satisfied                        are unlikely to remain in the system   survey        Hadley
                       Consumer                   subcontractors)                                         or to provide good services. Health
                       Satisfaction               satisfaction with both                                  plans should, therefore, conduct
                                                  clinical and fiscal                                     periodic surveys of providers to
                                                  areas                                                   ensure that they are satisfied with
                                                                                                          both the clinical and fiscal aspects
                                                                                                          of the service system.

222 EFFECTIVENESS      Provider                   Providers appeals                                                                              Complaints/ IBH
                       Outcomes/                  rate                                                                                           appeals/grie
                       Consumer                                                                                                                  vance
                       Satisfaction                                                                                                              records

223 EFFECTIVENESS      Provider                   Rates of Provider                                                                              Complaints/ IBH
                       Outcomes/                  complaints and                                                                                 appeals/grie
                       Consumer                   greivances                                                                                     vance
                       Satisfaction                                                                                                              records

224 EFFECTIVENESS      Provider                   Satisfaction of                                                                                              PI interviews
                       Outcomes/                  people trying to
                       Consumer                   implement the
                       Satisfaction               system increases




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DOCUMENT INFO
Description: Project on Consumer Satisfaction document sample