Planning, Using, and Adapting County Data Systems CalMHSA PEI TTACB Work Group March 5, 2014

1. Planning, Using, and Adapting County Data Systems  CalMHSA PEI TTACB Work Group March 5, 2014 Facilitated by RAND and SRI The California Mental Health Services Authority (CalMHSA) is an organization of county governments working to improve mental health outcomes for individuals, families and communities. Prevention and Early Intervention programs implemented by CalMHSA are funded by counties through the voter-approved Mental Health Services Act (Prop 63). Prop. 63 provides the funding and framework needed to expand mental health services to previously underserved populations and all of California’s diverse communities

2. Today’s work group is part of RAND’s CalMHSA TTACB project • Collaboration between CA counties, community-based service providers, CalMHSA, SRI, and RAND • Provide support for PEI implementation throughout CA Today we will focus on electronic data systems being used or planned by counties for capturing PEI process and outcomesinformation. 2

3. Agenda • Welcome and introductions • Key components of a PEI outcomes data system • Presentations from counties using different data systems • Los Angeles, Modoc, Monterey & Placer Counties •  Counties sharing experiences – Session 1 and 2 • Break out groups around different platforms  • Adapting data systems to changing requirements 3

4. Agenda • Welcome and introductions • Key components of a PEI outcomes data system • Presentations from counties using different data systems • Los Angeles, Modoc, Monterey & Placer Counties • Lunch – catch up with colleagues •  Counties sharing experiences – Session 1 and 2 • Break out groups around different platforms • Adapting data systems to changing requirements 4

5. What do you want a PEI outcomes data system to do? • Functionality required should dictate the components to incorporate • Some functions require similar components while others require unique components • Sometimes you cannot have both • Some functions require real-time data, some do not • Some functions may be done well enough already or be too costly to even consider • A team of users and experts can best address this question 5

6. Possible functions of outcome data systems • Compliance reporting and contract management • Clinical supervision and clinician training • Client-counselor service planning and progress review • Workflow monitoring and billing and case management • Performance management • Program continuous quality improvement (CQI) • Local/statewide evaluation and/or research support 6

7. Selecting a system to meet your needs and goals • Today’s audience includes users of at least 16 different software systems • Presentations from four counties and breakout groups will provide opportunities for sharing experiences • Vendors and users of other systems in your county can also be consulted • Demonstrations are another way to assess options 7

8. Assess fit and capacity within your county • Consider what it would take to adapt or replicate a system to meet your needs • Does it make sense to build your own or purchase? • Assess capacity within your county providers and administrators to run and support a system • Capacity is more than funding to build and install a system • Provider, clinician, agency staff skills e.g., for data entry, data processing, data analysis, interpretation and reporting • Technology (hardware and IT support) • Data systems already in place 8

9. Key components of a PEI outcomes data system 9

10. Key components of a data system • The infrastructure is the foundation and organizational structure and support needed for data system operation • The interfaces are the users who enter and receive the data • The content refers to the data elements the system captures 10

11. PEI outcomes data system infrastructure • Platform selection • Integration capacity • Security levels • System administration • Expertise • Users’ support • Adaptability 11

12. Infrastructure – platform selection • Desktop or web-based platform selection options • Security and access are key considerations • Counties here today use • MS Excel • MS Access • Anasazi or Avatar EHRs • Existing county server based systems • Systems custom built/adapted for MHSA/PEI outcomes 12

13. Infrastructure – integration capacity • Potential integration capacities include: • Billing • EHR/EMR • Other MHSA/BH/county agencies/community providers’ data systems • Contract compliance reports • Primary care 13

14. Infrastructure – security • Protects client privacy and compliance with federal HIPAA regulations and other relevant MediCal and state regulations • With individual data access will need to be strictly controlled • Levels of access can vary with type of user and limit access to private information • MOUs across agencies can articulate data sharing and privacy provisions • Need to consider internet, application, and physical security 14

15. Infrastructure – system administration • System administration requires expertise in: • Information technology (IT) • Auditing • Data processing • Data analysis • Report interpretation • Users’ support may include: • Training and technical assistance • Help desks for error resolution and new queries • Site visits to review audits • Q&A • User support groups 15

16. Infrastructure – adaptability • Deserves consideration at the start of a system design to understand what changes are possible and what are their costs • The addition of a new program can mean the need to add new outcome measures • Changing reporting requirements can mean the addition of data elements and data linkages • Customization by role promotes user friendliness • Screen customization for data entry and reports • Data query and ad hoc report customization can facilitate analysis and utility of the data 16

17. Key components of a data system • Infrastructure • Interfaces • Content 17

18. PEI outcomes data system interfaces • Data Input users • Direct data entry (individual and batch) • Data import to ease burden of data entry • Data quality can be built in (notifications, automated checks, audits) • Role-based interfaces are user friendly • Front desk • Clinician or service provider and supervisors • QA • Billing • IT • Management 18

19. System interfaces – output users • Data output users • Data exports • Standard reports for roles and for audits, e.g., missing data reports • Individual participant • Aggregate program, provider, site • Annual community report • Custom reports that users can design and modify easily 19

20. Key components of a data system • Infrastructure • Interfaces • Content 20

21. PEI outcomes data system content • Levels • Individual • Clients, families, clinicians • System • Providers, programs, counties • Community • Population and target populations • Structure and process information • Outcomes information 21

22. A Logic Model for Understanding the Impact ofPrevention and Early Intervention (PEI) Funding Does it make a difference? (Short and long-term outcomes) Where is it going? (Programs) What is it doing? (Program activities) PEI Funding Are there public health benefits? • New and enhanced prevention resources • Public awareness campaigns • Training and education of gatekeepers • Education and counseling programs • Community strengthening programs • New and enhanced • treatment resources • Treatment of mild-moderate mental illness • Treatment for new onset SMI • Increasedcollaboration and coordination among agencies • System change efforts • More and better prevention • Exposure to social marketing efforts • More teachers trained • More parents receiving coping skills training • More and better early intervention • Access/utilization of first-break early intervention programs • Use of school-based counseling services • Reduced suicide • Mental-health related • Prolonged suffering • Incarceration • Homelessness • School drop out • Foster care • Unemployment • Differences across groups • Changed knowledge, behaviors and attitudes • Increased general knowledge about mental illness • Increased identification of at-risk clients • Increased help-seeking • Decreased risk behaviors • Improved resilience and emotional well-being • Increased social connections • Decreased psychological distress • Increased family functioning • Improved school performance • Community Planning Process • Identified needs • Target populations 22

23. PEI structure and process information • Information about clients or program participants • Unique identifiers for unduplicated counts • Individual and family, program, counselor links • Client characteristics such as target population status • Demographics for reporting requirements, QI and evaluation • Client services utilization/attendance/participation • Program status and service duration • From start to completion or other disposition • Collateral services/systems • Referrals and transfers to and from other services 23

24. PEI outcomes information • Benchmark against goals and objectives of treatment plan or program standard • Assess symptoms/ dx./ baseline score on standard measure at outset of program (‘pre’) • Repeat data collection to measure progress/change over time (‘post’) • Core measures (across programs, agencies, counties) • Custom measures (specific to a program) Did services received make a difference? 24

25. Thank You! 25