Designing and Interpreting Cross-Sector Research

1. Designing and Interpreting Cross-Sector Research John A. Pandiani, Ph.D. Vermont Department of Mental Health and The Bristol Observatory

2. Data Are Everywhere

3. Cross-Sector Research Why ? How ? and Thinking About Findings

4. Why Use Cross-Sector Research? Enhance the Value of Your Data Already Paid For No New Data Collection Improve Data Quality

5. CMH MIS HMIS Overlap 5% 5% 5% 5% 4% 4% 4% 4% 3% 3% 3% 3% 2% 2% 2% 2% 1% 1% 1% 1% 0% 0% 0% Total Total SA SA AOP AOP CRT CRT 0% Total SA AOP CRT Total SA AOP CRT Two CMH Homeless Rates

6. Why Use Cross-Sector Research? Provides Prospective, Retrospective, and General Population Comparisons

7. How to do Cross-Sector Research Direct Linkage Probabilistic Linkage Case Management Probabilistic Overlap Estimation Service Systems Research

8. Probabilistic Population Estimation This equation counts the number of birth dates to estimate the unduplicated number of people.

9. Probabilistic Population Estimation For Specified Numbers of Birth Dates Within a Given Year

10. Caseload Overlap (A  B) = A + B – (A  B)

11. Thinking About Findings Two Critical Dimensions Time and Space Geographical Space Organizational Space

12. Thinking About Findings Program Evaluation Paradigm Access to Care Treatment Outcomes Practice Patterns

13. Thinking About Findings Discovery vs. Verification My Approach Observational Incremental Pragmatic Follow the Flow of Analysis

14. Disseminating Findings Widespread Sharing Broad Community of Learners Variety of Perspectives

15. Sixteen Examples of Cross-Sector Research Findings Access to Care Treatment Outcomes Practice Patterns Other Cross-Sector Analyses

16. Access to Care

17. Homeless Adults’ Access to CMH Services Homeless Adults’ Access to CMH Services Homeless Adults’ Access to CMH Services Homeless Adults’ Access to CMH Services 60% 60% 60% Vermont Vermont New Hampshire New Hampshire 60% Vermont New Hampshire Vermont New Hampshire 40% 40% 40% 40% 20% 20% 20% 20% 0% 0% 0% Total Total Male Male Female Female 18-34 18-34 35-49 35-49 50+ 50+ 0% Total Male Female 18-34 35-49 50+ Total Male Female 18-34 35-49 50+

18. Community MH Utilization Community MH Utilization Community MH Utilization Community MH Utilization Community MH Utilization 40% 40% 40% Vermont Population Criminal Charge Homeless 40% Vermont Population Criminal Charge Homeless 40% Vermont Population Criminal Charge Homeless Vermont Population Criminal Charge Homeless Vermont Population Criminal Charge Homeless 30% 30% 30% 30% 30% 20% 20% 20% 20% 20% 10% 10% 10% 10% 10% 0% 0% 0% Total Men Women 18-34 35-49 50+ 0% Total Men Women 18-34 35-49 50+ 0% Total Men Women 18-34 35-49 50+ Total Men Women 18-34 35-49 50+ Total Men Women 18-34 35-49 50+

19. Percent of SMI <10% 10%-15% 15%-20% 20%+ SMI in Section 8 Housing in VT and CT

20. SMI with Section 8 Housing SMI with Section 8 Housing SMI with Section 8 Housing SMI with Section 8 Housing 25% 25% Connecticut Vermont 25% Connecticut Vermont 25% Connecticut Vermont Connecticut Vermont 20% 20% 20% 20% 15% 15% 15% 15% c 10% 10% 10% 10% 5% 5% 5% 5% 0% 0% Total Male Female 18-34 35-49 50-64 65+ White Other 0% Total Male Female 18-34 35-49 50-64 65+ White Other 0% Total Male Female 18-34 35-49 50-64 65+ White Other Total Male Female 18-34 35-49 50-64 65+ White Other

21. ER Utilization by Diagnosis, VT Adults ER Utilization by Diagnosis, VT Adults ER Utilization by Diagnosis, VT Adults ER Utilization by Diagnosis, VT Adults Homeless Homeless Homeless General Population General Population General Population Homeless General Population 50% 50% 50% 50% 40% 40% 40% 40% 30% 30% 30% 30% 20% 20% 20% 20% 10% 10% 10% 10% 0% 0% 0% 0% Medical Medical Medical MH MH MH SA SA SA Medical MH SA

22. Relative Rate of ER Utilization Homeless vs. Other VT Adults Relative Rate of ER Utilization Homeless vs. Other VT Adults Medical Medical Mental Health Mental Health Substance Abuse Substance Abuse 30 30 25 25 20 20 Relative Rate Relative Rate 15 15 10 10 5 5 1 0 0 Total Total Male Male Female Female 18-34 18-34 35+ 35+

23. Treatment Outcomes

24. 50% 50% 50% Before Treatment After Treatment Before Treatment Before Treatment After Treatment After Treatment 40% 40% 40% 30% 30% 30% Percent Arrested Percent Arrested Percent Arrested 20% 20% 20% 10% 10% 10% 0% 0% 0% 1 2 3 4 5 6 7 8 9 10 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 Region Region Region VT Substance Abuse Service RecipientsArrested Before and After Treatment

25. VT SMI Service RecipientsIncarcerated Before and After Treatment VT SMI Service RecipientsIncarcerated Before and After Treatment VT SMI Service RecipientsIncarcerated Before and After Treatment Before Treatment After Treatment Before Treatment After Treatment Before Treatment After Treatment 20% 20% 20% 15% 15% 15% Percent Incarcerated Percent Incarcerated 10% 10% Percent Incarcerated 10% 5% 5% 5% 0% 0% 0% Total M F 18-34 35-49 50-64 M F M F M F Total M F 18-34 35-49 50-64 M F M F M F Total M F 18-34 35-49 50-64 M F M F M F Gender Age 18-34 35-49 50-64 Gender Age 18-34 35-49 50-64 Gender Age 18-34 35-49 50-64

26. Relative Risk of ArrestYoung Males (18 - 34) in Washington, DC Post 9/11 Pre 9/11 Post 9/11 Pre 9/11 4 4 3 3 Relative Risk Relative Risk 2 2 1 1 Sep 2001 - Sep 2002 0 0 Oct 1999 - Aug 2001 Sep 2001 - Sep 2002 Oct 1999 - Aug 2001

27. Practice Patterns

28. Residential Situation after State Hospital Discharge Residential Situation after State Hospital Discharge Residential Situation after State Hospital Discharge Residential Situation after State Hospital Discharge 75% 75% 75% 75% Nursing Nursing Nursing Nursing CMHC CMHC CMHC CMHC 50% 50% 50% 50% Inpatient Inpatient Inpatient Inpatient 25% 25% 25% 25% Incarcerated Incarcerated Incarcerated Incarcerated Section 8 Section 8 Section 8 Section 8 0% 0% 0% 0% Total M F M F M F M F Total M F M F M F M F Total M F M F M F M F Total M F M F M F M F Gender 18-34 35-49 50+ Gender 18-34 35-49 50+ Gender 18-34 35-49 50+ Gender 18-34 35-49 50+

29. 100% 100% 100% 80% 80% 80% 60% 60% 60% Percent of Clients Served Percent of Clients Served Percent of Clients Served 40% 40% 40% 20% 20% 20% 0% Homeless Other 0% 0% Homeless Other Homeless Other Adult MH Outpatient Clients with Less than 4 Services

30. Other Cross-Sector Analyses

31. Offender Offender Victim Victim Offender Victim Offender Victim 25 25 25 25 20 20 20 20 15 15 15 15 Relative Rate Relative Rate Relative Rate Relative Rate 10 10 10 10 5 5 5 5 1 0 0 0 0 Overall Overall Men Men Women Women 18-34 18-34 35+ 35+ Overall Men Women 18-34 35+ Overall Men Women 18-34 35+ Relative Rate of Domestic Violence Homeless Compared to General Population

32. CMH (SED) DCF (Delinquent) Special Education (EBD) Homeless Adults with Services as Youth Homeless Adults with Services as Youth Homeless Adults with Services as Youth Youth with Subsequent Adult Homelessness 50% 50% 50% 50% 40% 40% 40% 40% 30% 30% 30% 30% Percent of Homeless Young Adults Percent of Homeless Young Adults Percent of Homeless Young Adults Percent of Youth 20% 20% 20% 20% 10% 10% 10% 10% 0% 0% 0% 0% Total Total Boys Men Girls Women Total Total Men Men Women Women Youth with Subsequent Adult Homelessness Youth with Subsequent Adult Homelessness 50% 50% 40% 40% 30% 30% Percent of Youth Percent of Youth 20% 20% 10% 10% 0% 0% Total Total Boys Boys Girls Girls Children’s Services & Adult Homeless

33. Veterans Veterans Non-veterans Non-veterans 7 7 6 6 5 5 4 4 Percent Homeless Percent Homeless 3 3 2 2 1 1 0 0 Total Total Men Men Women Women Men Men Women Women Men Men Women Women 18-49 50+ 18-49 50+ Homelessness among MH Service Recipients

34. Vermont (n =355) New Hampshire (n =706) Both (n = 5) 0.5% People with Homeless Services in Bordering Counties of Vermont & New Hampshire

35. 0% 10% 20% 30% 40% 50% Medicaid Food Stamps State Medical Substance Abuse Corrections Probation Cash Benefits Temporary Family Assist. Abuse/Neglect Offenders Motor Vehicle Violators Mental Retardation CMHC Overlapwith Eleven Caseloads in CT

36. Thanks to People who collected these data People who manage the databases Barbara Carroll, Brennan Martin, & Walter Ochs Vermont MH Performance Indicator Project Karen Danyow The Bristol Observatory

38. USE THEDATA www.thebristolobservatory.com