Uniform Reporting System (URS) Data Output Tables

Purpose of URS Data Collection:

In response to the need for accountability for the expenditure of community mental health block grant funds received by States from the Federal Government, the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), Division of State and Community Systems Development (DSCSD), and State mental health agencies (SMHA) and their national organizations the National Association of State Mental Health Program Directors (NASMHPD) and the NASMHPD Research Institute, Inc. (NRI), have worked together since 1997 in an effort to ensure the uniform reporting of State-level data to describe the public mental health system and the outcomes of its programs.

In order to satisfy the requirement for uniformity of data definitions, the CMHS Uniform Reporting System (URS) was developed. The URS consists of 21 standardized tables (12 Basic tables and 9 Developmental tables) that SMHAs submit each December in their Community Mental Health Services Block Grant Implementation Report to CMHS. Starting in 2001, grants were awarded to SMHAs to help them build their data systems infrastructure to report URS data.

The URS data submitted by the States has been used to create 14 different Output Tables that show performance on issues of Access, Appropriateness, Outcomes, and System Management. These 14 URS Output Tables here on the CMHS website reflect the first year of State reporting of URS data (most States have submitted data for their State’s fiscal year 2002) and as such represent the initial effort to collect these data. Because, many States were just beginning the process of modifying their information systems to compile information using the recommended URS data definitions and table formats, only data from the 12 Basic Tables are included. CMHS and the States are currently testing and refining the 9 URS Developmental Tables. Once they are finalized, they will also be reported here.

Uses of URS Data:

The intent of the URS tables is to allow both (1) the tracking of individual State performance over time, and (2) the aggregation of State information to develop a national picture of the public mental health systems of the States.

The 14 URS Output Tables reported here show data for a selected State, along with the national U.S. average. NOTE: Many States have added footnotes that explain important variations in their data systems or their system’s reporting capacity.

Limitations of URS Data

1. The intent of the URS is not to make comparisons between States. Users of these data are cautioned that each State mental health agency has its own unique State laws and regulations regarding who it serves, its priority populations, and the existence of Medicaid managed care waivers and other variables that impact the number of mental health consumers who are counted as part of the SMHA system.
2. The data demonstrate that some States may serve fewer consumers with more intensive services, while other States may provide less intensive services to a broader range of consumers. However, the URS Tables should not be used to make judgments about which approach is better.
3. Because State mental health systems vary widely in their mission and the priority populations they are mandated to serve, the URS data are not intended to make comparisons between States, but rather to help systems monitor their own performance over time.
4. Many States have added footnotes to the tables that explain important variations in their data systems or their system’s reporting capacity.

Scope of Reporting:

The States, in concert with the Federal government, developed guidelines to define the scope of reporting by States to the URS. For the purposes of the URS, the “scope” of reporting was determined to be any part of the mental health “system” that comes under the auspices of the State mental health agency.

More specifically, the following guidelines were used for including and counting people in the URS:

1. All persons served directly by the State mental health agency (including persons who received services funded by Medicaid)
2. All persons in the system for whom the State mental health agency contracts for services (including persons whose services are funded by Medicaid).
3. Any other persons who are counted as being served by the State mental health agency or come under the auspices of the State mental health agency system. This includes Medicaid waivers, if the mental health component of the waiver is considered to be part of the SMHA system.
4. All identified persons who have received a mental health service, including screening, assessment, and crisis services. Telemedicine services were counted if they were provided to identified clients.
5. For States where a separate State agency is responsible for children=s mental health, where feasible, efforts were made to unduplicate clients between the child mental health agency and the adult mental health agency. If this unduplication was not feasible, this potential duplication was reported to indicate there was an overlap between the A0-17 group@ and the A18 and over group@ but that there was unduplication within each group.

Persons who were not included in the URS tables:

1. Persons who just received a telephone contact were not included, unless it was a telemedicine service to a registered client. Hotline calls to anonymous clients were not counted.
2. Persons who only received a Medicaid funded mental health service through a provider who was not part of the SMHA system were not included.
3. Persons who only received a service through a private provider or medical provider not funded by the SMHA were not included.
4. Persons with a single diagnosis of substance abuse or mental retardation were not included. All persons with a diagnosis of mental illness were counted, including persons with a co-occurring diagnosis of substance abuse or mental retardation.

Descriptions of URS Output Tables:

The following tables are available for each State based on the December 2002 reporting of URS data. Tables are grouped by the intended focus of their content. There are four (4) tables that address issues of “Access” to services—how many consumers received mental health services in States and in particular service settings. There are four (4) “Appropriateness” tables that look at whether persons are receiving appropriate care or levels of treatment. The Appropriateness Tables include measures of homeless persons served, admission rates, length of stay in inpatient programs, and treatment of persons with co-occurring mental health and substance abuse disorders. There are three (3) “Outcomes” tables that include State data on the employment status of consumers served by SMHAs, as well as tables that show consumers’ self-report on the outcomes from services. Finally, there are three (3) Structure domain tables, that provide information on the expenditures and funding sources of State mental health agencies, as well as how States expended their mental health block grant funds. A brief description of each table is provided below.

Access Domain: Table 1: Demographic Characteristics Of Persons Served By The State Mental Health Authority:

This table shows the numbers of mental health consumers served in each State across their entire system (both community and hospital services) by age, gender, race, and Hispanic/Latino status. The numbers of persons served and the rate served per 1,000 is shown for the selected State and the U.S. average.

Access Domain: Table 2: Persons Served In Community Mental Health Programs By Age And Gender:

This table shows the numbers of persons served in community mental health programs in each State, by age, and gender. The numbers of persons served and the rate served per 1,000 is shown for the selected State and the U.S. average.

Access Domain: Table 3: Persons Served In State Psychiatric Hospitals By Age And Gender

This table shows the numbers of persons served in State psychiatric hospitals in each State, by age, and gender. The numbers of persons served and the rate served per 1,000 is shown for the selected State and the U.S. average.

Access Domain: Table 4: Persons Served SMHA Systems With Medicaid And Other Funding Sources By Race And Gender

This table shows the numbers of persons served by each State mental health agency systems who had, at least some of their mental health services, paid for by Medicaid, by age, gender, race, and Hispanic/Latino status. The numbers of persons served and the rate served per 1,000 is shown for the selected State and the U.S. average.

Appropriateness Domain: Table 1: Homeless Persons Served By Community Mental Health Programs By Age And Gender

This table shows the numbers of homeless persons served in community mental health programs in each State, by age and gender. The numbers of homeless persons served and the rate served per 1,000 is shown for the selected State and the U.S. average. Homelessness was defined as homeless or living in a homeless shelter at some assessment during the reporting year.

Appropriateness Domain: Table 2: Number Of Admissions During The Year To State Hospital Inpatient And Community-Based

This table shows the numbers of persons admitted to State psychiatric hospitals each year and the total number of persons served each year. The rate of admissions per persons served is shown for the selected State and the U.S. average.

Appropriateness Domain: Table 3: Mean Length Of Stays Of Adults And Children In State Psychiatric Hospitals

This table shows the average length of stay in State psychiatric hospitals for persons who were discharged during the year and those still resident at the end of the year. The average length of stay is shows for children and adults, for the selected State and the U.S. average.

Appropriateness Domain: Table 4: Percent Of Adults And Children Served Who Meet The Federal Definitions For Adults with Serious Mental Illnesses (SMI) And Children with Serious Emotional Disturbances (SED And Percent Of Adults And Children Served Who Have Co-Occurring Mental Health/Alcohol and Other Drug Abuse Disorders (AOD)

This table shows for each State and the U.S. Average, the percent of the clients served who meet the State or Federal definitions of Adults with SMI and Children with SED. In addition, the table shows information for the selected State and the U.S. average on the percent of clients served by the SMHA who had a co-occurring mental health and alcohol or other drug abuse disorder.

Outcomes Domain: Table 1: Employment Status Of Adult Mental Health Consumers Served In The Community By Age And Gender

This table shows the numbers of persons who were competitively employed who were served in community mental health programs in each State, by age, and gender. The numbers of competitively employed persons served and the employment rate shown for the selected State and the national average employment rate. “Employed” was defined as competitively employed (full or part-time) at the last assessment available during the reporting year.

Outcomes Domain: Table 2: Consumer Survey Results

This table shows the persons who responded positively to consumer survey questions about the outcomes that resulted from services received, their assessment of the quality/appropriateness of services received, their access to services, and their participation in treatment planning. Consumer perceptions of care results are shown for the selected State and the national averages for each domain. Additional information about the survey instruments used by States, the sample size, and sample methodologies are included in this table.

Outcomes Domain: Table 3: Consumer Survey Results by Race

This table shows the consumer survey results from Outcomes Table 2, depicted by the race of survey respondents. Results are shown for the selected State and the national average. The reporting of consumer perception of care data by race was optional--not all States have conducted consumer surveys with adequate sample sizes to allow the reporting of results by race.

Structure Domain: Table 1: State Mental Health Agency Controlled Expenditures For Mental Health, FY 2001

This table shows the mental health expenditures of State mental health agencies, by major delivery auspice (State psychiatric hospitals, and community mental health providers). Data are depicted for the selected State and for the national average.

Structure Domain: Table 2: State Mental Health Agency Controlled Revenues By Funding Source, FY 2001

This table shows the funding sources of State mental health agencies. Revenues are depicted by: State sources, Medicaid, the CMHS Community Mental Health Block Grant, other Federal Funds, and other sources. Data are shown for the selected State and for the national average.

Structure Domain: Table 3: Federal Mental Health Block Grant Expenditures For Non-Direct Service Activities

This table shows the “non-direct service” expenditures of State of its allotment of the CMHS Community Mental Health Block Grant. Expenditures are shown for the categories of: Technical Assistance Activities, Planning Council Activities and Support, Administration, Data Collection/Reporting, and Other Activities. Data are depicted for the selected State and for the national average.