Part 3 - What values are new or changed within areas that we already collect for the QI File?

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1 PCE Systems 7/17/2015 Part 3 - What values are new or changed within areas that we already collect for the QI File? Field Name Values PCE Component tes Race Alaskan native American Indian Race/Ethnic Origin Changed-Previously 1 value, now separated. Hispanic Puerto Rican Mexican Cuban Other specific Hispanic or Latino Hispanic or Latino Ethnicity Changed-Previously yes/no, now detailed. Field Name Values PCE Component tes Corrections Related Tether Corrections/Legal New Status Post-booking diversion Status Arrests in Past 30 Days Number of separate arrests in the past 30 days Corrections/Legal Status New Field Name Values PCE Component tes Education schooling or less than one Education History New school grade Nursery school, pre-school, or head start Kindergarten Self-contained special education class Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 1 Year of college/university 2 Years of college/university or Associate Degree 3 Years of college/university Graduate or professional school Vocational school Currently in Mainstream Yes Education History New Page 1 of 8

2 PCE Systems 7/17/2015 Special Education School Attendance Status Yes, client has attended school at any time in the past 3 months, client has attended school at any time in the past 3 months t applicable Education History New Field Name Values PCE Component tes Employment N/A individual is under 16 years Employment/Financial New of age Field Name Values PCE Component tes Living Arrangement/Detailed Residential Care Living Arrangement Crisis Residence Residential Living Arrangement New Field Name Values PCE Component tes Veteran Status Veteran t a veteran Other Demographics Information Changed-Unknown is no longer a selection. Marital Status w Married/Cohabitating Other Demographics Information Changed-Added cohabitating. Field Name Values PCE Component tes Detailed SMI/SED Status SMI Designations New SED Neither SMI nor SED t Evaluated Integrated Substance Yes Designations New Page 2 of 8

3 PCE Systems 7/17/2015 Use and Mental Health Treatment tes: This list can be used to inform your clinicians on the new values that they will be able to choose within form fields that are already in use. Page 3 of 8

4 PCE Systems 7/17/2015 Part 4 - What fields are completely new and need to be placed within form screens? New field to be added Values PCE Component Name Time to Treatment # of days Entry to Treatment/Referral Prior Treatment Episodes Referral Source Detailed Criminal Justice Referral Codependent/Collateral Person Service Pregnant on Service Start Date 0 previous episodes 1 previous episode 2 previous episodes 3 previous episodes 4 previous episodes 5 previous episodes Unknown Individual Alcohol/drug abuse care provider School (Educational) Employer/Employee Assistance Program (EAP) Other community referral Court/criminal justice referral/dui/dwi (requires detailed criminal justice referral) Federal/State court Other court Probation/parole Other recognized legal entities Diversionary program Prison DUI/DWI Other t Applicable Client Codependent/collateral individual Yes female individual was pregnant on the date service started female individual was not pregnant on the date service started N/A male adult or prepubescent child Information Entry to Treatment/Referral Information Entry to Treatment/Referral Information Entry to Treatment/Referral Information Entry to Treatment/Referral Information Entry to Treatment/Referral Information Page 4 of 8

5 PCE Systems 7/17/2015 New field to be added Values PCE Component SDA, SSI or SSDI Enrolled Yes Employment / Financial New fields to be added Values Component Service Start Date MMDDYYYY TEDS record Service Start Time of Day HHMM military time TEDS record Type of Treatment Service Setting Detoxification, 24 hour service, free-standing residential Rehabilitation/residential short term (30 days or fewer) Rehabilitation/residential long term (more than 30 days) Ambulatory intensive outpatient Ambulatory non-intensive outpatient Ambulatory detoxification State psychiatric hospital State Mental Health Agency funded/operated community-based program Residential treatment center Other psychiatric inpatient Institutions under the justice system SA codependent/collateral individual served OR MH individual receiving assessment, evaluation, or screening only TEDS record Page 5 of 8

6 PCE Systems 7/17/2015 Page 6 of 8

7 PCE Systems 7/17/2015 New fields to be added Values Component Primary/Secondary/Tertiary Substance Use Problem ne Alcohol Cocaine/crack Marijuana/hashish Heroin n-prescription methadone Other opiates/synthetics PCP phencyclidine Hallucinogens Methamphetamine/speed Other amphetamines Other stimulants Benzodiazepines Other tranquilizers Barbiturates Other sedatives/hypnotics Inhalants Over-the-counter medications SUD Substances Primary/Secondary/Tertiary Route of Administration Primary/Secondary/Tertiary Frequency of Use Primary/Secondary/Tertiary Age at First Use Medication-assisted Opioid Therapy at this Agency Attendance at Self-Help Groups in Past 30 Days Other drugs Oral Smoking Inhalation Injection Other t applicable use in the past month 1-3 days in the past month 1-2 days in the past week 3-6 days in the past week Daily t applicable Newborn with substance dependency problem Age at first use, in years t applicable Yes t applicable attendance Less than once a week 1 to 3 times in past 30 days About once a week 4 to 7 times in past 30 days 2 to 3 times per week 8 to 15 times in past 30 days At least 4 times per week 16 to 30 times in past 30 days t collected (for MH records only) SUD Substances SUD Substances SUD Substances SUD Substances SUD Substances Page 7 of 8

8 PCE Systems 7/17/2015 Page 8 of 8

9 MI/DD Current QI field & value list Maps to this BH TEDS field and value Developmental Disability DD Designation t evaluated t evaluated Yes Yes Mental Illness/SED MI/SED Designation t evaluated t evaluated Yes Yes Date of Birth Date of Birth MMDDYYYY MMDDYYYY Gender Gender Female Female Male Male County County of Residence Alcona 01 Alger 02 Allegan 03 Alpena 04 Antrim 05 Arenac 06 Baraga 07 Barry 08 Bay 09 Benzie 10 Berrien 11 Branch 12 Calhoun 13 Canada 89 Cass 14 Charlevoix 15 Cheboygan 16 Chippewa 17 Clare 18 Clinton 19 Crawford 20 Delta 21 Dickinson 22 Eaton 23 Emmet 24 Genesee 25 Gladwin 26 Gogebic 27 Grand Traverse 28 Gratiot 29

10 MI/DD Current QI field & value list Maps to this BH TEDS field and value Hillsdale 30 Homeless 96 Houghton 31 Huron 32 Ingham 33 Ionia 34 Iosco 35 Iron 36 Isabella 37 Jackson 38 Kalamazoo 39 Kalkaska 40 Katrina Evacuee 00 Kent 41 Keweenaw 42 Lake 43 Lapeer 44 Leelanau 45 Lenawee 46 Livingston 47 Luce 48 Mackinac 49 Macomb 50 Manistee 51 Marquette 52 Mason 53 Mecosta 54 Menominee 55 Midland 56 Missaukee 57 Monroe 58 Montcalm 59 Montmorency 60 Muskegon 61 Newaygo 62 Oakland 63 Oceana 64 Ogemaw 65 Ontonagon 66 Osceola 67 Oscoda 68 Otsego 69 Ottawa 70 Out of State 00

11 MI/DD Current QI field & value list Maps to this BH TEDS field and value Presque Isle 71 Roscommon 72 Saginaw 73 Saint Clair 74 Saint Joseph 75 Sanilac 76 Schoolcraft 77 Shiawassee 78 Tuscola 79 Unknown 00 Van Buren 80 Washtenaw 81 Wayne 82 except city of Detroit Wexford City of Detroit 85 Wisconsin 86 Indiana 87 Ohio 88 Illinois Race 1 Race American Indian or Alaskan Nativ Alaskan native (Aleut, Eskimo) American Indian (non Alaskan native) Asian Asian Black or African American Black or African American Consumer refused to provide Refused to provide Native Hawaiian or other Pacific Native Hawaiian or other Pacific Islander Some other race Other single race Unknown Race Other single race White White Race 2 Race American Indian or Alaskan Nativ Asian Black or African American Consumer refused to provide Native Hawaiian or other Pacific Some other race Unknown Race White Race 3 Race American Indian or Alaskan Nativ Asian Black or African American Consumer refused to provide

12 Current QI field & value list Native Hawaiian or other Pacific Some other race Unknown Race White Hispanic Hispanic or Latino t Hispanic or Latino Unknown Education Attended/attending college College graduate Completed High School Completed less than high school In school K through 12th grade In Special Education In training program Education Attended/attending college College graduate Completed High School MI/DD Maps to this BH TEDS field and value Hispanic or Latino Ethnicity Puerto Rican Mexican Cuban Other specific Hispanic or Latino Hispanic or Latino specific origin not specified t of Hispanic or Latino origin Unknown Education 4 Years of College/University or Bachelor's Degree Grade 12 or GED schooling or less than one school grade Nursery school, pre school, or head start Kindergarten Self contained Special Education Class Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 1 Year of College/University 2 Years of College/University or Associate Degree 3 Years of College/University Graduate or professional school Vocational school School Attendance Status

13 Current QI field & value list Completed less than high school In school K through 12th grade In Special Education In training program Employment Status Employed full time Employed part time Facility based activity program In enclave/mobile crews In unpaid work t in competitive labor force Self employed Sheltered workshop Unemployed Minimum Wage N/A Yes Total Annual Income xxxxxx Number of Dependents nn Residential Living Arrangement Foster family home General residential home Homeless Institutional setting Nursing Care Facility Prison/jail/juvenile detention Private Residence w/ family Private Residence w/ spouse Specialized residential home Supported Independence Program MI/DD Maps to this BH TEDS field and value Yes, client has attending school at any time in the past 3 months Yes, client has attending school at any time in the past 3 months t applicable Employment Status Full time competitive, integrated employment Part time competitive, integrated employment t in competitive, integrated labor force t in competitive, integrated labor force t in competitive, integrated labor force t in competitive, integrated labor force Unemployed N/A individual is under 16 years of age Minimum Wage Individual is not working. Individual is currently earning less than minimum wage. Individual is currently earning minimum wage or more. Total Annual Income xxxxxx Number of Dependents nn Living Arrangements Foster Home/Foster Care Residential care Homeless Institutional Setting Institutional Setting Jail/Correctional/Other Institutions under the justice system Living in a private residence with natural or adoptive family member(s). "Family member" means parent, stepparent, sibling, child, or grandparent of the primary consumer or an individual upon whom the primary consumer is dependent for at least 50% o his/her financial support. Living in a private residence not owned by the PIHP, CMHSP or the contracted provider, alone or with spouse or non relative(s). Living in a private residence that is owned by the PIHP, CMHSP or the contracted provider, alone or with spouse or non relative Institutional Setting Crisis Residence

14 Current QI field & value list Corrections Related Status Arrested and booked Awaiting sentencing Awaiting trial Court supervision Diverted from arrest or booking In jail In prison Juvenile detention center Minor referred by court t under jurisdiction Paroled from prison Probation from jail Refused to give information MI/DD Maps to this BH TEDS field and value Corrections Related Status Pre sentencing (Adult)/Pre distribution (Youth) Pre trial (Youth or Adult) Booking diversion In jail In prison Juvenile detention center t under jurisdiction of corrections or law enforcement program Paroled from a state or federal correctional facility Probation Tether Post booking diversion

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