Use of Pooled State Administrative Data for Mental Health Services Research

Essock, Susan M.; Morrissey, J; Libby, Anne M.; Donahue, Sheila A.; Druss, Benjamin G.; Finnerty, Molly; Frisman, Linda K.; Narasimhan, Meera; Stein, Bradley D.; Wisdom, Jennifer P.; Zerzan, Judy

doi:10.1007/s10488-014-0620-y

Cited by 13 publications

(12 citation statements)

References 27 publications

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“…Administrative claims data have been identified as a valuable resource for researchers and policymakers alike to understand the sustainment of mental health policy/program initiatives across agencies ( 15 , 30 , 31 , 32 , 33 ). Claims data provide an opportunity for a novel application of survival analysis to examine sustainment in the context of large, system-driven EBP implementations.…”

Section: Introductionmentioning

confidence: 99%

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children’s Mental Health Services

Brookman‐Frazee

Zhan

Stadnick

et al. 2018

Front. Public Health

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Evidence-based practice (EBP) implementation requires substantial resources in workforce training; yet, failure to achieve long-term sustainment can result in poor return on investment. There is limited research on EBP sustainment in mental health services long after implementation. This study examined therapists’ continued vs. discontinued practice delivery based on administrative claims for reimbursement for six EBPs [Cognitive Behavioral Interventions for Trauma in Schools (CBITS), Child–Parent Psychotherapy, Managing and Adapting Practices (MAP), Seeking Safety (SS), Trauma-Focused Cognitive Behavior Therapy (TF-CBT), and Positive Parenting Program] adopted in a system-driven implementation effort in public mental health services for children. Our goal was to identify agency and therapist factors associated with a sustained EBP delivery. Survival analysis (i.e., Kaplan–Meier survival functions, log-rank tests, and Cox regressions) was used to analyze 19 fiscal quarters (i.e., approximately 57 months) of claims data from the Prevention and Early Intervention Transformation within the Los Angeles County Department of Mental Health. These data comprised 2,322,389 claims made by 6,873 therapists across 88 agencies. Survival time was represented by the time elapsed from therapists’ first to final claims for each practice and for any of the six EBPs. Results indicate that therapists continued to deliver at least one EBP for a mean survival time of 21.73 months (median = 18.70). When compared to a survival curve of the five other EBPs, CBITS, SS, and TP demonstrated a higher risk of delivery discontinuation, whereas MAP and TF-CBT demonstrated a lower risk of delivery discontinuation. A multivariate Cox regression model revealed that agency (centralization and service setting) and therapist (demographics, discipline, and case-mix characteristics) characteristics were significantly associated with risk of delivery discontinuation for any of the six EBPs. This study illustrates a novel application of survival analysis to administrative claims data in system-driven implementation of multiple EBPs. Findings reveal variability in the long-term continuation of therapist-level delivery of EBPs and highlight the importance of both agency and workforce characteristics in the sustained delivery of EBPs. Findings direct the field to potential targets of sustainment interventions (e.g., strategic assignment of therapists to EBP training and strategic selection of EBPs by agencies).

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Section: Introductionmentioning

confidence: 99%

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children’s Mental Health Services

Brookman‐Frazee

Zhan

Stadnick

et al. 2018

Front. Public Health

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“…For instance, Binswanger and colleagues [18] integrated criminal justice and health databases and determined that drug overdose among prisoners reentering the community yielded the greatest risk of death within the first few weeks of prison release. There have also been recent calls to employ state-collected administrative data to study access to mental health services among vulnerable populations, including those in corrections [19].…”

Section: Contextmentioning

confidence: 99%

Applying an Electronic Health Records Data Quality Framework Across Service Sectors: A Case Study of Juvenile Justice System Data

Aalsma

Schwartz

Haight

et al. 2019

eGEMs

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Context: Integrating electronic health records (EHR) with other sources of administrative data is key to identifying factors affecting the long-term health of traditionally underserved populations, such as individuals involved in the justice system. Linking existing administrative data from multiple sources overcomes many of the limitations of traditional prospective studies of population health, but the linking process assumes high levels of data quality and consistency within administrative data. Studies of EHR, unlike other types of administrative data, have provided guidance to evaluate the utility of big data for population health research. Case Description: Here, an established EHR data quality framework was applied to identify and describe the potential shortcomings of administrative juvenile justice system data collected by one of four case management systems (CMSs) across 12 counties in a Midwest state. The CMS data were reviewed for logical inconsistencies and compared along the data quality dimensions of plausibility and completeness. Major Themes: After applying the data quality framework, several patterns of logical inconsistencies within the data were identified. To resolve these inconsistencies, recommendations regarding data entry, review, and extraction are offered. Conclusion: The recommendations related to achieving quality justice system data can be applied to future efforts to link administrative databases from multiple sources. Increasing trust in administrative data quality related to vulnerable populations ultimately improves knowledge of pressing public health concerns.

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“…Use of system administrative data provides one method of measuring penetration and volume and aligns with calls for use of these data to understand practice patterns and inform implementation efforts [ 19 , 20 ]. However, by itself, penetration/volume of a practice within a workforce is insufficient to determine the maintained success of the implementation.…”

Section: Focus On Sustainmentmentioning

confidence: 99%

The 4KEEPS study: identifying predictors of sustainment of multiple practices fiscally mandated in children’s mental health services

Lau

Brookman‐Frazee

2015

Implementation Sci

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BackgroundResearch to date has largely focused on predictors of adoption and initial implementation of evidence-based practices (EBPs), yet sustained implementation is crucial to deliver a return on investments in dissemination. Furthermore, most studies focus on single EBPs, limiting opportunities to study the fit between practice characteristics EBPs and implementation contexts.Methods/designThis observational study will characterize implementation sustainment and identify organizational and therapist characteristics that predict sustainment of multiple practices being implemented within a fiscal mandate in the largest public mental health system in the USA. Specific aims are to (1) characterize sustainment outcomes (volume/penetration, EBP concordant care); (2) use mixed methods to characterize inner context (agency- and therapist-level) factors and early implementation conditions; and (3) identify inner context factors and early implementation conditions that predict sustainment outcomes. This study will undertake original data collection and analysis of existing data sources to achieve its aims. Archived reports and documents will be used to characterize early implementation conditions in 102 agencies. Administrative claims data will be used to characterize volume and penetration outcomes over 8 years. Therapist and program manager surveys will be administered to characterize sustained EBP concordant care and inner context determinants of sustainment. An in-depth study in a subset of agencies will yield interview data and recordings of treatment sessions for validation of the EBP concordant care scale.DiscussionThis project will yield new understanding of whether and how multiple EBPs can be sustained in public mental health systems undergoing a policy-driven community implementation effort. We will produce generalizable models for characterizing sustainment, including feasible and flexible measurement of practice across multiple EBPs. The findings will inform the development of implementation interventions to promote sustained delivery of EBPs to maximize their public health impact.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0388-4) contains supplementary material, which is available to authorized users.

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Use of Pooled State Administrative Data for Mental Health Services Research

Cited by 13 publications

References 27 publications

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children’s Mental Health Services

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children’s Mental Health Services

Applying an Electronic Health Records Data Quality Framework Across Service Sectors: A Case Study of Juvenile Justice System Data

The 4KEEPS study: identifying predictors of sustainment of multiple practices fiscally mandated in children’s mental health services

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