Form TEDS_MH and MH-CLD TEDS_MH and MH-CLD TEDS_MH and MH-CLD Data Elements

Treatment Episode Data Set (TEDS)

Attachment A1_TEDS_MH and MH-CLD Data Elements.xlsx

MH-CLD BCI Data

OMB: 0930-0335

Document [xlsx]
Download: xlsx | pdf
LEGEND
Key field = must not be blank. Key fields, taken together, are used to uniquely identify and link records.
Data set classifications, i.e., SDS, MDS, and SuDS, apply to MH-TEDS admission variables only.

TEDS/MH-TEDS
MH-CLD
Variable Name Data Field Reference Number Categories
Variable Name Data Field Reference No. Categories
Admission Record Discharge/Update Record
Data Files
Value taken from admission record Value taken at time of discharge or data update
BCI SHR
SYSTEM DATA SET (SDS)

System Transaction Type SDS 1
DIS 1

Transaction Type C-00 R-00



A=Add


A=Add



C=Change


C=Change



D=Delete


D=Delete
State Code –- Key field SDS 2
DIS 2 2 alphanumeric
Reporting State Code H-02 H-01 2 alphanumeric
Reporting Date SDS 3
DIS 3 MMYYYY
This information is contained in the file name algorithm

MMDDYYYY
MINIMUM DATA SET (MDS)

State Provider Identifier – Key field MDS 1 DIS 11 DIS 4 1-15 alphanumeric
Not reported
Client Identifier – Key field MDS 2 DIS 12 DIS 5 1-15 alphanumeric
Client Identifier C-01 R-01 1-15 alphanumeric
Codependent or Collateral – Key field MDS 3 DIS 13 DIS 6 1=codependent/collateral 2=client
Not reported
Client Transaction Type – Key field MDS 4

A=Initial Admission (SA)
Not reported



T=Transfer or change in service (SA)



M=Initial Admission (MH)



X=Transfer or change in service (MH)
Date of Admission – Key field MDS 5 DIS 15
MMDDYYYY
Client Status - at Start of Reporting Period (Dateof Admission is used by the state to report this translated variable) C-02
1=New client

2=Continuing client;
Prior Treatment Episodes MDS 6

Optional reporting MH clients with co-occurring SA
Not reported



0=0 Previous episodes



1=1



2=2



3=3



4=4



5=5 or more



7=unknown



8=not collected
Referral Source MDS 7

Optional reporting for MH
Not reported



01=Individual



02=Alcohol/drug abuse care provider



03=Other health care provider



04=School



05=Employer/EAP



06=Other community referral



07=court/criminal justice referral



97=unknown



98=not collected
Date of Birth MDS 8 DIS 17
MMDDYYYY
Age (Date of Birth is used by the state to report this calculated variable) C-05




01010007=unknown






01010008=not collected



Gender MDS 9 DIS 18


Gender C-04




1=male


1=male



2=female


2=female



7=unknown


7=unknown



8=not collected


8=not collected
Race MDS 10 DIS 19


Race C-06




01=Alaska Native






02=American Indian and Alaska Native


02=American Indian and Alaska Native



13=Asian


13=Asian



23=Native Hawaiian or other Pacific Islander


23=Native Hawaiian or other Pacific Islander



03=Asian or Pacific Islander


03=Asian or Pacific Islander (temporary code)



04= Black or African American


04= Black or African American



05=White


05=White



20=Other single race


20=Some other race alone



21=Two or more races


21=Two or more races







22=Hispanic (temporary code)



97=unknown


97=unknown



98=not collected


98=not collected
Hispanic or Latino Origin (Ethnicity) MDS 11 DIS 20
01=Puerto Rico
Ethnicity C-07
11=Puerto Rican (optional)



02=Mexican


12=Mexican (optional)



03=Cuban


13=Cuban (optional)



04=Other Specific Hispanic or Latino


14=Other Specific Hispanic



05 Not of Hispanic Origin


02=Not of Hispanic Origin



06=Hispanic, specific origin not specified


01=Hispanic origin regardless of race



97=unknown


97=unknown



98=not collected


98=Not collected
Education MDS 12
MHD 5

School Grade Level C-25




00= less than one grade completed or no schooling


00=no years of schooling



01-11=grades 1 thru 11th


01-11=grades 1 thru 11th



12=12th grade or GED


12 = 12th grade



13=Freshman or first year in a 2-year (Associate) Degree


17=freshman (1st year in College)



14=Sophomore or second year in a 2-year (Associate) Degree


18=sophomore (2nd year in College)



15=Junior in college


19=junior (3rd year in College)



16=Senior in college or Bachelor's Degree


20=senior (4th year in College)



17=Some Post-Graduate Study- Degree not completed






18= Master's Degree completed






19-25= Post graduate study






70= graduate or professional school (can be used instead of codes 17-25)


21=Graduate or professional school



71=vocational school


16=vocational school



72=nursery school, pre-school


13=nursery school, pre-school (head start)



73=kindergarten


14=kindergarten



74=self-contained special education class


15=self-contained special education class



97=unknown


97 = unknown



98=not collected


98=not collected
Employment Status MDS 13
DIS 24

Competitive Employment Status at admission and end of the reporting period C-09 and C-10




01=full time


01=full time



02=part-time


02=part time



03=unemployed


03=unemployed



04=not in the labor force


84=not in the labor force



05=employed, full/part-time not specified (temporary code)


05=employed, full/part-time not specified (temporary code)



97=unknown


97=unknown



98=not collected


98=not collected
Substance Abuse Problem (Primary, Secondary, Tertiary) MDS 14a MDS 14b MDS 14c
DIS 21a DIS 21b DIS 21c Optional reporting for MH clients with co-occurring SA - see Manual for SA problem categories
Not reported
Route of Administration (Primary, Secondary, Tertiary Substances) MDS 15a MDS 15b MDS 15c

Optional reporting for MH clients with co-occurring SA - see Manual for SA route of administration categories
Not reported
Frequency of Use (Primary, Secondary, Tertiary Substances) MDS 16a MDS 16b MDS 16c
DIS 22a DIS 22b DIS 22c Optional reporting for MH clients with co-occurring SA - see Manual for SA frequency of use categories
Not reported
Age at First Use (Primary, Secondary, Tertiary, Substances) MDS 17a MDS 17b MDS 17c

Optional reporting for MH clients with co-occurring SA)
Not reported
Type of Treatment Service/ Treatment Setting – Key field MDS 18 DIS 16 DIS 7

Service Setting Status Throughout the Reporting Period C-15




01=detox, 24-hr, hospital






02= detox, 24-hr, residential






03=rehabilitation/residential-hospital (not detox)






04=rehabilitation/residential-short term (<30 days)






05=rehabilitation/ residential-long term (>30 days)






06=ambulatory-intensive outpatient






07=ambulatory-non-intensive outpatient






08=ambulatory-detoxification






72=state psychiatric hospital


1=state psychiatric hospital



73=SMHA funded/operated community-based program


2=SMHA funded/operated community-based program



74=residential treatment center


3=residential treatment center



75=other psychiatric inpatient


4=other psychiatric inpatient



76=institutions under the justice system


5=institutions under the justice system



96=Not applicable (use only for codependents or collateral clients (SA) and for MH clients receiving MH assessments, evaluation, or screening only)



Medication-Assisted Opioid Therapy MDS 19

Optional reporting for MH clients with co-occurring SA
Not reported



1=Yes



2=No



6=Not applicable



7=unknown



8=not collected
SUPPLEMENTAL DATA SET (SuDS)

Detailed Drug Code (Primary, Secondary, Tertiary) SuDS 1 SuDS 2 SuDS 3

Optional reporting for MH clients with co-occurring SA - see Manual for SA drug code categories
Not reported
Diagnostic Code (DSM/ICD) SuDS 4

xxx.xx, xxx.--, xxx.--, xxx.x-
Not reported



999.97=unknown



999.98=not collected
Co-occurring substance abuse and mental health problems (old name in TEDS: Psychiatric problem in addition to alcohol and drug) SuDS 5

1=yes
Substance abuse problem C-21
1=yes



2=no


2=no



7=unknown


7=unknown



8=not collected


8=not collected
Pregnant at Admission SuDS 6

Optional reporting for MH
Not reported



1=Yes



2=No



6=Not applicable



7=unknown



8=not collected
Veteran Status SuDS 7

Optional reporting for MH
Not reported



1=Veteran



2=Not a veteran



7=unknown



8=not collected
Living Arrangements SuDS 8
DIS 23

Residential status at start and end of the reporting period C-12 and C-13




01=homeless


01=homeless



02=dependent living (under age 18 living with parents, relatives, or guardians)


37=private residence (children only)



22=dependent living: residential care and other residential status


03=residential care







08=other residential status



32=dependent living: foster home/foster care


02=fosterhome/foster care



42=dependent living: crisis residence


04=crisis residence



52=dependent living:institutional setting


05=institutional setting



62=dependent living: jail and other institutions under the justice system


06=jail/correctional facility



72=dependent living: adults in private residence who needs assistance in daily living


27=private residence, dependent living (adult)



03=independent living


17=private residence, independent living (adult)



04=private residence, living arrangement not specified, adults (temporary code)


07=private residence, living arrangement not specified (adult)



97=unknown


97=unknown



98=not collected


98=not collected
Source of Income/Support SuDS 9

Optional reporting for MH
Not reported



01=wages/salary



02=public assistance



03=retirement/pension



04=disability



20=other



21=none



97=unknown



98=not collected
Health Insurance SuDS 10

Optional reporting for MH
Not reported



01=private insurance



02=Blue Cross/Blue Shield



03=Medicare



04=Medicaid



06=HMO



20=other



21=none



97=unknown



98=not collected
Payment Source, Primary (Expected or Actual) SuDS 11

Optional reporting for MH
Not reported



01=self-pay



02=Blue Cross/Blue Shield



03=Medicare



04=Medicaid



05=Other government payments



06=Worker's compensation



07=other health insurance companies



08=no charge



09=other



97=unknown



98=not collected
Detailed Not-in-Labor Force SuDS 12
DIS 25

Competitive Employment Status - at start and end of the reporting period (as a selection category) C-09 and C-10




01=homemaker


14=homemaker



02=student


24=student



03=retired


34=retired



04=disabled


44=disabled



05= resident of institution or persons receiving services from institutional facilities such as hospitals, jails, prisons, etc.






06=other


64=other reported classification



07=sheltered/non-competitive employment


74=sheltered/non-competitive employment



96=not applicable (if employment status is not 04, NILF)


96=not applicable



97=unknown


97=unknown







84=NILF, classification not specified



98=not collected


98=not collected
Detailed Criminal Justice Referral SuDS 13

Optional reporting for MH
Not reported



01=state/federal court



02=other court



03=probation/parole



04=other recognized legal entity



05=diversionary program



06=prison



07=DUI/DWI



08=other



96=not applicable



97=unknown



98=not collected
Marital Status SuDS 14

Optional reporting for MH
Marital Status O-1
optional reporting



01=never married


01=never married



02=now married/living as couple or cohabiting


02=married/living as couple



03=separated


03=separated



04=divorced


04=divorced



05=widowed


05=widowed



97=unknown


97=unknown



98=not collected


98=not collected
Days Waiting to Enter Treatment SuDS 15

optional reporting for MH clients with co-occurring SA
Not reported



000-996=number of days waiting



997=unknown



998=not collected
Arrests in Past 30 Days SuDS 16
DIS 26

Number of Arrests in Prior 30 days - at start and end of the reporting period C-22 and C-23




00-96=number of arrests


00-96=number of arrests



97=unknown


97=unknown



98=not collected


98=not collected
Attendance at Self-Help Groups in Past 30 Days SuDS 17
DIS 27 optional reporting for MH clients with co-occurring SA
Not reported



01=no attendance



02=less than once a week



03=about once a week



04=2 to 3 times per week



05=at least 4 times a week



06=some attendance



97=unknown



98=not collected
Diagnostic Code Set Identifier SuDS 18
MHD 1

Diagnostic Code Identifier H-08




1=DSM-IV


1=DSM IV



2=ICD-9


2=ICD-9



3=ICD-10


3=ICD 10



4=DSM-V


4=DSM V



5=DSM-IIIR






7=unknown






8=not collected



Diagnostic Code - ICD 10 Compatible, Substance Abuse SuDS 19



Substance Abuse Diagnosis C-20




xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx-


xxx.xxxx; xxx.xxx-; xxx.xx--; xxx.x---; xxx----







999.9996=no substance abuse diagnosis



999.9997=unknown






999.9998=not collected



Other Variables




Date of Discharge - Key field

DIS 9 MMDDYYYY
Client status - at end of the reporting period (Date of Discharge is used by the state to report this translated variable) C-03

Reason for Discharge, Transfer, or Discontinuance of Treatment

DIS 10

Discharge reasons BCI (C-03) SHR (R-03)





12=treatment completed 01=completed SH inpatient treatment





22= lost contact or administrative discharge 03=left against medical advise, eloped, failed to return from leave, non-compliance with treatment and/or policy; 04=client choice



03=terminated by facility





04=transferred to another treatment program or facility provider

07=discharged to other inpatient provider



14=transferred to another treatment program/facility but did not report





05=incarcerated or released by or to courts
32=discharged to corrections, jail 02=released by or to courts



06=death
43=death of client 06=death



07=Other (includes aging out of the children's MH system, extended placement (conditional release), and all other reasons)
52=aged out; 62= other specified reasons 05=extended placement; 09=reason not classified elsewhere



08= Unknown - This code will continue to be accepted. However, states are encouraged to use the code 97 Unknown instead





24=transferred to another treatment program or facility that is not in the state reporting system





34 =discharged temporarily to an acute medical facility for medical services

08=discharged to an acute medical facility for medical services



96 = Not appliciable





97=unknown
72=reason unknown
97=unknown



98=not collected
82=reason not collected
98=not collected
Client Discharge Transaction Type - Key field
DIS 14 DIS 28 D=Discharge (SA client) E=Discharge (MH client) U=Data update (MH client)
Not reported
MH Diagnostic Code - one (ICD-10 Compatible) MHA 1a
MHD 2a xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx-
Mental Health Diagnosis - one C-17
xxx.xxxx; xxx.xxx-; xxx.xx--; xxx.x---; xxx----



999.9997 unknown


999.9997=unknown



999.9998=not collected


999.9998=not collected
MH Diagnostic Code - two (ICD-10 Compatible) MHA 1b
MHD 2b

Mental Health Diagnosis - two C-18




xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx-;


xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx-







999.9996 no second diagnosis



999.9997 unknown


999.9997=unknown



999.9998=not collected


999.9998=not collected
MH Diagnostic Code - three (ICD-10 Compatible) MHA 1c
MHD 2c

Mental Health Diagnosis - three C-19




xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx-


xxx.xxxx; xxx.xxx-; xxx.xx--; xxx.x---; xxx----







999.9996 no third diagnosis



999.9997 unknown


999.9997=unknown



999.9998=not collected


999.9998=not collected
SMI/SED Status MHA 2
MHD 3

SMI/SED Status C-08




1=SMI


1=SMI



2=SED


2=SED



3=at risk for SED (optional)


3=at risk for SED (optional)



4=Not SMI/SED


4=Not SMI/SED



7=unknown


7=unknown



8=not collected


8=not collected
School Attendance Status MHA 3
MHD 4

School Attendance Status C-24




1=Yes, client has attended school at any time in the past 3 months


1=Yes, client has attended school at any time in the past 3 months



2=No, client has not attended school at any time in the past three months


2=No, client has not attended school at any time in the past three months



6=not applicable ( non-school age)


6=not applicable



7=unknown


7=unknown



8=not collected


8=not collected
SH-Legal Status at Admission MHA 4



State Hospital-Admission Legal Status
R-05



01=voluntary-self


01=voluntary-self



02=voluntary-others (parents, guardians, etc)


02=voluntary-others (parents, guardians, etc)



03=involuntary-civil


03=involuntary-civil



04=involuntary-criminal


04=involuntary-criminaL



05=involuntary-juvenile justice


05=involuntary-juvenile justice



06=involuntary-civil, sexual


06=involuntary-civil, sexual



96=not applicable






97=unknown


97=unknown



98=not collected


98=not collected
GAF/CGAS Score – Optional MHA 5
MHD 6 optional reporting
GAF/CGAS Score O-02
optional reporting



0-100 GAF/CGAS Score


0-100 GAF/CGAS score



997 = Unknown


997=unknown



998 = Not collected



Not reported
SH-Discharge Sequence Number
R-02 ## - chronological order of discharge events from the earliest (numbering starts at 1 per client)
Not reported
SH-Number of Days Elapsed Before State Hospital Readmission
R-04 ### - calculated difference between the discharge date and next admission date
Not reported
Competitive Employment - Update Flag C-11
0=no update



1=C-10 is an update



8=unknown
Not reported
Residential Status - Update Flag C-14
0=no update



1=C13 is an update



8=unknown
Not reported
One-service date flag C-16
1=one service date



2=multiple service dates
Not reported
Record Type H-01
H=header record
Not reported
File Type H-03 H-02 P=production; T=test
Not reported
Start of the reporting period H-04 H-03 YYYYMM
Not reported
End of the reporting period H-05 H-04 YYYYMM
Not reported
Client record count H-06 H-05 ######## - total # of client records
Not reported
Optional Data Elements Report Flag H-07
1=Yes, state is reporting some or all of the optional data elements



2=No, state is not reporting any of the optional data elements










Report Date: July 17, 2015








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