Attachment A1 - 2019 TEDS - MH-TEDS and MH-CLD Data Elements 1.30.19.xlsx

Treatment Episode Data Set (TEDS)

Attachment A1 - 2019 TEDS - MH-TEDS and MH-CLD Data Elements 1.30.19.xlsx

OMB: 0930-0335

Document [xlsx]
Download: xlsx | pdf




OMB No. 0930-0335








Expiration Date: xx/xx/xx




Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB control number for this project is 0930-0335.  Public reporting burden for this collection of information is estimated to average 10 hours per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-B, Rockville, Maryland, 20857.























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 through 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 (MH)


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



01=none




02=alcohol




03=cocaine/crack




04=marijuana/hashish




05=heroin




06=non-prescription methadone




07=other opiates and synthetics




08=PCP-phencyclidine




09=hallucinogens




10=methamphetamine/speed




11=other amphetamines




12=other stimulants




13=benzodiazepine




14=other tranquilizers




15=barbiturates




16=other sedatives or hypnotics




17=inhalants




18=over-the-counter medications




20=other drugs




97=unknown




98=not collected




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
01=oral




02=smoking




03=inhalation




04=injection




20=other




97=unknown




98=not collected










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
01=no use in the past month




02=1-3 days in the past month




03=1-2 days in the past week




04=3-6 days in the past week




05=daily




96=N/A




97=unknown




98=not collected














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
00=newborn with a substance dependency problem




01-95=age at first use, in years




96=N/A




97=unknown




98=not collected




Type of Treatment Service/ Treatment Setting – Key field MDS 18 DIS 16 DIS 7

Not reported



01=detox, 24-hr, hospital
Service Setting Status Throughout the Reporting Period C-15




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






73=SMHA funded/operated community-based program


1=state psychiatric hospital



74=residential treatment center


2=SMHA funded/operated community-based program



75=other psychiatric inpatient


3=residential treatment center



76=institutions under the justice system


4=other psychiatric inpatient



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


5=institutions under the justice system
Medication-Assisted Opioid Therapy MDS 19

Optional reporting for MH clients with co-occurring SA






1=Yes
Not reported



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

0201=alcohol




0301=crack




0302=other cocaine




0401=marijuana/hashish




0501=heroin




0601=non-prescription methadone




0701=codeine




0702=propoxyphene




0703=oxycodone




0704=meperidine




0705=hydromorphone




0706=butorphanol, morphine, opium, and other narcotic analgesics, opiates or synthetics




0707=pentazocine




0708=hydrocodone




0709=tramadol




0710=buprenorphin (subutex, suboxone)




0801=PCP




0901=LSD




0902=DMT, mescaline, peyote, psilocybin, STD, and other hallucinogens




1001=methamphetamine/speed




1101=amphetamine




1103=Methylenedioxymethamphetamine (MDMA, Ecstasy)




1109="Bath Salts", phenmetrazine, and other amines and related drugs




1201=other stimulants




1202=Methylphenidate (Ritalin)




1301=Alprazolam (Xanax)




1302=Chlordiazepoxide (Librium)




1303=Clorazepate (Tranzene)




1304=Diazepam (Valium)




1305=Flurazepam (Dalmane)




1306=Lorazepam (Ativan)




1307=Triazolam (Halcion)




1308=Halazepam, oxazepam (Serax), prazepam, temazepam (Restoril), and other Benzodiazepines




1309=Flunitrazepam (Rohypnol)




1310=Clonazepam (Klonopin,Rivotril)




1401=Meprobamate (Miltown)




1403=Other non-benzodiazepine tranquilizers




1501=Phenobarbital




1502=Secobarbital/Amobarbital (Tuinal)




1503=Secobarbital (Seconal)




1509=Amobarbital, pentobarbital (Nembutal) and other barbiturate sedatives




1601=Ethchlorvynol (Placidyl)




1602=Glutethimide (Doriden)




1603=Methaqualone (Quaalude)




1604=Chloral hydrate and other Non-Barbiturate Sedatives/hypnotics




1701=Aerosols




1702=Nitrites




1703=Gasoline, glue, and other inappropriately inhaled products




1704=Solvents (paint thinner and other solvents)




1705=Anesthetics (chloroform, ether, nitrous oxide, and other
anesthetics)





1801=Diphenhydramine




1809=Other antihistamines, aspirin, Dextromethorphan (DXM) and other cough syrups, Ephedrine, sleep aids, and any other legally obtained, non-prescription medication




2001=Diphenylhydantoin/Phenytoin (Dilantin)




2002=Synthetic Cannabinoid "Spice", Carisoprodol (Soma) and
other drugs





2003=GHB/GBL (gamma-hydroxybutyrate, gammabutyrolactone)




2004=Ketamine (Special K)




9996=N/A




9997=unknown




9998=not collected




Diagnostic Code (DSM/ICD) SuDS 4

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



999.97=unknown
Not reported



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



2=no
Substance abuse problem C-21
1=yes



7=unknown


2=no



8=not collected


7=unknown
Pregnant at Admission SuDS 6

Optional reporting for MH


8=not collected



1=Yes
Not reported



2=No



6=Not applicable



7=unknown



8=not collected
Veteran Status SuDS 7

Optional reporting for MH



1=Veteran
Not reported



2=Not a veteran



7=unknown



8=not collected
Living Arrangements SuDS 8
DIS 23




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




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


01=homeless



22=dependent living: residential care and other residential status (MH only)


37=private residence (children only)







03=residential care



32=dependent living: foster home/foster care (MH only)


08=other residential status



42=dependent living: crisis residence (MH only)


02=fosterhome/foster care



52=dependent living:institutional setting (MH only)


04=crisis residence



62=dependent living: jail and other institutions under the justice system (MH only)


05=institutional setting



72=dependent living: adults in private residence who needs assistance in daily living (MH only)


06=jail/correctional facility



03=independent living


27=private residence, dependent living (adult)



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


17=private residence, independent living (adult)



97=unknown


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



98=not collected


97=unknown
Source of Income/Support SuDS 9

Optional reporting for MH


98=not collected



01=wages/salary
Not reported



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



01=private insurance
Not reported



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



01=self-pay
Not reported



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




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




02=student


14=homemaker



03=retired


24=student



04=disabled


34=retired



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


44=disabled



06=other






07=sheltered/non-competitive employment (MH only)


64=other reported classification



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


74=sheltered/non-competitive employment



97=unknown


96=not applicable







97=unknown



98=not collected


84=NILF, classification not specified
Detailed Criminal Justice Referral SuDS 13

Optional reporting for MH


98=not collected



01=state/federal court
Not reported



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



01=never married
Marital Status O-01
optional reporting



02=now married/living as couple or cohabiting


01=never married



03=separated


02=married/living as couple



04=divorced


03=separated



05=widowed


04=divorced



97=unknown


05=widowed



98=not collected


97=unknown
Days Waiting to Enter Treatment SuDS 15

optional reporting for MH clients with co-occurring SA


98=not collected



000-996=number of days waiting
Not reported



997=unknown



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




00-96=number of arrests
Number of Arrests in Prior 30 days - at start and end of the reporting period C-22 and C-23




97=unknown


00-96=number of arrests



98=not collected


97=unknown
Attendance at Self-Help Groups in Past 30 Days SuDS 17
DIS 27 optional reporting for MH clients with co-occurring SA


98=not collected



01=no attendance
Not reported



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




1=DSM-IV
Diagnostic Code Identifier H-08




2=ICD-9


1=DSM IV



3=ICD-10


2=ICD-9



4=DSM-V


3=ICD 10



5=DSM-III R


4=DSM V



7=unknown






8=not collected



Diagnostic Code - ICD 10 Compatible, Substance Abuse SuDS 19









xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx-
Substance Abuse Diagnosis C-20








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



999.9997=unknown


999.9996=no substance abuse diagnosis



999.9998=not collected


999.9997=unknown
Other Variables


999.9998=not collected
Date of Discharge - Key field

DIS 9 MMDDYYYY




Reason for Discharge, Transfer, or Discontinuance of Treatment

DIS 10 01=treatment completed
Client status - at end of the reporting period (Date of Discharge is used by the state to report this translated variable) C-03




02=dropped out of treatment
Discharge reasons BCI (C-03) SHR (R-03)



03=terminated by facility
12=treatment completed 01=completed SH inpatient treatment



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



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

04=client choice



05=incarcerated or released by or to courts

07=discharged to other inpatient provider



06=death





07=Other (includes aging out of the children's MH system, extended placement (conditional release), and all other reasons)
32=discharged to corrections, jail 02=released by or to courts



08= Unknown - This code will continue to be accepted. However, states are encouraged to use the code 97 Unknown instead
42=death of client 06=death



24=transferred to another treatment program or facility that is not in the state reporting system
52=aged out; 62= other specified reasons 05=extended placement; 09=reason not classified elsewhere



34 =discharged from the state hospital to an acute medical facility for medical services (MH only)





96 = Not appliciable (MH only)





97=unknown

08=discharged to an acute medical facility for medical services


98=not collected







72=reason unknown
97=unknown
Client Discharge Transaction Type - Key field
DIS 14 DIS 28 D=Discharge (SA client) E=Discharge (MH client) U=Data update (MH client)
82=reason not collected
98=not collected
MH Diagnostic Code - one (ICD-10 Compatible)


xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx-
Not reported
MHA 1a
MHD 2a 999.9997 unknown







999.9998=not collected
Mental Health Diagnosis - one C-17
xxx.xxxx; xxx.xxx-; xxx.xx--; xxx.x---; xxx----






999.9997=unknown
MH Diagnostic Code - two (ICD-10 Compatible) MHA 1b
MHD 2b xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx-;


999.9998=not collected


Mental Health Diagnosis - two C-18




999.9997 unknown


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



999.9998=not collected


999.9996 no second diagnosis







999.9997=unknown
MH Diagnostic Code - three (ICD-10 Compatible) MHA 1c
MHD 2c xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx-


999.9998=not collected





Mental Health Diagnosis - three C-19




999.9997 unknown


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



999.9998=not collected


999.9996 no third diagnosis







999.9997=unknown
SMI/SED Status MHA 2
MHD 3 1=SMI


999.9998=not collected



2=SED
SMI/SED Status C-08




3=at risk for SED (optional)


1=SMI



4=Not SMI/SED


2=SED


7=unknown


3=at risk for SED (optional)



8=not collected


4=Not SMI/SED







7=unknown
School Attendance Status MHA 3
MHD 4 1=Yes, client has attended school at any time in the past 3 months


8=not collected



2=No, client has not attended school at any time in the past three months
School Attendance Status C-24




6=not applicable ( non-school age)


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



7=unknown


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


8=not collected


6=not applicable







7=unknown
SH-Legal Status at Admission MHA 4

01=voluntary-self


8=not collected



02=voluntary-others (parents, guardians, etc)
State Hospital-Admission Legal Status
R-05



03=involuntary-civil


01=voluntary-self



04=involuntary-criminal


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



05=involuntary-juvenile justice


03=involuntary-civil



06=involuntary-civil, sexual


04=involuntary-criminaL



96=not applicable


05=involuntary-juvenile justice



97=unknown


06=involuntary-civil, sexual



98=not collected






optional reporting


97=unknown
GAF/CGAS Score – Optional MHA 5
MHD 6 0-100 GAF/CGAS Score


98=not collected



997 = Unknown
GAF/CGAS Score O-02
optional reporting



998 = Not collected


0-100 GAF/CGAS score







997=unknown
Not reported






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






Competitive Employment - Update Flag C-11
0=no update








1=C-10 is an update
Not reported






8=unknown






Residential Status - Update Flag C-14
0=no update








1=C13 is an update
Not reported






8=unknown






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






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






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 12, 2018








File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

© 2024 OMB.report | Privacy Policy