Technical Guidance

Technical Guidance for OD2A:
LOCAL Linkage to and
Retention in Care Surveillance
Overdose Data to Action: Limiting Overdose through Collaborative Actions in Localities (OD2A: LOCAL)
(CDC-RFA-CE-23-0003)

Version 1.0
October 6th, 2023

For OD2A: LOCAL recipients only. Not for public dissemination.

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Table of Contents
Supporting Documents

3

List of acronyms and abbreviations

4

1.

Introduction

5

2.

Purpose of Reporting Standardized Linkage to Care Indicators

6

3.

General Data Sharing for OD2A: LOCAL

7

3.1 Background

7

3.2 CDC’s data dissemination and data sharing requirements for all OD2A: LOCAL recipients

8

4.

Cascade of Care for Substance Use Disorder

5.

Linkage to and Retention in Care Surveillance Indicator Definitions

9
10

Indicator 1: Individuals with OUD and/or StUD Newly Identified

10

Indicator 2: Individuals Engaged by Linkage to Care Programs

14

Indicator 3: Individuals Referred by Service Type

15

Indicator 4: Individuals Linked to Care by Service Type

16

Indicator 5: Individuals by Treatment Status and Service Type

19

Reporting Timeframe and Reporting Lag

21

Required and Optional Indicators

21

Disaggregation of Indicators by Key Characteristics

22

Considerations for Geographic Coverage across Indicators

23

Service Type

23

6. How to Use the OD2A: LOCAL Linkage to and Retention in Care Surveillance Data Submission
Templates

24

6.1 Entering Data into Templates

24

6.2 What’s in the Template?

24

6.3 Sections That Need to be Completed

26

6.4 Answering the Metadata Questions

28

6.5 Other FAQs about the Template

32

7. Reporting Timelines

34

7.1 Important Dates/Deadlines for OD2A: LOCAL Linkage to and Retention in Care Data Submissions 34
7.2 Important Dates/Deadlines for OD2A: LOCAL Linkage to and Retention in Care Data Products

35

Appendix 1: List of abbreviations for each jurisdiction participating in OD2A: LOCAL Linkage to and
Retention in Care Surveillance
36

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Supporting Documents
1
2

Linkage to and Retention in Care Surveillance Toolkit
OD2A: LOCAL Linkage to and Retention in Care Surveillance Aggregate Data
Template

For OD2A: LOCAL recipients only. Not for public dissemination.
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List of acronyms and abbreviations
CBT
CDC
CoC
ED
EMS
MOUD
OD2A: LOCAL
OEND
OUD
PDMP
SSP
StUD
SUD
TEDS

Cognitive Behavioral Therapy
Centers for Disease Control and Prevention
Cascade of Care
Emergency Department
Emergency Medical Services
Medications for Opioid Use Disorder
Overdose Data to Action: Limiting Overdose through Collaborative
Actions in Localities
Overdose Education and Naloxone Distribution
Opioid Use Disorder
Prescription Drug Monitoring Program
Syringe Services Program
Stimulant Use Disorder
Substance Use Disorder
Treatment Episode Data Set

For OD2A: LOCAL recipients only. Not for public dissemination.
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1. Introduction
This document describes the guidance for data collected in CDC’s Overdose Data to Action:
Limiting Overdoses Through Collaborative Actions in Localities (OD2A: LOCAL), optional
Component C: Linkage to and Retention in Care Surveillance. The overall purpose of this
component is to collect and analyze standardized information on a set of key surveillance
indicators to measure linkage to and retention in care and treatment among persons with an
opioid use disorder (OUD) and/or stimulant use disorder (StUD). This information can be used to
inform prevention activities, and direct public health resources where they are most needed. The
following guidance will orient OD2A: LOCAL recipients to all aspects of Linkage to and Retention in
Care Surveillance, including:

•
•
•
•

data sharing,
linkage to and retention in care surveillance indicators and case definitions,
data aggregation in the standard data submission templates, and
reporting timelines.

For questions about this guidance, please email [email protected].
We look forward to working in partnership with OD2A: LOCAL recipients and providing technical
support to ensure the success of the cooperative agreement and support data sharing between
your jurisdiction and the OD2A: LOCAL surveillance support team. We also look forward to
learning from you throughout OD2A: LOCAL about your ongoing efforts to ensure high data quality
to better understand linkage to and retention in care for substance use disorder in your
jurisdiction.
Sincerely,
The CDC OD2A: LOCAL Surveillance Support Team

For OD2A: LOCAL recipients only. Not for public dissemination.
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2. Purpose of Reporting Standardized Linkage to Care Indicators
Local health departments are uniquely well-suited to implement surveillance systems for standardized
Linkage to and Retention in Care (LTC) indicators. Following an extensive environmental scan and with
input from local and state overdose prevention and response programs, the CDC defined a substance
use disorder cascade of care (CoC) and set of minimum, standard measures to asses local LTC efforts.
Linkage to care connects at-risk individuals to evidence-based treatment, services, and supports,
thereby reducing the risk of overdose and other harms associated with substance use. Comprehensive
data on the efficacy of these efforts is needed so that health departments can measure the impact of
their linkage to care programs, inform overdose prevention activities, and appropriately allocate public
health resources where they are most needed.
Adopting standardized indicators for Linkage to and Retention in Care helps ensure not only data quality
and comprehensiveness but also fosters a robust foundation for deriving insights into disparities, unmet
needs, and optimal practices across the care cascade. Collecting data for standardized linkage to care
indicators will facilitate:
•

Consistency: Standardized indicators ensure that data collection, measurement, and reporting
practices remain consistent across various jurisdictions and health departments. This
consistency enables meaningful comparisons and benchmarking, allowing for a comprehensive
understanding of the Linkage to and Retention in Care landscape across different contexts.

•

Accuracy: With standardized indicators, health departments can accurately assess the
effectiveness of their Linkage to Care initiatives and programs. Consistent measurement
methodologies enable reliable tracking of progress over time, providing insights into the success
of interventions and identifying areas needing improvement.

•

Identification of gaps and disparities: Standardized indicators reveal gaps, disparities, and
variations in Linkage to Care outcomes across different populations, geographic regions, and
demographic groups. This knowledge is crucial for tailoring interventions to address specific
needs and ensuring equitable access to care.

•

Research and evaluation efforts: Standardized data supports research and evaluation efforts.
Meaningful insights can be drawn from the data, contributing to the development of best
practices, evidence-based interventions, and policy recommendations.

•

Reporting and accountability: Standardized indicators enhance accountability and transparency.
Health departments can accurately report on their Linkage to Care efforts and demonstrate the
impact of their programs and initiatives.

•

Resource optimization: By adopting standardized indicators, health departments can optimize
the allocation of resources. They can focus their efforts on strategies that have demonstrated

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effectiveness and discontinue or modify less impactful initiatives.
•

Cross-jurisdictional collaboration: Standardized indicators facilitate collaboration and
knowledge sharing among health departments and jurisdictions. Common indicators enable the
exchange of insights, lessons learned, and best practices, fostering a collective effort to improve
Linkage to Care outcomes.

Ultimately, a standardized approach ensures that a greater number of individuals access the care they
require and drives meaningful change in how individuals are connected to care. Health departments
may need or desire to measure additional indicators specific to their communities and programs. As
relationships, data access, and technologies improve, health departments will have the data to assess
program reach, effectiveness, impact, and equity. The CDC intends to foster a dynamic partnership and a
continuous learning process with funded recipients to understand and implement effective strategies
for enhancing Linkage to and Retention in Care surveillance.

3. General Data Sharing for OD2A: LOCAL
3.1 Background
This section describes key data dissemination and data sharing requirements for health departments
that receive an Overdose Data to Action: Limiting Overdose through Collaborative Actions in Localities
(OD2A: LOCAL) award from CDC (CDC-RFA-CE-23-0003).
Public dissemination and sharing of data submitted by recipients to CDC is governed by general
requirements that apply to all OD2A: LOCAL recipients. Federal mandates to both disseminate and
secure data collected from entities is briefly described. Requirements set forth in the Office and
Management and Budget (OMB) memo, “Open Data Policy–Managing Information as an Asset” (OMB
M-13-13)1; Executive Order 13642 titled “Making Open and Machine Readable the New Default for
Government Information”2; and the Office of Science and Technology Policy (OSTP) memorandum titled
“Increasing Access to the Results of Federally Funded Scientific Research” (OSTP Memo) 3 mandate that
CDC is responsible for disseminating data it has collected from funded entities, subject to limits imposed
by law, resources, confidentiality, technology, and data quality.
CDC recognizes the critical importance of maintaining standards of data quality, upholding individual
and institutional privacy and confidentiality, and ensuring impartiality in the sharing of public health
data. CDC stores all data received by recipients in an access-controlled share folder, which resides on the
CDC Network. The CDC Network follows all National Institute of Standards and Technology (NIST)
requirements for data security.

1

https://project-open-data.cio.gov/policy-memo/
https://obamawhitehouse.archives.gov/the-press-office/2013/05/09/executive-order-making-open-andmachine-readable-new-default-government3 https://obamawhitehouse.archives.gov/sites/default/files/microsites/ostp/ostp_public_access_memo_2013.pdf
2

For OD2A: LOCAL recipients only. Not for public dissemination.
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3.2 CDC’s data dissemination and data sharing requirements for all OD2A: LOCAL
recipients
CDC, in partnership with recipients, will use submitted data to improve linkage to care surveillance and
further refine the reporting requirements. Information about how jurisdictions can securely submit data
and share data products with CDC will be provided in future guidance. CDC will provide feedback on
data received by recipients on such things as data quality, data entry errors, the application of case
definitions, continuous quality improvement, and dissemination of success stories to a broad audience.
CDC will work collaboratively with jurisdictions to improve the quality, completeness, and timeliness of
data shared with CDC. CDC will review and conduct quality control checks on data submitted by the
jurisdiction prior to conducting analysis; if discrepancies are identified, CDC staff will reach out to the
jurisdiction to identify the problem and facilitate correction or resubmission of the data. Once data are
submitted by the jurisdiction and verified by CDC, they are considered validated, and CDC is permitted
to disseminate results widely and publicly. In coordination with funded jurisdictions, CDC may share
analyses and results to highlight progress in establishing standardized linkage to care surveillance. Below
are several examples:
•
•
•
•
•

Print, including publications in peer-reviewed literature, MMWRS, published reports, data
briefs, periodicals, brochures, books, and media correspondence,
Electronic, such as the CDC website (e.g., dashboards), listserv, and e-mail,
Audiovisual, broadcast scripts, audio or videotapes, and video casting,
Oral, formal speeches, oral presentations, and interviews, or commentaries for publication or
broadcast,
Data briefs or tables shared with CDC, HHS, and other governmental leaders in response to
internal or external requests,

Across all CDC dissemination products, data suppression rules will be used to prevent possible
identification through publication of tables combining characteristics that could be used to identify an
individual (e.g., age, sex, race/ethnicity, and geographic location). CDC will suppress data for case counts
ranging from 1 to 9 cases at the jurisdiction level. CDC aims to provide recipients with advance
notification before CDC publicly releases any print publications (e.g., peer-reviewed publications,
MMWRs) or web data (e.g., website updates using the data) that use data submitted by recipients.

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4. Cascade of Care for Substance Use Disorder
Component C: Linkage to and Retention in Care Surveillance involves reporting standardized Linkage to Care indicators across stages of the
Cascade of Care (CoC) for persons identified with OUD and/or StUD. The stages of the CoC include: 1) Identification of need, 2) Engagement with
linkage to care programs, 3) Referral to care and treatment, 4) Linkage to care/Treatment initiation, and 5) Treatment retention (see Figure 4.1).
These stages are described in more detail in the Linkage to and Retention in Care Surveillance Toolkit, which is provided as an attachment.

Figure 4.1. A generalized representation of the Cascade of Care (CoC) for Substance Use Disorder (SUD) illustrates how persons with a SUD
may progress along the CoC to receive care and treatment services and the linkage to care surveillance indicators used to measure each stage.

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5. Linkage to and Retention in Care Surveillance Indicator Definitions
Indicator 1: Individuals with OUD and/or StUD Newly Identified
Variable name:
• identified_n
Description: This indicator measures the number of newly4 identified individuals with a treatment need
during the reporting period. This indicator establishes the cohort that will be followed through the
cascade of care (CoC). These cohorts are defined based on the entry point to care where they are
identified (see Entry Point Criteria section below). Individuals who are identified across multiple entry
points can be counted more than once e.g., an individual can be counted once for the nonfatal overdose
entry point/cohort and again for the second entry point. The treatment need is assessed according to
the General Inclusion and Exclusion Criteria listed below that are Applicable to all Entry Points.
Measurement: Count (n) of unique individuals.
General Inclusion Criteria Applicable to All Entry Points:
• Individuals with a diagnosed OUD and/or StUD, including any positive screening or assessment
results that indicate a potential OUD and/or StUD or identify them as being at risk of overdose.
• Individuals who are experiencing symptoms consistent with an OUD and/or StUD in the absence of a
clinical diagnosis or any positive screening or assessment results.
• Individuals who are accessing health services with a primary focus on addressing OUD and/or StUD,
including those who are seeking assistance with managing their opioid and/or stimulant use in a
clinical or specialized treatment setting.
• Individuals who are accessing harm reduction or social support services for opioid and/or stimulant
use, including injection drug use.
• Individuals who self-report or express concerns related to their opioid and/or stimulant use or
identify themselves as being at risk of overdose.
• Individuals with a history of any previous substance use disorder, including those who have received
treatment or engaged with harm reduction services, who are now using opioids and/or stimulants.
• Individuals with a co-occurring Substance Use Disorders (SUDs), who also meet the criteria for OUD
and/or StUD.
General Exclusion Criteria Applicable to All Entry Points:
• Individuals with multiple encounters in an entry point during a single reporting period should only
be counted once to avoid double-counting.
• Individuals with any other substance use disorder who do not also meet the above criteria for OUD

4

"Newly" in this context is relative to the reporting period, encompassing individuals who are entering the Cascade
of Care for the first time known to the given reporting locality. This term aims to capture individuals who haven't
been included in previous data calls.

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•

and/or StUD.
Individuals who have been identified and counted in previous reporting periods and are currently
retained in substance use services or treatment programs.

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Entry Point Criteria
The entry point describes a setting where a jurisdiction may first interact with, or identify, an individual with OUD and/or StUD. The following table includes a
description of suggested populations for inclusion and potential data sources for each entry point.
Entry Point
Nonfatal Overdose

Other Clinical Care

Criminal JusticeInvolved

Harm Reduction
Services

Suggested Populations for Inclusion
• Individuals who have experienced a nonfatal overdose
during the reporting period (regardless of substance involved)
who also have an OUD and/or StUD diagnosis or are
experiencing symptoms consistent with an OUD and/or StUD.
• Individuals who have experienced an opioid-involved
and/or stimulant-involved nonfatal overdose during the
reporting period, in the absence of information on an OUD or
StUD diagnosis.
• Individuals with a confirmed or suspected OUD and/or StUD
diagnosis who are seeking care in a clinical setting (e.g.,
primary care, ED, inpatient hospitalization) for conditions
other than a nonfatal overdose. This could include co-morbid
conditions like HIV or Hepatitis C, infections related to drug
injection or other injuries, prenatal or postpartum care,
among others.

• Individuals involved in the criminal justice system, which
may include those who are incarcerated in jails or prisons,
those who are released from incarceration, or those who are
eligible for pre-trial diversion programs, who screen positive
for possible OUD and/or StUD.
• Individuals actively participating in community-based harm
reduction and syringe services programs.

Possible Data Sources
• EMS system - responses for suspected nonfatal overdoses
• ED syndromic surveillance - substance-specific overdose
syndrome visits
• Hospital discharge data - nonfatal overdose hospital discharges
• Overdose reportable condition surveillance systems - individuals
identified through mandatory case reporting in jurisdictions where
overdose is a reportable condition
• Reportable case management systems - acute viral hepatitis
cases, other reportable comorbidities for people who inject drugs
• Electronic health records diagnosis data, all-payers claim
databases, Medicaid claims data, and other clinical data sources
with diagnosis data
• Data from healthcare facilities, clinics, or hospitals where
individuals receive diagnoses and treatment for substance use
disorders. This could include electronic health records or
administrative databases.
• Criminal justice release records
• Department of Corrections data

• Program-collected data on harm reduction program service
utilization

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Other CommunityBased Programs

Self-Referrals

Other

• Individuals actively participating in other community-based
programs (beyond harm reduction), including homeless
services and groups like Alcoholics Anonymous or Narcotics
Anonymous, that work with individuals at increased risk for
overdose.
• Individuals who self-identify as having an OUD and/or StUD
or being at risk of overdose by accessing SUD hotlines,
accessing coordination services, or being referred by family or
friends.
Program-defined entry point not otherwise described. Must
be approved by CDC.

• Program-collected data on community-based program service
utilization

• Program-collected data from substance use hotlines or
coordination services

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Indicator 2: Individuals Engaged by Linkage to Care Programs
Variable name:
• engaged_n
Description: Among those identified with a treatment need during the reporting period, the number of
individuals engaged by linkage to care program staff through in-person contact, phone calls, or other
personal interactions like text messaging. Individuals who are engaged by LTC programs should be
counted regardless of their intention to seek care or treatment and regardless of the length of
interaction with program staff. A period of 60 days is set from the date of identification to the date of
engagement. This 60-day window establishes a timeframe for engagement; individuals who are not
engaged by staff within this period will not be counted in the indicator.
Linkage to care program staff includes any professional who assists individuals in accessing treatment
and harm reduction services. Linkage to care program staff may provide any of the following:
assessment, information and education, referrals and coordination, support and guidance, and followup and monitoring. Possible roles that linkage to care program staff may have include:
• Medical professionals
• Administrative staff
• Social workers
• Peer support specialists or Recovery coaches
• Outreach workers
• Case managers
• Addiction/Substance use counselors
Measurement: Count (n) of unique individuals. Should be a subset of individuals identified during the
reporting period (identified_n) who are engaged within a period of 60 days from the date of
identification.
Possible data sources:
Overdose prevention and response program data systems:
• Case investigations or individual follow-up
• Outreach program records or staff interviews
• Program enrollment or registration records, including referral and case management systems
• Tally of program coordinator activity logs or tracking forms
• Reports or notes from other service providers

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Indicator 3: Individuals Referred by Service Type
Variable names:
• referred_MOUD_n
• referred_behavioral_n
• referred_unspecified_n
• referred_anytreatment_n
• referred_harmred_n
Description:
• referred_MOUD_n: Among those identified with a treatment need during the reporting period, the
number of individuals who were referred to MOUD treatment within a period of 60 days. See
Service Type section for a description of MOUD treatment.
• referred_behavioral_n: Among those identified with a treatment need during the reporting period,
the number of individuals who were referred to behavioral treatment within a period of 60 days.
See Service Type section for a description of behavioral treatment.
• referred_unspecified_n: Among those identified with a treatment need during the reporting period,
the number of individuals who were referred to treatment within a period of 60 days, but the
specific type of treatment was not specified.
• referred_anytreatment_n: Among those identified with a treatment need during the reporting
period, the total number of individuals who were referred to any treatment type within a period of
60 days, including MOUD, behavioral or unspecified. See Service Type section for descriptions of
MOUD and behavioral treatment.
• referred_harmred_n: Among those identified with a treatment need during the reporting period,
the number of individuals who were referred to harm reduction services within a period of 60 days.
See Service Type section for a description of harm reduction services.
A referral includes any formal connection to support services or treatment options. This includes
referrals made by healthcare providers, social workers, social service providers, community
organizations, law enforcement, navigators, peer support specialists, or other relevant sources. Referred
individuals should be included regardless of whether they were engaged by linkage to care program
staff. This indicator could also include self-referrals if those individuals are also included in the initial
cohort of identified individuals. Duplicate or redundant referrals made for the same individual for the
same service type should only be counted once. The variable allows for
flexibility in capturing referrals to treatment services when the exact treatment type is not clearly
defined at the time of referral or information on treatment type is not available.
A period of 60 days is set from the date of identification to the date of referral. This 60-day window
establishes a timeframe for referral; individuals who are not referred to treatment or harm reduction
services within this period will not be counted in the indicator.
Measurement: Count (n) of unique individuals. Should be a subset of individuals identified during the

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reporting period (identified_n) who are referred within a period of 60 days from the date of
identification. This count does not need to be a subset of individuals engaged by linkage to care program
staff (engaged_n).
• referred_MOUD_n should also be a subset of referred_anytreatment_n
• referred_behavioral_n should also be a subset of referred_anytreatment_n
• referred_unspecified_n should also be a subset of referred_anytreatment_n
• Individuals referred to multiple service types should be counted only once for
.
Possible data sources:
Treatment provider data systems:
• Substance use treatment data collected by state agencies for submission to SAMHSA’s
Treatment Episode Data Set (TEDS)5
• Provider reports from treatment provider data system
Clinical EHR systems:
• Referrals made by healthcare providers to specialized treatment services
• Reporting modules that track and generate reports on referral activities
Overdose prevention and response program data systems:
• Case investigations or individual follow-up
• Outreach program records or staff interviews
• Program enrollment or registration records
• Tally of program coordinator activity logs or tracking forms
• Referral records from other service providers or agencies
• Reports or notes from social workers or counselors

Indicator 4: Individuals Linked to Care by Service Type
Variable names:
• initiated_MOUD_n
• initiated_behavioral_n
• initiated_unspecified_n
• initiated_anytreatment_n
• initiated_harmred_n
Description:
• initiated_MOUD_n: Among those identified with a treatment need during the reporting period, the
number of individuals who were successfully linked to/initiated MOUD treatment within a period of
60 days. See Service Type section for a description of MOUD treatment.
5

May only include data from facilities that receive public funding.

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•

•

•

•

initiated_behavioral_n: Among those identified with a treatment need during the reporting period,
the number of individuals who were successfully linked to/initiated behavioral treatment within a
period of 60 days. See Service Type section for a description of behavioral treatment.
initiated_unspecified_n: Among those identified with a treatment need during the reporting period,
the number of individuals who initiated treatment within a period of 60 days, but the specific type of
treatment was not specified.
initiated_anytreatment_n: Among those identified with a treatment need during the reporting
period, the number of individuals who were successfully linked to/initiated any treatment type
within a period of 60 days, including MOUD, behavioral or unspecified. See Service Type section for
descriptions of MOUD and behavioral treatment.
initiated_harmred_n: Among those identified with a treatment need during the reporting period,
the number of individuals who were successfully linked to/initiated harm reduction services within a
period of 60 days. See Service Type section for a description of harm reduction services.

Individuals who initiate multiple service types should only be counted once for
. The variable allows for flexibility in counting
individuals who initiate treatment when the exact treatment type is not clearly defined or information
on treatment type is not available.
The definition of successful linkage to care or initiation may vary depending on the service type:
• MOUD treatment – Filling a prescription for, or directly receiving one of the three FDA-approved
MOUD medications: buprenorphine, methadone, or naltrexone. In cases where data on
prescription fulfillment is not available, receipt of a prescription could also be considered
initiation, although prescription fulfillment is preferable. For methadone treatment, initiation is
recognized when an individual starts receiving methadone directly at a methadone clinic. MOUD
initiation may also include initiation of MOUD that occurs immediately at identification before
further engagement or referral by linkage to care program staff (e.g., initiation of buprenorphine
in the emergency department).
• Behavioral treatment – Initiation refers to an initial consultation with a service provider.
• Harm reduction services – Initiation may include accepting naloxone through overdose
education and naloxone distribution (OEND) programs, utilizing drug checking services,
accessing syringe services programs (SSP), participation in Hepatitis C (HCV) services, and other
services provided by harm reduction service providers.
A period of 60 days is set from the date of identification to the date of initiation for treatment or harm
reduction. This 60-day window establishes a timeframe for being successfully linked to care; individuals
who do not initiate treatment or harm reduction services within this period will not be counted in the
indicator.6
6

Note that individuals who do not initiate treatment, could still be referred, and linked to harm reduction or other
ancillary services. Once in harm reduction, these individuals could then be considered a new cohort for the harm

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This indicator should not include the following:
• Individuals who only undergo short-term detoxification without any initiation of MOUD for
maintenance or other evidence-based treatment for OUD. Although short-term detox may
involve the use of medications used for MOUD (e.g., buprenorphine, methadone), this alone is
not considered evidence-based treatment and may increase the risk of adverse events, such as
overdose.
• Individuals who receive opioid medications solely for pain management purposes and do not
meet the criteria for substance use disorder treatment or support services.
Measurement: Counts (n) of unique individuals. Should be a subset of individuals identified during the
reporting period (identified_n). This count does not need to be a subset of individuals engaged by
linkage to care program staff (engaged_n) or individuals referred to treatment or harm reduction
services (referred_n). Note: Individuals who are identified during Q1 and linked to care during Q2 should
be reflected in the Linked to Care indicator counts for Q1, provided that the time between identification
and linked to care does not exceed 60 days.
• initiated_MOUD_n should also be a subset of initiated_anytreatment_n
• initiated_behavioral_n should also be a subset of initiated_anytreatment_n
• initiated_unspecified_n should also be a subset of initiated_anytreatment_n
Possible data sources:
Self-report data:
• Program data system – case investigations or individual follow-up
Treatment provider data systems:
• Treatment claims from state Medicaid data
• Substance use treatment data collected by state agencies for submission to SAMHSA’s
Treatment Episode Data Set (TEDS)
o May only include data from facilities that receive public funding
• Provider reports from treatment provider data system
• Data on buprenorphine prescriptions from state Prescription Drug Monitoring Program (PDMP)

reduction entry point, facilitating measurement of linkage to treatment services and contributing to a more
comprehensive understanding of the care continuum.

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Indicator 5: Individuals by Treatment Status and Service Type
Variable names:
Service Type
Treatment
Status

MOUD

Behavioral treatment

Treatment unspecified

Retained

status_MOUD_
retained_n

status_behavioral_
retained_n

status_unspecified_
retained_n

Completed

status_MOUD_
completed_n

status_behavioral_
completed_n

status_ unspecified_
completed_n

Incarcerated

status_MOUD_
incarcerated_n

status_behavioral_
incarcerated_n

status_ unspecified_
incarcerated_n

Deceased

status_MOUD_
deceased_n

status_behavioral_
deceased_n

status_ unspecified_
deceased_n

Other

status_MOUD_
other_n

status_behavioral_
other_n

status_ unspecified _
other_n

Unknown/
missing

status_MOUD_
unknown_n

status_behavioral_
unknown_n

status_unspecified_
unknown_n

Description: Among those identified during the reporting period who were successfully linked to care,
the number of individuals who are retained in treatment, completed treatment, are incarcerated, are
deceased, or are lost to follow-up (e.g., status unknown or missing) six months after being linked to
care. This indicator is reported separately for the following service types: MOUD, behavioral treatment
and treatment unspecified. See Service Type section for descriptions of MOUD and behavioral
treatment. Note: This indicator is not reported for the harm reduction service type, due to the difficulty in
defining and measuring retention in harm reduction services. 7
Status definitions:
Status
Definition
Retained
Individuals who are active in the treatment program at six months follow-up.
Completed
Individuals who completed the treatment program prior to six months follow-up.
Lost to
Individuals who did not complete the treatment program and are no longer active.
Follow-up
Includes individuals who “drop out” of treatment for unknown reasons, or for whom
treatment is terminated by the facility.

7

Harm reduction services often have different service structures and objectives compared to MOUD and
behavioral treatment, cater to individuals with varying levels of engagement, and may offer support services
without requiring ongoing participation. Limited longitudinal record keeping, and concerns about erosion of trust
with more extensive data collection are additional factors underlying the omission of harm reduction services from
the treatment status indicator.

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Status
Incarcerated
Deceased
Other
Unknown

Definition
Individuals who are incarcerated prior to six months follow-up.
Individuals who died prior to six months follow-up.
Individuals with a status other than those in this list.
Individuals for whom status at six months is not known because, for example,
discharge record is lost or incomplete.

Measurement: Count (n) of unique individuals. Should be a subset of individuals identified during the
reporting period (identified_n).
• status_MOUD_retained_n should also be a subset of initiated_MOUD_n
• status_MOUD_completed_n should also be a subset of initiated_MOUD_n
• status _MOUD_incarcerated_n should also be a subset of initiated_MOUD_n
• status _MOUD_deceased_n should also be a subset of initiated_MOUD_n
• status _MOUD_other_n should also be a subset of initiated_MOUD_n
• status _MOUD_unknown_n should also be a subset of initiated_MOUD_n
• status _behavioral_retained_n should also be a subset of initiated_behavioral_n
• status _behavioral_completed_n should also be a subset of initiated_behavioral_n
• status _behavioral_incarcerated_n should also be a subset of initiated_behavioral_n
• status _behavioral_deceased_n should also be a subset of initiated_ behavioral_n
• status _behavioral_other_n should also be a subset of initiated_ behavioral_n
• status _behavioral_unknown_n should also be a subset of initiated_behavioral_n
• status_unspecified_retained_n should also be a subset of initiated_unspecified_n
• status_unspecified_completed_n should also be a subset of initiated_unspecified_n
• status_unspecified_incarcerated_n should also be a subset of initiated_unspecified_n
• status_unspecified_deceased_n should also be a subset of initiated_unspecified_n
• status_unspecified_other_n should also be a subset of initiated_unspecified_n
• status_unspecified_unknown_n should also be a subset of initiated_unspecified_n
Possible data sources:
• See data sources listed under Linked to Care indicator.

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Reporting Timeframe and Reporting Lag
The “Identified” indicator provides an aggregate count of individuals identified during each three-month
quarter. Subsequent indicators (“Engaged”, “Referred”, “Linked to Care”, “Treatment Status”) track
identified individuals as they move through the cascade of care and should include a subset of those
identified individuals within that specific quarter, regardless of when the subsequent event occurred.
Therefore, indicators are reported according to the quarter during which the individuals were identified,
not during the quarter during which the events occurred. It's important to note that the “Engaged”,
“Referred”, and “Initiated” indicators are only included in the aggregate data submitted to CDC if these
events occur within a 60-day window following identification.8 For example:
• An individual was identified on February 20th, engaged on March 2nd, referred on March 10th, linked
to/initiated care on April 10th, and retained in care as of October 7th.
• Since this individual was identified during Q1 (Jan – Mar), counts for the “Identified”, “Engaged”,
“Referred”, “Linked to Care”, and “Treatment Status” indicators should all be reported for Q1, even
though the last two indicators in the cascade (“Linked to Care” and “Treatment Status”) occurred
after the end of Q1.
Data are submitted to CDC every six months, and each data submission should include two quarters of
aggregate data. “Identified”, “Engaged”, “Referred”, and “Linked to Care” indicators are defined as
“short term” indicators while the “Treatment Status” indicator is defined as a “follow-up” indicator.
Short term indicators for each quarter have a 2-month reporting lag, while the follow-up indicator for
each quarter has an 8-month reporting lag. See the Reporting Timelines section for data submission
deadlines and quarters that should be included with each data submission. See Table 4.1 below for a list
of short term and follow-up indicators.

Required and Optional Indicators
Some indicators will be required in Years 2 & 3 and/or in Years 4 & 5, while others will be optional
in Years 2 & 3 and/or in Years 4 & 5. See Table 4.1 below for a summary of required and optional
indicators for each year of data submission.
Table 5.1. Indicators by Required versus Optional and Short Term versus Follow-up
Year 2 & 3:
Year 4 & 5:
Required or
Required or
Short term or
Variable Name of Indicator
Optional
Optional
Follow-up
identified_n
Required
Required
Short term
engaged_n
Required
Required
Short term
referred_MOUD_n
Required
Required
Short term
referred_behavioral_n
Optional
Required
Short term
8

The 60-day window for “Engaged”, “Referred”, and “Initiated” indicators is a necessary limitation for reporting
aggregate data to CDC and ensures these indicators can be collected within a single reporting period.

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referred_unspecified_n
referred_anytreatment_n
referred_harmred_n
initiated_MOUD_n
initiated_behavioral_n
initiated_unspecified_n
initiated_anytreatment_n
initiated_harmred_n
status_MOUD_retained_n
status_MOUD_completed_n
status_MOUD_incarcerated_n
status_MOUD_deceased_n
status_MOUD_other_n
status_MOUD_unknown_n
status_behavioral_retained_n
status_behavioral_completed_n
status_behavioral_incarcerated_n
status_behavioral_deceased_n
status_behavioral_other_n
status_behavioral_unknown_n
status_unspecified_retained_n
status_ unspecified _completed_n
status_ unspecified _incarcerated_n
status_ unspecified _deceased_n
status_ unspecified _other_n
status_ unspecified _unknown_n

Optional
Optional
Required
Required
Optional
Optional
Optional
Required
Required
Required
Required
Required
Required
Required
Optional
Optional
Optional
Optional
Optional
Optional
Optional
Optional
Optional
Optional
Optional
Optional

Optional
Required
Required
Required
Required
Optional
Required
Required
Required
Required
Required
Required
Required
Required
Required
Required
Required
Required
Required
Required
Required
Required
Required
Required
Required
Required

Short term
Short term
Short term
Short term
Short term
Short term
Short term
Short term
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up
Follow-up

Disaggregation of Indicators by Key Characteristics
Disaggregation by demographic variables provides more information about who is moving through the
CoC. Understanding the demographics of individuals entering and engaging in the CoC can guide
programming and outreach efforts supportive of equitable linkage to care. Some disaggregates will be
required in Years 2 & 3, while others will be optional in Years 2 & 3. All disaggregates will be required in
Years 4 & 5. See Table 4.2 below for a summary of planned required and optional disaggregates for each
year of data submission.
Table 5.2. Disaggregates by Required versus Optional
Year 2 & 3:
Variable Name of Disaggregate
Required or Optional
jurisdiction
Required
quarter
Required

Year 4 & 5:
Required or Optional
Required
Required

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year
entry_point
substance_type
sex
age_group
race
ethnicity

Required
Required
Required (opioids only)
Optional
Optional
Optional
Optional

Required
Required
Required (opioids and stimulants)
Required
Required
Required
Required

Considerations for Geographic Coverage across Indicators
Among those identified during the reporting period, individuals can be counted in subsequent indicators
even if they are engaged, referred, initiated, or retained in different geographical regions or jurisdictions
outside the catchment area where they were identified. The ability to capture identified individuals
across geographical regions and jurisdictions will depend on what data sources are available in the
linkage to care surveillance system. Ideally, individuals accessing care for opioid use disorder and/or
stimulant use disorder across multiple locations are accounted for and included in the measurement of
linkage to and retention in care. This will help provide a more comprehensive view of the linkage to and
retention rates, regardless of the specific location or region where individuals are receiving services.

Service Type
Service Type refers to the different treatment and ancillary services options. The current indicator
descriptions focus on three service types. A fourth option for unspecified treatment is included for
scenarios where a program may not have the immediate capabilities to distinguish between the type of
treatment provided.
1. MOUD – This includes FDA-approved medications for treating opioid use disorder, including
buprenorphine, methadone, or extended-release naltrexone, alone or in combination with
behavioral treatment.
2. Behavioral Treatment – This includes any evidence-based behavioral strategies such as
counseling, motivational interviewing, cognitive behavioral therapy (CBT), contingency
management, and community reinforcement approach, alone or in combination with
MOUD.
3. Unspecified Treatment – This indicates that the type of treatment was not specified because
a program did not have the immediate capability of distinguishing between different types
of treatment provided or because the treatment type was not clearly defined at the time of
referral.
4. Harm Reduction Services – This includes syringe service and overdose education and
naloxone distribution (OEND) programs that provide a range of services, including linkage to
substance use disorder treatment; access to and disposal of sterile syringes and injection
equipment; fentanyl test strip distribution; vaccination, testing and linkage to care and
treatment for infectious diseases; and linkage to social services, including housing and
transportation services.

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6. How to Use the OD2A: LOCAL Linkage to and Retention in Care
Surveillance Data Submission Templates
Purpose: This section provides guidance for OD2A: LOCAL-funded jurisdictions to submit linkage to
and retention in care surveillance indicators and metadata to CDC. Please refer to the Reporting
Timelines section for the specific dates when data and metadata are due.
To facilitate consistency in these data submissions, CDC developed standardized data submission
templates for inputting the required indicators described in previous sections as aggregate counts.
Please note that CDC is requesting that jurisdictions enter all counts — please do not suppress
small numbers. If the count is zero, please enter “0.” All numbers will be available to the CDC
OD2A: LOCAL surveillance support team only, and the team will not share any counts with anyone
outside the support team. When aggregating counts, CDC will avoid calculating percentages, rates,
or percent change estimates based on small counts.

6.1 Entering Data into Templates
If copying and pasting data from other output files into the data templates, it will be necessary to:
•

•

Copy and paste from a CSV file to avoid receiving false positive error messages in the
template. This includes using exported files from SAS and other software used to
generate output. Other output files can be saved as CSV files if needed before copying
and pasting into the templates.
Paste data as values into the Excel templates. This can be completed either by:
o

o

Option 1
▪ Right-click in the cell where the data will be pasted.
▪ Under the “Paste Options” menu, click on “Values (V)”—the icon is
the clipboard with “123”.
Option 2
▪ Click on the “Paste” drop-down menu at the top left of the screen.
▪ Under the “Paste Options” menu, click on “Values (V)”—the icon is
the clipboard with “123”.

6.2 What’s in the Template?
There is one data submission template that must be used for OD2A: LOCAL Linkage to and Retention in
Care Surveillance data submission: OD2A_LOCAL_LTC_Data_Submission_Template_Aggregate. This
spreadsheet includes 10 tabs:
1. Introduction: Includes a description and links to each tab within the spreadsheet.
2. Variable_definition: Includes a description of each of the variables in the indicators tabs. The
following information is provided for each variable:

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3.
4.
5.

6.

7.

8.

9.

10.

•

• Full Variable Name
• Abbreviated Variable Name
• Description
• Subset of Other Indicators
• Data Type
• Values
• Years 2/3 Required or Optional
• Years 4/5 Required or Optional
Metadata_LTC: Includes metadata questions to be completed. This tab is required and must be
completed and submitted by all jurisdictions with each data submission.
Indicators_nonfatalOD: Includes indicators for the Nonfatal Overdose entry point. This tab is
required and must be completed and submitted by all jurisdictions with each data submission.
Indicators_otherclinical: Includes indicators for the Other Clinical Setting entry point. This tab is
optional and must be completed and submitted only by jurisdictions who are collecting data for
this entry point.
Indicators_criminaljustice: Includes indicators for the Criminal Justice-Involved entry point. This
tab is optional and must be completed and submitted only by jurisdictions who are collecting
data for this entry point.
Indicators_harmreduction: Includes indicators for the Harm Reduction Programs entry point.
This tab is optional and must be completed and submitted only by jurisdictions who are
collecting data for this entry point.
Indicators_community: Includes indicators for the Other Community-Based Programs entry
point. This tab is optional and must be completed and submitted only by jurisdictions who are
collecting data for this entry point.
Indicators_selfreferral: Includes indicators for the Self-Referral entry point. This tab is optional
and must be completed and submitted only by jurisdictions who are collecting data for this entry
point.
Indicators_other: Includes indicators for the Other entry point. This tab is optional and must be
completed and submitted only by jurisdictions who are collecting data for this entry point.

The “Indicators” tabs have structured fields for data entry to provide a consistent framework for
data collection across entry points. Entry points are the settings where data on the cohort of
newly identified individuals with a treatment need for opioid use/OUD and/or stimulant
use/StUD are collected. Each indicator tab is intended to capture aggregate data related to a
distinct entry point for individuals moving through the cascade of care, from identification to
engagement, referral, initiation of treatment or harm reduction services, and status at 6
months. The structure of each “Indicators” tab is as follows:
o Required Aggregate Information: The required indicators provide aggregate data for
the specific entry point and are in Row 4 for the first quarter of data and Row 80 for the
second quarter. Note that only cells in Row 4 that are shaded in green will be required
at the start of the funding period (see Required and Optional Indicators).

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o

o

Optional Disaggregated Information: Following the two rows of aggregate information
for both quarters, each row corresponds to the disaggregated data for demographic
variables. Only one variable is disaggregated in each row (note that race and ethnicity
variables are combined and are therefore the exception).
Linkage to Care Indicators: Columns J to AM are where counts of individuals can be
reported across the across stages of the Cascade of Care (CoC). Note multiple columns
for Referred, Initiated and Treatment Status 6 Months after Initiation due to
stratification by service type.
▪ Referred indicators: Columns L to P capture counts for individuals referred by
service type.
▪ Initiated indicators: Columns Q to U capture counts for individuals linked to care
by service type.
▪ Status indicators: Columns V to AM capture counts for individuals by treatment
status and service type.

6.3 Sections That Need to be Completed
Metadata
• Complete all fields in the metadata tab to provide essential contextual information about the
data. Ensure that no fields are left blank.
•

Provide a contact for CDC to email with questions about the data submission.

•

See Answering the Metadata Questions for further instructions.

Indicators
•

•

Only enter data in tabs for the entry points for which you are collecting data.
o This must include the Nonfatal Overdose entry point and at least one other
entry point.9
o Do not delete the other tabs; include them with your submission but leave all
cells blank.
Enter information for jurisdiction name (i.e., assigned jurisdiction abbreviation, see
Appendix 1), quarter, and year for each of the 2 quarters included in the 6-month
reporting period. These fields are pre-filled with different colors to distinguish the 2
quarters:
o Completing these columns is necessary for ensuring the accuracy of CDC’s data
management procedures.
o Cells in Columns A to C are pre-filled in purple for the first quarter of the 6month reporting period and in blue for the second quarter of the 6-month
reporting period.

9

Entry points are where individuals with an OUD and/or StUD are identified and are a way of defining cohorts as
they enter the CoC. Programs should aim to collect data within each entry point-defined cohort to understand at
which places they are seeing the most success at identifying, referring, and linking individuals to treatment.

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•

Cells are programmed to remove the fill colors when information for jurisdiction name,
quarter, and year is entered. Please verify that all rows include the correct information
for jurisdiction, year, and quarter. Enter all data for the required indicators for each
entry point and quarter. Cells corresponding to required indicators and disaggregates
for Years 2 & 3 are pre-filled in green. Cells are programmed to remove the fill colors
when information is entered. Please ensure that all required cells are completed.
o Only Rows 4 and 80 contain required indicators.
o Provide the total counts of identified individuals and engaged individuals for
opioid use disorder.
o Provide the total counts of referred individuals for each required service type
(MOUD and harm reduction services).
o Provide the total counts of individuals linked to care (initiated) for each
required service type (MOUD and harm reduction services).
o Provide the total counts for treatment status at 6 months for each required
service type (MOUD and harm reduction services).
o In cases where the specific treatment type (e.g., MOUD) is unavailable due to
data limitations, jurisdictions should utilize the “treatment unspecified”
category. Please include a description of the “treatment unspecified” category
and its use as a response to reporting limitations in the metadata.

•

If available, enter data for the optional indicators and disaggregates. If you are not submitting
data for any of the optional indicators, leave those cells blank.
o Provide the total counts of identified individuals and engaged individuals for
stimulant use disorder (Rows 42 and 118).
o Provide the total counts of referred individuals for each optional service type
(behavioral treatment, treatment unspecified and any treatment).
o Provide the total counts of individuals linked to care (initiated) for each
optional service type (behavioral treatment, treatment unspecified and any
treatment).
o Provide the total counts for treatment status at 6 months for each optional
service type (behavioral treatment, treatment unspecified and any treatment).
o Provide the total counts for each indicator disaggregated by sex, age group,
race, and ethnicity.
o Note that the sum of counts within each set of rows for disaggregated counts by sex,
age group, race and ethnicity should match the corresponding overall total for that
specific quarter (as represented in Rows 4 and 80). For example, any disaggregated
data by sex (Column F) in quarter 1 for Opioids (Rows 5 to 7) should sum to the
Overall counts for Opioids in Row 4. Similarly, any disaggregated data by sex (Column
F) in quarter 2 for Opioids (Rows 81 to 83) should sum in each Indicator column to the
Overall counts for Opioids in Row 80.
For rows with corresponding data, ensure that all fields for jurisdiction, quarter, and

•

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year for each of the 2 quarters are completed for each entry point where any data is
submitted.
o Completing these columns is necessary for ensuring the accuracy of CDC’s data
management procedures.
o Note that there should be no purple or blue cells in any of Columns A to B for
rows with required indicators and any additional rows where data has been
entered for optional indicators.
o Fields for jurisdiction, quarter, and year do not have to be entered in Columns
A to B if there is no corresponding data entered in Columns J to AM.

6.4 Answering the Metadata Questions
Please answer the following questions in the Metadata_LTC tab of the
OD2A_LOCAL_LTC_Data_Submission_Template_Aggregate spreadsheet.
Please note that a Data Source Catalogue tool will be provided as a separate resource to create an
inventory of information required for answering metadata questions. This tool will help jurisdictions
organize existing data assets, understand internal data management processes, and document external
data sharing practices. The inventory can be used to help effectively locate, manage, use, and share data
assets.
1. Select the entry points for which your jurisdiction is reporting data. (At least two entry
points must be selected, one of which must be Nonfatal overdose.)
•
•
•

Nonfatal overdose (required) is automatically selected.
Select any additional entry points from the drop-down menus provided.
If there is no data available for a third or any additional entry points, choose the "N/A"
option from the drop-down menu for the remaining entry points.

2. Describe the population captured at each entry point for which your jurisdiction is reporting data.
•

•

Provide a brief description of the population captured at each entry point for which your
jurisdiction is reporting data, including relevant characteristics or criteria used for
identification. Responses for this section must not exceed a 3000-character limit.
If the "N/A" option was selected for any additional entry points, the population
description for those entry points will automatically update to "N/A."

3. Please identify and describe the data sources that were used to report data on each
indicator (e.g., identified_n, engaged_n, referred_n, initiated_n, status_n). Descriptions should
comment on data availability, frequency of data availability, data granularity whether the data
is identifiable, and whether data is linked to other data sources. Describe any changes or
improvements in data sources since the previous reporting period.

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The following points should be addressed:
•
•
•
•
•
•
•
•

Indicate the primary sources of data that were used to report data for each indicator.
Describe the origin, purpose, and any relevant characteristics of the data source.
Explain if and how the data sources are linked or integrated.
Data availability: Specify whether the data source is publicly available, restricted to partner
organizations, sourced from internal records, etc.
Frequency of Availability: Describe how often the data is updated, refreshed, or can be
accessed. Mention if there are any delays in data availability.
Data Granularity: Indicate whether the data is collected at an individual level or aggregated.
Data Identifiability: Clarify whether the data contains identifiable information.
Changes or Improvements: Detail any updates, improvements, or changes made to the data
sources since the previous reporting period.

4. Please describe partner organizations the local linkage to care surveillance system including their
relevance to the CoC for opioid and/or stimulant use disorder and the strength of relationship
(Rate from 1 [weakest; some data sharing, inconsistent] to 5 (strongest; coordination between
programs, MOU's between organizations]). Describe any changes in relationship strength since the
previous reporting period.
The following points should be addressed:
•

•

•

•

Relevance to the CoC: Describe how each partner organization contributes to the CoC
for opioid and/or stimulant use disorder. Explain their role in the surveillance strategy
and their impact on data coverage and quality.
Assign a rating from 1 (weakest) to 5 (strongest) to indicate the strength of the
relationship. Briefly explain the rationale for the assigned rating, considering factors
such as data sharing, collaboration, and whether Memorandums of Understanding
(MOUs) are established.
Changes in Relationship Strength: Detail any changes in the strength of the relationship
since the previous reporting period (not applicable for first reporting period). Example:
o "Our collaboration with Organization C has grown stronger (rating increased from 2
to 3) thanks to increased communication and joint efforts in refining data collection
processes."
The description should offer a clear understanding of how these partnerships contribute
to the success of your surveillance strategy.

5. Please describe any facilitating technology or automation that supports the local linkage to care
surveillance system. Describe any changes or improvements since the previous reporting period.
•

Provide a description of any technological tools or automation methods that have been
used to facilitate or enhance your local linkage to care surveillance system.

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•

•

Examples of technology and automation might include:
o Incorporating interoperable data exchange platforms for sharing patient-level data
across various stakeholders.
o Leveraging big data analytics tools to process and derive insights from large and
diverse data sources.
o Utilizing software or technologies that address challenges such as data privacy,
security, data silos, and budget or resource constraints.
o Developing machine learning or other data analytics algorithms or procedures to
facilitate data integration and analysis.
If applicable, highlight any advancements or modifications that have been implemented
since the last reporting period.

6. Please provide a qualitative assessment of the data coverage or representativeness for each
reported indicator for the Nonfatal overdose entry point (e.g., identified_n, engaged_n, referred_n,
initiated_n, status_n).
•

•
•

Within the Nonfatal overdose entry point, please provide an overall qualitative
assessment of the completeness of reported data for each indicator in the CoC,
considering reporting coverage and related data gaps and limitations.
Be specific regarding challenges that might impact the completeness or
representativeness of data submitted.
Some examples may include the following, with corresponding details:
o Incomplete records, missing variables or fields, or instances where key data elements are
not fully captured.
o Underrepresentation or incomplete coverage of individuals e.g., for specific entry points
or indicators, for certain demographic groups, geographic areas, etc.
o Challenges related to data privacy and confidentiality, which might result in data
suppression or the exclusion of certain cases or variables.
o Challenges in data linkage or integration across multiple systems or databases, resulting
in incomplete or fragmented data records.
o Inability to contact or follow up with individuals through the CoC: The completeness of
reported data may be affected by individuals who cannot be contacted or followed up
with, posing challenges in referring and linking them to linkage to care services. Factors
such as disconnected phone numbers, changes in contact information, or individuals who
are transient or have unstable housing situations can make it difficult to establish
communication and ensure follow-up.

7. Please provide a qualitative assessment of the data coverage or representativeness for each
reported indicator for additional entry points (e.g., identified_n, engaged_n, referred_n,
initiated_n, status_n).
•

Within additional entry points, please provide an overall qualitative assessment of the

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•
•

completeness of reported data for each indicator in the CoC, considering reporting
coverage and related data gaps and limitations.
Be specific regarding challenges that might impact the completeness or
representativeness of data submitted.
Some examples with corresponding details are listed above under metadata question 6.

8. Please identify other strengths and limitations of the data based on other quality attributes of the
data, like uniqueness, timeliness, validity, accuracy, and consistency.
•
•
•
•
•

For each quality attribute (uniqueness, timeliness, validity, accuracy, consistency),
comment on how your data performs in relation to that attribute.
Please highlight any notable strengths and areas where your data excels.
Identify any limitations or challenges that might impact the quality of your data.
Include details on any improvements or changes since the previous reporting period.
The following are examples of strengths and limitations for each attribute:
o Uniqueness:
• Strength: Data benefits from unique identifiers assigned to each
individual, minimizing the risk of double-counting or duplication.
• Limitation: In some cases, individuals might be registered under
different identifiers if they interact with multiple care providers.
o Timeliness:
• Strength: Data reporting process has improved, leading to more
frequent updates and timely submissions.
• Limitation: Delays in data collection and reporting which impact the
timeliness of our data.
o Validity:
• Strength: Data collection methods are aligned with standardized
protocols, ensuring the validity of the information gathered.
• Limitation: Data entry errors or misunderstandings of reporting criteria
which may introduce validity concerns.
o Accuracy:
• Strength: Data validation checks, and quality assurance procedures are
implemented.
• Limitations: Some inconsistencies in data entry or analysis that may
affect accuracy of certain data points.
o Consistency:
• Strength: Data collection guidelines and definitions have remained
consistent over time, allowing for meaningful comparisons and trend
analysis.
• Limitation: Data discrepancies or inconsistencies are identified during data
reconciliation processes between different reporting entities or levels (e.g.,
local, regional, national).

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•

Additional examples of data quality attributes can be found here:
https://www.cdc.gov/ncbddd/hearingloss/documents/dataqualityworksheet.pdf

9. Who should CDC contact with questions about this data report?
•

Name and contact email

6.5 Other FAQs about the Template
Preparation of Datasets
-

Q: What date should we use to determine whether to include individuals and in which
quarter they belong?
A: Use the date of the first encounter at a given entry point to determine whether to
include individuals identified within the specified quarter. Individuals counted under
other indicators should be a subset of those included in the “Identified” indicator.

-

Q: Should I enter a 0 for cells with counts equal to zero?
A: Yes, if the count is zero, please enter 0. Please leave cells for which you are not submitting
data null or blank (e.g., optional indicators or disaggregates, or indicators in tabs
corresponding to entry points for which you are not collecting data). If counts are missing for
any other reason, also leave the cells blank.

Metadata
-

Q: How are the metadata going to be used by CDC?
A: Metadata help CDC staff better understand issues related to data quality and
completeness. Metadata also help us with appropriate interpretation of changes
observed. Please reach out directly to the OD2A: LOCAL surveillance support team to
alert them to specific issues that should be documented in the metadata tab.

Data Submission and Quality Control
-

Q: Are there specific file-naming conventions that jurisdictions should use when
submitting aggregate data to CDC?
A: Yes, please use the following file-naming conventions:
o First 4-5 letters should be the jurisdiction abbreviation (see Appendix 1 for your
jurisdiction’s assigned abbreviation).
o

The next space should be an underscore followed by LTC, “_LTC”

o

The next part of the file name includes information on the reporting due date:

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▪

Use 2 digits for the month and 4 digits for the year to indicate the
reporting due date.

▪

Ensure that the data collection template is saved in the xlsx format
to maintain compatibility with CDC’s data management procedures.
Examples:

▪

-

•

ACPA_LTC_12_2024.xlsx

•

PHPA_LTC_06_2025.xlsx

Q: How do I submit the templates to CDC?
A: Further guidance about data submissions processes will be provided during Year 1 of
the funding period, before the first data submission is due in December 2024.

-

Q: Can CDC provide any quality control (QC) resources to help jurisdictions ensure data
are accepted by CDC?
A: CDC will provide jurisdictions with QC programs before the first data submission is due
in December 2024. These will most likely be in SAS and/or R formats.

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7. Reporting Timelines
Purpose: To outline detailed schedule for reporting requirements of standardized indicators
to measure linkage to and retention in care (data submissions) and data products developed by
recipients to disseminate findings to key local partners and/or the public.
The following tables indicate deliverable dates for OD2A: LOCAL Linkage to and Retention in
Care Surveillance data submissions and data products. Please note that all data submissions
and data products are due by 11:59 PM EST on the date specified. Instructions on how to
submit data submissions and data products to CDC will be provided prior to the first
deliverable date.

7.1 Important Dates/Deadlines for OD2A: LOCAL Linkage to and Retention in Care
Data Submissions
Table 7.1. Dates and Deadlines for Short term and Follow-up Indicators

Quarter(s) Included in Data
Submission
Q3 2024 (Sept only) plus any
historical dataⴕ
Q4 2024 (Oct-Dec)
Q1 2025 (Jan-March)
Q2 2025 (Apr-Jun)
Q3 2025 (Jul-Sept)
Q4 2025 (Oct-Dec)
Q1 2026 (Jan-March)
Q2 2026 (Apr-Jun)
Q3 2026 (Jul-Sept)
Q4 2026 (Oct-Dec)
Q1 2027 (Jan-March)
Q2 2027 (Apr-Jun)
Q3 2027 (Jul-Sept)
Q4 2027 (Oct-Dec)
Q1 2028 (Jan-March)

Submission Date for Short
term Indicators (2-month
lag)*
December 16, 2024

Submission Date for Followup Indicator (8-month lag)**

June 16, 2025

December 15, 2025

December 15, 2025

June 15, 2026

June 15, 2026

December 21, 2026

December 21, 2026

June 21, 2027

June 21, 2027

December 20, 2027

December 20, 2027

June 19, 2028

June 19, 2028

August 21, 2028***

June 16, 2025

* Short term indicators include: Identified, engaged, referred and initiated. See Reporting Timeframe and
Reporting Lag section for more information.
** Follow-up indicator is treatment status. See Reporting Timeframe and Reporting Lag section for more
information.
*** Only Q4 2027 required

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Historical data refers to any previous data that jurisdictions may have collected on linkage to and retention in
care indicators. For the first data submission (Sept only for Q3 2024), jurisdictions have the option of providing any
data they have collected previously in addition to the data for Sept 2024.
ⴕ

Figure 7.1. Linkage to Care leading and lagging indicator reporting timeline

7.2 Important Dates/Deadlines for OD2A: LOCAL Linkage to and Retention in Care
Data Products
Data Product
Year 2 data product
Year 3 data product
Year 4 data product
Year 5 data product

Due Date
August 31, 2025
August 31, 2026
August 31, 2027
August 31, 2028

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Appendix 1: List of abbreviations for each jurisdiction participating in
OD2A: LOCAL Linkage to and Retention in Care Surveillance
Jurisdiction Name
Allegheny County, PA
Baltimore County, MD
Broward County, FL
Cuyahoga County, OH
Duval County, FL
Franklin County, OH
Hamilton County, OH
City of New Haven, CT
Palm Beach County, FL
Philadelphia, PA
Pima County, AZ
Seattle & King County, WA

Abbreviation
ACPA
BCMD
BCFL
CCOH
DCFL
FCOH
HCOH
NHCT
PBCFL
PHPA
PCAZ
SKCWA