| Part 1. Data Field Crosswalk Worksheet | |||||||
| All fields should be reported unless specified as optional. | |||||||
| TEDS Data | State Data | Comments Please use this column space to provide explanations, definitions, limitations, or other contextual information pertinent to data collection, reporting, and mapping. In particular, if the state is not collecting any given data fields or categories, please provide explanations. If the State is not collecting or reporting data for a subset of the population, also provide explanations. If the State has concrete plans to collect or report them in the future, indicate an approximate date that the State plans to begin submission of the data fields/categories for all or the subset of the population. If the State is collecting optional data fields but opted not to report, cite reasons. |
|||||
| TEDS # | Code | Categories | State Item # | Code | Data Item Description | ||
| System Data Set | |||||||
| SDS 1 | System Transaction Type | ||||||
| A | Add | ||||||
| C | Change | ||||||
| D | Delete | ||||||
| SDS 2 | State Code (key field) | ||||||
| 2 Character state abbreviation | |||||||
| SDS 3 | Reporting Date (MMYYYY) | ||||||
| Minimum Data Set (Admission Record) | |||||||
| MDS 1 | State Provider Identifier (key field) | ||||||
| 1-15 Alphanumeric characters | |||||||
| MDS 2 | Client Identifier (key field) | ||||||
| 1-15 Alphanumeric characters | |||||||
| MDS 3 | Codependent/Collateral (key field) | ||||||
| 1 | Codependent/Collateral (SU only) | ||||||
| 2 | Client | ||||||
| MDS 4 | Client Transaction Type (key field) | ||||||
| A | Initial admission (SU) | ||||||
| T | Transfer (SU) | ||||||
| M | Initial admission (MH) | ||||||
| X | Transfer (MH) | ||||||
| MDS 5 | Date of Admission (key field) | ||||||
| MMDDYYYY | |||||||
| MDS 6 | Previous SU Treatment Episodes (optional for MH) | ||||||
| 0-4 | Number of previous episodes | ||||||
| 5 | 5 or more Previous episodes | ||||||
| 6 | Not applicable (MH only) | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| MDS 7 | Referral Source (optional for MH) | ||||||
| 01 | Individual | ||||||
| 02 | Alcohol/Drug use care provider | ||||||
| 03 | Other health care provider | ||||||
| 04 | School (Educational) | ||||||
| 05 | Employer/Employee Assistance Program (EAP) | ||||||
| 06 | Other community referral | ||||||
| 07 | Court/Criminal justice referral | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MDS 8 | Date of Birth | ||||||
| MMDDYYYY | |||||||
| 01010007 | Unknown | ||||||
| 01010008 | Not collected | ||||||
| MDS 9 | Sex | ||||||
| 1 | Male | ||||||
| 2 | Female | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| MDS 10 | Race (Hispanic collected as race should be coded 97 in Race and 06 in Ethnicity) | ||||||
| 01 | Alaska native (Aleut, Eskimo) | ||||||
| 02 | American indian or Alaska native | ||||||
| 03 | Asian or pacific islander | ||||||
| 13 | Asian | ||||||
| 23 | Native hawaiian or other pacific islander | ||||||
| 04 | Black or african american | ||||||
| 05 | White | ||||||
| 20 | Other single race | ||||||
| 21 | Two or more races | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MDS 11 | Hispanic or Latino Origin (Ethnicity) | ||||||
| 01 | Puerto Rican | ||||||
| 02 | Mexican | ||||||
| 03 | Cuban | ||||||
| 04 | Other specific hispanic or latino | ||||||
| 05 | Not of hispanic or latino origin | ||||||
| 06 | Hispanic or latino - specific origin not specified | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MDS 12 | Education | ||||||
| 00 | Less than one school grade or no schooling | ||||||
| 01 | Grade 1 | ||||||
| 02 | Grade 2 | ||||||
| 03 | Grade 3 | ||||||
| 04 | Grade 4 | ||||||
| 05 | Grade 5 | ||||||
| 06 | Grade 6 | ||||||
| 07 | Grade 7 | ||||||
| 08 | Grade 8 | ||||||
| 09 | Grade 9 | ||||||
| 10 | Grade 10 | ||||||
| 11 | Grade 11 | ||||||
| 12 | Grade 12 or GED | ||||||
| 13 | 1st Year of College/University (Freshman) | ||||||
| 14 | 2nd Year of College/University (Sophomore) or Associate Degree | ||||||
| 15 | 3rd Year of College/University (Junior) | ||||||
| 16 | 4th Year of College (Senior) or Bachelor's Degree | ||||||
| 17 | Some Post-Graduate Study - Degree not completed | ||||||
| 18 | Master's Degree completed | ||||||
| 19-25 | Post- Graduate study | ||||||
| 70 | Graduate or professional school | ||||||
| 71 | Vocational school | ||||||
| 72 | Nursery school or pre-school (MH only) | ||||||
| 73 | Kindergarten (MH only) | ||||||
| 74 | Self-contained special education class (MH only) | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MDS 13 | Employment Status (SU & MH NOM) | ||||||
| 01 | Full time | ||||||
| 02 | Part time | ||||||
| 03 | Unemployed | ||||||
| 04 | Not in labor force | ||||||
| 05 | Employed, Full/Part time not specified (MH only) | ||||||
| 96 | Not applicable (MH only) | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MDS 14 (A, B, C) | Substance Use (Primary, Secondary, Tertiary) (SU NOM, optional for MH) | ||||||
| 01 | None | ||||||
| 02 | Alcohol | ||||||
| 03 | Cocaine | ||||||
| 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 | ||||||
| 96 | Not applicable (MH only) | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MDS 15 (A, B, C) | Route of Administration (Primary, Secondary, Tertiary substances) (optional for MH) | ||||||
| 01 | Oral | ||||||
| 02 | Smoking | ||||||
| 03 | Inhalation | ||||||
| 04 | Injection (intravenous, intramuscular, intradermal, or subcutaneous) | ||||||
| 20 | Other | ||||||
| 96 | Not applicable | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MDS 16 (A, B, C) | Frequency of Use (Primary, Secondary, Tertiary substances) (SU NOM, optional for MH) | ||||||
| 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 | Not applicable | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MDS 17 (A, B, C) | Age at First Use (primary, secondary, tertiary substances) (optional for MH) | ||||||
| 00 | Newborn | ||||||
| 01-95 | Age at first use | ||||||
| 96 | Not applicable | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MDS 18 | Type of Treatment/Service Setting (key field) | ||||||
| 01 | Withdrawal management, 24-hour service, hospital inpatient | ||||||
| 02 | Withdrawal management, 24 hour service, free-standing residential | ||||||
| 03 | Rehabilitation/residential - hospital (other than withdrawal management) | ||||||
| 04 | Rehabilitation/residential - short term (30 days or fewer) | ||||||
| 05 | Rehabilitation/residential - long term (more than 30 days) | ||||||
| 06 | Ambulatory - intensive outpatient | ||||||
| 07 | Ambulatory - non-intensive outpatient | ||||||
| 08 | Ambulatory - Withdrawal management | ||||||
| 72 | State psychiatric hospital | ||||||
| 73 | SMHA funded/operated community-based program | ||||||
| 74 | Residential treatment center | ||||||
| 75 | Other psychiatric inpatient | ||||||
| 76 | Institutions under the justice system | ||||||
| 96 | Not applicable (use only for codependents or collateral clients) (SU only) | ||||||
| MDS 19 | Medications for Opioid Use Disorder (optional for MH) | ||||||
| 1 | Yes | ||||||
| 2 | No | ||||||
| 6 | Not applicable | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| Supplemental Data Set | |||||||
| SuDS (1, 2, 3) | Detailed Drug Code (Primary, Secondary, Tertiary) (optional for both SU and MH) | ||||||
| 0201 | Alcohol | ||||||
| 0301 | Crack | ||||||
| 0302 | Other Cocaine | ||||||
| 0401 | Marijuana/Hashish, THC, and any other cannabis sativa preparations | ||||||
| 0501 | Heroin | ||||||
| 0601 | Non-Prescription Methadone | ||||||
| 0701 | Codeine | ||||||
| 0702 | Propoxyphene (Darvon) | ||||||
| 0703 | Oxycodone (Oxycontin) | ||||||
| 0704 | Meperidine (Demerol) | ||||||
| 0705 | Hydromorphone (Dilaudid) | ||||||
| 0706 | Butorphanol (Stadol), morphine (MS contin), opium, and other narcotic analgesics, opiates or synthetics | ||||||
| 0707 | Pentazocine (Talwin) | ||||||
| 0708 | Hydrocodone (Vicodin) | ||||||
| 0709 | Tramadol (Ultram) | ||||||
| 0710 | Buprenorphine (Subutex, Suboxone) | ||||||
| 0711 | Fentanyl | ||||||
| 0801 | PCP | ||||||
| 0901 | LSD | ||||||
| 0902 | DMT, mescaline, peyote, psilocybin, STP, 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 | ||||||
| 1605 | Xylazine | ||||||
| 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, gamma- butyrolactone) | ||||||
| 2004 | Ketamine (Special K) | ||||||
| 9996 | Not applicable – Use when the value in "Substance Use" is 01 None | ||||||
| 9997 | Unknown | ||||||
| 9998 | Not collected | ||||||
| SuDS 4 | Diagnostic Code (DSM or ICD) (optional for both SU and MH) | ||||||
| xxx.xx | |||||||
| 999.96 | No SU Diagnosis (MH only) | ||||||
| 999.97 | Unknown | ||||||
| 999.98 | Not collected | ||||||
| SuDS 5 | Co-occurring Mental and Substance Use Disorders (optional for both SU and MH) | ||||||
| 1 | Yes, client has co-occuring mental and substance use disorders | ||||||
| 2 | No, client does not have co-occuring mental and substance use disorders | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| SuDS 6 | Pregnant at Admission (optional for both SU and MH) | ||||||
| 1 | Yes, client was pregnant at admission | ||||||
| 2 | No, client was not pregnant at admission | ||||||
| 6 | Not applicable - use this code for male clients or pre-pubescent females | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| SuDS 7 | Veteran Status (optional for both SU and MH) | ||||||
| 1 | Veteran | ||||||
| 2 | Not a veteran | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| SuDS 8 | Living Arrangements (SU & MH NOM) | ||||||
| 01 | Homeless | ||||||
| 02 | Dependent Living | ||||||
| 22 | Dependent living: residential care (MH only) | ||||||
| 32 | Dependent living: foster home/foster care (MH only) | ||||||
| 42 | Dependent living: crisis residence (MH only) | ||||||
| 52 | Dependent living: institutional setting (MH only) | ||||||
| 62 | Dependent living: jail and other institutions under the justice system (MH only) | ||||||
| 72 | Dependent living: adults in private residence who need assistance in daily living (MH only) | ||||||
| 03 | Independent Living | ||||||
| 04 | Private residence, living arrangement not specified, adults (temporary code MH only) | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| SuDS 9 | Source of Income/Support (optional for both SU and MH) | ||||||
| 01 | Wages/salary | ||||||
| 02 | Public assistance | ||||||
| 03 | Retirement/pension | ||||||
| 04 | Disability | ||||||
| 20 | Other | ||||||
| 21 | None | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| SuDS 10 | Health Insurance (optional for both US and MH) | ||||||
| 01 | Private insurance (other than BCBS or HMO) | ||||||
| 02 | Blue Cross/Blue Shield (BCBS) | ||||||
| 03 | Medicare | ||||||
| 04 | Medicaid | ||||||
| 06 | Health maintenance organization (HMO) | ||||||
| 20 | Other (e.g., TRICARE) | ||||||
| 21 | None | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| SuDS 11 | Payment Source, Primary (optional for both SU and MH) | ||||||
| 01 | Self-pay | ||||||
| 02 | Blue Cross/Blue Shield | ||||||
| 03 | Medicare | ||||||
| 04 | Medicaid | ||||||
| 05 | Other government payments | ||||||
| 06 | Worker's compensation | ||||||
| 07 | Other health insurance companies | ||||||
| 08 | No charge (free, charity, special research or teaching) | ||||||
| 09 | Other | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| SuDS 12 | Detailed Not in Labor Force (SU & MH NOM) | ||||||
| 01 | Homemaker | ||||||
| 02 | Student | ||||||
| 03 | Retired | ||||||
| 04 | Disabled | ||||||
| 05 | Resident of institution | ||||||
| 06 | Other | ||||||
| 07 | Sheltered/Non-competitive employment (MH only) | ||||||
| 96 | Not applicable | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| SuDS 13 | Detailed Criminal Justice Referral (optional for both SU and MH) | ||||||
| 01 | State/Federal court | ||||||
| 02 | Other court | ||||||
| 03 | Probation/parole | ||||||
| 04 | Other recognized legal entity | ||||||
| 05 | Diversionary program | ||||||
| 06 | Prison | ||||||
| 07 | DUI/DWI program | ||||||
| 08 | Other | ||||||
| 96 | Not applicable | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| SuDS 14 | Marital Status (optional for both SU and MH) | ||||||
| 01 | Never married | ||||||
| 02 | Now married | ||||||
| 03 | Separated | ||||||
| 04 | Divorced | ||||||
| 05 | Widowed | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| SuDS 15 | Days Waiting to Enter Substance Use Treatment (optional for both SU and MH) | ||||||
| 000-995 | Number of days waiting | ||||||
| 996 | Not applicable (MH only) | ||||||
| 997 | Unknown | ||||||
| 998 | Not collected | ||||||
| SuDS 16 | Arrests in Past 30 Days (SU & MH NOM) | ||||||
| 00-96 | Number of arrests | ||||||
| 97 | unknown | ||||||
| 98 | not collected | ||||||
| SuDS 17 | Attendance at Substance Use Self-Help Groups in Past 30 Days (SU NOM, optional for MH) | ||||||
| 01 | No attendance | ||||||
| 02 | Less than once a week | ||||||
| 03 | About once a week | ||||||
| 04 | 2 to 3 times per week | ||||||
| 05 | At least 4 times a week | ||||||
| 06 | Some attendance - number of times and frequency is unknown | ||||||
| 96 | Not applicable (MH only) | ||||||
| 97 | Unknown | ||||||
| 98 | Not Collected | ||||||
| SuDS 18 | Diagnostic Code Set Identifier | ||||||
| 1 | DSM-IV | ||||||
| 2 | ICD-9 | ||||||
| 3 | ICD-10 | ||||||
| 4 | DSM-V | ||||||
| 5 | DSM-III-R | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| SuDS 19 | Substance Use Diagnosis (optional for both SU and MH) | ||||||
| xxx.xxxx | |||||||
| 999.9996 | No Substance Use Diagnosis (MH only) | ||||||
| 999.9997 | Unknown | ||||||
| 999.9998 | Not collected | ||||||
| SuDS 20 | Gender (optional for both SU and MH) | ||||||
| 01 | Male | ||||||
| 02 | Female | ||||||
| 03 | Transgender (Male to Female) | ||||||
| 13 | Transgender (Female to Male) | ||||||
| 23 | Transgender [Temporary code] | ||||||
| 04 | Two-Spirit [American Indian or Alaska Native Only] | ||||||
| 06 | Other | ||||||
| 16 | I don't know | ||||||
| 26 | Prefer not to answer | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| SuDS 21 | Sexual Orientation (optional for both SU and MH) | ||||||
| 01 | Straight or Heterosexual | ||||||
| 02 | Lesbian or Gay | ||||||
| 03 | Bisexual | ||||||
| 04 | Two-Spirit [American Indian or Alaska Native only] | ||||||
| 06 | Other | ||||||
| 16 | I don't know | ||||||
| 26 | Prefer not to answer | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MH Specific Admission Data Set | |||||||
| MHA 1a | MH Diagnostic Code - one (optional for SU) | ||||||
| xxx.xxxx | |||||||
| 999.9996 | No MH Diagnosis-One (SU only) | ||||||
| 999.9997 | Unknown | ||||||
| 999.9998 | Not collected | ||||||
| MHA 1b | MH Diagnostic Code - two (optional for SU) | ||||||
| xxx.xxxx | |||||||
| 999.9996 | No MH Diagnosis -Two | ||||||
| 999.9997 | Unknown | ||||||
| 999.9998 | Not collected | ||||||
| MHA 1c | MH Diagnostic Code - three (optional for SU) | ||||||
| xxx.xxxx | |||||||
| 999.9996 | No MH Diagnosis -Three | ||||||
| 999.9997 | Unknown | ||||||
| 999.9998 | Not collected | ||||||
| MHA 2 | SMI/SED Status (optional for SU) | ||||||
| 1 | SMI | ||||||
| 2 | SED | ||||||
| 3 | At risk for SED (optional) | ||||||
| 4 | Not SMI/SED | ||||||
| 6 | Not applicable (SU only) | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| MHA 3 | School Attendance Status (optional for SU) | ||||||
| 1 | Yes, client has attended school at any time in the past 3 months | ||||||
| 2 | No, client has not attended school at any time in the past 3 months | ||||||
| 6 | Not applicable | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| MHA 4 | Legal Status at Admission to State Hospital (Not applicable for SU) | ||||||
| 01 | Voluntary-self | ||||||
| 02 | Voluntary-others (parents, guardians, etc) | ||||||
| 03 | Involuntary-civil | ||||||
| 04 | Involuntary-criminal | ||||||
| 05 | Involuntary-juvenile justice | ||||||
| 06 | Involuntary-civil, sexual | ||||||
| 96 | Not applicable | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MHA 5 | CGAS/GAF Score (optional for both MH and SU) | ||||||
| 0-100 | GAF/CGAS Score | ||||||
| 996 | Not applicable (SU only) | ||||||
| 997 | Unknown | ||||||
| 998 | Not collected | ||||||
| Discharge Data Set | |||||||
| DIS 1 | System Transaction Type | ||||||
| A | Add | ||||||
| C | Change | ||||||
| D | Delete | ||||||
| DIS 2 | State Code (key field) | ||||||
| 2 character state abbreviation | |||||||
| DIS 3 | Reporting Date (MMYYYY) | ||||||
| DIS 4 | State Provider Identifier (key field) | ||||||
| 1-15 Alphanumeric | |||||||
| DIS 5 | Client Identifier (key field) | ||||||
| 1-15 Alphanumeric | |||||||
| DIS 6 | Codependent/Collateral (key field) | ||||||
| 1 | Codependent/Collateral | ||||||
| 2 | Client | ||||||
| DIS 7 | Type of Treatment /Service Setting (key field) | ||||||
| 01 | Withdrawal management, 24-hour service, hospital inpatient (SU only) | ||||||
| 02 | Withdrawal management, 24 hour service, free-standing residential (SU only) | ||||||
| 03 | Rehabilitation/residential - hospital (other than withdrawal management) (SU only) | ||||||
| 04 | Rehabilitation/residential - short term (30 days or fewer) (SU only) | ||||||
| 05 | Rehabilitation/residential - long term (more than 30 days) (SU only) | ||||||
| 06 | Ambulatory - intensive outpatient (SU only) | ||||||
| 07 | Ambulatory - non-intensive outpatient (SU only) | ||||||
| 08 | Ambulatory - Withdrawal management (SU only) | ||||||
| 72 | State psychiatric hospital | ||||||
| 73 | SMHA funded/operated community-based program | ||||||
| 74 | Residential treatment center | ||||||
| 75 | Other psychiatric inpatient | ||||||
| 76 | Institutions under the justice system | ||||||
| 96 | Not applicable (use only for codependents or collateral clients (SU only) | ||||||
| DIS 8 | Date of Last Contact or Data Update (key field for MH) | ||||||
| MMDDYYYY | |||||||
| 01010007 | Unknown | ||||||
| 01010008 | Not Collected | ||||||
| DIS 9 | Date of Discharge (key field) | ||||||
| MMDDYYYY | |||||||
| 01010006 | Not Applicable (use for MH update record only) | ||||||
| DIS 10 | Reason for Discharge, Transfer, or Discontinuance of Treatment | ||||||
| 01 | Treatment completed | ||||||
| 02 | Dropped out of treatment | ||||||
| 03 | Terminated by facility | ||||||
| 04 | Transferred to another treatment program or facility | ||||||
| 14 | Transferred to another treatment program but client is no show | ||||||
| 24 | Transferred to another treatment program or facility that is not in the SSA or SMHA reporting system | ||||||
| 34 | Discharged from the state hospital to an acute medical facility for medical services (MH only) | ||||||
| 05 | Incarcerated or released by or to courts | ||||||
| 06 | Death | ||||||
| 07 | Other | ||||||
| 96 | Not applicable (use for MH update record only) | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| DIS 11 through DIS 20 - the values come from the Admission file | |||||||
| DIS 11 | Provider Identifier (from admission record MDS 1) | ||||||
| DIS 12 | Client Identifier (from admission record MDS 2) | ||||||
| DIS 13 | Co-dependent/Collateral (from admission record MDS 3) | ||||||
| DIS 14 | Client Transaction Type (from admission record MDS 4) | ||||||
| DIS 15 | Date of Admission (from admission record MDS 5) | ||||||
| DIS 16 | Type of Service (from admission record MDS 18) | ||||||
| DIS 17 | Date of Birth (from admission record MDS 8) | ||||||
| DIS 18 | Sex (from admission record MDS 9) | ||||||
| DIS 19 | Race (from admission record MDS 10) | ||||||
| DIS 20 | Ethnicity (from admission record MDS 11) | ||||||
| DIS 21 (A, B, C) | Substance Use (primary, secondary, tertiary) (SU NOM, optional for MH) | ||||||
| 01 | None | ||||||
| 02 | Alcohol | ||||||
| 03 | Cocaine | ||||||
| 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 | ||||||
| 96 | Not applicable (MH only) | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| DIS 22 (A, B, C) | Frequency of Use at Discharge (Primary, secondary and tertiary) (SU NOM, optional for MH) | ||||||
| 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 | Not applicable | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| DIS 23 | Living Arrangement (SU & MH NOM) | ||||||
| 01 | Homeless - clients with no fixed address; includes homeless shelters | ||||||
| 02 | Dependent living | ||||||
| 03 | Independent living | ||||||
| 04 | Private residence, living arrangement not specified, adults [temporary code] (MH only] | ||||||
| 22 | Dependent living: residential care (MH only) | ||||||
| 32 | Dependent living: foster home/foster care (MH only) | ||||||
| 42 | Dependent living: crisis residence (MH only) | ||||||
| 52 | Dependent living: institutional setting (MH only) | ||||||
| 62 | Dependent living: jail/correctional facility and other institutions under the justice system (MH only) | ||||||
| 72 | Dependent living: private residence(MH only) | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| DIS 24 | Employment Status (SU & MH NOM) | ||||||
| 01 | Full-time | ||||||
| 02 | Part-time | ||||||
| 03 | Unemployed | ||||||
| 04 | Not in labor force | ||||||
| 05 | Employed, full/part-time not specified [temporary code] )MH only) | ||||||
| 96 | Not applicable (MH only) | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| DIS 25 | Detailed Not In Labor Force (SU & MH NOM) | ||||||
| 01 | Homemaker | ||||||
| 02 | Student | ||||||
| 03 | Retired | ||||||
| 04 | Disabled | ||||||
| 05 | Resident of institution | ||||||
| 06 | Other | ||||||
| 07 | Sheltered/non-competitive employment (MH only) | ||||||
| 96 | Not applicable | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| DIS 26 | Arrests in Past 30 Days (SU & MH NOM) | ||||||
| 00-96 | Number of arrests | ||||||
| 97 | unknown | ||||||
| 98 | Not collected | ||||||
| DIS 27 | Attendance at SU Self-Help Groups in Past 30 Days (SU NOM, optional for MH) | ||||||
| 01 | No attendance | ||||||
| 02 | Less than once a week | ||||||
| 03 | About once a week | ||||||
| 04 | 2 to 3 times per week | ||||||
| 05 | At least 4 times a week | ||||||
| 06 | Some attendance - number of times and frequency is unknown | ||||||
| 96 | Not applicable (MH only) | ||||||
| 97 | Unknown | ||||||
| 98 | Not Collected | ||||||
| DIS 28 | Client Transaction Type (key field) | ||||||
| D | Discharge (SU client) | ||||||
| E | Discharge (MH client) | ||||||
| U | Update (MH client) | ||||||
| MH Discharge/Update Data Set | |||||||
| MHD 1 | Diagnostic Code Set Identifier (optional for SU) | ||||||
| 1 | DSM-IV | ||||||
| 2 | ICD-9 | ||||||
| 3 | ICD-10 | ||||||
| 4 | DSM-V | ||||||
| 5 | DSM-III-R | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| MHD 2a | MH Diagnostic Code - one (optional for SU) | ||||||
| xxx.xxxx | |||||||
| 999.9996 | No MH Diagnosis - One (SU only) | ||||||
| 999.9997 | Unknown | ||||||
| 999.9998 | Not collected | ||||||
| MHD 2b | MH Diagnostic Code - two (optional for SU) | ||||||
| xxx.xxxx | |||||||
| 999.9996 | No MH Diagnosis - Two | ||||||
| 999.9997 | Unknown | ||||||
| 999.9998 | Not collected | ||||||
| MHD 2c | MH Diagnostic Code - three (optional for SU) | ||||||
| xxx.xxxx | |||||||
| 999.9996 | No MH Diagnosis - Three | ||||||
| 999.9997 | Unknown | ||||||
| 999.9998 | Not collected | ||||||
| MHD 3 | SMI/SED Status (optional for SU) | ||||||
| 1 | SMI | ||||||
| 2 | SED | ||||||
| 3 | At risk for SED (optional) | ||||||
| 4 | Not SMI/SED | ||||||
| 6 | Not applicable (SU only) | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| MHD 4 | School Attendance Status (MH NOM, optional for SU) | ||||||
| 1 | Yes, client has attended school at any time in the past 3 months | ||||||
| 2 | No, client has not attended school at any time in the past 3 months | ||||||
| 6 | Not applicable | ||||||
| 7 | Unknown | ||||||
| 8 | Not collected | ||||||
| MHD 5 | Education (MH NOM, optional for SU) | ||||||
| 00 | Less than one school grade or no schooling | ||||||
| 01 | Grade 1 | ||||||
| 02 | Grade 2 | ||||||
| 03 | Grade 3 | ||||||
| 04 | Grade 4 | ||||||
| 05 | Grade 5 | ||||||
| 06 | Grade 6 | ||||||
| 07 | Grade 7 | ||||||
| 08 | Grade 8 | ||||||
| 09 | Grade 9 | ||||||
| 10 | Grade 10 | ||||||
| 11 | Grade 11 | ||||||
| 12 | 12th grade or GED | ||||||
| 13 | 1st Year of college/university (Freshman) | ||||||
| 14 | 2nd Year of college/university (Sophomore) or Associate Degree | ||||||
| 15 | 3rd Year of college/university (Junior) | ||||||
| 16 | 4th Year of college/university (Senior) or Bachelor's Degree | ||||||
| 17 | Some post-graduate study - degree not completed | ||||||
| 18 | Master's Degree completed | ||||||
| 19-25 | Post graduate study | ||||||
| 70 | Graduate or professional school | ||||||
| 71 | Vocational school | ||||||
| 72 | Nursery school or pre-school | ||||||
| 73 | Kindergarten | ||||||
| 74 | Self-contained special education class | ||||||
| 97 | Unknown | ||||||
| 98 | Not collected | ||||||
| MHD 6 | CGAS/GAF Score (Optional for both SU and MH) | ||||||
| 0-100 | GAF/CGAS Score | ||||||
| 996 | Not applicable (SU only) | ||||||
| 997 | Unknown | ||||||
| 998 | Not collected | ||||||
| Part 2. Contextual Information | ||
| Reporting Item/ Data Element | Requested Information | State Comments |
| General Reporting | ||
| Client Duplication | Please specify areas and magnitude of possible client duplication. If none, please insert 'NA' | |
| Admission | Describe the State definition or concept of "admission". | |
| Discharge | Describe the State definition of "discharge" | |
| Administrative Discharges | Describe the State policy. If none, please describe the operational definition used in this reporting. | |
| Access to State Hospital Data | Describe how the State access state hospital data (e.g., cite if the State has direct access to the state hospital data base, the State has to request data, the State receives periodic snapshot of state hospital data base, etc.) | |
| Reporting of children's data | Describe how children's data are integrated in this reporting (e.g., cite if the State has integrated database for adults and children; children system IT actively participates in all CMHS/CSAT trainings for this reporting; etc.) | |
| Data collection or update policy /practice/ schedule | Specify the policy, frequency. and types of data regularly collected/updated by the State | |
| Reporting exclusion | Describe reporting exclusions or underreporting of clients, facilities, providers, and/or service types/settings. (e.g. Clients under managed care although under the auspices of the State are not included in this reporting). If none, please insert 'NA' | |
| Other general comments not covered elsewhere | ||
| Data Footnotes The data elements specified below require the State to provide explanations. Other footnotes on these data elements may be added. States may add other data elements where specific State data footnotes are needed. |
||
| Client ID | Cite if non-PHI ID was created for TEDS/MH-TEDS use only, or if State is using the existing non-PHI State ID | |
| Describe the method used in creating the non-PHI ID, if non-PHI ID was created for TEDS/MH-TEDS use only | ||
| Other State footnotes | ||
| Race | If the 1997 OMB guideline has not been adopted or fully implemented, describe the State data collection protocol for collecting race. Highlight deviation from OMB Guidelines (e.g. i.e., state is using different race categories, is not using a self-identification method, or allows a client to select more than one race category). If the State has adopted OMB guidelines, please insert 'NA' | |
| Describe the State Plan towards building capacity to adopt OMB Guidelines | ||
| Other State footnotes | ||
| Ethnicity | If the 1997 OMB guideline has not been adopted or fully implemented, describe the State data collection protocol for collecting ethnicity. Highlight deviation from OMB Guidelines. If the State has adopted OMB guidelines, please insert 'NA' | |
| Describe the State Plan towards building capacity to adopt OMB Guidelines | ||
| Other State footnotes | ||
| SMI/SED Status (optional for SU-TEDS) | Cite State definition for SMI. | |
| Cite State definition for SED. | ||
| If Code 3 (At Risk for SED) is used, cite the State definition of At Risk for SED | ||
| Describe al populations served by the state, e.g. SPMI only, SMI and SPMI only, all persons with mental illness, etc. | ||
| Other State footnotes | ||
| Employment | Cite State's operational definition for employment, unemployment, and Not in the Labor Force | |
| Specify if the State collects employment status for 16 and 17 year old clients | ||
| Other State footnotes | ||
| Co-Occurring Mental and Substance Use Disorders | Is the method of determining whether a client has co-occurring mental and SU disorders the same across the state or varies by individual providers? If the method is statewide, describe the method (e.g., diagnosis and screening questionnaire conducted to all clients at time of admission) | |
| Other State footnotes: | ||
| Number of Arrests in Prior 30 Days | Describe the source of data or how the data are collected (e.g., criminal justice agencies, semi-annual assessment of clients by the provider/at the facility, clients are asked "have you been arrested in the past 30 days?" etc.) | |
| Other State footnotes: | ||
| School Attendance/ Education | Describe the source of data or how the data are collected (e.g., based on semi-annual assessment of clients, clients are asked "has your child been attending school in the past 3 months?" etc.) | |
| Other State footnotes: | ||
| Mental Health Diagnosis (optional for SU) | If not completely explained in Part 1, describe how the State collects diagnosis (Do you limit the number of diagnoses? To how many? Do you have it as administrative data? How often is it updated? Do you use the claims data for diagnosis?) | |
| Explain specifying the code, code description, and the corresponding disease standard classification if codes that do not map to the selected disease standard classification. | ||
| Other State footnotes | ||
| Substance Use Diagnosis (optional for MH) | If not completely explained in Part 1, describe how the State collects diagnosis (Do you limit the number of diagnoses? To how many? Do you have it as administrative data? How often is it updated? Do you use the claims data for diagnosis?) | |
| Other State footnotes | ||
| GAF/CGAS Score (optional for both SU and MH) | Cite if State is using alternate tool for functioning and specify the instrument used. | |
| Other State footnotes | ||
| Other Data Element: | Specify: | |
| Part 3. Reporting Characteristics | |||||||
| TEDS State Reporting Characteristics | |||||||
| State or territory | Facilities reporting TEDS data to the state SSA in SAMHSA reporting | Eligible clients | Other (Specify) | Client transaction type (Initial transmission vs transfer) | |||
| Facilities required to report to the state SSA | Facilities reporting voluntarily to the state SSA |
Type of treatment | Change of service within episode | Change of provider within episode |
|||
| MH-TED State Reporting Characteristics | |||||||
| State or territory | Facilities reporting MH-TEDS data to the state SMHA in SAMHSA reporting | Eligible clients | Other (Specify) | Client transaction type (Initial transmission vs transfer) | |||
| Facilities required to report to the state SMHA | Facilities reporting voluntarily to the state SMHA |
Service setting | Change of service within episode | Change of provider within episode |
|||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |