" ""'''
AN ASSESSMENT OF 
DATA

COLLECTION FOR ALCOHOL

DRUG ABUSE  AND MENTAL

HEALTH SERVICES

-lit Vd 
OFFICE OF INSPECTOR GENERAL 
OFFICE OF ANALYSIS AND INSPECTIONS 
JANUARY 1989  AN ASSESSMENT OF 
DATA

COLLECTION FOR ALCOHOL

DRUG ABUSE  AND MENTAL

HEALTH SERVICES

Richard P. Kusserow 
INSPECTOR GENERAL 
OAI-02-88-00120  JANUARY 1989  ............ ................................................... ..............................  .......... .............................. ....................... .................  ................  ....................  ....... ............... 
............ ............. ...............  ................. . ................ ................ ................ ....... . .... .......... ............ ...........  .......... ...................................... ............ 
TABLE OF CONTENTS

PAGE 
EXECUTIVE SUMMARY 
INTRODUCTION............  ..................................... 1
Backgro und 
 ........................ ............ ...... 1
...................... 5
Issues...... 
Methodology................................................................................................. 5
.................................. ........ ........... 6
FINDINGS 
Present Data Collection........... 

Data Pro blems and 
Concerns......... 

Set.....................................................

Receptivity to a National Data 

CONCLUSIONS.......................... 
 EXECUTIVE SUMMARY 
PURPOSE 
The purpose of this inspection was to assess the nature and extent of available data relating to 
State alcohol, drug abuse, and mental health programs and to ascertain any difficulties in ob
taining meaningful data. 
BACKGROUND 
This inspection was requested by the Alcohol, Drug Abuse, and Mental Health Administration 
(ADAMH). It was prompted by their concern, shared by the Administration and Congress 
that comparble data are not available across States to effectively answer questions about al
cohol, drg abuse, and mental health programs nationally. 
Funding for these programs has always been primarly by the State governments with a per
centage provided by the Federal Government. Prior to 1981 , the Federal share took the form 
of categorical grants with federally mandated State reponing requirements. In 1981 , these 
categorical grants were consolidated into the ADMS (Alcohol, Drug Abuse, and Mental 
Health Services) block grant which allowed the States to more fully determine their own 
program needs and establish their own data collection systems within certain limitations. 
The block grant legislation required applications from the States and annual reports with no 
specified format. As a result, the type of information submitted by the States could, and even
tually did, var. However, the 1984 ADMS amendments required the Deparment of Health 
and Human Services (HS) to develop model data collection criteria and forms, in consult
ation with appropriate national interest groups. 
In 1.986, the Anti-Drug Abuse Act created a new Alcohol and Drug Abuse Treatment and 
Rehabilitation (ADTR) block grant which provided additional funds to the State substance 
abuse programs. 
The ADAMH continues to collect a range of provider and epidemiological data on the in
cidence and prevalence of alcohol, drug abuse, and mental health disorders on both an annual 
and periodic basis. These are in the form of surveys or inventories rather than ongoing data 
collection on client characteristics and the delivery of services. A number of earlier Federal 
data systems which collected detailed treatment, patient, staffing, and related data prior to the 
block grant program have been phased out. One that was phased out but continues to be col
lected by some States is the Client Oriented Data Acquisition Process (CODAP) which 
provided client characteristics and treatment information on all clients in federally funded 
drug abuse treatment programs.  ISSUES AND METHODOLOGY 
The following issues were addressed: what data are actually being collected by the 
States and 
professional associations; what are the problems and concerns of individuals who have a need 
for and/or collect information about these programs; and how receptive are involved in
dividuals to the establishment and use of a uniform national data set? 
The inspection was conducted in three phases. During phase one
, on-site visits were made to 
the State drg, alcohol and mental health programs and 26 local providers in nine States , repre
senting a cross section of the countr, to gain insights on the kinds of data essential to collect 
and their uses. In phase two, telephone discussions were held with representatives of the 
remaining 41 State programs to obtain their perceptions regarding present and future data col
lection. In phase three, the copies of the data sets, data element definitions, and data reporting 
procedures received from 45 State mental health programs and 48 State substance abuse 
programs were collected and analyzed. 
FINDINGS 
Present Data Collection

Most States have extensive data collection systems, though most believe they lack key data. 
Although similar elements are collected by many States, the breakdowns and definitions vary 
widely from State to State. 
Vinually all State programs collect individual client data and can give aggregate reports when
ever needed. Some of the most commonly collected data elements in the substance abuse data 
sets from each State include basic demographic elements such as age and sex (collected 98 
percent of the time), primar drg of abuse (68 percent), and admission type (67 percent). 
Five of these States continue to collect CODAP in its entirety, and many States continue to col
lect some of the CODAP data elements in their exact format. 
Similarly, the most common mental health data elements collected include age (94 percent), 
sex (91 percent), race (85 percent), history of treatment (71 percent), and diagnosis (69 per
cent). 
More than two-thirds of the States believe that the collection of waiting list data would be use
ful. However, less than one-third are presently collecting such data. 
Almost all (92 percent) of the State substance abuse programs and most (75 percent) of the 
State mental health programs say they can identify the specific provider recipients of block 
programs can trace the block grant funds to the treat
grant funds. The State substance abuse 
ment environment in 90 percent of the States, and 86 percent can trace it to the treatment 
modality. Mental health programs are less likely to have these capacities: 49 percent of the  State menta health programs can identify both the treatment modality and environment receiv
ing block grant funds.

Data Problems And Concerns 
The problem most frequently mentioned concerning lack of data was the difficulty in answer
ing questions from legislatures or other external sources at both the State and Federal levels. 
Other problems were related to information needed by program administrators to manage and 
evaluate their programs. This included the inability to identify the number of individuals 
served and to provide information on specific areas such as intravenous drug use , relapse 
homeless persons, funding sources and private sector programs. 
Several problems in data collection were mentioned. The absence of uniform definitions of 
data elements was cited repeatedly. 
Respondents also cited difficulties in getting a statewide unduplicated count (i.e., a count that 
does not show duplicative services to the same client). Support was expressed for use of a uni
que client identifier to help provide data on relapse and to assure effective coordination of ser
vice delivery among providers and monitoring of service outcomes. However, many cited 
concerns for the client s confidentiality as an obstacle to an unduplicated count. 
Receptivity To A National Data Set 
Most States see value in having a uniform national data set. (85 percent of the State substance 
abuse programs and 77 percent of the State mental health programs). 
Over half the States feel the collection of minimum national data should be mandatory. Al
most all say they do not like to have anything mandated. However, they also state that the 
only way this could work is if all States paricipate in a uniform fashion. 
Key uses of uniform national data, according to respondents, include comparsons among 
States and information for outside sources such as legislatures. One State said, " We need na
tionally comparable data to answer questions for Government, legislature and the press. 
Other uses include allocation of funds, program management, reportng, research, and 
program planning. Others felt the data would be useful to evaluate the effectiveness of 
programs. Vinually all States want the Federal Government to pay for the collection of data; 
half would be wiling to pay a share of the costs.  CONCLUSIONS 
Data collected by the States, although extensive, is not comparable and currently cannot be ag
gregated into reliable national statistics. This has proved a problem for the States, and they 
are receptive to the idea of a  national data set. 
trly  minimum
The following key issues in data collection need to be resolved before a decision could be 
made to proceed with a national minimum data set. Those issues include: the worth of a na
tional minimum data set to the Federal Government, how and to what extent such a data col
lection should be federally funded, whether it should be voluntar or mandatory, how 
consensus on data elements and definitions should be reached, and how best to utilize the data 
once it is collected. 
COMMENTS ON THE DRAFT REPORT 
The report was shared with the Assistant Secretar for Health and the Alcohol , Drug Abuse 
, which includes the National Institute on Alcohol Abuse 
and Mental Health Administration
and Alcoholism, the National Institute of Drug Abuse, and the National Institute of Mental 
Health. The report was favorably received by these entities and no changes were recom
mended.  INTRODUCTION

PURPOSE 
The purpose of this inspection was to assess the nature and extent of available data relating to 
State alcohol, drug abuse, and mental health programs and to ascertain any difficulties in ob
taining meaningful data. 
BACKGROUND 
Origin of Study 
This inspection was requested by the Alcohol, Drug Abuse, and Mental Health Administration 
(ADAMHA). It was prompted by their concern, shared by the Administration and Congress. 
that comparable data are not available across States to be able to effectively answer questions 
about the alcohol , drug abuse, and mental health programs nationally. 
Legislative History 
To understand these concerns, it is helpful to review the legislative background of the alcohol 
drg abuse, and menta health programs. Funding for these programs has always been primari
ly by the State governments with a percentage provided by the Federal Government. Pror to 
1981 , the Federal share took the form of categorical grants with the primar administrative 
responsibilities located at the Federal level and with federally mandated State reportng re
quirements. In 1981 , these categorical grants were consolidated into the Alcohol, Drug 
Abuse, and Mental Health Services (ADMS) block grant with primar aaministrative respon
sijJility being shifted to the States. This change allowed States to more fully determine their 
own program needs, set priorities, allocate funds, and establish their own data collection sys
tems within certin limitations. 
The block grant legislation required applications from the States containing descriptions of in
tended uses for the funds. It also required annual reports, with no specified format. As a 
result, the type of information that each State would submit could and eventually did var. 
The legislation also required compliance reviews to be performed by the Federal Government 
in several States each year.

States were also required to establish criteria to evaluate the effective perfomlance of local 
providers receiving ADMS block grant funds. The results were to be used by the State to 
guide internal management of block grant activities. However, there was no requirement to 
provide these evaluations to the Federal Government. The Federal agencies were nevertheless 
required to provide reports to the Congress on block grants.  The 1984 ADMS amendments required the Department of Health and Human Services (HHS) 
to develop model data collection criteria and forms, in consultation with appropriate national 
interest groups. The goal was to obtain national-level data on services provided, the number 
and types of clients served, and total funding (information on how ADAMHA has imple
mented this is on page 3-4 of this report). 
In 1986, the Anti-Drug Abuse Act created a new Alcohol and Drug Abuse Treatment and 
Rehabilitation (ADTR) block grant which provided additional funds to the States as an emer
gency enhancement to their substance abuse programs. It also allowed the Federal Govern
ment to conduct data collection activities and specified that up to 1 percent of the total amount 
appropriated could be used to evaluate alcohol and drug abuse treatment programs. 
However, this data collection authority was tempered by the Paperwork Reduction Act. The 
act precluded the Secretar from imposing burdensome requirements and from prescribing the 
manner of compliance for application or description of the uses of funds. 
Another block grant was established in 1987 to provide services to homeless individuals who 
are chronically mentally ill. 
Funding 
The ADMS block grant funds for Fiscal Year (FY) 1985 amounted to $490 000,000 and were 
reduced to $468,930,000 in FY 1986. The FY 1987 ADMS grant was $508, 860,000; an addi
tional $162 855,000 was added by the ADTR block grant for a total of$671 715,QOO. The 
average block grant share of the total State FY 1987 funds was 18 percent, with a high of 68 
percent and a low of 1. 6 percent. 
HHS Data Collection Policy 
The Deparent s policy on evaluating block grants provides for the collection of descriptive 
information necessar for Federal policy development. However, any information to be col
lected must be readily available or be easily collected or compiled by the States. 
Types of Data 
There are several important types of data collected relating to alcohol, drug abuse, and mental 
health programs. Among the most important types of data collected are the following: 
is information maintained on an individual who receives services from a provider. 
Client Data 

This information is used to determine the amount of service rendered to individuals, and to 
classify these individuals by such categories as sex, age, type of problem and type of treat
ment. This, in turn , assists decision-makers, managers and researchers in answering questions 
about patient populations, showing differential use of services among patient groups, and fur
nishing descriptive information about providers.  is collected from providers to identify the location, scope, characteristics, and 
Provider data 

activities of providers of alcohol, drg abuse,. and mental health services. This is used to gain 
a picture of the kinds of services available within a particular geographic area. Some of this 
data is derived by aggregating individual client data for each provider. 
determines the cost of services provided. 
Financial data 

shows who receives what, from whom, at what cost, and with what effect. 
Event data 

is maintained on all individuals who provide services to clients or sup
Human resources data 

port the administrative strcture of the organization. This can give numbers employed, dis
trbution, demographics, training, and employment characteristics of staff to address issues 
such as recruitment, standards compliance, discrimination in employment, and shortage areas. 
is used to determine the incidence and prevalence of alcohol, drg 
Epidemiological data 

abuse, and mental health disorders in a given population. 
Activities 
ADAMHA Data Collection 

The ADAMHA collects a range of provider and epidemiological data on both an annual and 
periodic basis. These are in the form of surveys or inventories rather than ongoing data collec
tion on client characteristics and the delivery of services. 
The National Drug and Alcohol Treatment Utilzation Survey (NDATUS) , originally con
ducted in 1974 by NIDA, has been conducted periodically. This is provider data collected to 
identify the location, scope, and characteristics of drg abuse and alcoholism treatment and 
prevention units and activities throughout the nation in both public and private sector 
providers. 
A number of systems which collected detailed data on treatment, patients , staffng, and related 
matters prior to the block grant program have been phased out. These include the National Al
coholism Profie Information System (NAPIS), the State Alcoholism Profile Information Sys
tem (SAPIS), and the Client Oriented Data Acquisition Process (cODAP). Prior to the block 
grants, cODAP--a client data collection instrumentuwas required of all treatment clinics 
receiving Federal funds. It provided client characteristics and treatment information on all 
clients admitted to and discharged from federally funded drug abuse treatment programs. 
The ADAMHA and the Institutes -- the National Institute of Mental Health (NIMH), the Na
tional Institute on Alcohol Abuse and Alcoholism (NIAAA), and the National Institute of Drug 
Abuse (NIDA) -- have taken the following actions in response to the 1984 amendments which 
required HHS to cooperate with special interest groups to develop data collection criteria and 
forms:  The Mental Health Statistics Improvement Program (MHSIP), a cooperative 
Federal/State program designed to upgrade mental health data collection 
activities, has been active for over 12 years as a joint effort in the development of 
suggested client, event, and human resources data eleme :1ts. However, its system 
has not been implemented in any formal way. 
Under a contract from the NIMH, the National Association of State Mental Health 
Program Directors (NASMHPD) have developed a methodology for compiling 
comparable data on State mental health agency allocations and expenditure of 
funds as well as sources of revenue for mental health operations. Originally 
supported by NIMH, it is now conducted by NASMHPD without Federal support. 
The NIM, in collaboration with NASMHPD, is proposing to implement a State 
mental health data profie system in FY 
1989. It wil contain information on the 
organization, funding, operation, and services provided through State mental 
health agencies. A feasibilty study was completed in 1987. 
Both NIAAA and NIDA have established a cooperative relationship with and 
provided funds to the National Association of State Alcohol and Drug Abuse 
Directors (N ASADAD) for the collection and analysis of data voluntarily 
submitted by the States on alcohol and drug abuse funding and services. Existing 
sources of information are utilized for this reporting which is known as the State 
Alcohol and Drug Abuse Profile (SADAP). The data are not verified by either 
HHS or NASADAD, and States are not required to collect them in any uniform 
way. 
Key Data Collection Issues 
When contemplating data collection , a number of issues arse which must be considered. Data 
can be collected on individual activities on a regular basis (monthly, quarerly, or annually) or 
in the form of special studies or surveys done either periodically or one time only using sam
pling techniques. Individual data (which is data collected on each individual client in the 
facilty) can be aggregated or combined in reports to provide specific information. In other 
cases only aggregate data can be collected. 
When collecting individual client data two important issues arise. The first involves the dif
ficulty of achieving an unduplicated count. Clients may be counted more than once if they 
are 
discharged and readmitted either to that or another facility. If an unduplicated count cannot be 
assured, the data collected can exaggerate the size of the treatment need in a given area and/or 
the number of people in treatment. 
A second important issue in the collection of individual client data is the importance of con
fidentiality. Many clients are reluctant to provide information on their mental health and sub stance abuse treatment. In addition, many States have laws prohibiting the release of any in
formation about these clients. Although this data is of crucial planning importance for those 
who run treatment programs, it is also importnt to those providing the data that no data be 
traceable to an individual client. 
INSPECTION ISSUES 
What data are actually being collected by the States and professional associations? 
What are the problems and concerns of individuals who have a need for and/or 
collect information about these programs? 
How receptive are involved individuals to the establishment and use of a uniform 
national data set?

METHODOLOGY 
This inspection was conducted in three phases. Initially, on-site visits were made to the State 
drg, alcohol, and mental health programs in nine States representing a cross section of the 
countr. Discussions were held to determine the kinds of data presently being collected and 
their uses. Insights were also obtained regarding the kinds of data considered essential to col
lect. 
Additionally, visits were made in each of the nine States to three local-level providers: one 
each for alcohol, drg, and community mental health programs. They included six social 
detoxification, three medical detoxification, four methadone maintenance, and three drug-free 
programs in the substance abuse area. The mental health program visits included four subur
ban, five urban, and one rural community mental health centers. The facilities ranged in 
patient load from 14 to 20,000 clients. Discussions with providers gave grass roots percep
tions as to the strengths and weaknesses of the States ' data collection systems as well as in
sights into the providers' data collection needs and practices. 
The second phase consisted of telephone discussions with representatives of the alcohol, drug 
abuse, and mental health programs of the remaining 41 States and the District of Columbia to 
obtain perceptions regarding their present data collection procedures and their ideas about a 
national data collection system. 
The third phase consisted of collecting copies of the data sets, data element definitions and 
data reporting procedures presently in use by each of the 50 States and the District of Colum
bia. This information was analyzed for both varations and commonalities in the elements, 
definitions, and reporting procedures.  FINDINGS 
PRESENT DATA COLLECTION 
The data analysis in this first section and all graphs and charts derived from it are based on the 
client data sets received from 45 State mental health programs and 48 State substance abuse 
programs. We chose to analyze the client data sets because client data is the most generally 
collected data type and because client data is used by State program administrators and 
providers to generate reports which wil provide information on patients, providers and ser-
VIces. 
State Data Sets Usually Include Individual Client Data 
Most States have extensive data collection systems, but most believe that they lack key data. 
Although similar elements are collected by many States, the breakdowns and definitions vary 
widely from State to S ate. 
Virtually all State programs collect individual client data from providers, though they collect it 
in different ways. It is usually on a State-prepared form which is submitted on a monthly 
basis, and produce aggregate reports upon request. Funding does sometimes limit the number 
of reports which can be generated. Four State mental health programs and four State sub
stance abuse programs collect only aggregate data. Additionally, some mental health 
programs collect individual data only at the institutional level and collect aggregate data from 
their other programs. Two of the eight programs that collect aggregate data only are in large 
States with populations of about 10 milion; the other six are in medium to small States with 
populations ranging from 750,000 to 5 millon. At least two State programs do not have a 
data collection instrment for use at the State level. These States provide the county or area 
offices with a list of key data elements that must be available upon request. The offices can 
then use any data collection instruments they choose and can collect any desired additional 
data. 
In addition to this regular data collection, most States produce special reports or surveys on 
topics of paricular interest. Some examples of these include a report of the estimated number 
of problem drnkers , a sex offender report, a statistical prospective on drg abuse treatment 
and a report on re-arest following residential treatment for repeat offender drunken drivers. 
Figure I contains the most commonly collected individual client data elements found in the 
substance abuse data sets from each State. As can be seen below, the elements range from 
basic demographic information such as age and sex (collected 98 percent of the time) to the 
primar drg of abuse (68 percent) and admission type (67 percent).  FIGURE I 
MOST COMMON SUBSTANCE ABUSE ELEMENTS COLLECTED 
DATA ELEMENTS 
SEX 
AGE1B 
RACE 
ADMISSION DATE 
EMPLOYMENT 
REFFERAL SOURCE 
EDUCATION 
FACILITY NUMBER 
MARITAL STATUS 
CLIENT ID 

PRIMARY DRUG 
ADMISSION TYPE 
100  110 
0/ OF STATES COLLECTING DATA 
Similarly, the most common mental health data elements collected are shown in figure II 
below. They include basic demographic elements such as age (94 percent), sex 
(91 percent), 
and race (85 percent). Also included are history of 
treatment (71 percent) and diagnosis (69 
percent). 
FIGURE II 
MOST COMMON MENTAL HEALTH ELEMENTS COLLECTED 
DATA ELEMENTS 
AGE/ODB 
SEX 
ADMISSION DATE

RACE 
HISTORY OF TREATMENT 
DIAGNOSIS 
EDUCATION 
MARITAL STATUS 
EMPLOYMENT 
COUNTY OF RESIDENCE 
FACILITY NUMBER 
FEDERAL SOURCE 
100 
110 
% OF STATES COLLECTING DATA  Further analysis of figures I and II reveals that substance abuse programs are morefrequently 
collecting uniform data elements than mental health programs. The average percentage of 
States which report collecting these common data elements is 81 for substance abuse 
programs and 73 for mental health programs. 
Although the national collection of cODAP was discontinued in 1981 , five States continue to 
collect it. Many States continue to collect some of the CODAP data elements in the exact 
CODAP format. These include sex (84 percent of all States), education (66 percent), and in
formation on other drugs (48 percent). 
FIGURE II 
SUBSTANCE ABUSE DATA ELEMENTS COLLECTED IDENTICAL TO CODAP 
DATA ELEMENTS 
SEX 
EDUCATION 
OTHER DRUG USED 
PRIMARY DRUG 
ARREST RECORD 
AGE OF FIRST USE 
HISTORY OF TREATMENT 
'0 20 30 40 50 60 70 80 90 100 
110 
0/ OF STATES IDENTICAL TO CODAP 
State Data Elements and Definitions Val) 
Although most States collect basic demographic information, the breakdowns and definitions 
var widely from State to State. For example, race is broken down in at least 10 different 
ways. Some States have five categories, others six categories, etc. Even States that define the 
of categories do not necessarly delineate them into identical 
elements in the same  number 
categories. For example , while one State breaks down race into "white, black, American In
dian, other " another uses "black, white, Asian , other" (see figure IV).  FIGURE IV 
SUBSTANCE ABUSE DATA: 
STATE PROGRAMS IN REPORTING RACE 
VARIA TIONS  OF 
8(4".)  100R MORE (10%) 
NOT COLLECTED (6%) 
7 (16".) 
3(4%) 
6(18%) 
5(12".) 
# OF CATEGORIES OF RACE USED 
Employment status is defined in at least nine different ways. Some States have four 
categories, others have six categories, etc. A number of States do not collect employment 
status. As with race and other types of data, the States that define the elements in the same 
number of categories do not necessarly define them identically. For example, while one State 
breaks employment status into "full time, part time, ared forces, homemaker, retired, inmate 
of an institution, other " another uses "works 35 hours or more in competitive job market 
works 35 hours or less in competitive job market
, works 35 hours or more in a noncompetitive 
job market (such as sheltered workshop or protective environment), works 35 hours or less in 
an noncompetitive job market, unemployed, not in labor force
, unknown" (see figure V). 
FIGURE V 
MENTAL HEALTH DATA: 
STATE PROGRAMS IN REPORTING EMPLOYMENT STATUS 
VARIATIONS  OF 
10 OR MORE (20"-' 
917%) 
819%) 
#I OF CATEGORIES OF 
EMPLOYMENT STATUS USED  Data elements which we analyzed from the State individual client data sets were often col
lected in vared ways among States. Even sex and age were collected in different ways. 
Because the States collect information in different formats, the State data cannot be accurately 
aggregated into national data. Thus, although almost all States may be collecting the 
same 
data elements (such as those discussed above) their data collection efforts cannot be used to 
make reliable national projections or enable States to compare their programs with those of 
other States. 
Data Sets Often Lack Elements Considered Important 
Some data elements considered to be important by State substance abuse and mental health 
professionals are collected by less than half of the States. Figures VI and VII show some data 
elements considered to be important by State substance abuse and mental health professionals 
which are not collected by many States. 
FIGURE VI 
SUBSTANCE ABUSE ELEMENTS NOT CONSISTENTLY COLLECTED 
ALTHOUGH CONSIDERED IMPORTANT 
DATA ELEMENTS 
DIAGNOSIS 
DWI ARRESTS 
SEVERITY OF USE 
TREATIlNT ENVIRONMENT

ROUTE OF ADMIN. 
TREATMENT MODALITY

TREATMENT HISTORY 
10 20 30 40 50  70 BO 90 100 
110 
0' -r: C"TATC"C"1"1"1 I CI"TI..I-nATA 
Only 38 percent of States collect route of administration (how the drug is taken). Profes
sionals consider this crucial data needed to properly deal with the growing AIDS crisis. The 
collection of accurate data about the route of administration of the 
drgs used by those in treat
ment helps to provide trend information on IV drg users. Only 30 percent of the States col
lect data on the severity of use, while 36 percent collect treatment environment (see figure VI 
above).  , "
FIGURE VII 
MENTAL HEALTH ELEMENTS NOT CONSISTENTLY COLLECTED 
ALTHOUGH CONSIDERED IMPORTANT 
DATA ELEMENTS 
PRESENTING PROBLEM 
LEVEL OF FUNCTIONING 
TREATMENT ENVIRONMENT 
VETERAN STATUS 
TREATMENT MODAUTY 
ADMISSION TYPE 
10 20 30 40 50 60 70 80 90 
100 110 
% OF STATES COLLECTING DATA 
Some elements considered to be important by State mental health professionals are presently 
collected by less than one-third of the States. Only 13 percent of the States collect data on the 
presenting problem at the client s time of admission (the reason the client comes to the 
facility). The client s level of functioning at admission is collected by 18 percent of the States. 
Twenty-nine percent of the States keep information on the treatment environment for each 
client (see figure VII above). 
The most common reasons given by State program admnistrators for not collecting these data 
were lack of funds and lag time between identifying data needs and data collection form up
dates. 
Most States Believe the Collection of Waiting List Data Would Be Useful 
More than two-thirds of the States believe that the collection of waiting list data would be use
ful, though less than one-third are presently collecting such data. Most States consider it im
portnt that all providers define a waiting list uniformly. One provider said its waiting list 
stared after the patient completed the intake process , was deemed appropriate, and given an 
appointment. Others had waiting lists comprised of anyone who called. One methadone main
tenance center kept the names of everyone who called, but expected the person to periodically 
call back, since this showed real interest. One State program administrator said  the problem 
is no generally accepted definition of a waiting list. 
Sixty-one percent of the providers visited maintain waiting lists for at least some of their ser
vices. For some services mandated by the courts a waiting list is essential because the client 
must prove he/she is on a waiting list for treatment in order to avoid incarceration.  , "
The most frequently mentioned uses of a waiting list are to document the need for services 
and to make funding decisions. One State representative said  It is definitely a valuable tool 
at the State level to help justify additional appropriations and identify unmet needs. 
Others not in favor of waiting lists said these individuals might request services at one mo
ment and, if they are put off, not be interested when the services are available. They con
sidered it important to treat the patients or refer them elsewhere. 
Almost All States are Able to Identify Providers Receiving Block Grant Funds. 
Almost all (92 percent) of the State substance abuse programs and most (75 percent) of the 
State mental health programs say they can identify the specific provider recipients of block 
programs can trace the block grant funds to the treat
grant funds. The State substance abuse 
ment environment in 90 percent of the States, and 86 percent can trace it to the treatment 
modality. Thirty-nine percent can identify the client  receiving the funds. Mental health 
programs are less likely to have these capacities: 49 percent of the State mental health 
programs can identify both the treatment modality and environment receiving block grant 
funds. Only 16 percent can identify the actual clients. 
Forty-two percent of the providers visited can separate data by funding source. 
Of these 
providers, 40 percent can identify ADMS clients and 30 percent can identify ADTR clients. 
DATA PROBLEMS AND CONCERNS 
State Program Administrators and Providers Experience a 
Variety of Problems Due to Lack 
of Data 
The problem most frequently mentioned was the difficulty in answering questions from legis
latures or other external sources at both the State and Federal levels. Many State program ad
ministrators also mentioned their inability to compare their State activities with those of other 
similar States or those States seen as leaders in the field. 
Other problems were related to information which was not available to help program ad
ministrators design, manage, and evaluate programs. These include the inability to identify 
the number of individuals served and to provide information in specific areas such as IV drug 
use, relapse rates, homeless persons, funding sources, and private sector programs. 
Beyond the problems at the State level, almost one-half of the local providers visited reported 
problems due to lack of data; 54 percent said there were additional data they would like to 
have. One provider said, " It would be interesting to know where similar agencies are, we 
have nothing to compare ourselves to.  State Program Administrators and Providers also Experience a Variety of Problems in Data 
Collection 
Some States offcials felt that the collection of data on private sector programs was important 
but difficult to collect. They felt that the collection of this data should be par of the State 
licensing or certification process so that this gap is filled. 
Another problem is the difficulty in getting uniform definitions of elements. One person said 
s difficult to get uniform definitions from provider to provider throughout the State
, how 
could we expect uniform national definitions?" In spite of this, most agreed that the stand
ardization of definitions is essential. 
Respondents also discussed the problem with the automation of data collection. While almost 
all States have parially or fully automated data collection, many providers are not automated. 
In most States, providers and State agencies lack compatible systems; data are usually sub
mitted on hard copy to be entered at the State level. 
Lastly, a few States raised the issue of quality and felt not enough is being done in this area. 
This is paricularly important because only through adequate quality control can accurate data 
be assured.

State Program Administrators Report that Unique Client Identifiers are Needed to Assure 
an Un duplicated Count 
Confidentiality concerns about client identification make it difficult to get an unduplicated 
count, thus making it impossible to track a patient throughout State programs. However
, 60
percent of the States indicated they can obtain unduplicated counts. In 
most of these States a 
client identifier is assigned to each client when he/she is admitted to a facility. Thus, an un-
duplicated count can be achieved as long as the client continues to be treated at a particular 
facility. Admission to a new facility, however, would give the client a new identifying num
ber. 
Several States, however, did discuss their use of a unique State client identifier. This iden
tification number is made up of coded numbers and letters derived from certain unchanging 
characteristics of a client such as the first letter of the first name or the date of birth and 
mother s maiden name. A client does not need to memorize this number. In some States each 
facility in the State knows the code for constructing this number and can recreate the number 
based on the client's unchanging characteristics. In other States the State itself constructs the 
numbers upon collection of the individual client data. This ensures an unduplicated count for 
all facilties within a State. 
Most respondents mentioned the importance of the unique client identifier for effective coor
dination of service delivery among agencies and monitoring of service outcomes. Further
, out come data, which some respondents said is frequently unavailable, is difficult to obtain 
without a unique statewide identifier. 
Providers Do Not Always Receive Reports Based on the Data They Submit 
Although some providers feel that State and national data collection is helpful and 73 percent 
get reports back from the States on the information they submit, only 19 percent said they get 
national reports. Others feel that although they collect data for the State separate from their in
ternal data collection, they never get anything useful back from the State and certainly not 
from the Federal Government. 
States Fund Data Collection at Low Levels 
States fund data collection at low levels, despite encountering problems due to the lack of 
data. Most respondents estimated that one percent or less of their total expenditures are spent 
on data collection. Almost two-thirds of the State program administrators thought this was not 
enough. Many had difficulty coming up with their estimates. 
There were however, several State program administrators that said they spent a lot more than 
1 percent and felt they were spending an appropriate amount. One State program ad
ministrator estimated spending seven percent, another estimated 13 percent. These State 
program administrators are satisfied with their own data collection systems and feel that their 
own instrument would be appropriate for a national data set. 
RECEPTIVITY TO A NATIONAL DATA SET 
Most States See Value in Having a Uniform National Data Set 
Eighty-five percent of the State substance abuse program administrators and 77 percent of the 
State mental health program administrators see value in having a uniform national data set. In 
contrast, only half of the providers see such value. 
Over half the States feel the collection of minimum national data should be mandatory. Al
most all say they do not like to have anything mandated but the only way this could work is if 
everyone parcipates in a uniform fashion. 
Virtually all States (86 percent) want the Federal Government to pay for the collection of the 
data; nevertheless, half the States would be wiling to pay a share of the costs. 
Key uses of uniform national data according to respondents include comparng one State to 
another and providing information to.outside sources such as legislatures. One State said " 
need nationally comparable data to answer questions for Government, legislature and the 
press. " Other uses include allocation of funds, program management, reporting, research, and  , "

, ", " , " , "
program planning. Others felt the data would be useful to evaluate the effectiveness of 
programs. 
Many States mentioned that there should be Federal leadership with a high participation by 
the States in developing standards and definitions. Some also said there should be sufficient 
lead time to implement the data collection system. Others mentioned the importance of techni
cal assistance from the Federal Government, parcularly for small States. Still others sug
gested a pilot program or test run before the new system gets underway. Additionally, several 
number when selecting elements for a national 
States stressed the importance of a  minimum 
data set. One State said, "The key is minimum. " Another said, "In any national system there 
should be core elements, but also enough flexibility and room for demonstration projects and 
optional reporting elements. 
States would like timely reports from the Federal Government in a useful format. 
One said 
Clear, standardized definitions are probably the single most important item in developing a 
national data set, along with appropriate technical assistance. Rapid turnaround time is also 
very important. " Another State said  To be meaningful to States, the main thing is to make 
output more current and timely. It doesn t help to have 2-year-old data. " These words were 
echoed by many.

Prior and Present Data Sets 
Viewed as Useful 
Discussions with the States about prior and present data sets revealed that most State sub
stance abuse respondents view CODAP as a useful form of national data collection. Sixty-
four percent of the States have a positive recollection of the value of CODAP. 
Twelve substance abuse programs recommended some form of CODAP as the minimum data 
elements to collect nationally. One said, "It was useful, well thought out, a significant mini
mum system. " Another State mentioned  Good for comparsons to other States, helped plan 
treatment and strategies. " Stil others thought it was good information but contained too much 
data and did not give feedback timely enough. 
Forty percent of the States said that SADAP and NDATUS are useful. Four recommended 
SADAP as minimum data elements and four recommended NDATUS. Some said it is all they 
have to see what s going on nationally and to compare themselves with other States. 
However, some felt SADAP data is not too reliable since its categories are not the categories 
they use. One said  It addresses a different structure than we have...! find myself filling out 
unknown ' or ' not applicable ' too much of the time. " Another State mentioned a validity 
problem and said  It is too general , hard to cross tab, hard to make decisions based on it. 
Most State mental health respondents feel that MHSIP is a useful form of national data collec
tion. Most States are familiar with MHSIP and are complimentar of the task force working 
on its development. However, other than a few basic demographic data elements, States are 
not collecting MHSIP data. One State commented  We pay attention to it, but we don t use 
it." Another said, " It gives a good frame ofreference.  , "
It is important to note that MHSIP is a program to establish data standards for mental health 
decision support systems. It presently has data elements for client data, event data, and human 
resources data. It was the client data that people were most familiar with , although some 
thought event data was important to maintain. The MHSIP recommends minimum data ele
ments with a specific strcture , but at this time does not have a standard data collection docu
ment. Twenty-five mental health programs and three substance abuse programs recommend 
MHSIP as minimum data elements to collect nationally. One State said  If we can get all 50 
States to agree and use the same definitions, then it wil be a very good system. 
National Minimum Data Elements Recommended by State Program Administrators 
Many State program administrators recommend, should a national minimum data set be con
MHSIP data elements for mental health programs and CODAP or some 
strcted, the use of 
varation for drg and alcohol programs. 
The specific elements most often recommended by the State substance abuse program ad
ministrators include demographics, modality or serVices provided, type of substance, and 
route of administration. Those most often recommended by the mental health program ad
ministrators include demographics, services provided, clients served, and diagnosis.  CONCLUSIONS

This report was conducted to provide ADAMHA and other departmental decision-makers with 
information on the alcohol, drg abuse, and mental health data collection activities of the 
States and State receptivity to the idea of a national minimum data set. We can conclude from 
the findings of this report that the data collected by the States, although extensive, are not com
parable and cannot currently be aggregated into reliable national statistics. We can also con
clude that the States experience this as a problem and are receptive to the idea of a truly 
national data set. 
minimum 
However, the following key issues in data collection need to be resolved before a decision 
could be made to proceed with a national minimum data set. Those issues include: the worth 
of a national minimum data set to the Federal Government, how and to what extent such a 
data collection should be federally funded, whether it should be voluntary or mandatory, how 
consensus on data elements and definitions should be reached, and how best to utilize the data 
once it is collected. 
COMMENTS ON THE DRAFT REPORT 
The report was shared with the Assistant Secretar for Health and the Alcohol, Drug Abuse, 
and Mental Health Administration, which includes the National Institute on Alcohol Abuse 
and Alcoholism, the National Institute of Drug Abuse, and the National Institute of Mental 
Health. The report was favorably received by these entities and no changes were recom
mended.