Incorporated Document 19
Performance Outcomes Measurement Manual
Contents
Core requirements for all measures
Employment Overview
Target Population
ADULT MENTAL HEALTH
M0003 Average annual days worked for pay for adults with severe and persistent mental illness
M0703 Percent of adults with serious mental illness who are competitively employed
M0016 Number of adults with a serious and persistent mental illness in the community served
M0017 Number of adults in mental health crisis served
M0018 Number of adults with forensic involvement served
M0742 Percent of adults with severe and persistent mental illnesses who live in stable housing environment.
M0743 Percent of adults in forensic involvement who live in stable housing environment.
M0744 Percent of adults in mental health crisis who live in stable housing environment.
CHILDREN’S MENTAL HEALTH
M0031 Number of SED children to be served
M0032 Number of ED children to be served
M0033 Number of at-risk children to be served
M0377 Percent of children with emotional disturbances who improve their level of functioning
M0378 Percent of children with serious emotional disturbances who improve their level of functioning
M0778 Percent of children with emotional disturbance (ED) who live in stable housing environment
M0779 Percent of children with serious emotional disturbance (SED) who live in stable housing environment
M0780 Percent of children at risk of emotional disturbance who live in stable housing environment
M0012 Percent of school days seriously emotionally disturbed (SED) children attended.
ADULT SUBSTANCE ABUSE
M0755 Percent of adults who successfully complete substance abuse treatment services.
M0063 Number of adults that receive substance related services
M0756 Percent of adults with substance abuse who live in a stable housing environment at the time of discharge.
M0753 Percentage change in clients who are employed from admission to discharge.
M0754 Percent change in the number of adults arrested 30 days prior to admission versus 30 days prior to discharge.
CHILDREN’S SUBSTANCE ABUSE
M0052 Number of children that receive substance related services.
M0725 Percent of children who successfully complete substance abuse treatment services.
M0751 Percent change in the number of children arrested 30 days prior to admission versus 30 days prior to discharge.
M0752 Percent of children with substance abuse who live in a stable housing environment at the time of discharge.
Core requirements for all measures
- Valid DCF contract
- Valid target population at start of the episode of care
- Valid fund source
- TANF only for services funded through the TANF Other Cost Accumulators (OCA)
- SAMH, Title XXI, PTS, Local Match when appropriate
- Report capabilities must be based on the following hierarchies
- Subcontractor to ME
Employment Overview
The Department tracks employment across several measures. Employment measures are focused on the consumer’s employment status followingadmission. Employment data is required for all consumers between the ages of 18 and 62 who are receiving services in non-institutional setting.
Definitions from the Florida Department of Economic Opportunity[1] are used as the basis for determining employment in Florida. DEO defines employment as including persons who: did any work as paid employees, worked in their own business or farm, or worked 15 hours or more as unpaid workers in a family business during the reference week (normally the week including the 12th of the month). It also includes those who had a job but did not work due to a temporary absence. Each employed person is counted only once, even if they had more than one job.
Unemployment is defined as those who did not have a job during the reference week, were available for work, and made specific efforts to find a job sometime during the 4 weeks prior to the reference week.
Target Population
To ensure that outcome measures accurately represent an episode of care, an individual’s target population is established at admission. The Department recognizes that an episode of care may extend well beyond a particular fiscal year. As such, it is important that service providers accurately record all admissions and discharges.
ADULT MENTAL HEALTH
M0003 Average annual days worked for pay for adults with severe and persistent mental illness
This output is reported as a whole number.
- Target population is persons with a severe and persistent mental illness;
- Received mental health treatment services;
- Eligible services limited to:
- 06 - Day / Night
- 08 - In-Home and On-Site Services Overlay
- 12- Medical Services
- 14 - Outpatient-Individual
- 20 - Residential Level 3
- 21 - Residential Level 4
- 34- FACT Teams
- 35 - Outpatient-Group.
- Exclude persons that received assessment only services;
- Ages 18 to 62;
- Exclude persons that were served at a state mental health treatment facility any time during the review period.
- Employment status is one of the following at any time during the review period:
- 10 - Active military, overseas
- 20 - Active military, USA
- 30 - Full Time
- 31 - Unpaid Family Workers (minimum of 15 hours worked for family business)
- 40 - Part Time
- 70 - Unemployed
- 50 - Leave of Absence
- For leave of absence, the provider should inquire how many days worked prior to the leave of absence.
- For each person
- Count the number of post-admission outcome records (e.g., periodic or discharge) per person per provider.
- Sum the number of days worked per person per provider.
- Divide the number of days worked by the count of post-admission outcome records (e.g., periodic or discharge) per person per provider.
- Multiply result by 12.1667 to arrive at an ‘annual’ estimate.
- Round the result to the nearest whole number.
For example, John Doe has the following three performance outcome records:
PROVID / SPROVID / EVALDATE / DAYSWORK59-1234567 / 59-7654321 / 07/19/2013 / 12
59-1234567 / 59-7654321 / 10/12/2013 / 15
59-1234567 / 59-2222222 / 09/09/2013 / 18
At the ME (PROVID) level, days worked is:
1)Number of records = 3
2)Sum of days worked = (12+15+18) = 45
3)45 / 3 = 15
4)15*12.1667 = 182.5
5)Round to 183
At the SPROVID level, days worked for SPROVID 59-7654321 is:
1)Number of records = 2
2)Sum of days worked = (12+15) = 27
3)27 / 2 = 13.5
4)13.5*12.1667 = 164.3
5)Round to 164
M0703 Percent of adults with serious mental illness who are competitively employed
This outcome is reported as a percent.
- Target population includes persons witha serious mental illness ;
- Most recent evaluation is periodic or discharge;
- Received mental health treatment services;
- Eligible services limited to:
- 06 - Day / Night
- 08 - In-Home and On-Site Services Overlay
- 12- Medical Services
- 14 - Outpatient-Individual
- 20 - Residential Level 3
- 21 - Residential Level 4
- 34- FACT Teams
- 35 - Outpatient-Group
- Exclude persons that received assessment only services;
- Ages 18 to 62;
- Numerator = distinct count of persons where employment status includes any of the following:
- 10 - Active military, overseas
- 20 - Active military, USA
- 30 - Full Time
- 31 - Unpaid Family Workers (minimum of 15 hours worked for family business)
- 40 - Part Time
- 50 - Leave of Absence
- For leave of absence, the provider should inquire how many days worked prior to the leave of absence.
- Denominator = distinct count of persons where employment status includes any of the following:
- 10 - Active military, overseas
- 20 - Active military, USA
- 30 - Full Time
- 31 - Unpaid Family Workers
- 40 - Part Time
- 50 - Leave of Absence
- 70 - Terminated/Unemployed
- Divide to obtain the percent of adults with serious mental illness who are competitively employed;
- Round result to the nearest whole number.
For example, ME1 and ME2 have the following performance outcome records:
PROVID / SPROVID / SSN / EMPLOYMENT STATUS59-1234567 / 59-7654321 / 123456789 / 30 - Full Time
59-1234567 / 59-7654321 / 987654321 / 50 – Leave of Absence
59-1234567 / 59-2222222 / 121212121 / 70 – Terminated/Unemployed
59-3333333 / 59-5555555 / 954673027 / 70 – Terminated/Unemployed
At the ME level, the percent of adults with serious mental illness who are competitively employed for ME1 (59-1234567) is:
1)Numerator = 2
2)Denominator = 3
3)Percent = 66.66%
4)Round = 67%
At the ME level, the percent of adults with serious mental illness who are competitively employed for ME2 (59-333333333) is:
1)Numerator = 0
2)Denominator = 1
3)Percent = 0%
4)Round = 0%
At the SPROVID level, days worked for SPROVID 59-7654321 is:
1)Numerator = 2
2)Denominator = 2
3)Percent = 100%
4)Round = 100%
M0016 Number of adults with a serious and persistent mental illness in the community served
This output is reported as a whole number.
- Persons identified with a severe and persistent mental illness at the start of the episode of care
- Received any mental health services;
- 18 years of age or older;
- Distinct count at:
- ME level;
- Subcontractor level.
M0017 Number of adults in mental health crisis served
This output is reported as a whole number.
- Persons that do not meet criteria for having a severe and persistent mental illness or forensic involvement that received at least one CSU or Crisis Support service during the review period;
- 18 years of age or older;
- Distinct count at:
- ME level;
- Subcontractor level.
M0018Number of adults with forensic involvement served
This output is reported as a whole number.
- Persons whose legal status at the start of the episode of careindicates forensic involvement;
- Received mental health services
- Exclude persons that received assessment only services unless the assessment was part of a competency to proceed to trial determination;
- 18 years of age or older;
- Distinct count at:
- ME level;
- Subcontractor level.
M0742 Percent of adults with severe and persistent mental illnesses who live in stable housing environment.
This outcome is reported as a percent.
- Persons identified with a severe and persistent mental illness at the start of the episode of care;
- Received mental health treatment services;
- Eligible services limited to:
- 06 - Day / Night
- 08 - In-Home and On-Site Services Overlay
- 12- Medical Services
- 14 - Outpatient-Individual
- 20 - Residential Level 3
- 21 - Residential Level 4
- 34- FACT Teams
- 35 - Outpatient-Group
- Exclude persons that received assessment only services, and persons that are incarcerated or residing in any non-community based institutional settings
- 18 years of age or older;
- Most recent evaluation is periodic or discharge;
- Numerator = distinct count of persons where residential status includes any of the following:
- 01 - Independent Living-alone
- 02 - Independent Living-with Relatives
- 03 - Independent Living-with Non-Relatives
- 04 - Dependent Living-with Relatives
- 05 - Dependent Living-with Non-Relatives
- 06 - Assisted Living Facility (ALF)
- 07 - Foster Care/Home
- 08 - Group Home
- 11 - Nursing Home
- 12 - Supported Housing
- 17 – Limited Mental Health Assisted Living Facility (LM-ALF)
- Denominator = distinct count of persons where residential status includes any of the following:
- 01 - Independent Living-alone
- 02 - Independent Living-with Relatives
- 03 - Independent Living-with Non-Relatives
- 04 - Dependent Living-with Relatives
- 05 - Dependent Living-with Non-Relatives
- 06 - Assisted Living Facility (ALF)
- 07 - Foster Care/Home
- 08 –Adult Residential Treatment Facility
- 09 – Homeless
- 10 – State Mental Health Treatment Facilities
- 11 - Nursing Home
- 12 - Supported Housing
- 13 – Correctional Facilities
- 15 - Crisis Residence
- 17 - Limited Mental Health Assisted Living Facility (LM-ALF)
- 99 - Not Available or Unknown
For example, ME1 and ME2 have the following performance outcome records:
PROVID / SPROVID / SSN / RESIDENTIAL STATUS59-1234567 / 59-7654321 / 123456789 / 01 - Independent Living-alone
59-1234567 / 59-7654321 / 987654321 / 05 - Dependent Living-with Non-Relatives
59-1234567 / 59-2222222 / 121212121 / 13 - Correctional Facility (NOT INCLUDED)
59-3333333 / 59-5555555 / 954673027 / 15 - Crisis Residence
At the ME level, the percent of adults with serious mental illness who are living in stable housing for ME1 (59-1234567) is:
1)Numerator = 2
2)Denominator = 2
3)Percent = 100.00%
4)Round = 100.00%
At the ME level, the percent of adults with serious mental illness who are living in stable housing for ME2 (59-333333333) is:
1)Numerator = 0
2)Denominator = 1
3)Percent = 0.00%
4)Round = 0.00%
At the SPROVID level, stable housing for SPROVID 59-7654321 is:
1)Numerator = 2
2)Denominator = 2
3)Percent = 100.00%
4)Round = 100.00%
M0743 Percent of adults in forensic involvement who live in stable housing environment.
- This outcome is reported as a percent.Persons whose legal status at the start of the episode of care indicates forensic involvement;
- Release pending hearing-competent
- Release pending hearing-ITP
- Conditionally released-ITP
- Released pending hearing – NGI
- Conditionally released – NGI
- Incompetent to Proceed – Age 21+
- Received mental health treatment services;
- Eligible services limited to:
- 06 - Day / Night
- 08 - In-Home and On-Site Services Overlay
- 12- Medical Services
- 14 - Outpatient-Individual
- 20 - Residential Level 3
- 21 - Residential Level 4
- 34- FACT Teams
- 35 - Outpatient-Group
- Exclude persons that received assessment only services unless the assessment was part of a competency to proceed to trial determination;
- 18 years of age or older;
- Most recent evaluation is periodic or discharge;
- Numerator = distinct count of persons where residential status includes any of the following:
- 01 - Independent Living-alone
- 02 - Independent Living-with Relatives
- 03 - Independent Living-with Non-Relatives
- 04 - Dependent Living-with Relatives
- 05 - Dependent Living-with Non-Relatives
- 06 - Assisted Living Facility (ALF)
- 07 - Foster Care/Home
- 08 - Group Home
- 11 - Nursing Home
- 12 - Supported Housing
- 17 – Limited Mental Health Assisted Living Facility (LM-ALF)
- Denominator = distinct count of persons where residential status includes any of the following:
- 01 - Independent Living-alone
- 02 - Independent Living-with Relatives
- 03 - Independent Living-with Non-Relatives
- 04 - Dependent Living-with Relatives
- 05 - Dependent Living-with Non-Relatives
- 06 - Assisted Living Facility (ALF)
- 07 - Foster Care/Home
- 08 – Adult Residential Treatment Facility
- 09 - Homeless
- 10 - Hospital
- 11 - Nursing Home
- 12 - Supported Housing
- 13 - Correctional Facility
- 15 - Crisis Residence
- 17 – Limited Mental Health Assisted Living Facility (LM-ALF)
- 99 - Not Available or Unknown
M0744 Percent of adults in mental health crisis who live in stable housing environment.
This outcome is reported as a percent.
- Persons that do not meet criteria for having a severe and persistent mental illness or forensic involvement that received at least one CSU or Crisis Support service during the review period;
- Received mental health treatment services;
- Eligible services limited to:
- 06 - Day / Night
- 08 - In-Home and On-Site Services Overlay
- 12- Medical Services
- 14 - Outpatient-Individual
- 20 - Residential Level 3
- 21 - Residential Level 4
- 34- FACT Teams
- 35 - Outpatient-Group
- Exclude persons that received assessment only services unless the assessment was part of a competency to proceed to trial determination;
- 18 years of age or older;
- Most recent evaluation is periodic or discharge;
- Numerator = distinct count of persons where residential status includes any of the following:
- 01 - Independent Living-alone
- 02 - Independent Living-with Relatives
- 03 - Independent Living-with Non-Relatives
- 04 - Dependent Living-with Relatives
- 05 - Dependent Living-with Non-Relatives
- 06 - Assisted Living Facility (ALF)
- 07 - Foster Care/Home
- 08 - Group Home
- 11 - Nursing Home
- 12 - Supported Housing
- 17 – Limited Mental Health Assisted Living Facility (LM-ALF)
- Denominator = distinct count of persons where residential status includes any of the following:
- 01 - Independent Living-alone
- 02 - Independent Living-with Relatives
- 03 - Independent Living-with Non-Relatives
- 04 - Dependent Living-with Relatives
- 05 - Dependent Living-with Non-Relatives
- 06 - Assisted Living Facility (ALF)
- 07 - Foster Care/Home
- 08 - Group Home
- 09 - Homeless
- 10 - Hospital
- 11 - Nursing Home
- 12 - Supported Housing
- 13 - Correctional Facility
- 15 - Crisis Residence
- 17 – Limited Mental Health Assisted Living Facility (LM-ALF)
- 99 - Not Available or Unknown
CHILDREN’S MENTAL HEALTH
M0031 Number of SED children to be served
This output is reported as a whole number.
- Children identified with severe emotional disturbance at the start of the episode of care;
- Received mental health services;
- Under 18 years of age at the time of admission;
- Distinct count at:
- ME level;
- Subcontractor level.
M0032 Number of ED children to be served
- Children identified with emotional disturbance at the start of the episode of care;
- Received mental health services;
- 18 years of age or younger;
- Distinct count at:
- ME level;
- Subcontractor level.
M0033 Number of at-risk children to be served
- Children who do not meet criteria for emotional disturbance or severe emotional disturbance at the start of the episode of care;Received mental health services;
- Under 18 years of age at the time of admission;
- Distinct count at:
- ME level;
- Subcontractor level.
M0377 Percent of children with emotional disturbances who improve their level of functioning
- Children identified with emotional disturbance at the start of the episode of care;
- Received mental health services;
- Under 18 years of age at the time of admission;
- The Department’s tool for measuring functional level is the Children’s Functional Assessment Ratings Scale (CFARS);
- Must have two CFARS for comparison purposes;
- Current CFARS cannot be an admission CFARS.
- Prior CFARS cannot be a discharge CFARS.
- For each child per provider with a pair of CFARS
- Sum together the scores on the 16 domains to arrive at a total CFARS scores for the current and for the prior CFARS.
- Subtract the current CFARS total score from the prior CFARS total score
- Assign a score of +1 to improved for each child if:
- Current score minus prior score is negative or
- Current total score less than 48 and danger to self and danger to others are both less than or equal to three;
- Else assign a score of 0 to improved for each child.
- Numerator = Count of all children where improved = 1;
- Denominator = Count of all children where improved =0 or 1;
- Round to nearest whole number.
For example, ME1 has the following CFARS records:
RECORD / PROVID / SPROVID / SSN / EVALUATION DATE / PURPOSE / TOTAL SCORE1 / 59-1234567 / 59-7654321 / 123456789 / 07/22/2013 / 1 – ADMISSION / 120
2 / 59-1234567 / 59-7654321 / 123456789 / 02/01/2014 / 2 – PERIODIC / 90
3 / 59-1234567 / 59-2222222 / 010101010 / 09/18/2013 / 1 – ADMISSION / 115
4 / 59-1234567 / 59-5555555 / 954673027 / 06/20/2013 / 3 – DISCHARGE / 80
5 / 59-1234567 / 59-5555555 / 954673027 / 08/10/2013 / 1 - ADMISSION / 95
In the example above, only records 1 and 2 are valid pair of CFARS for comparison. Records 4 and 5 would not be valid as the current CFARS is an admission and the prior was a discharge.
At the ME level, the percent of children with emotional disturbances who improve their level of functioning would be calculated as:
1)Current Total Score (90) minus prior Total Score (120) = -30;
2)Assign a score of +1 to improved for SSN 123456789;
3)Numerator = count of records where improved = 1 (1);
4)Denominator = count of records where improved = 1 or 0 (1);
5)Percent = 100%
6)Round = 100%
M0378 Percent of children with serious emotional disturbances who improve their level of functioning
Children identified with serious emotional disturbance at the start of the episode of care;received mental health services;
- Under 18 years of age at the time of admission;
- Must have two CFARS for comparison purposes;
- Current CFARS cannot be an admission CFARS.
- Prior CFARS cannot be a discharge CFARS.
- For each child per provider with a pair of CFARS
- Sum together the scores on the 16 domains to arrive at a total CFARS scores for the current and for the prior CFARS.
- Subtract the current CFARS total score from the prior CFARS total score
- Assign a score of +1 to improved for each child if:
- Current score minus prior score is negative or
- Current total score less than 48 and danger to self and danger to others are both less than or equal to three;
- Else assign a score of 0 to improved for each child.
- Numerator = Count of all children where improved = 1;
- Denominator = Count of all children where improved =0 or 1;
- Round to nearest whole number.
For example, ME1 has the following CFARS records: