CIMOR How To…

 

Guidance on ADA Data Collection and Reporting in CIMOR

Created on 01/02/08

Updated on 03/21/11

Consumer Episode of Care

Admission

ADMISSION DATE

Indicates the date of the first face-to-face treatment contact (includes assessments.)

 

Important Notes: 

ADMISSION DATE and DISCHARGE DATE define the Consumer’s Episode of Care. 

 

Program FROM DATE and Program Level FROM DATE should never come before ADMISSION DATE.  Programs are contained within Episode’s of Care and Program Levels (if applicable) are contained within Programs.

ADMISSION REASON

Indicates the reason Consumer is being admitted to the program. (DMH standard definition)

 

Valid entries:

Criteria Met: - Generally applies to Consumers whose admission is voluntary (including voluntary by guardian) and who meet the eligibility criteria to receive services.

Court Ordered- A court has issued an order for the Consumer to receive outpatient services.

Commitment - A Consumer has been involuntarily admitted to receive inpatient services without a court order (e.g. admission by law enforcement)

Court Ordered & Commitment - A court has issued an order for the Consumer to receive inpatient services.

DD Intake and Evaluation – (Do not use for ADA Episode of Care)

Administrative Transfer – Transfer between facilities

 

Important Notes:

 

Involuntary commitments, where the individual presents a likelihood of serious harm to self or others as the result of substance abuse, should be marked either as Commitment or Courted Ordered & Commitment.  Involuntary commitments will involve either detox or residential services (9 CSR 30-3).  Involuntary commitments require specific forms:

 

Commitment will involve an Application Imminent Harm (DMH 132), an Affidavit (DMH 142), and a List of Witnesses (DMH 137) and is initiated by a Peace Officer or a Qualified Substance Abuse Counselor.

 

Courted Ordered & Commitment will typically involve an Order for 96 Hour Detention (DMH 129, OSCA MH 20) or a 30-day commitment order Judgment for Involuntary Detention (DMH 136, OSCA MH 40).

 

Codependents should be coded as Criteria Met.

 

Drug Court consumers should be coded as Criteria Met (but will need to select Drug Court as a REFERRAL SOURCE).

 

A consumer ordered to treatment by a probation or parole officer should be marked Criteria Met (but will need to select District Parole and Probation as a REFERRAL SOURCE).

 

DOC ID

 

Indicates the Department of Corrections identification number assigned to the Consumer.

 

Important Notes:

DOC ID is only applicable for those Consumers that have been or are currently under the supervision of the Missouri Department of Corrections.

 

DOC ID is a required field if the REFERRAL SOURCE is a DOC referral source.

 

INITIAL CONTACT DATE

 

Indicates the date the Consumer requested services and was available to receive services for the specified treatment episode. Initial request may have been over the phone or in person.

 

Important Notes:

 

If currently not collected, may enter “1/1/01” to signify “unknown/not collected.”

 

For a Consumer who is in an Episode of Care and is currently receiving services:  If a second Episode of Care must be created for legitimate administrative reasons, then enter “1/1/01” on the second Episode of Care to signify “not applicable.”

 

INITIAL CONTACT DATE is not date that the Consumer first ever contacted the provider if consumer had prior episodes.  INITIAL CONTACT DATE refers to the current episode of care.  It will be used to calculate “days waiting to enter treatment”.  It is intended to capture the number of days the client must wait to begin treatment because of program capacity, treatment availability, admissions requirements, or other program requirements.  It should not include time delays caused by client unavailability or client failure to meet any requirement or obligation.

 

INITIAL CONTACT DATE may never be greater than admission date.

INITIAL CONTACT DATE may be equal to admission date if Consumer was admitted when treatment was first requested.

INITIAL CONTACT DATE may equal the date the Consumer was placed on a waiting list if a treatment slot was not available upon first request.

DIVISION

Consumers receiving substance abuse treatment services will be enrolled under ADA Division.

PROBATION & PAROLE

 

If REFERRAL SOURCE = District Probation and Parole:  Indicates the probation and parole office that referred consumer to services.

 

If REFERRAL SOURCE = DOC – Institutional Treatment Program:  Indicates the correctional center that referred consumer to services.

 

[See CIMOR for specific list.]

 

Important Notes:

 

This field only appears if District Probation/Parole or DOC – Institutional Treatment Program is selected for REFERRAL SOURCE.

Obtain PROBATION & PAROLE from the Missouri Department of Corrections – Community Services Treatment Referral Form.  It is important that the correct P&P Office be entered into CIMOR as ADA must generate reports by P&P Office.

PROVIDER SITE

 

Important Notes: 

It is acceptable for the enrolling agency to admit (EOC Admission screen) under the parent agency but encounters (EOC Services screen) must be recorded under the site where services are provided.

 

Parent (main) sites are of the format “Agency Name” while children (satellite) sites are of the format “Agency Name – City” or “Agency Name – City (Street).”  When entering encounter data,

 

Do not put encounter data under parent site unless Consumer received services at the parent site.

 

REFERRAL SOURCE

Describes the person or agency referring the Consumer to the program.

 

This is a field that is used department wide and must serve many uses.  The list of selections for this field is long and selections are not always mutually exclusive.  Listed below are the preferred selections to be used for ADA Consumers.

 

Preferred valid entries for ADA Consumers:

 

CRIMINAL JUSTICE INVOLVEMENT

Attorney / Legal Counsel

Drug Court

Court, Law Enforcement, Corrections – Other than drug court, DOC program, or SATOP

District Probation and Parole

DOC – Institutional Treatment Program– (Only for use by DOC programs)

DOC – Transitional Housing– (Only for use by DOC programs)

DOC – Other – (Only for use by DOC programs)

Mental Health Court

SATOP Screening – Includes DUI/DWI

Other, Non-Voluntary - (Use only if no other criminal justice involvement category works)

 

MENTAL HEALTH / HEALTH

CMHC – Community Mental Health Center

Disease Management– Program funded by DMH and MO HealthNet

Freestanding ADA– Another ADA treatment agency

Private Practice MH Prof – Private Practice Mental Health Professional

Non-Psychiatric Physician

Other Mental Health Facility

Managed Behavioral Health Organization

Managed Care Health Plan

Medical Facility– Medical facility (non-mental health)

Non-Psychiatric Physician

Veterans Administration

 

INDIVIDUAL

Self

Family, Relatives

 

OTHER

Clergy

Department of Social Services

Former Consumer

Help Line– Includes Missouri’s Problem Gambling helpline (888-BETS-OFF) and TEL-LINK (DHSS’s referral line for maternal and child health care)

LEAD Institute– Leadership Education and Advocacy for the Deaf

School System

Self Help

Social or Community Agency (unspecified)

Other (Unspecified) – (Limit use for ADA Consumers)

 

Important Notes: 

The above list does not preclude user from using other entries if user has a compelling reason to do so. 

 

Do not use the selections beginning with "Inpatient.."  These selections were requested for use with DD Consumers.

 

If DOC and one of the MO HealthNet plans referred a consumer, the DOC referral should “trump” the MO HealthNet plan.

 

If referral to treatment was DOC or Drug Court, in particular, be sure to mark appropriate referral source.  ADA must be able to identify DOC and Drug Court referrals for reporting purposes.

Commitment

 

ADMISSION TYPE

 

Describes the type of commitment.

 

This is a field that is used department wide and the list of selections for this field is long.  Not all selections are appropriate for ADA admissions.  Listed below are the recommended selections for use for ADA Consumers.

 

Recommended entries for ADA Consumers:

 

VOLUNTARY - ADULT

Vol - Adult – Self: Adult by Self

Vol - Adult – Guardian: Adult by Guardian

Vol - Adult - Dur Pow Atty: Adult by Durable Power of Attorney

 

VOLUNTARY - MINOR

Vol - Minor – Guardian: Minor by Guardian

Vol - Minor – Self: Minor by Self

Vol - Minor – Parent: Minor by Parent

Vol - Minor - Legal Custodian: Minor by Legal Custodian

 

INVOLUNTARY – COURT ORDER

Invol Civ - Ad Ct Ord: Adult Court Order

Invol Civ - Minor Ct Ord: Minor Court Order

 

INVOLUNTARY – INITIATED BY A PEACE OFFICER

Invol Civ - Ad Ct Ord (Peace Off-Imm Harm): Adult Court Order by Peace Officer (Imminent Harm)

Invol Civ - Minor Ct Ord (PeaceOff-Imm Harm): Minor Court Order by Peace Officer (Imminent Harm)

 

INVOLUNTARY – INITIATED BY A QSAP

Invol Civ - (Qual ADA Couns-Imm Harm): by Qualified Alcohol and Drug Abuse Counselor (QSAP) (Imminent Harm)

 

Important Notes:

Involuntary commitments, where the individual presents a likelihood of serious harm to self or others as the result of substance abuse, require specific forms:

 

Commitment by a Peace Officer

 

If the involuntary commitment was initiated by a Peace Officer, then the following forms would be presented:

·        an Application Imminent Harm (DMH 132),

·        an Affidavit (DMH 142), and

·        a List of Witnesses (DMH 137).

 

If Consumer is an adult – code as Invol Civ - Ad Ct Ord (Peace Off-Imm Harm).

If Consumer is a minor – code as Invol Civ - Minor Ct Ord (PeaceOff-Imm Harm).

 

Commitment by the Court

 

If the involuntary commitment was court ordered, then the following forms are typically involved:

·  96 hour: an Order for 96 Hour Detention (DMH 129, OSCA MH 20) or

·  30 day: Judgment for Involuntary Detention (DMH 136, OSCA MH 40).

 

If Consumer is an adult – code as Invol Civ - Ad Ct Ord.

If Consumer is a minor – code as Invol Civ - Minor Ct Ord.

 

Commitment by a Qualified Substance Abuse Professional (QSAP)

If the involuntary commitment was initiated by a QSAP, this would involve the same forms as listed under Peace Officer.  This would be coded as Invol Civ - (Qual ADA Couns-Imm Harm).

 

Codependents should not be marked involuntary commitment.

 

A Drug Court recommendation or sanction or a Probation/Parole Office mandate do not constitute involuntary commitments.

 

If commitment status changes from involuntary to voluntary or voluntary to involuntary, then a new commitment needs to be added to CIMOR.

 

COUNTY

 

Identifies the county which originated the commitment order, generally found on the commitment forms.

 

FROM DATE

 

Start date of commitment.

 

TO DATE

 

End date of commitment.

 

PRIMARY COMMITMENT

 

For ADA, identifies the current commitment.

 

Important Notes:

For an ADA Episode of Care, only one ADA commitment will exist at any given time (Note this may be different for a CPS Episode of Care) but an ADA Episode of Care may have multiple commitments covering different periods of time (i.e. Client’s status changes from voluntary to involuntary)

Discharge

DISCHARGE REASON

Reason for closing Consumer’s ADA Episode of Care.

 

Valid entries:

Additional Services Advised, Referral Made– Satisfactory progress in treatment and is being referred to another ADA agency for continuation of treatment (Note AA/NA is not considered ADA treatment)

Admitted in Error – To be used when admission made to wrong Consumer and cannot be deleted because diagnosis has been entered.

Consumer Completed Treatment– Consumer has satisfactorily completed his/her individual treatment plan and is not being referred to any other level of ADA treatment.  (Note AA/NA is not considered ADA treatment.)  Also appropriate for Consumers who have self-terminated after significant engagement in treatment with serious work on treatment plan objectives and reason for discharge as Completed is most accurate description of episode.

Consumer died - (Also enter deceased date, if known, on Consumer Demographics)

Consumer dropped out – Program is willing to continue treatment services but Consumer stopped showing up for or participating in planned ADA treatment services.

Consumer moved away – Consumer relocated to area away from treatment provider

Consumer would not comply with rules– includes Consumer showing up for treatment under the influence

Incarcerated-offense during treatment / satisfactory progress – Consumer incarcerated due to an offense committed while in treatment and Consumer was making satisfactory progress in treatment / recovery.

Incarcerated-offense during treatment / unsatisfactory progress – Consumer incarcerated due to an offense committed while in treatment and Consumer was making unsatisfactory progress in treatment / recovery.

Incarcerated-charge pre-treatment / satisfactory progress – Consumer incarcerated due to old warrant or charge arising prior to treatment and Consumer was making satisfactory progress in treatment / recovery.

Incarcerated-charge pre-treatment / unsatisfactory progress – Consumer incarcerated due to old warrant or charge arising prior to treatment and Consumer was making unsatisfactory progress in treatment / recovery.

Medical Reasons – Other health or mental health issues prevent Consumer from continuing ADA treatment.  May include transfer to hospital or other health care facility.

Transferred Consumer – Unsatisfactory progress in treatment and is being referred to another agency for ADA treatment. (Note AA/NA is not considered ADA treatment)

Did not meet assessment criteria –To be used when Consumer is admitted into an ADA EOC but subsequent assessments indicate Consumer does not need ADA treatment.

 

Important Notes:

 

NOTE For the person entering a discharge reason, it is important to find the best fitting category.

 

For the purpose of DISCHARGE REASON, the term referral is taken to mean referral to ADA treatment and not to self-help groups or non-ADA treatment.  ADA will use data item FOLLOW-UP TYPE to collect information on follow-up recommendations including that for self-help groups or non-ADA treatment.

DISCHARGE DATE

The date of the last service in the Consumer’s Episode of Care.

 

Important Notes:

 

ADMISSION DATE and DISCHARGE DATE define the Consumer’s Episode of Care.  Program TO DATE and Program Level TO DATE should never come after DISCHARGE DATE.  Programs are contained within Episodes of Care and Program Levels (if applicable) are contained within Programs.

FOLLOW UP TYPE

Indicates type of program/agency recommended to Consumer upon discharge.  For ADA Episodes of Care, priority should be given to ADA treatment or ADA support follow up types.  If no ADA follow up type is provided, then enter other applicable follow up type.

 

Valid entries:

…for ADA treatment or support

Community Self-Help – Peer-based groups including AA/NA, Al-Anon, Gambler’s Anonymous

Inpatient Substance abuse – Detox with hospital supervision

Outpatient Treatment – ADA outpatient treatment

Residential Treatment Center– ADA residential treatment

Recovery Support – Agencies providing non-clinical treatment services supportive of recovery including spiritual counseling, employment coaching, life skills training, etc.

 

…for other mental health or medical

Administrative Agent

Case management

Community program – (Non-ADA)

Community Psychiatric Rehabilitation Center

Inpatient medical facility – Medical (non-mental health) treatment with hospital supervision

Inpatient psychiatric facility– Psychiatric treatment with hospital supervision

Medication Management, PCP –Primary care physician

Medication Management, Psychiatrist

Outpatient Clinic Program – (Non-ADA)

Residential Care Facility – (Non-ADA)

Sheltered Living Situation – Living environments organized to support people with disabilities

Sheltered Work Environment- Work organized by specialized providers (usually contracted with DESE) to create assembly jobs for people with disabilities

Skilled Nursing Facility

 

…for other

Half-way House

Returned to Penal/Correctional Inst

Other – (Only if no other category is suitable, specify in comments)

None

 

DO NOT USE:

Against Medical Advice- (Do not use for ADA Consumers)

Medical Hospital – (Do not use for ADA Consumers)

 

Diagnosis

 

For CSTAR Consumers, clinical diagnosis information must be entered in CIMOR.  The CSTAR programs require at least one ADA diagnosis on Axis I.

 

Important Notes:

 

Diagnostic impressions are not allowed in CIMOR.  If a diagnostic impression is made, it goes in the Consumer’s file but not in CIMOR.

PRINCIPAL

The diagnosis that was “chiefly responsible for occasioning the evaluation or admission to clinical treatment.” (DSM-IV, American Psychiatric Association 2000.) 

 

Important Notes: 

For a given Episode of Care, only one diagnosis can be marked as PRINCIPAL.

 

For an ADA Episode of Care and CSTAR program, an ADA diagnosis must be marked as PRINCIPAL.  In CIMOR, diagnosis information is associated with the Episode of Care.  A co-occurring Consumer can have an ADA principal diagnosis on an ADA episode of care and a CPS principal diagnosis on a CPS episode of care.

 

PRIMARY

A primary diagnosis is one that is not dependent on a co-existing illness.

 

Important Notes: 

For a given Episode of Care, more than one diagnosis can be marked as primary.

Program

STATUS

Indicates status of Consumer’s program

 

Valid entries:

…for Program Assignment:

 

Assigned – Use for all new assignments.

…for Program Closure:

Administrative Discharge– (Reserve for use by Central Office)

Completed – Consumer has completed the program goals or has had significant engagement in treatment with serious work on treatment plan objectives so that status as Completed is most accurate description

Eloped – Program is willing to continue treatment services but Consumer stopped showing up for or participating in planned ADA treatment services.

Incorrectly assigned – Incorrect program has been selected.

Noncompliant – Consumer would not comply with program/agency rules including Consumer showing up for treatment under the influence.

On Leave – (Do not use for ADA Program Assignment.)

Transferred – Consumer is being assigned to a different program or referred to a different ADA treatment agency.

Withdrawn – Agency is terminating Consumer’s treatment due to non-compliance

LIVING ARRANGEMENT (defined under Consumer Demographics)

FROM DATE (PROGRAM/LEVEL)

Indicates start date of the program or program level.

 

Important Notes

Program FROM DATE and Program Level FROM DATE should never come before ADMISSION DATE.  Programs are contained within Episode’s of Care and Program Levels (if applicable) are contained within Programs.

 

TEDS Data

General/Family/Legal

CURRENTLY PREGNANT

Indicates if female Consumer is pregnant.

 

Valid entries:

No

Yes

Unknown

Refused to answer

 

Important Notes

If Consumer’s pregnancy status changes during treatment, do update information in this field.  Avoid using selection Unknown.  Do ask female Consumers about pregnancy status.

DATA COLLECTION DATE

 

Indicates most recent date in which the Consumer was interviewed and TEDS data was collected.

 

Important Notes:

 

TEDS data must be collected at admission; level program level changes, if applicable; and at discharge.

 

DATA COLLECTION DATE must fall within the PROGRAM FROM DATE and TO DATE and PROGRAM LEVEL FROM DATE and TO DATE, if applicable.

 

DATA COLLECTION DATE cannot be a future date unless the program level is an authorized level and DATA COLLECTION DATE is equal to the program level FROM DATE.

At program closure, DATA COLLECTION DATE must equal the Program TO DATE.

 

LEGAL STATUS

 

Indicates Consumer’s current judicial status.

 

Valid entries:

 

Not Applicable – No current involvement with the judicial system.

Awaiting Disposition

On Probation

On Parole

Incarcerated

Unknown – (Only allowed at program closure when Consumer PROGRAM STATUS is not Completed.)

 

LIVING ARRANGEMENT (defined under Consumer Demographics

 

MARITAL STATUS (defined under Consumer Demographics

 

Important Notes:

CIMOR will prompt user if Consumer’s age<18 and MARITAL STATUS is anything other than NEVER MARRIED.

NUMBER OF ARRESTS IN PAST 30 DAYS

 

Indicates number of arrests Consumer has had in the past 30 days.  Data item is collected at admission; level program level changes, if applicable; and at discharge.

 

Valid entries:

 

0, 1, 2, …, 96 (Listed separately)

Unknown (Valid only at Program Closure when Consumer PROGRAM STATUS is not Completed).

 

NUMBER OF CHILDREN IN YOUR CARE (defined under Consumer Demographics

 

Important Notes:

 

Does not include step-children.

 

If a Consumer has more than 20 children in his/her care, select 20.

 

NUMBER OF CHILDREN REMOVED FROM CUSTODY

 

Number of children that Division of Family Services has removed from Consumer’s custody.

 

Valid entries:

 

0, 1, 2, …, 20 (Listed separately)

Unknown – (Valid only at Program Closure when Consumer PROGRAM STATUS is not Completed)

 

Important Notes:

Does not include step-children.

 

NUMBER OF LIFETIME DUI ARRESTS

 

Indicates number of DUI arrests Consumer has had over the course of his/her lifetime.  Data are collected at admission, may be updated as needed.

 

Valid entries:

 

0, 1, 2, …, 96 (Listed separately)

 

VETERAN STATUS

 

Indicates whether Consumer has ever served in the Uniformed Services.

 

Valid entries:

 

Yes

No

 

Important Notes:

 

“Armed Forces” include Army, Navy, Air Force, Marines, Coast Guard, Public Health Service Commissioned Corps, Coast and Geodetic Survey, etc.)

 

CIMOR will prompt user if Consumer’s age < 18 and VETERAN STATUS=yes.

School/Work/Support

 

CONSUMER WEEKLY INCOME

Indicates weekly income of Consumer only even if Consumer is a minor.

 

Valid entries:

 

None

$1 - $49

$50 - $99

$100 - $149

$150 - $199

$200 - $299

$300 - $499

$500 and over

Unknown – (Valid only at Program Closure when Consumer PROGRAM STATUS is not Completed.)

 

Important Notes:

Note difference between WEEKLY INCOME and MONTHLY INCOME.  WEEKLY INCOME refers to Consumer’s income.  MONTHLY INCOME refers to household income. (…and WEEKLY INCOME refers to a shorter timeframe.)

EDUCATION (STATUS)

Specifies the highest school grade the Consumer has completed in formal education.  This can include education received while incarcerated.

 

Valid entries:

Kindergarten

1st Grade – 12th Grade - (Listed separately)

GED

1st Year College – 4th Year College - (Listed separately)

Graduate College

1 Yr Graduate

3 Yr Graduate

Doctorate Degree

Master Degree

No Academic

Tech Education in addition to High School

Tech Education in lieu of High School

Unknown - (Should not be used for ADA program assignment)

 

EMPLOYMENT STATUS (defined under Consumer Demographics

 

Important Notes:

 

CIMOR will prompt user if Consumer’s age<16 and EMPLOYMENT STATUS is full-time or part-time.

 

ENROLLED IN SCHOOL OR JOB TRAINING

Indicates if Consumer is enrolled in school or job training.

 

Valid entries:

No – Not currently engaged in any educational type activities

Yes – Includes formal academic education (elementary, secondary, college), GED classes, adult basic education, adult continuing education (non-credit), vocational school or training that is a certificate or diploma program,

Unknown - (Not allowed on ADA Program Assignment)

GRADE POINT AVERAGE (GPA)

Indicates Consumer’s Grade Point Average (GPA) for the most recent single term.  GPA is required for all CSTAR Adolescent primary Consumers.

 

Valid entries:

 

Grade

4-Point Scale

11-Point Scale

A+ / A

4

11

A-

3.67

10

B+

3.33

9

B

3

8

B-

2.67

7

C+

2.33

6

C

2

5

C-

1.67

4

D+

1.33

3

D

1

2

D-

0.67

1

F

0

0

 

Not Applicable – Use for 19 year-old consumers or adolescents who already have a GED but are enrolled in the CSTAR Adolescent Program.

Unknown - (Valid only at Program Closure when Consumer PROGRAM STATUS is not Completed.)

 

Important Notes:

The intent of this data item is to capture information on current school performance.  Do not report a GPA based on grades earned over multiple years (i.e. Cumulative GPA.)

 

Report the GPA for the current quarter if known; otherwise, report GPA for the most recent completed quarter (or other reporting term) as indicated on student’s most recent report card.

 

HOUSEHOLD MONTHLY INCOME AMOUNT

Indicates gross monthly income from all sources as shown on the most current Standard Means Test.  Includes income sources from Consumer and Spouse (if applicable) or Parents if parents are the financially responsible party.  Sources of income includes employment (wages, salary, tips, bonuses, self-employment), unearned income (rental income, dividends, interest), child support, retirement / pensions / social security / other benefits (i.e. VA), alimony, assistance (unemployment, SSI, worker’s comp)

INCOME SOURCE

Indicates Consumer’s principal source of financial support.  For children under 18, this field indicates the parent’s primary source of income support.

 

Valid entries:

[Employment]

Employment

Self Employment

[Retirement]

Civil Service Retirement

Military – Military Retirement Allotment

RR – Railroad Retirement

SSA – Social Security Benefits

Retirement – Other Retirement

 

[Other Benefits / Assistance]

VA – Veterans Administration Benefits Disability

SSDI – Social Security Disability Income

SSI – Supplemental Security Income

Work Comp– Workers Compensation

Public Assistance– State

Unemployment

Disability – Disability Income from source other than Social Security Disability Income and Veterans Administration Benefits Disability.

 

[Other Sources]

Alimony – Maintenance Alimony

Child Support

Family/Friends

Illegal

UEI – Unearned (Dividends, Interest, Rental Income)

LEGAL STATUS

Indicates Consumer’s current judicial status.

 

Valid entries:

Not Applicable – No current involvement with the judicial system.

Awaiting Disposition

On Probation

On Parole

Incarcerated

Unknown – (Not allowed on ADA Program Assignment)

 

OCCUPATION

 

Indicates Consumer’s current occupation (i.e. “What kind of work is Consumer doing?”)

 

Valid entries:

 

Not applicable – Includes Unemployed and Not in Labor Force (i.e. homemakers, students, preschool, retired, disabled, those that are not employed and have not been seeking work in the past 30 days).

Clerical Workers – Typically, office support work, includes secretaries and administrative assistants

Craftsman – Includes carpenters, construction workers, etc.

Farm Labors – Typically, non-skilled agricultural workers

Farmer & Farm Mgr – Owner or manager of farm / agricultural business.

Laborers, Non-Farm – Typically non-skilled, includes stockers, drivers, factory assembly workers, etc.

Managers, Officials, Proprietors – Typically involves managerial or administrative work, includes administrators, office executives, business owners, elected officials, etc.

Military Service

Operatives (Mech Indus) – Typically mechanical work, includes auto mechanics, factory mechanics, appliance repair, etc.

Professional – Typically work requiring a license, certification, or degree, includes nurses, accountants, teachers, engineers, dentist, doctors, veterinarians, etc.

Sales Workers – Automobile sales, retail sales, etc.

Service and Household Workers – Typically non-skilled, includes janitors and building cleaners, food service workers, cashiers, etc.

Other – (Can be used for ADA if no other category works)

 

Important Notes:

 

If Consumer has more than one occupation, identify the one that he/she spends the most time doing.

 

OCCUPATION cannot be Not Applicable if EMPLOYMENT STATUS is full-time or part-time.

CIMOR will default to Not Applicable if EMPLOYMENT STATUS is of the type Not in Workforce.  User may change from the default value as needed.

 

PUBLIC ASSISTANCE

 

Public assistance and social insurance programs Consumer is currently receiving.  Consumer may be in more than one PUBLIC ASSISTANCE program at a time.

 

Valid entries:

 

None – (If selected, cannot select any others) Consumer is not receiving any public assistance and not in any social insurance programs.

Temporary Assistance to Needy Families – (TANF)

Food Stamps

General Relief

Medicaid

Supplemental Security Income

Low-Income Home Energy Assistance

Legal Services For the Poor

In-Home Supportive Services

Grants to Assist Victims of Domestic Violence

Refugee Assistance

Substance Abuse Treatment Assistance

Psychiatric Services

Mental Retardation and Development Disabilities

School Lunch Assistance

Section 8 Housing Payments

Section 8 Housing Vouchers

Public Housing

Other Subsidized Housing

Higher Education Grants

Higher Education Loans

College Work/Study Payments

Head Start

Trade Adjustment Assistance

Missouri Crime Victim Compensation

Job Opportunities and Basic Skills Training

Veteran Compensation

Medicare

Social Security Retirement Benefits

Social Security Disability Benefits

Social Security Survivors’ Benefits

Black Lung Disease Benefits

Unemployment Compensation

Railroad Retirement Benefits

Worker’s Compensation

Veterans’ Pensions

Government Pensions

Other – (Use only if none of the other categories work).

 

Important Notes:

 

If Consumer has multiple types of public assistance, mark all that apply.  This field allows for multiple selections.  If None is marked, then no other selections can be made.

 

SPECIAL EDUCATION

 

Indicates the level of Consumer’s special education requirements.

 

Valid entries:

 

Special Education (Unspecified)

Trainable Mental Retardation (State Schools for the Retarded)

Educable Mental Retardation

Remedial Reading

Elementary and Secondary Special Education

Special School

Speech Therapy

Learning Disabled Classroom

Behavior Disordered Classroom

No Special Education

Resource Room

Special Education Testing Suggested

 

Sub Abuse/Medical

 

COUNTY WHERE SERVICES WILL BE RECEIVED

 

Indicates county where Consumer will receive ADA services.

 

Valid entries:

 

See CIMOR for actual list. Acceptable entries include any Missouri county name.

 

DEVELOPMENTAL PROBLEM

 

Indicates if Consumer has a developmental problem

 

Important Notes:

 

“Developmental Problem” is to include developmental disabilities such as mental retardation, cerebral palsy, head injuries, autism, epilepsy, and certain learning disabilities.  Such conditions must have occurred before age 22, with the expectation that they will continue.

 

MEDICATION PRESCRIBED FOR ADDICTION TREATMENT

Indicates medication that is prescribed as part of Consumer’s substance abuse treatment plan.

 

Valid entries:

 

None Prescribed

Naltrexone

Naloxone

Vivitrol

Other Antagonist

Methadone

Laam

Buprenorphine

Suboxone

Acamprosate calcium (Campral)

Propoxyphene-N

Cyclazocine

Disulfiram – (Antabuse)

Tranquilizers (Valium, Librium, etc.)

Anti-Depressants

Others – (Only use if no other category is appropriate)

 

Important Notes:

 

The intent of this field is to capture current status.  Historical data should not be reported here.

 

MEDICATION PRESCRIBED FOR ADDICTION TREATMENT may be prescribed by someone other than the enrolling agency.  The intent is to capture what medications are part of the Consumer’s treatment plan and not who prescribed the medications.

 

Be sure to update MEDICATION PRESCRIBED FOR ADDICTION TREATMENT if change occurs during the course of Consumer’s Episode.

 

This field is capturing information on pharmacological treatment.  Do not indicate substance abused here.

 

If Consumer is currently taking more than one medication, mark all that apply.  This field allows for multiple selections.  If None is marked, then no other selections can be made.

 

PRIMARY HEALTH INSURANCE

 

Indicates Consumer’s primary health insurance (if any).  The insurance may or may not cover alcohol or drug treatment.

 

Valid entries:

 

Blue Cross/Blue Shield

Health Maintenance Organization

Other Private Insurance

Medicare

Medicaid

Other (e.g. TRICARE, CHAMPUS)

None

 

PRIMARY SOURCE OF PAYMENT

 

Indicates primary source of payment for this ADA treatment.

 

Valid entries:

 

Blue Cross / Blue Shield

Medicaid

Medicare

Other Gov – Other Government Payments

Workers Comp – Workers Compensation

Other Insurance – Other Health Insurance Companies

Self Pay

No charge – Charity, Special Research or Teaching

Other – (Only use if no other category works)

 

Important Notes:

 

If multiple payment sources exist, select the payment source with the largest percentage.  When payment percentages are equal, then select either source.

 

Other Gov payment includes state general revenue and federal Substance Abuse Prevention and Treatment (SAPT) Block Grant funding streams (i.e. non-Medicaid POS funding.)

 

PRIOR DETOX

 

Indicates the number of previous Detox treatment episodes that Consumer has received in any alcohol and drug program.

 

Valid entries:

 

0 – No prior detox treatment.

1, 2, …, 4 (Listed separately)

5 or more

 

Important Notes:

 

Do not count the current treatment Episode.

 

PRIOR RESIDENTIAL

 

Indicates the number of previous residential treatment episodes that Consumer has received in any alcohol and drug program.

 

Valid entries:

 

0 – No prior detox treatment.

1, 2, …, 4 (Listed separately)

5 or more

 

Important Notes:

 

Do not count the current treatment Episode.

 

PRIOR OUTPATIENT

 

Indicates the number of previous outpatient treatment episodes that Consumer has received in any alcohol and drug program.

 

Valid entries:

 

0 – No prior detox treatment.

1, 2, …, 4 (Listed separately)

5 or more

 

Important Notes:

 

Do not count the current treatment Episode.

 

PROVIDER SITE

 

Indicates site at which consumer will receive services.

 

Important Notes:

 

If consumer will be receiving services from multiple sites, select the site where the majority of services will be received.

 

Be sure to update PROVIDER SITE when transferring Consumer to a different program level at a different location.

 

Do not confuse PROVIDER SITE on the Episode Admission and PROVIDER SITE on ADA TEDS:

 

Episode Admission: Parent organization may be selected for all Consumers.

ADA TEDS: Must select actual site where services will be delivered.

 

PSYCHOLOGICAL PROBLEM

 

Identifies whether Consumer has a psychological problem independent of his/her alcohol or drug use problem.  Consumer may or may not be receiving treatment for psychological problem.  Consumer’s psychological problem may or may not be under control.

 

Valid entries:

 

No

Yes

 

Important Notes:

 

For the purpose of this data item, “psychological problem” may include schizophrenia and other psychotic disorders, mood disorders, anxiety disorders, somatoform disorders, factitious disorders, dissociative disorders, sexual and gender identify disorders, eating disorders, sleep disorders, impulsive-control disorders, adjustment disorders, personality disorders, and disorders usually first diagnosed in infancy, childhood, or adolescence. (DSM-4, American Psychiatric Association 2000)

 

If during the course of treatment, Consumer is diagnosed with a psychiatric disorder, be sure to update data item PSYCHOLOGICAL PROBLEM.

 

SUBSTANCES ABUSED

 

This section collects data on Consumer’s substance problems.  Each substance ranking (Primary, Secondary, Tertiary) has associated fields for route of administration, frequency of use, and age of first use.  The ranking is to identify an ordering of Consumer’s substance problem based on the impact to Consumer’s quality of life.  Determination should be based on a combination of factors such as the relative importance of the substance in causing the Consumer to seek treatment, the frequency and intensity of the abuse, the substance that caused the person the most problems, etc.  Primary substance data must be provided for a primary user (non-collateral) Consumer. Secondary and tertiary data must be collected from Consumer.

 

Age of First Use

 

Indicates actual or approximate age Consumer first used substance identified in the SUBSTANCE data field.

 

Valid entries:

 

0, 1, 2, …, 96 (Listed separately)

 

Important Notes:

 

AGE OF FIRST USE cannot be greater than Age at Admission.

 

If Substance Abused is None, then AGE OF FIRST USE will default to Not Applicable.

 

Frequency of Use in Past 30 Days

 

Indicates number of days in the last 30 that Consumer reported any use at all of the substance identified in the SUBSTANCE data field.

 

Valid entries:

 

0, 1, 2, …, 30 (Listed separately)

Unknown – (Valid only at Program Closure when Consumer PROGRAM STATUS is not Completed)

 

Important Notes:

 

The response cannot be more than 30 days.

 

Ask specifically about behavior in “the past 30 days”.  Do not use “in the past month” as a substitute – this may lead to confusion and inaccurate responses.  Example:  If data are collected from Consumer on May 15th, the past 30 days covers April 16 to May 15.

 

If SUBSTANCE ABUSED is None, then AGE OF FIRST USE will default to Not Applicable.

 

Route

 

Identifies the typical way in which Consumer administers SUBSTANCE.

 

Valid entries:

 

Oral – Includes ingesting, swallowing, drinking, or dissolving drugs in the month or sublingually.

Smoking – Includes smoking the drug on its own (in a pipe, bong, etc.) and putting the drug in a tobacco cigarette to be smoked.

Inhalation – Includes the deliberate concentration and inhalation of common household products to get high (“Huffing,” “Bagging,” “Sniffing,” “Snorting”). Also includes lighting or heating the drug and inhaling the resulting smoke.

IV Injection– Includes injecting drugs into veins.

Non-IV Injection – Includes injecting drugs into muscles and subcutaneous injecting (“skin popping”).

Not Applicable – Route will auto-populate with “Not Applicable” when “None” is selected for the secondary and/or tertiary drug.

 

Important Notes:

 

In cases where two or more routes are routinely used, the most serious route should be identified.  Order of severity from most to least: IV Injection, Non-IV Injection, Smoking, Inhalation/Sniff, Oral.

 

Make sure the ROUTE goes with the appropriate SUBSTANCE (i.e. no inhaling alcohol or injecting tobacco.)

 

If SUBSTANCE ABUSED is None, then ROUTE will default to Not Applicable.

 

Substance Abused

 

Indicates substances abused by Consumer.

 

Valid entries:

 

[Alcohol]

Alcohol

 

[Cocaine]

Crack – Includes freebase cocaine – chips, chunks, or rocks

Other Cocaine – Includes powder form (Cocaine hydrochloride.)

 

[Marijuana]

Marijuana / Hashish / THC – Includes Marinol (contains THC) if non-prescribed.

 

[Opiates]

Heroin

Morphine (Kadian, Avinza, MS Contin)

Fentanyl (Duragesic)

Diphenoxylate (Lomotil)

Non-prescription Methadone - (Do not report MEDICATION PRESCRIBED FOR ADDICTION TREATMENT here. Report substance abused.)

Codiene (700)

D-Propoxyphene (Darvon)

Oxycodone (Oxycontin)

Meperidine HCI (Demerol)

Hydromorphone (Dilaudid)

Pentazocine (Talwin)

Hydrocodone (Vicodin)

Tramadol (Ultram)

Other Opiates and Synthetics

 

[Hallucinogens]

PCP or PCP Combinations

LSD

Other Hallucinogens

 

[Stimulants]

Methamphetamine / Speed

Amphetamine (Adderall, Dexedrine)

Methylenedioxmethamphetamine (MDMA,Ecstasy)

Methylphenidate (Ritalin)

Other Amphetamines

Other Stimulants

 

[Benzodiazepines]

Alprazolam (Xanax)

Chlordiazepoxide (Librium)

Clorazepate (Tranzene)

Diazepam (Valium)

Flurazepam (Dalmane)

Lorazepam (Ativan)

Triazolam (Halcion)

Estazolam (ProSom)

Flunitrazepam (Rohypnol)

Clonazepam (Clonopin, Rivotril)

Other Benzodiazepines

 

[Tranquilizers]

Meprobamate (Miltown)

Other Tranquilizers

 

[Sedatives]

Phenobarbital

Secobarbital / Amobarbital (Tuinal)

Secobarbital (Seconal)

Mephobarbital (Mebaral)

Pentobarbital Na (Nembutal)

Other Barbiturate Sedatives

Ethclorvynol (Placidyl)

Glutethimide (Doriden)

Methaqualone

Other Non-Barbituarate Sedatives

Other Sedatives

 

[Inhalants]

Aerosols - Sprays that contain propellants and solvents.  Includes spray paints, deodorant and hair sprays, vegetable oil sprays for cooking, and fabric protector sprays.

Nitrites – Includes cyclohexyl nitrite, isoamyl (amyl) nitrite, isobutyl (butyl) nitrite (slang: “poppers,” “snappers”)

Solvents – Includes paint thinners and removers, dry-cleaning fluids, degreasers, gasoline, glues, correction fluids, and felt-tip marker fluids.

Anesthetics – Includes nitrous oxide, ether, halothane, chloroform

Other Inhalants

 

[Other drugs]

Diphenhydramine

Over-the-counter

Diphenylhydantion Phenytoin (Dilantin)

GHB/GBL (Gamma-Hydroxybutyrate, Gamma-Butyrolacton)

Ketamine (Special K) – Also “vitamin K”

Other Drugs – (Use if no other category works.)

Tobacco – (Valid only as secondary or tertiary.) – Includes cigarettes, cigars, and pipe, chewing tobacco.

 

[None]

None – only allowed for Secondary or Tertiary.

 

Important Notes:

 

Primary, Secondary, and Tertiary substance information must be collected from Consumer.  An attempt should be made to get a comprehensive picture of Consumer’s use of substance(s).  If Consumer has no Secondary substance, then enter None for SUBSTANCE for ranking Secondary.  If Consumer has no Tertiary substance, then enter None for SUBSTANCE for ranking Tertiary.  If None is indicated for SUBSTANCE, CIMOR will populate NUMBER OF DAYS OF USE IN PAST 30 DAYS, ROUTE, and AGE OF FIRST USE with Not Applicable.

 

The same SUBSTANCE cannot be listed as one more than one ranking (Primary, Secondary, Tertiary).

 

Unprescribed use of prescription medication or misuse of prescribed medication (e.g. taking more than prescribed) should also be recorded.

 

This is the substance list used for the federal TEDS reporting (with the exception of the Tobacco category.)  While other tools (i.e. ASI, GPRA) may use broader drug categories, be as specific as possible in identifying Consumer’s substance problem(s) for this data item.

 

Use Other Drugs as a last resort – if none of the other categories are appropriate.

 

IN THE PAST 30 DAYS, HOW MANY DAYS DID CONSUMER ATTEND SELF-HELP PROGRAMS

 

Indicates the number of days within the past 30 days that the consumer has attended a self-help program.  This includes attendance at AA, NA, Oxford House, Secular Organization for Sobriety, Women for Sobriety and other self-help/mutual support groups focused on recovery from substance abuse and dependence.

 

Valid entries:

 

0, 1, 2, …, 30 (listed separately)

Unknown (Valid only at Program Closure when Consumer PROGRAM STATUS is not Completed.)

 

Additional Closure

 

HIV TEST

 

Indicates the results of Consumer’s last HIV test.

 

Valid entries:

 

HIV Positive

AIDS/ARC Diagnosis - (AIDS / AIDS-related complex)

HIV Negative

HIV Status Unknown

Not Collected

 

NUMBER OF CHILDREN RETURNED TO CUSTODY

 

Number of children that Division of Family Services has returned to your custody.

 

Valid entries:

 

0, 1, 2, …, 20 (Listed separately)

Unknown – (Valid only at Program Closure when Consumer PROGRAM STATUS is not Completed.)

 

Important Notes:

 

Does not include step-children.

 

Data is collected at Program Closure only.

 

NUMBER OF CHILDREN RETURNED TO CUSTODY cannot be greater than NUMBER OF CHILDREN REMOVED FROM CUSTODY.

 

If a consumer had more than 20 children returned to his/her custody, then select 20.

 

TREATMENT BIRTHS

 

Number of Live Births

 

Number of live births given by pregnant Consumer during the current treatment program.

 

Valid entries:

 

0, 1, 2, …, 10 (Listed separately)

Unknown – (Valid only at Program Closure when Consumer PROGRAM STATUS is not Completed.)

 

Important Notes:

 

Data is collected at Program Closure only.

 

Make every attempt to collect this data if Consumer is a pregnant female.  This is an important outcome measure for ADA.  The treatment provider is expected to track this information while the consumer is engaged in treatment.  Reserve use of Unknown for rare occasions when information cannot be obtained.

 

If Consumer gives birth to living twins, then record “2” for NUMBER OF LIVE BIRTHS.

 

Number of Drug Free Births

 

Number of births given by pregnant Consumer during the current treatment program and where illicit drugs were not detected in newborn drug screening.

 

Valid entries:

 

0, 1, 2, …, 10

Unknown

 

Important Notes:

 

Data is collected at Program Closure only.

 

NUMBER OF DRUG FREE BIRTHS must be less than or equal to the NUMBER OF LIVE BIRTHS.   Reserve use of Unknown for rare occasions when information cannot be obtained.  Make every attempt to collect this data if Consumer is a pregnant female.  This is an important outcome measure for ADA.  The treatment provider is expected to track this information while the consumer is engaged in treatment.

 

Exposure Reason

 

Reason for newborn drug exposure.

 

Valid entries:

 

Entered treatment and delivered shortly thereafter

Tested positive for a drug with a long half-life

Relapse

Unknown

 

Important Notes:

 

Data is collected at Program Closure only.

 

EXPOSURE REASON is required if NUMBER OF DRUG FREE BIRTHS is less than the NUMBER OF LIVE BIRTHS.

 

Comments

 

COMMENTS

 

Text box may be used to add any pertinent notes regarding Consumer’s TEDS data, treatment planning or progress, etc.