CHAPTER 4

STATE DATA

TEDS is an aggregate of data collected through disparate State Substance Abuse Agency data collection systems. States have cooperated with the federal government in the data collection process, and significant progress has been made toward developing a standardized data set. However, because each state system is unique, and each State has unique powers and mandates, significant differences exist among States. These differences are compounded by evolving health care payment systems. Thus State-to-State comparisons must be made with extreme caution. Some sources of apparent State-to-State variation in substance abuse patterns include:

• States continually review and improve their data collection and processing. When possible, States send revised data for earlier years to TEDS. When this is not possible, however, the change in the data collection system may appear as an unusual increase in client admissions. For example, admissions in Iowa doubled between 1995 and 1996 because Iowa began to include Medicaid clients in its data reporting system in 1996.

  Table 4.1 presents key characteristics of State data collection systems. Most States require facilities that receive State/public funding to report data to the State. 'State/public funding' generally refers to funding distributed by the State Substance Abuse Agency, but may also include funding distributed through another public agency. Some States require that additional categories (e.g., private facilities, methadone clinics, etc.) also report. In some States, other categories of facilities report voluntarily.

  Most States report data on all clients in a facility that is required to report to the State. However, some States report only those clients that receive State/public funds.

  All States except Wisconsin are able to provide State-wide data. Wisconsin is unable to collect data from 5 counties (including the cities of Madison and Milwaukee). These counties represent an estimated 32% of the State/public-funded clients.

• Great variation is seen in the States' ability to identify and report client admissions and transfers. The goal for the TEDS system is to identify treatment episodes. Thus a change in service type or a change in provider, without an interruption in treatment, would ideally be categorized as a transfer. This requires, however, that clients be assigned unique IDs that can be linked across providers, and not all States are legally and/or technologically able to do this. A majority of States can identify transfers that occur when a client changes service type within the structure of a given provider. However, far fewer can identify a transfer that occurs when a client changes providers. Several States do not themselves track transfers, but report as transfers to TEDS those clients who are discharged and readmitted within a specified time-period (which may vary from State to State).

  Figure 22 and Table 4.2 portray individual State reporting patterns for admissions, transfers, and co-dependents.

• Not all States report all data items in the Minimum and Supplemental Data Sets. Most States report the Minimum Data Set for all or nearly all clients. However, the items reported from the Supplemental Data Set vary tremendously across States.

  Tables 4.3 and 4.4 indicate, by State, the item response rates for the Minimum and Supplemental Data Sets.

• States differ widely in the amount of public funding available for substance abuse treatment, and in the constraints placed on the use of funds. States may be directed to target special populations such as pregnant women or adolescents. Where funds are limited, States may be compelled to exercise triage in admitting persons to treatment, admitting only those with the most 'severe' problems. In States with higher funding levels, a larger proportion of the population in need of treatment may be admitted, including the less severely impaired.

• States may include or exclude certain sectors of the treatment population, such as those related to criminal justice or detoxification. Treatment programs based in the criminal justice system may or may not be administered through the State Substance Abuse Agency, and this relationship may change over time. Detoxification facilities, which can generate large numbers of admissions, are not uniformly considered as treatment facilities. For example, the number of TEDS admissions reported in Texas declined significantly from 1995 to 1996. The most significant factor in this decline was that Texas stopped reporting its criminal justice system's substance abuse clients to TEDS in 1996. In addition, a reallocation of resources resulted in the closure of several detoxification units, facilities which typically generate large numbers of admissions.

• Tables 4.5 - 4.7 present numbers of admissions and admission rates by State. Rates are presented as crude rates per 100,000 population. However, to facilitate comparisons, rates adjusted for age, sex, and race/ethnicity are also presented. This technique is used to take into account the demographic variation across States.

  Interpretation of these tables and comparison across States should be made cautiously, and should take into account the many sources of variation detailed above.