Form HLTH5516 "Application to Request Mha Mrr Data for Evaluation, Planning or Research - Mental Health & Substance Use (Mha Mrr) Data Checklist" - British Columbia, Canada

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Download Form HLTH5516 "Application to Request Mha Mrr Data for Evaluation, Planning or Research - Mental Health & Substance Use (Mha Mrr) Data Checklist" - British Columbia, Canada

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APPLICATION TO REQUEST MHA MRR DATA
FOR EVALUATION, PLANNING OR RESEARCH
MENTAL HEALTH & SUBSTANCE USE
DATA CHECKLIST
MINISTRY OF HEALTH USE ONLY
File Number
Date Received
Submit this completed form to the email address:
HealthDataHA@gov.bc.ca
ISP Appendix
Questions about the request process or any part of this application
may be directed to the email address above.
PROJECT TITLE
BASED UPON THE FOLLOWING COHORT NAMED AND DESCRIBED ON THE HEALTH DATA REQUEST FORM (HLTH 5426)
(if there is no cohort then write N/A)
AND FURTHER LIMITED TO THE DATE RANGE
(N.b. HAs collect and report data by fiscal year period)
(write N/A where not applicable)
From (yyyy/mm/dd)
To (yyyy/mm/dd)
OTHER DATE RANGE AND FILTERING CRITERIA
(more complex filtering may be possible and require additional details leading to additional custom coding and delays in processing your request)
DATA COMPONENT SELECTION
(Check the files you need)
The required fields must also be specified on later pages of this form.
DATA COMPONENT
NOTES
Client
Service Episode
Always required when other MHA MRR data are provided
Service Event
Diagnostic 5 (Containing DSM-5 codes)
Required by the MHA MRR only for level 3 services
Diagnostic (Containing DSM-IV TR codes)
Required by the MHA MRR only for level 3 services
Health of the Nation Outcome Scale (HoNOS)
Required by the MHA MRR only for level 2 and 3 services
Substance Use
Required by the MHA MRR only for level 2 and 3 services
Please consult the acccompanying data dictionary for information on level 1, 2, and 3 services.
HLTH 5516 2019/04/29 PAGE 1 OF 8
APPLICATION TO REQUEST MHA MRR DATA
FOR EVALUATION, PLANNING OR RESEARCH
MENTAL HEALTH & SUBSTANCE USE
DATA CHECKLIST
MINISTRY OF HEALTH USE ONLY
File Number
Date Received
Submit this completed form to the email address:
HealthDataHA@gov.bc.ca
ISP Appendix
Questions about the request process or any part of this application
may be directed to the email address above.
PROJECT TITLE
BASED UPON THE FOLLOWING COHORT NAMED AND DESCRIBED ON THE HEALTH DATA REQUEST FORM (HLTH 5426)
(if there is no cohort then write N/A)
AND FURTHER LIMITED TO THE DATE RANGE
(N.b. HAs collect and report data by fiscal year period)
(write N/A where not applicable)
From (yyyy/mm/dd)
To (yyyy/mm/dd)
OTHER DATE RANGE AND FILTERING CRITERIA
(more complex filtering may be possible and require additional details leading to additional custom coding and delays in processing your request)
DATA COMPONENT SELECTION
(Check the files you need)
The required fields must also be specified on later pages of this form.
DATA COMPONENT
NOTES
Client
Service Episode
Always required when other MHA MRR data are provided
Service Event
Diagnostic 5 (Containing DSM-5 codes)
Required by the MHA MRR only for level 3 services
Diagnostic (Containing DSM-IV TR codes)
Required by the MHA MRR only for level 3 services
Health of the Nation Outcome Scale (HoNOS)
Required by the MHA MRR only for level 2 and 3 services
Substance Use
Required by the MHA MRR only for level 2 and 3 services
Please consult the acccompanying data dictionary for information on level 1, 2, and 3 services.
HLTH 5516 2019/04/29 PAGE 1 OF 8
CLIENT DATA FIELD SELECTION
(This section only relevant when client data selected on page 1)
SUMMARY:
The client data elements provide demographic information. Client records must be accompanied by at least one service episode record.
FIELD NAMES
VARIABLE NAMES
REASON FOR REQUEST
PHN will not be released. A randomised
C2
PHN (Personal Health Care Number)
MRG_CLNT_ANON_ID
study ID will be provided.
C3
City
SRC_CITY
C4
Home Province, State or Other Country
SRC_PROV_STATE
Postal code is not available for regular
C5
Postal Code
data requests but various geographical
breakdowns can be provided.
Not available for regular data requests.
C6
Birth Date
SRC_BRTH_DATE
An age or age group can be provided.
C7
Sex Code
CLNT_GENDER_LABEL
C8
Marital Status
MRTL_STS_LABEL
C9
Height
HT
C10 Weight
WT
C11 Household Composition
HHLD_CMPSN_LABEL
C16 Highest Level of Education Completed
HGST_LVL_EDUC_LABEL
C17 Current Educational Engagement
CURR_EDUC_ENGMT_LABEL
C18 Employment Status Declaration
DCLRD_EMPL_STS_LABEL
C19 Employment Hours
MHA_EMPL_TM_LVL_LABEL
C20 WCB, Sickness or Disability Flag
SICK_DSBLTY_FLG_LABEL
C21 Duration of WCB, Sickness or Disability
DSBLTY_DUR_CAT_LABEL
C22 Criminal Justice Involvement
CRMNL_JSTC_STG_LABEL
C23 Nature of Criminal Justice Involvement
CRMNL_CHRG_CAT_LABEL
C24 Legal Status First Field
LGL_CSTRNT_1_LABEL
C25 Legal Status Second Field
LGL_CSTRNT_2_LABEL
C26 Estimated Age
EST_AGE_CAT_LABEL
C27 History of Suicide Attempts
SUICIDE_ATMT_HIST_FLG
C28 History of Violence
VLNC_EVDNC_LABEL
C29 Age of First Use of Alcohol
FRST_ALCL_USE_AGE_LABEL
C30 Age of First Use of Tobacco
FRST_TBCO_USE_AGE_LABEL
C31 Age of First Use of Marijuana
FRST_MRJN_USE_AGE_LABEL
C32 Age of First Use of Any Other Substance
FRST_OTH_USE_AGE_LABEL
HLTH 5516 2019/04/29 PAGE 2 OF 8
SERVICE EPISODE DATA FIELD SELECTION
(This section only relevant when client data are selected)
SUMMARY:
Date of First Contact is the first contact with client or collaterals (for example, client’s clinician, physician or caregiver) where clinically
relevant information is exchanged. At Date of First Contact the client may be enrolled in one or more Continuum of MHSU Services.
Each Service type represents a Service Episode.
FIELD NAMES
VARIABLE NAMES
REASON FOR REQUEST
PHN will not be released. A randomised
C2
PHN (Personal Health Care Number)
MRG_CLNT_ANON_ID
study ID will be provided.
SRV_EPSD_ANON_ID
SRV_EPSD_ANON_ID
S2
Continuum of MHSU Services
MHA_SRV_TP_LABEL
S3
Referral Source
MHA_RFRL_SRC_TP_LABEL
S4
Referral Date
RFRL_DATE_LABEL
S5
Date of First Contact
FRST_CTCT_DATE_LABEL
S6
Date of First Service Event
FRST_SRV_DATE_LABEL
S7
Date of First Service Event in Reporting Period
PRD_1ST_SRV_DT_LABEL
S8
Date of Last Service Event in Reporting Period
PRD_LST_SRV_DT_LABEL
S9
Number of Service Events in Reporting Period
PERIOD_SRV_EVT_CNT
S10 Living Arrangement
RSDC_ARNGMT_LABEL
S11 Acute Inpatient – Secure Room
ACUTE_INPTNT_SEC_RM_FLG
S12 Acute Inpatient - Transport
MHA_ACUTE_TRNSPT_LABEL
S13 MHSU Affected Relationship
AFCTD_RELN_LABEL
S14 Service Agency Location Code
MHA_SRV_AGCY_LABEL
S15 Type of CBT Intervention
CBT_STTG_TP_LABEL
S16 Type of DBT Intervention
DBT_STTG_TP_LABEL
S17 Date Extended Leave Ends
XTND_LV_END_DATE
S18 Date of Discharge from Service
SRV_PROG_DSCHG_DT_LABEL
S19 Reason for End of Service
SRV_END_RSN_LABEL
S20 Date of Hospital to Community Contact
HSP_CMTY_CTCT_DATE
S21 Reason for No Community Follow up Contact
FLWP_FAIL_RSN_LABEL
S22 Pregnancy
MHA_PRGCY_STS_LABEL
S23 Parenting
MHA_PRNTG_STS_LABEL
S24 Suicide Attempt
SUICIDE_ATMT_IND
S25 Violence
VLNC_EVDNC_LABEL
S26 Peer Support Service
PEER_SUPT_SRV_FLG
S27 Fetal Alcohol Spectrum Disorder (FASD)
MHA_FASD_LABEL
HLTH 5516 2019/04/29 PAGE 3 OF 8
SERVICE EVENT DATA FIELD SELECTION
(This section only relevant when client and episode data are selected)
SUMMARY:
The Service Event is a single encounter between the client and a mental health and substance use service provider.
FIELD NAMES
VARIABLE NAMES
REASON FOR REQUEST
Used to link the event record to the
SRV_EPSD_ANON_ID
SRV_EPSD_ANON_ID
corresponding episode
SRV_DATE_LABEL, SRV_TM_OF_
T2
Date and Time of Service Event
DAY
DSM-5 DATA FIELD SELECTION
(This section only relevant when client data and specific services are selected
)
1
SUMMARY:
For all clients, four years of age or older, at least one diagnosis is captured at enrolment and discharge for either DSM-5 or
DSM-IV TR (axis 1 and axis 2). Clients enrolled before April 1, 2016 have a DSM-IV diagnosis at enrolment in the Diagnostic table.
If they are discharged after April 1, 2016, they have a DSM-5 diagnosis at discharge record in the Diagnostic 5 table.
FIELD NAMES
VARIABLE NAMES
REASON FOR REQUEST
Used to link the event record to the
SRV_EPSD_ANON_ID
SRV_EPSD_ANON_ID
corresponding episode
D1 DSM-5 Date of Diagnostic Assessment at Enrolment
ENRL_ASSMT_DATE
D2 DSM-5 Clinician’s Impression at Enrolment
ENRL_CLN_IMPR_FLG_LABEL
D3 DSM-5 Diagnosis at Enrolment 1 (Primary)
DSM5_ENRL_DX_1_LABEL
D4 DSM-5 Diagnosis at Enrolment 2 (Secondary)
DSM5_ENRL_DX_2_LABEL
D5 DSM-5 Diagnosis at Enrolment 3 (Tertiary)
DSM5_ENRL_DX_3_LABEL
D6 DSM-5 Diagnosis at Enrolment 4 (Quaternary)
DSM5_ENRL_DX_4_LABEL
D7 DSM-5 Diagnosis at Enrolment 5 (Quinary)
DSM5_ENRL_DX_5_LABEL
D8 Date of Diagnostic Assessment at Discontinuation
DISC_ASSMT_DATE
D9 Clinician’s Impression at Discontinuation
DISC_CLN_IMPR_FLG_LABEL
D10 DSM-5 Diagnosis at Discontinuation 1 (Primary)
DSM5_DISC_DX_1_LABEL
D11 DSM-5 Diagnosis at Discontinuation 2 (Secondary)
DSM5_DISC_DX_2_LABEL
D12 DSM-5 Diagnosis at Discontinuation 3 (Tertiary)
DSM5_DISC_DX_3_LABEL
D13 DSM-5 Diagnosis at Discontinuation 4 (Quaternary)
DSM5_DISC_DX_4_LABEL
D14 DSM-5 Diagnosis at Discontinuation 5 (Quinary)
DSM5_DISC_DX_5_LABEL
Please consult the data dictionary
1
HLTH 5516 2019/04/29 PAGE 4 OF 8
DSM-IV TR DATA FIELD SELECTION
(This section only relevant when client data and specific services are selected
)
1
SUMMARY:
For all clients, four years of age or older, at least one diagnosis is captured at enrolment and discharge for either DSM-5 or
DSM-IV TR (axis 1 and axis 2). Clients enrolled before April 1, 2016 have a DSM-IV diagnosis at enrolment in the Diagnostic table.
If they are discharged after April 1, 2016, they have a DSM-5 diagnosis at discharge record in the Diagnostic 5 table.
FIELD NAMES
VARIABLE NAMES
REASON FOR REQUEST
Used to link the event record to the
SRV_EPSD_ANON_ID
SRV_EPSD_ANON_ID
corresponding episode
D1 Date of Diagnostic Assessment At Enrolment
ENRL_ASSMT_DATE
D2 Date of Diagnostic Assessment At Discontinuation
DISC_ASSMT_DATE
D3 Diagnosis Axis 5: GAF Score at Enrolment or Service
AX5_GAF_ENRL_SCORE
D4 Diagnosis Axis 5: GAF Score at Discontinuation
AX5_GAF_DISC_SCORE
D5 Initial DSM-IV-TR Diagnosis Axis 1: Primary or First at
DSM_AX1_ENRL_DX_1_LABEL
Enrolment
D6 DSM-IV-TR Diagnosis Axis 1: Primary or First at
DSM_AX1_DISC_DX_1_LABEL
Discontinuation
D7 Initial DSM-IV-TR Diagnosis Axis 1: Second or
DSM_AX1_ENRL_DX_2_LABEL
Secondary at Enrolment
D8 DSM-IV-TR Diagnosis Axis 1: Second or Secondary at
DSM_AX1_DISC_DX_2_LABEL
Discontinuation
D9 Initial DSM-IV-TR Diagnosis Axis 1: Other at
DSM_AX1_ENRL_DX_O_LABEL
Enrolment
D10 DSM-IV-TR Diagnosis Axis 1: Other at Discontinuation
DSM_AX1_DISC_DX_O_LABEL
D11 Initial DSM-IV-TR Diagnosis Axis 2: Primary or First at
DSM_AX2_ENRL_DX_1_LABEL
Enrolment
D12 DSM-IV-TR Diagnosis Axis 2: Primary or First at
DSM_AX2_DISC_DX_1_LABEL
Discontinuation
D13 Initial DSM-IV-TR Diagnosis Axis 2: Second or
DSM_AX2_ENRL_DX_2_LABEL
Secondary at Enrolment
D14 DSM-IV-TR Diagnosis Axis 2: Second or Secondary at
DSM_AX2_DISC_DX_2_LABEL
Discontinuation
D15 Clinician’s Impression
CLNCN_IMPRSSN_FLG_LABEL
Please consult the data dictionary
1
HLTH 5516 2019/04/29 PAGE 5 OF 8
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