Appendix A

About the Treatment Episode Data Set (TEDS)

Introduction

This report presents data from the Treatment Episode Data Set (TEDS) on the demographic and substance abuse characteristics of This report presents data from the Treatment Episode Data Set (TEDS) on the demographic and substance abuse characteristics of admissions to substance abuse treatment. The Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), coordinates and manages collection of TEDS data from the States.

The Treatment Episode Data Set (TEDS) is a compilation of client-level data routinely collected by the individual State administrative data systems to monitor their substance abuse treatment systems. Generally, facilities that are required to report to the State substance abuse agency (SSA) are those that receive public funds and/or are licensed or certified by the SSA to provide substance abuse treatment (or are administratively tracked for other reasons).

TEDS is one of the three components of SAMHSA's Drug and Alcohol Services Information System (DASIS), the primary source of national data on substance abuse treatment. The other two components are:

The TEDS system comprises two major components, the Admissions Data Set and the Discharge Data Set. The TEDS Admissions Data Set includes client-level data on substance abuse treatment admissions from 1992 through the present. The TEDS Discharge Data Set can be linked at record level to admissions, and includes information from clients discharged in 2000 and later. For both data sets, selected data items from the individual State data files are converted to a standardized format consistent across States. These standardized data constitute TEDS.

The TEDS Admissions Data System consists of a Minimum Data Set of items collected by all States, and a Supplemental Data Set where individual data items are reported at the States' option.

The Minimum Data Set consists of 19 items that include:

The Supplemental Data Set consists of 17 items that include psychiatric, social, and economic measures.

History

National-level data collection on admissions to substance abuse treatment was first mandated in 1972 under the Drug Abuse Office and Treatment Act, P.L. 92-255. This act initiated Federal funding for drug treatment and rehabilitation, and required reporting on clients entering drug (but not alcohol) abuse treatment. The Client-Oriented Data Acquisition Process (CODAP) was developed to collect admission and discharge data directly from Federally-funded drug treatment programs. (Programs for treatment of alcohol abuse were not included.) Reporting was mandatory for all such programs, and data were collected using a standard form. CODAP included all clients in Federally-funded programs regardless of individual funding source. Reports were issued from 1973 to 1981 based on data from 1,800 to 2,000 programs, including some 200,000 annual admissions.

In 1981, collection of national-level data on admissions to substance abuse treatment was discontinued because of the introduction of the Alcohol, Drug Abuse, and Mental Health Services (ADMS) Block Grant. The Block Grant trans­ferred Federal funding from individual programs to the States for distribution, and it included no data reporting requirement. Participation in CODAP became voluntary; although several States submitted data through 1984, the data were in no way nationally representative.

In 1988, the Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments (P.L. 100-690) established a revised Substance Abuse Prevention and Treatment (SAPT) Block Grant and mandated Federal data collection on clients receiving treatment for either alcohol or drug abuse. The Treatment Episode Data Set (TEDS) data collection effort represents the Federal response to this mandate. TEDS began in 1989 with the issue of 3-year development grants to States.

State Data Collection Systems

TEDS is an exceptionally large and powerful data set that covers a significant proportion of all admissions to substance abuse treatment. TEDS is a compilation of data collected through the individual data collection systems of the State substance abuse agencies (SSAs) for substance abuse treatment. States have cooperated with the Federal Government in the data collection process, and substantial 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 State data collection systems. These differences are compounded by evolving health care payment systems, and State-to-State comparisons must be made with extreme caution.

The number and client mix of TEDS admissions do not represent the total national demand for substance abuse treatment or the prevalence of substance abuse in the general population.

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 reporting by certain sectors of the treatment population, and these sectors may change over time. For example, treat­ment programs based in the criminal justice system may or may not be administered through the State SSA. Detoxification facilities, which can generate large numbers of admissions, are not uniformly considered treatment facilities and are not uniformly reported by all States.

Appendix Table 1 presents key characteristics of State data collection systems for 2010. However, these characteristics can change ­as State substance abuse treatment systems change, and thus may be responsible for some year-to-year variation within States.

This requires, however, that clients be assigned unique IDs that can be linked across providers; not all States are legally and/or technologically able to do this. Most States can identify as transfers a change in service type within the structure of a given provider. However, fewer can also identify a transfer involving a change of provider. Several States do not track transfers, but instead report as transfers those clients who are discharged and readmitted with­in a specified (State-specific) time period.

Because some admission records in fact may represent transfers, the number of admissions reported probably overestimates the number of treatment episodes. Some States reported a limited data set on codependents of substance abusers entering treatment. On average, from 2010 through 2010, 83 percent of all records submitted were client admissions, 15 percent were client transfers, and 2 percent were codependents of substance abusers.

Admissions from facilities that report late to the States will appear in a later data submission to SAMHSA, so the number of annual admissions in a report may be higher in subsequent reports. The number of additional admissions is small because of the time lag in issuing the report. Thus the percentage distributions will change very little in subsequent reports, although Census division- and State-level data may change somewhat more for States with reporting delays (State report only).

States continually review and improve their data collection and processing. When systematic errors are identified, States may revise or replace historical TEDS data files. While this process represents an improvement in the data system, the historical statistics in this report will differ slightly from those in earlier reports.

Appendix Tables 2 and 3 indicate the proportions of records by State or jurisdiction for which valid data were received for 2010. States are expected to report all variables in the Minimum Data Set (Appendix Table 2). Variables in the Supplemental Data Set are collected at the States' option (Appendix Table 3).

Report-Specific Considerations

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