Thursday, November 6, 2014

Big Data in Public Mental Health: If Clients Only Knew…

The Dilemma

Here is the agency clinician’s dilemma. As a provider, you want to help people. But…for every individual that you provide services to, there are strings attached. More specifically, reams of papers to be signed, electronic data to be produced, highly personal information to be stowed away in a “secure” database. How bad is it?

Just Imagine...

I have a 15 year old girl that I see for individual therapy. Answers to the following questions have to go in my electronic health record if I want to be compliant. How exactly should I tell this teen upfront that this is what will happen? How would she feel on day one if she knew that the answers to all these questions were going to live on some server for years to come?

The Required Data

1. What’s your name?
2. What’s your social security number?
3. What is your ethnicity?
4. Are you Hispanic?
5. Do you have additional races?
6. What is your address?
7. What kind of living situation is it?
8. Do you rent or own?
9. What is your mother’s first name?
10. What is an emergency contact’s name?
11. What is the emergency contact’s relationship to you?
12. Does he or she live with you?
13. What is his / her address?
14. What is his / her phone number?
15. What is another emergency contact’s information?
16. What is your birth date?
17. Have you ever gone by other names?
18. What is your gender?
19. What was your name given at birth?
20. Are you a caregiver? If yes, for how many children?
21. What is your address?
22. What is your phone number?
23. What county is that in?
24. What country were you born in?
25. What county were you born in?
26. What state were you born in?
27. What is your employment status?
28. What language do you speak?
29. What other languages do you speak?
30. What is the language that you are most proficient in?
31. What language do you prefer speaking?
32. What is your marital status?
33. Are you in school?
34. What kind of school do you go to?
35. What grade are you in?
36. What are the names of everybody that lives in your house?
37. What are their genders?
38. Which ones are guardians?
39. Which ones are household dependants?
40. What are their relationships to you?
41. Do you have Medi-Cal?
42. What is your Medi-Cal number?
43. What is the address where you want to receive your Medical billing statements?
44. Who referred you and why?
45. Rate the problems in your family
46. Rate the problems with your living situation
47. Rate the problems with your social functioning
48. Rate the problems with your recreational functioning
49. Rate the problems with your mental development (If your mental development is a problem, you’ll need to rate 4 more items)
50. Rate the problems with your job functioning
51. Rate your legal problems
52. Rate your medical problems
53. Rate your physical problems
54. Rate your sexual problems
55. Rate your sleep problems
56. Rate your school behavior problems
57. Rate your school achievement problems
58. Rate your school attendance problems
59. Rate how big a strength your family is
60. Rate how big a strength your interpersonal skills are
61. Rate how big a strength your optimism is
62. Rate how big a strength your education is
63. Rate how big a strength your vocation is
64. Rate how big a strength your talents and interests are
65. Rate how big a strength your religion / spirituality is
66. Rate how big a strength your community life is
67. Rate how big a strength relationship permanence is for you
68. Rate how big a strength resiliency is for you
69. Rate how big a strength resourcefulness is for you
70. Rate how big a problem speaking English is for you
71. Rate how big a problem your cultural identity is for you
72. Rate how big a problem practicing cultural rituals is for you
73. Rate how big a problem cultural stress is for you
74. Rate how big a problem it is that your caregiver doesn’t supervise you
75. Rate how big a problem it is that your caregiver doesn’t advocate for you
76. Rate how big a problem it is that your caregiver doesn’t understand what your needs and strengths are
77. Rate how big a problem your caregiver’s organization is
78. Rate how big a problem your caregiver has in accessing social resources
79. Rate how big a problem your caregiver has with residential stability
80. Rate how big a problem your caregiver has with physical problems
81. Rate how big a problem your caregiver has with mental health
82. Rate how big a problem your caregiver has with substance abuse
83. Rate how big a problem your caregiver has with mental development (like if he or she has a low IQ)
84. Rate how big a problem your caregiver has with keeping you safe
85. Rate how psychotic you are
86. Rate how impulsive or hyperactive you are
87. Rate how big a problem depression is for you
88. Rate how big a problem anxiety is for you
89. Rate how big a problem being oppositional is for you
90. Rate how big a problem your conduct is (i.e., do you exhibit antisocial behavior including but not limited to lying, stealing, manipulating others, sexual aggression, being violent toward people, property or animals)
91. Rate how big of a problem you are having adjusting to a traumatic experience (If this is a problem, you’ll need to rate 8 more items. And if you were sexually abused, there are 9 items specific to sexual abuse after that)
92. Rate how big a problem it is for you to control your anger
93. Rate how big a problem substance abuse is for you (If it is a problem, you’ll need to rate 6 items about your substance abuse)
94. Rate how big a problem being suicidal is for you
95. Rate how big a problem self mutilation is for you
96. Rate how big a problem it is that you hurt yourself in ways other than self mutilation
97. Rate how big a danger you are to other people (If you are a danger to other people, you’ll need to rate 14 more items)
98. Rate how big a problem sexual aggression is for you (If sexual aggression is a problem for you, you’ll need to rate 10 more items, like “Type of Sex Act”)
99. Rate how big a problem your judgment is
100. Rate how big a problem fire setting is for you (If fire setting is a problem for you, you’ll need to rate 7 more items about fire setting)
101. Rate how big a problem social behavior is for you (i.e., getting in trouble on purpose)
102. What is your gender identity?
103. What is your sexual orientation?
104. What are your current symptoms, behaviors, and stressors?
105. When did your current symptoms start?
106. Have you ever gotten treatment for your symptoms before?
107. Have you ever been hospitalized?
108. What other providers have you worked with?
109. What dates did you see those providers?
110. What is your immigration history?
111. Have you had any issues with acculturation?
112. What are your religious beliefs?
113. What are your strengths (including skills, personality traits, intelligence, resiliency, insight, etc.)?
114. What was your mom’s pregnancy like?
115. How was your mom’s birth with you? Were there complications?
116. Did your mom do drugs or drink alcohol while she was pregnant with you?
117. When did you crawl, walk, talk, and get potty trained?
118. Did you have a healthy attachment to your parents?
119. Did you have problems as a child when you were separated from your parents?
120. What was your temperament like when you were little?
121. Did you get along with your peers?
122. Who all is in your family?
123. Does your family have financial issues?
124. Are there relationship issues in your family?
125. What are all the different places that you have lived?
126. Have you ever lived with someone outside your family?
127. Does your family have mental health, substance abuse, or medical problems? Who and what kind?
128. What is your social support system?
129. Do you have friends?
130. What is your educational history?
131. Do you have special needs at school?
132. Do you have an individualized educational plan (IEP)?
133. What is your work history?
134. Do you have a social worker?
135. A probation officer?
136. Do you get services from anyone else?
137. What is your medical history?
138. What medications do you take?
139. What are the doses?
140. Are they over the counter?
141. When did you start those medications?
142. Do you have any side effects?
143. Do you have problems adhering to the guidelines for taking these medications?
144. What is the name of your doctor?
145. What is your doctor’s phone number?
146. Do you use substances including caffeine?
147. Which ones?
148. When was the last time you used each substance?
149. How much do you normally use?
150. How often do you use?
151. How long have you been using?
152. How old were you when you started to use?
153. Are you homicidal or assaultive?
154. Are you suicidal, or do you hurt yourself?
155. Do you have access to weapons?
156. Have you been exposed to trauma?
157. Have you been neglected or abused?
158. Have you been exposed to domestic violence?
159. What kind of legal issues do you have?
160. Are you involved in crime or gangs?
161. Do you or have you ever run away?
162. Do you engage in inappropriate or risky sexual behavior?
163. Are you at risk because of substance use?
164. Are you at risk because of cognitive impairment?
165. Are you at risk because of cultural isolation?
166. Are you at risk because of a potential for victimization?
167. Are you at risk of homelessness?
168. What is your appearance?
169. What is your motor movement?
170. What is your behavior (e.g., cooperative, uncooperative, etc.)?
171. What is your state of consciousness (e.g,, alert)?
172. Do you know who you are?
173. Do you know where you are?
174. Do you know what day it is?
175. Do you know what month it is?
176. Do you know what year it is?
177. Do you know what is going on right now?
178. How does your face show emotion?
179. What is your mood like?
180. What is your thought process like?
181. Do you have delusions or hallucinations?
182. What is my impression of your intelligence?
183. What is my impression of your memory?
184. What is my impression of your judgment?
185. What area of your life does a mental health disorder impair most (Health, Daily Activities, Social Relationships, or Living Arrangement)
186. What is your Axis I mental health disorder (You have one if you are getting services from me)?
187. What is your Axis II mental health disorder?
188. What medical conditions do you have?
189. What Psychosocial and Environmental Problems do you have?
190. What is your global assessment of functioning (GAF) score?
191. How old is your caregiver?
192. Does your caregiver have problems with literacy?
193. What level of education does your caregiver have?
194. Does your caregiver need additional education or training in order to get a job?
195. Does your caregiver have a job?
196. Is it part time or full time?
197. Does it pay enough and give benefits?
198. Is your caregiver at risk of losing housing?
199. Does your caregiver have problems providing food to your household?
200. Does everyone in your house have access to medical care?
201. What is the narrative of how you ended up in mental health services, and what do I (your therapist) think you should do about it?
202. What are your desired results (i.e., what do you want to get out of therapy)?
203. What is your desired transition (i.e., what will it look like when you don’t need to see me anymore, written in the present tense)
204. What obstacles are going to come up?
205. What are your simple, measurable, attainable, realistic, and time-limited short-term goals?
206. What strengths are going to help you achieve your desired results, desired transition, and short-term goals?
207. What are your action steps to work toward your goal?
208. What are my action steps to help you work toward your goal?

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