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Designing and Interpreting Cross-Sector Research. John A. Pandiani, Ph.D. Vermont Department of Mental Health and The Bristol Observatory. Data Are Everywhere. Cross-Sector Research. Why ? How ? and Thinking About Findings. Why Use Cross-Sector Research?. - PowerPoint PPT Presentation
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Designing and Interpreting Cross-Sector Research
John A. Pandiani, Ph.D.Vermont Department of Mental Health
and The Bristol Observatory
Data Are Everywhere
Cross-Sector Research
Why ? How ?
and
Thinking About Findings
Why Use Cross-Sector Research?
Enhance the Value of Your Data
Already Paid For
No New Data Collection
Improve Data Quality
Two CMH Homeless Rates CMH MIS HMIS Overlap
0%
1%
2%
3%
4%
5%
Total SA AOP CRT
0%
1%
2%
3%
4%
5%
Total SA AOP CRT
0%
1%
2%
3%
4%
5%
Total SA AOP CRT
0%
1%
2%
3%
4%
5%
Total SA AOP CRT
Why Use Cross-Sector Research?
ProvidesProspective, Retrospective,
andGeneral Population Comparisons
How to do Cross-Sector Research
Direct Linkage
Probabilistic Linkage Case Management
Probabilistic Overlap EstimationService Systems Research
jl
ijj ilP
1 365
365
This equation counts the number of birth dates to estimate the unduplicated number of people.
Probabilistic Population Estimation
Birth Dates Number of People1 1.003 ± 0.10310 10.15 ± 0.776100 117 ± 9200 290 ± 22300 632 ± 64350 1,177 ± 171360 1,603 ± 325
For Specified Numbers of Birth Dates Within a Given Year
Probabilistic Population Estimation
(A B) = A + B – (A B)
Caseload Overlap
Two Critical Dimensions
Time and Space
Geographical SpaceOrganizational Space
Thinking About Findings
Program Evaluation Paradigm
Access to Care
Treatment Outcomes
Practice Patterns
Thinking About Findings
Thinking About Findings Discovery vs. Verification
My Approach
ObservationalIncrementalPragmatic
Follow the Flow of Analysis
Widespread Sharing
Broad Community of Learners
Variety of Perspectives
Disseminating Findings
Access to Care
Treatment Outcomes
Practice Patterns
Other Cross-Sector Analyses
Sixteen Examples of Cross-Sector Research Findings
Access to Care
0%
20%
40%
60%
Total Male Female 18-34 35-49 50+
Vermont New Hampshire
Homeless Adults’ Access to CMH Services
0%
20%
40%
60%
Total Male Female 18-34 35-49 50+
Vermont New Hampshire
Homeless Adults’ Access to CMH Services
0%
20%
40%
60%
Total Male Female 18-34 35-49 50+
Vermont New Hampshire
Homeless Adults’ Access to CMH Services
0%
20%
40%
60%
Total Male Female 18-34 35-49 50+
Vermont New Hampshire
Homeless Adults’ Access to CMH Services
0%
10%
20%
30%
40%
Total Men Women 18-34 35-49 50+
Vermont Population Criminal Charge Homeless
Community MH Utilization
0%
10%
20%
30%
40%
Total Men Women 18-34 35-49 50+
Vermont Population Criminal Charge Homeless
Community MH Utilization
0%
10%
20%
30%
40%
Total Men Women 18-34 35-49 50+
Vermont Population Criminal Charge Homeless
Community MH Utilization
0%
10%
20%
30%
40%
Total Men Women 18-34 35-49 50+
Vermont Population Criminal Charge Homeless
Community MH Utilization
0%
10%
20%
30%
40%
Total Men Women 18-34 35-49 50+
Vermont Population Criminal Charge Homeless
Community MH Utilization
Percent of SMI
<10% 10%-15%
15%-20% 20%+
SMI in Section 8 Housing in VT and CT
0%
5%
10%
15%
20%
25%
Total Male Female 18-34 35-49 50-64 65+ White Other
Connecticut Vermont
SMI with Section 8 Housing
0%
5%
10%
15%
20%
25%
Total Male Female 18-34 35-49 50-64 65+ White Other
Connecticut Vermont
SMI with Section 8 Housing
0%
5%
10%
15%
20%
25%
Total Male Female 18-34 35-49 50-64 65+ White Other
Connecticut Vermont
SMI with Section 8 Housing
0%
5%
10%
15%
20%
25%
Total Male Female 18-34 35-49 50-64 65+ White Other
Connecticut Vermont
c
SMI with Section 8 Housing
0%
10%
20%
30%
40%
50%
Medical MH SA
Homeless General Population
ER Utilization by Diagnosis, VT Adults
0%
10%
20%
30%
40%
50%
Medical MH SA
Homeless General Population
ER Utilization by Diagnosis, VT Adults
0%
10%
20%
30%
40%
50%
Medical MH SA
Homeless General Population
ER Utilization by Diagnosis, VT Adults
0%
10%
20%
30%
40%
50%
Medical MH SA
Homeless General Population
ER Utilization by Diagnosis, VT Adults
Relative Rate of ER Utilization Homeless vs. Other VT Adults
0
5
10
15
20
25
30
Total Male Female 18-34 35+
Rela
tive
Rate
Medical Mental Health Substance Abuse
Relative Rate of ER Utilization Homeless vs. Other VT Adults
0
5
10
15
20
25
30
Total Male Female 18-34 35+
Rela
tive
Rate
Medical Mental Health Substance Abuse
1
Treatment Outcomes
Pe
rce
nt
Arr
es
ted
0%
10%
20%
30%
40%
50%
1 2 3 4 5 6 7 8 9 10Region
Before Treatment After Treatment
VT Substance Abuse Service Recipients Arrested Before and After Treatment
Pe
rce
nt
Arr
es
ted
0%
10%
20%
30%
40%
50%
1 2 3 4 5 6 7 8 9 10Region
Before Treatment After Treatment
Pe
rce
nt
Arr
es
ted
0%
10%
20%
30%
40%
50%
1 2 3 4 5 6 7 8 9 10Region
Before Treatment After Treatment
VT SMI Service Recipients Incarcerated Before and After Treatment
0%
5%
10%
15%
20%
Total M F 18-34 35-49 50-64 M F M F M F
Gender Age 18-34 35-49 50-64
Per
cen
t In
carc
erat
ed
Before Treatment After Treatment
VT SMI Service Recipients Incarcerated Before and After Treatment
0%
5%
10%
15%
20%
Total M F 18-34 35-49 50-64 M F M F M F
Gender Age 18-34 35-49 50-64
Per
cen
t In
carc
erat
ed
Before Treatment After Treatment
VT SMI Service Recipients Incarcerated Before and After Treatment
0%
5%
10%
15%
20%
Total M F 18-34 35-49 50-64 M F M F M F
Gender Age 18-34 35-49 50-64
Per
cen
t In
carc
erat
ed
Before Treatment After Treatment
Relative Risk of ArrestYoung Males (18 - 34) in Washington, DC
Post 9/11
Sep 2001 - Sep 2002
Post 9/11
Sep 2001 - Sep 2002
Pre 9/11
0
1
2
3
4
Rel
ativ
e R
isk
Oct 1999 - Aug 2001
Pre 9/11
0
1
2
3
4
Rel
ativ
e R
isk
Oct 1999 - Aug 2001
Practice Patterns
Residential Situation after State Hospital Discharge
0%
25%
50%
75%
Nursing
CMHC
Inpatient
Incarcerated
Section 8
Total M F M F M F M F
Gender 18-34 35-49 50+
Residential Situation after State Hospital Discharge
0%
25%
50%
75%
Nursing
CMHC
Inpatient
Incarcerated
Section 8
Total M F M F M F M F
Gender 18-34 35-49 50+
Residential Situation after State Hospital Discharge
0%
25%
50%
75%
Nursing
CMHC
Inpatient
Incarcerated
Section 8
Total M F M F M F M F
Gender 18-34 35-49 50+
Residential Situation after State Hospital Discharge
0%
25%
50%
75%
Nursing
CMHC
Inpatient
Incarcerated
Section 8
Total M F M F M F M F
Gender 18-34 35-49 50+
Adult MH Outpatient Clients with Less than 4 Services
0%
20%
40%
60%
80%
100%
Homeless Other
Per
cen
t o
f C
lien
ts S
erve
d
0%
20%
40%
60%
80%
100%
Homeless Other
Per
cen
t o
f C
lien
ts S
erve
d
0%
20%
40%
60%
80%
100%
Homeless Other
Per
cen
t o
f C
lien
ts S
erve
d
Other Cross-Sector Analyses
Relative Rate of Domestic Violence Homeless Compared to General Population
0
5
10
15
20
25
Overall Men Women 18-34 35+
Rel
ativ
e R
ate
Offender Victim
0
5
10
15
20
25
Overall Men Women 18-34 35+
Rel
ativ
e R
ate
Offender Victim
0
5
10
15
20
25
Overall Men Women 18-34 35+
Rel
ativ
e R
ate
Offender Victim
0
5
10
15
20
25
Overall Men Women 18-34 35+
Rel
ativ
e R
ate
Offender Victim
1
Homeless Adults with Services as Youth
0%
10%
20%
30%
40%
50%
Total Men Women
Perc
ent o
f Hom
eles
s Yo
ung
Adul
ts
Youth with Subsequent Adult Homelessness
0%
10%
20%
30%
40%
50%
Total Boys Girls
Perc
ent o
f You
th
CMH (SED) DCF (Delinquent) Special Education (EBD)
Children’s Services & Adult Homeless
Homeless Adults with Services as Youth
0%
10%
20%
30%
40%
50%
Total Men Women
Perc
ent o
f Hom
eles
s Yo
ung
Adul
ts
Youth with Subsequent Adult Homelessness
0%
10%
20%
30%
40%
50%
Total Boys Girls
Perc
ent o
f You
th
Homeless Adults with Services as Youth
0%
10%
20%
30%
40%
50%
Total Men Women
Perc
ent o
f Hom
eles
s Yo
ung
Adul
ts
Youth with Subsequent Adult Homelessness
0%
10%
20%
30%
40%
50%
Total Boys Girls
Perc
ent o
f You
th
0
1
2
3
4
5
6
7
Total Men Women Men Women Men Women18-49 50+
Pe
rce
nt
Ho
me
les
s
Veterans Non-veterans
0
1
2
3
4
5
6
7
Total Men Women Men Women Men Women18-49 50+
Pe
rce
nt
Ho
me
les
s
Veterans Non-veterans
Homelessness among MH Service Recipients
People with Homeless Services in Bordering Counties of Vermont & New Hampshire
Vermont (n =355)
New Hampshire
(n =706)
Both(n = 5)0.5%
CMHC Overlapwith Eleven Caseloads in CT
0% 10% 20% 30% 40% 50%
Medicaid
Food Stamps
State Medical
Substance Abuse
Corrections
Probation
Cash Benefits
Temporary Family Assist.
Abuse/Neglect Offenders
Motor Vehicle Violators
Mental Retardation
Thanks to
People who collected these dataPeople who manage the databases
Barbara Carroll, Brennan Martin, & Walter OchsVermont MH Performance Indicator Project
Karen DanyowThe Bristol Observatory
USE THE
DATA
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