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Service Utilization Questionnaire

1,389 Shared Subjects

Service Utilization Questionnaire - Youth
Clinical Assessments
Questionnaire
06/04/2013
suq01
12/18/2023
View Change History
01
Definition
Submission Template
Query Element Name Data Type Size Required Description Value Range Notes Aliases
src_subject_id String 20 Required Subject ID how it's defined in lab/project newid, subjectid, subjid
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for research subject NDAR*
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY InterviewYear, datacollecteddate
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0::1440 Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month. adi_age
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported gender
Query therapy_spec_ed String 50 Recommended Is the subject enrolled in any special educational classes or learning environments? Yes; No
Query suq01_a Integer Recommended SE Learning - Ages 0 :: 8 0 = 10 years or younger; 1 = 11 years; 2 = 12 years; 3 = 13 years; 4 = 14 years; 5 = 15 years; 6 = 16 years; 7 = 17 years; 8 = 18 years or older
Query suq01_b Integer Recommended SE Learning - Period of Time 0 :: 5 0 = 0 to 6 months; 1 = Six months to a year; 2 = More than a year to two years; 3 = More than two years to four years; 4 = Four to seven years; 5 = More than seven years
Query suq02 Integer Recommended Special education for behavioral or emotional support? 0; 1 0 = No; 1 = Yes
Query suq02_a Integer Recommended SE Emotional Support - Ages 0 :: 8 0 = 10 years or younger; 1 = 11 years; 2 = 12 years; 3 = 13 years; 4 = 14 years; 5 = 15 years; 6 = 16 years; 7 = 17 years; 8 = 18 years or older
Query suq02_b Integer Recommended SE Emotional Support - Period of time 0 :: 5 0 = 0 to 6 months; 1 = Six months to a year; 2 = More than a year to two years; 3 = More than two years to four years; 4 = Four to seven years; 5 = More than seven years
Query suq03 Integer Recommended Mental health or counseling services? 0; 1; -99; 88; 77 0 = No; 1 = Yes; -99= N/A ; 88= Missing ; 77= Refused
Query suq03_a Integer Recommended Mental Health/Counseling Services - Ages 0 :: 8 0 = 10 years or younger; 1 = 11 years; 2 = 12 years; 3 = 13 years; 4 = 14 years; 5 = 15 years; 6 = 16 years; 7 = 17 years; 8 = 18 years or older
Query suq03_b Integer Recommended Mental Health/Counseling Services - Period of time 0 :: 5 0 = 0 to 6 months; 1 = Six months to a year; 2 = More than a year to two years; 3 = More than two years to four years; 4 = Four to seven years; 5 = More than seven years
Query suq03_c Integer Recommended Mental Health/Counseling Services - Number of times received 0 :: 5 0 = Once; 1 = 2 to 5 times; 2 = 6 to 10 times; 3 = 11 to 20 times; 4 = 21 to 50 times;
suq03_d String 255 Recommended Mental Health/Counseling Services - Diagnosis
Query suq03_e Integer Required Mental Health/Counseling Services - Medications 0; 1;999 0 = No; 1 = Yes
suq03_e_comm String 255 Recommended Mental Health/Counseling Services - Medications descriptions
Query suq04 Integer Recommended Drug treatment not in-patient? 0; 1 0 = No; 1 = Yes
Query suq04_a Integer Recommended Drug treatment not in-patient - Ages 0 :: 8 0 = 10 years or younger; 1 = 11 years; 2 = 12 years; 3 = 13 years; 4 = 14 years; 5 = 15 years; 6 = 16 years; 7 = 17 years; 8 = 18 years or older
Query suq04_b Integer Recommended Drug treatment not in-patient - Period of time 0 :: 5 0 = 0 to 6 months; 1 = Six months to a year; 2 = More than a year to two years; 3 = More than two years to four years; 4 = Four to seven years; 5 = More than seven years
Query suq04_c Integer Recommended Drug treatment not in-patient - Number of times received 0 :: 5 0 = Once; 1 = 2 to 5 times; 2 = 6 to 10 times; 3 = 11 to 20 times; 4 = 21 to 50 times;
Query suq05 Integer Recommended In-patient drug treatment? 0; 1 0 = No; 1 = Yes
Query suq05_a Integer Recommended In-Patient Drug Treatment - Ages 0 :: 8 0 = 10 years or younger; 1 = 11 years; 2 = 12 years; 3 = 13 years; 4 = 14 years; 5 = 15 years; 6 = 16 years; 7 = 17 years; 8 = 18 years or older
Query suq05_b Integer Recommended In-Patient Drug Treatment - Period of time 0 :: 5 0 = 0 to 6 months; 1 = Six months to a year; 2 = More than a year to two years; 3 = More than two years to four years; 4 = Four to seven years; 5 = More than seven years
Query suq05_c Integer Recommended In-Patient Drug Treatment - Number of times received 0 :: 5 0 = Once; 1 = 2 to 5 times; 2 = 6 to 10 times; 3 = 11 to 20 times; 4 = 21 to 50 times;
Query suq06 Integer Recommended Therapeutic foster care? 0; 1 0 = No; 1 = Yes
Query suq06_a Integer Recommended Therapeutic Foster Care - Ages 0 :: 8 0 = 10 years or younger; 1 = 11 years; 2 = 12 years; 3 = 13 years; 4 = 14 years; 5 = 15 years; 6 = 16 years; 7 = 17 years; 8 = 18 years or older
Query suq06_b Integer Recommended Therapeutic Foster Care - Period of time 0 :: 5 0 = 0 to 6 months; 1 = Six months to a year; 2 = More than a year to two years; 3 = More than two years to four years; 4 = Four to seven years; 5 = More than seven years
Query suq06_c Integer Recommended Therapeutic Foster Care - Number of times received 0 :: 5 0 = Once; 1 = 2 to 5 times; 2 = 6 to 10 times; 3 = 11 to 20 times; 4 = 21 to 50 times;
Query suq07 Integer Recommended Day treatment for mental health or behavioral problems? 0; 1 0 = No; 1 = Yes
Query suq07_a Integer Recommended Day Treatment - Ages 0 :: 8 0 = 10 years or younger; 1 = 11 years; 2 = 12 years; 3 = 13 years; 4 = 14 years; 5 = 15 years; 6 = 16 years; 7 = 17 years; 8 = 18 years or older
Query suq07_b Integer Recommended Day Treatment - Period of time 0 :: 5 0 = 0 to 6 months; 1 = Six months to a year; 2 = More than a year to two years; 3 = More than two years to four years; 4 = Four to seven years; 5 = More than seven years
Query suq07_c Integer Recommended Day Treatment - Number of times received 0 :: 5 0 = Once; 1 = 2 to 5 times; 2 = 6 to 10 times; 3 = 11 to 20 times; 4 = 21 to 50 times;
suq07_d String 255 Recommended Day Treatment - Diagnosis
Query suq07_e Integer Required Day Treatment - Medications 0; 1;999 0 = No; 1 = Yes
suq07_e_comm String 255 Recommended Day Treatment - Medications descriptions
Query suq08 Integer Recommended Residential treatment for mental health or behavioral problems? 0; 1 0 = No; 1 = Yes
Query suq08_a Integer Recommended Residential Treatment - Ages 0 :: 8 0 = 10 years or younger; 1 = 11 years; 2 = 12 years; 3 = 13 years; 4 = 14 years; 5 = 15 years; 6 = 16 years; 7 = 17 years; 8 = 18 years or older
Query suq08_b Integer Recommended Residential Treatment - Period of time 0 :: 5 0 = 0 to 6 months; 1 = Six months to a year; 2 = More than a year to two years; 3 = More than two years to four years; 4 = Four to seven years; 5 = More than seven years
Query suq08_c Integer Recommended Residential Treatment - Number of times received 0 :: 5 0 = Once; 1 = 2 to 5 times; 2 = 6 to 10 times; 3 = 11 to 20 times; 4 = 21 to 50 times;
suq08_d String 255 Recommended Residential Treatment - Diagnosis
Query suq08_e Integer Required Residential Treatment - Medications 0; 1;999 0 = No; 1 = Yes
suq08_e_comm String 255 Recommended Residential Treatment - Medications descriptions
hospitalizations String 200 Recommended has the subject had any hospitalisations
Query suq09_a Integer Recommended Hospitalization - Ages 0 :: 8 0 = 10 years or younger; 1 = 11 years; 2 = 12 years; 3 = 13 years; 4 = 14 years; 5 = 15 years; 6 = 16 years; 7 = 17 years; 8 = 18 years or older
Query suq09_b Integer Required Hospitalization - Period of time 0 :: 5;999 0 = 0 to 6 months; 1 = Six months to a year; 2 = More than a year to two years; 3 = More than two years to four years; 4 = Four to seven years; 5 = More than seven years
Query suq09_c Integer Required Hospitalization - Number of times received 0 :: 5;999 0 = Once; 1 = 2 to 5 times; 2 = 6 to 10 times; 3 = 11 to 20 times; 4 = 21 to 50 times;
suq09_d String 255 Recommended Hospitalization - Diagnosis
Query suq09_e Integer Required Hospitalization - Medications 0; 1;999 0 = No; 1 = Yes
suq09_e_comm String 255 Recommended Hospitalization - Medications descriptions
prev_date Date Recommended Date of Previous Assessment
Query resource_code1 Integer Recommended Resource 1 code: 0::5 0=none; 1=emergency stay for physical problems; 2=emergency stay for psychiatric problems; 3=inpatient stay for physical problems; 4=inpatient stay for psychiatric problems; 5=day hospitalization or residential care utilization_hospital_code
Query resource_code2 Integer Recommended Resource 2 code: 0::5 0=none; 1=emergency stay for physical problems; 2=emergency stay for psychiatric problems; 3=inpatient stay for physical problems; 4=inpatient stay for psychiatric problems; 5=day hospitalization or residential care
Query resource_code3 Integer Recommended Resource 3 code: 0::5 0=none; 1=emergency stay for physical problems; 2=emergency stay for psychiatric problems; 3=inpatient stay for physical problems; 4=inpatient stay for psychiatric problems; 5=day hospitalization or residential care
Query resource_code4 Integer Recommended Resource 4 code: 0::5 0=none; 1=emergency stay for physical problems; 2=emergency stay for psychiatric problems; 3=inpatient stay for physical problems; 4=inpatient stay for psychiatric problems; 5=day hospitalization or residential care
resour_start1 Date Recommended Resource 1 start date utilization_start_date
resour_start2 Date Recommended Resource 2 start date
resour_start3 Date Recommended Resource 3 start date
resour_start4 Date Recommended Resource 4 start date
resour_stop1 Date Recommended Resource 1 stop date utilization_stop_date
resour_stop2 Date Recommended Resource 2 stop date
resour_stop3 Date Recommended Resource 3 stop date
resour_stop4 Date Recommended Resource 4 stop date
Query elig_inclusion_check Integer Recommended Checks for a pass/fail on Elig for Inclusion 0::3 0=Failed (Ineligible); 1=Passed (Eligible); 2=In screening; 3=NA
Query dataquality Integer Recommended Data quality 0::5 0=No data (cancelled); 1=Data entered but only once, has missing data; 2=Data entered but only once, no missing data; 3=Double entered; 4=Data frozen for cleaning; 5=Data clean/locked
visit_name String 20 Recommended session ID/screening ID visitnumber
Query visit String 60 Recommended Visit name timept, visitlabel
Query instance Integer Recommended Instance 0::100 The number of instance of the first degree relative.
Query subjecttype String 20 Recommended Subject Type Control;Prodromal; Enhanced; Non-Enhanced
Query seq_visit Integer Recommended Number sequenceof inpatient visits in past 6 months inpt
Query hc27_1 Integer Recommended During the past 12 months have you stayed overnight in a hospital other than those already mentioned 0;1 0=No; 1=Yes hc27
Query hc29a Integer Recommended Inpatient hospital type 1::7 1 = State or county mental hospital; 2 = General Hospital; 3 = Va Hospital; 4 = Private Psychiatric Hospital; 5 = Multi-service community mental health center; 6 = Substance abuse facility; 7 = None of the above
Query hc30a Integer Recommended Was inpatient hospital stay for-A physical problem 0;1 0=No; 1=Yes
Query hc30b Integer Recommended Was inpatient hospital stay for-A mental health problem 0;1 0=No; 1=Yes
Query hc30c Integer Recommended Was inpatient hospital stay for-An alcohol problem 0;1 0=No; 1=Yes
Query hc30d Integer Recommended Was inpatient hospital stay for-A drug problem 0;1 0=No; 1=Yes
Query hc30e Integer Recommended Was inpatient hospital stay for-Some other problem 0;1 0=No; 1=Yes
Query hc31 Integer Recommended How many nights did you stay in this facility?
Query hc31a Integer Recommended How many nights did you stay in the inpatient hospital-Refused
Query days_baseline Integer Recommended Days since baseline hc_erdays, hc_inptdays, hc_outptdays, hc_psych_erdays, intdays
Query casa13 Integer Recommended Hospital emergency room for any emotional, behavioral, or substance use problems (past 6 months) 0;1 0 = No; 1 = Yes er
Query casa13y Integer Recommended Number of visits to hospital emergency room for any emotional, behavioral, or substance use problems (past 6 months) hc19
Query hc20_months Integer Recommended When did you go to the ER (months from baseline)
Query hc21a Integer Recommended EMERGENCY ROOM TYPE 1::7 1 = State or county mental hospital; 2 = General Hospital; 3 = Va Hospital; 4 = Private Psychiatric Hospital; 5 = Multi-service community mental health center; 6 = Substance abuse facility; 7 = None of the above
Query hc22a Integer Recommended Was ER visit for-A physical problem 0;1 0=No; 1=Yes
Query hc22b Integer Recommended Was ER visit for-A mental health problem 0;1 0=No; 1=Yes
Query hc22c Integer Recommended Was ER visit for-An alcohol problem 0;1 0=No; 1=Yes
Query hc22d Integer Recommended Was ER visit for-A drug problem 0;1 0=No; 1=Yes
Query hc22e Integer Recommended Was ER visit for-Some other problem 0;1 0=No; 1=Yes
Query hc23a Integer Recommended Where you admisttd to a-Hospital 0;1 0=No; 1=Yes
Query hc23b Integer Recommended Where you admisttd to a-Psychiatric crisis center 0;1 0=No; 1=Yes
Query hc23c Integer Recommended Were you admitted to a-Temporary crisis center 0;1 0=No; 1=Yes
Query hc24a Integer Recommended Was Hospital Admission for-A physical problem 0;1 0=No; 1=Yes
Query hc24b Integer Recommended Was Hospital Admission for-A mental health problem 0;1 0=No; 1=Yes
Query hc24c Integer Recommended Was Hospital Admission for-An alcohol problem 0;1 0=No; 1=Yes
Query hc24d Integer Recommended Was Hospital Admission for-A drug problem 0;1 0=No; 1=Yes
Query hc24e Integer Recommended Was Hospital Admission for-Some other problem 0;1 0=No; 1=Yes
Query hc26 Integer Recommended INPATIENT FACILITYTYPE 1::7 1 = State or county mental hospital; 2 = General Hospital; 3 = Va Hospital; 4 = Private Psychiatric Hospital; 5 = Multi-service community mental health center; 6 = Substance abuse facility; 7 = None of the above
Query psych_er Integer Recommended Psychiatric ER number sequenceof Psychiatric ER visits in past 6 months
Query hc32 Integer Recommended Other than a hospital or emergency room, did you receive help for a psychiatric emergency or crisis from some other source in the past 6 months 0;1 0=No; 1=Yes
Query hc34 Integer Recommended How many times in the past 6 months did you receive services atpsychiatric emergency or crisis 0;1
Query hc34a Integer Recommended How many times in the past 6 months did you receive services at psychiatric emergency or crisis-refused
Query hc35a2 Integer Recommended How many times in the past 6 months did you see-provider 1 0;1
Query hc35a_3a Integer Recommended Did provider 1-Write a prescription for you or consult with you on medication 0;1 0=No; 1=Yes
Query hc35a_3b Integer Recommended Did provider 1-Provide you with some kind of mental health counseling 0;1 0=No; 1=Yes
Query hc35a_3c Integer Recommended Did provider 1-Provide you with some kind of vocational counseling 0;1 0=No; 1=Yes
Query hc35a_3d Integer Recommended Did provider 1-Provide you with some kind of spiritual or religious counseling 0;1 0=No; 1=Yes
Query hc35a_3e Integer Recommended Did provider 1-Provide you with some kind of peer support 0;1 0=No; 1=Yes
Query hc35b2 Integer Recommended How many times in the past 6 months did you see -provider 2 0
Query hc35b_3a Integer Recommended Did provider 2-Write a prescription for you or consult with you on medication 0;1 0=No; 1=Yes
Query hc35b_3b Integer Recommended Did provider 2-Provide you with some kind of mental health counseling 0;1 0=No; 1=Yes
Query hc35b_3c Integer Recommended Did provider 2-Provide you with some kind of vocational counseling 0;1 0=No; 1=Yes
Query hc35b_3d Integer Recommended Did provider 2-Provide you with some kind of spiritual or religious counseling 0;1 0=No; 1=Yes
Query hc35b_3e Integer Recommended Did provider 2-Provide you with some kind of peer support 0;1 0=No; 1=Yes
Query hc35c2 Integer Recommended How many times in the past 6 months did you see -provider 3 0
Query hc35c_3a Integer Recommended Did provider 3-Write a prescription for you or consult with you on medication 0;1 0=No; 1=Yes
Query hc35c_3b Integer Recommended Did provider 3-Provide you with some kind of mental health counseling 0;1 0=No; 1=Yes
Query hc35c_3c Integer Recommended Did provider 3-Provide you with some kind of vocational counseling 0;1 0=No; 1=Yes
Query hc35c_3d Integer Recommended Did provider 3-Provide you with some kind of spiritual or religious counseling 0;1 0=No; 1=Yes
Query hc35c_3e Integer Recommended Did provider 3-Provide you with some kind of peer support 0;1 0=No; 1=Yes
Query outpt Integer Recommended Outpatient visit number sequenceof outpatient visits in past 6 months
Query srfa5b2 Integer Recommended number of visits 0::100; -99 Psychiatric Clinic; -99=NK hc38a
Query srfa5b3 Integer Recommended average minutes/visit 000::999; -99 Psychiatric Clinic; -99=NK hc39a
Query srfa5a2 Integer Recommended Number of visits 0::50 Commnity Mental Health Clinic Services hc38b
Query srfa5a3 Integer Recommended average minutes/visit 000::999 Commnity Mental Health Clinic Services hc39b
Query srfa5c2 Integer Recommended number of visits 0::50 Family Service or Guardian Agency hc38c
Query srfa5c3 Integer Recommended average minutes/visit 000::999 Family Service or Guardian Agency hc39c
Query srfa5i2 Integer Recommended number of visits 0::50 Vocational Rehabilitation hc38d
Query srfa5i3 Integer Recommended average minutes/visit 000::999 Vocational Rehabilitation hc39d
Query hc38e Integer Recommended In the past month, how many times did you visit- A skills trainer(not including services received at the Connection Program) 0::50
Query hc39e Integer Recommended On average, how long did each visit with-A skills trainer last 000::999 Minutes
Query srfa5l2 Integer Recommended number of visits 0::50 Case Management/PACT (note: If included in previous categories do not double count) hc38f
Query srfa5l3 Integer Recommended average minutes/visit 000::999 Case Management/PACT (note: If included in previous categories do not double count) hc39f
Query hc38g Integer Recommended In the past month, how many times did you visit- A peer support program or counseling program 0::50
Query hc39g Integer Recommended On average, how long did each visit with-A peer support programast 000::999 Minutes
Query srfa5e2 Integer Recommended number of visits 0::50 Alcohol or Drug Counseling hc38h
Query srfa5e3 Integer Recommended average minutes/visit 000::999 Alcohol or Drug Counseling hc39h
Query srfa5f2 Integer Recommended number of visits 0::60 Self-Help Group (AA, NA, Peer Support) hc38i
Query srfa5f3 Integer Recommended Self-Help Group (AA, NA, Peer Support) average minutes/visit 000::999 Self-Help Group (AA, NA, Peer Support) hc39i
Query srfa5g2 Integer Recommended number of visits 0::50 Day Hospital/Day Treatment Center hc38j
Query srfa5g3 Integer Recommended average number of minutes 000::999 Day Hospital/Day Treatment Center hc39j
Query srfa5h2 Integer Recommended number of visits 0::50 VA Clinic hc38k
Query srfa5h3 Integer Recommended average minutes/visit 000::999 VA Clinic hc39k
Query hc38l Integer Recommended In the past month, how many times did you visit- Some other mental health professionalsuch as a social worker or psychologist or nurse 0::50
Query hc39l Integer Recommended On average, how long did each visit with-other mental health professional last 000::999 Minutes
Query srfa5o2 Integer Recommended number of visits 0::100; -99 Other services; -99=NK hc38m
Query srfa5o3 Integer Recommended average minutes/visit 000::999; -99 Other services; -99=NK hc39m
Query srfa6a Integer Recommended PrivateMedicalDoctor number of visits 0::50 hc40a
Query srfa6b Integer Recommended Private Health Care Practitioner (Non-M.D.) number of visits 0::50 hc40b
Query srfa6c Integer Recommended OutpatientClinic number of visits 0::50 hc40c
Query srfa6f Integer Recommended Other number of visits 0::50 hc40d
Query sumhc38 Integer Recommended Average number of times when in for a visit(s) number of times servicefrequency
Query avghc39 Float Recommended Average number of minutes at visits Minutes visitminutes
site String 101 Recommended Site Study Site
Query hc28_months Integer Recommended When were you admitted to the inpatient hospital (days from baseline)
Query study_id Integer Recommended Study ID number 46=Acute Phase; 47=Stabilization Phase
Query servicetype Integer Recommended Type of service (in the past 3 months) 1::31 1 = MEDICAL SERVICES: Medical Visit; 2 = MEDICAL SERVICES: Other Ambulatory Visit; 3 = PSYCHOLOGICAL SERVICES: Clinical Case Management; 4 = PSYCHOLOGICAL SERVICES: Medication Visit; 5 = PSYCHOLOGICAL SERVICES: Combined Medication and Psychotherapy; 6 = PSYCHOLOGICAL SERVICES: Psychotherapy: Individual; 7 = PSYCHOLOGICAL SERVICES: Psychotherapy: Group; 8 = PSYCHOLOGICAL SERVICES: Psychotherapy: Couples/Family; 9 = PSYCHOLOGICAL SERVICES: Diagnostic/Intake Evaluation; 10 = PSYCHOLOGICAL SERVICES: Alcohol/Drug Visit (outpatient); 11 = PSYCHOLOGICAL SERVICES: Self-Help Groups; 12 = PSYCHOLOGICAL SERVICES: Other Psychological Service; 13 = PSYCHOLOGICAL SERVICES: SEDE Study Research Visit; 14 = PROFESSIONAL SUPPORT SERVICES: Nursing Service; 15 = PROFESSIONAL SUPPORT SERVICES: Personal Home Aide Service; 16 = PROFESSIONAL SUPPORT SERVICES: Home Meal Delivery Service; 17 = PROFESSIONAL SUPPORT SERVICES: Transportation Assistance; 18 = PROFESSIONAL SUPPORT SERVICES: Physical/Occupational Therapy; 19 = PROFESSIONAL SUPPORT SERVICES: Other Service (Describe); 20 = OTHER SUPPORT SERVICES: Emergency Room Visit; 21 = OTHER SUPPORT SERVICES: Crisis Team Visit; 22 = OTHER SUPPORT SERVICES: Day Treatment Program; 23 = OTHER SUPPORT SERVICES: Partial Hospitalization Program; 24 = OTHER SUPPORT SERVICES: Alcohol/Drug Rehabilitation; 25 = OTHER SUPPORT SERVICES: Inpatient Hospitalization;26=Intensive Case manager; 27=Job Training; 28=mammogram Technician; 29=Massage; 30=Mental Health Support Club Hou; 31=Office of Vocational Rehabilitation
Query week Float Recommended Week in level/study 99=week 10-week 14 intid
Query providertype Integer Recommended Type of Provider 1::31 1 = Medical Doctor (MD); 2 = Psychiatrist (MD); 3 = Psychologist (PhD); 4 = Social Worker; 5 = Nurse; 6 = Professional Trainee; 7 = Unspecified therapist or counselor; 8 = Religious Leader (priest, minister, rabbi); 9 = Other Provider (specify); 10 = Peer Supporter (sponsor, congregational member); 11 = Vocational Rehabilitation Counselor; 12 = Alternative Medicine Provider; 13=Chiropractor, 14=Dentist (DDS), 15=Unknown, 16=Oncologist (MD), 17=Opthalmologist (MD), 18=Orthopedic Surgeon (MD), 19=Physician Assistant (PA), 20= Podiatrist (MD), 21= Social Worker; 22=Home Health Provider ; 23=Home Health Service Provider; 24=Intensive Case Manager; 25=Mammogram Technician; 26= Massage Therapist; 27=Physical Therapist; 28=Social Service Agency; 29=AlcoholicsAnonymousGroup; 30=Intern; 31=Marriage Family Therapy/Counseling
Query servicesite Integer Recommended Site of Service 1::14 1 = HOSPITALS: Psychiatric Hospital; 2 = HOSPITALS: General Hospital; 3 = OUTPT CLINICS: MH Center Outpt Clinic (County funded clinic); 4 = OUTPT CLINICS: MH Center Outpt Clinic (Voluntary clinic); 5 = OUTPT CLINICS: Hospital Based MH Clinic; 6 = OUTPT CLINICS: Alcohol/Drug clinic; 7 = OUTPT CLINICS: Medical Clinic; 8 = OUTPT CLINICS: Other Outpt Clinic; 9 = OUTPT CLINICS: Private Practice Office; 10 = OUTPT CLINICS: University Counseling Center; 11 = OUTPT CLINICS: Family/Social Service Agency; 12 = OUTPT CLINICS: Home; 13 = OUTPT CLINICS: Other; 14=NK
Query servicereason Integer Recommended Reason for service 1::7; -99 1 = Physical Problem (old); 2 = Physical Problem (new); 3 = Mental Health Problem; 4 = Depression; 5 = Alcohol/Drug Abuse; 6 = Other; 7=Bipolar Disorder; -99
Query estimatedfee Float Recommended Estimated fee per visit Record patient out-of-pocket expense
Query paymentmethod Integer Recommended Primary method of payment 1::10 1 = Medicare; 2 = Medicaid; 3 = Veteran's Program/Other Gov't Aid; 4 = Insurance: Indemnity; 5 = Insurance: Managed Care; 6 = Self-pay; 7 = Free; 8 = Other; 9 = Managed Medicaid/Medicare; 10 = NK
Query csi2 Float Recommended How many months have passed of this school year?
Query csi3 Integer Recommended How many children are in this class?
Query csi4 Integer Recommended Is this a mainstream or special education class? 1;2 1=Mainstream; 2=Special education
Query csi1 Integer Recommended What grade is this class?
Query fseqno Integer Recommended Sequence Number 0::999 The FSEQNO variable in the ADJ form has a special interpretation compared to other forms. For example, ADJ FSEQNO of '1' can be thought of as being '001', FSEQNO of '2' can be thought of as being '002', and FSEQNO of '3' can be thought of as being '003'. The first digit of FSEQNO relates to the corresponding ENF sequence number at that visit and the third digit relates to the specific adjudicator who completed the adjudication form.
othprov String 250 Recommended Other care provider
Query csi2_b Integer Recommended Have you used any Psychological Services in the past 3 months? 0;1 0=No; 1=Yes
Query csi3_b Integer Recommended Have you used any Professional Supportive Services in the past 3 months? 0;1 0=No; 1=Yes
Query csi4_b Integer Recommended Have you used any of the following in the past 3 months? (Emergency Room, Crisis Team Visit, Day Treatment Program, Partial Hospitalization Program, Alcohol/Drug Rehab, Inpatient Hospitalization) 0;1 0=No; 1=Yes
Query csi1_b Integer Recommended Have you used any Medical Services in the past 3 months? 0;1 0=No; 1=Yes
name_study String 50 Recommended Name of initial study
su_ad3a String 100 Recommended If you have reached out to a crisis hotline (calling or texting) since the last time we spoke, how many times? Indicate if it was calling or texting.
su_parent1 Integer Recommended Since your last contact with the study on (timeframe): Has your teen been admitted to any hospital related to a mental health or behavioral concern (psychiatric hospitalization)? 0::2 0 = No; 1 = Yes; 2 = Do not know
su_parent1a Integer Recommended Since your last contact with the study on (timeframe): If your teen has been admitted to any hospital related to a mental health or behavioral concern (psychiatric hospitalization), how many admissions?
su_parent2 Integer Recommended Since your last contact with the study on (timeframe): Has your teen been to a day (partial) treatment program or partial hospitalization? 0::2 0 = No; 1 = Yes; 2 = Do not know
su_parent2a Integer Recommended Since your last contact with the study on (timeframe): If your teen has been to a day (partial) treatment program or partial hospitalization, how many admissions?
su_parent3 Integer Recommended Since your last contact with the study on (timeframe): Has she/he been to a hospital emergency room for any emotional, behavioral, or substance use problems? 0::2 0 = No; 1 = Yes; 2 = Do not know
su_parent3a Integer Recommended Since your last contact with the study on (timeframe): If she/he has been to a hospital emergency room for any emotional, behavioral, or substance use problems, how many visits?
su_parent4 Integer Recommended Since your last contact with the study on (timeframe): Has your teen been admitted to an inpatient alcohol or drug treatment unit or detox unit? 0::2 0 = No; 1 = Yes; 2 = Do not know
su_parent4a Integer Recommended Since your last contact with the study on (timeframe): If your teen has been admitted to an inpatient alcohol or drug treatment unit or detox unit, how many admissions?
su_parent5 Integer Recommended Since your last contact with the study on (timeframe): Has your teen had any help from a crisis hotline? 0::2 0 = No; 1 = Yes; 2 = Do not know
su_parent5a Integer Recommended Since your last contact with the study on (timeframe): If your teen had any help from a crisis hotline, how many times?
su_parent6 Integer Recommended Since your last contact with the study on (timeframe): Has your teen received any outpatient mental health services, such as an evaluation or treatment (therapy) from a psychologist, social worker, or a counselor? 0::2 0 = No; 1 = Yes; 2 = Do not know
su_parent6a Integer Recommended Since your last contact with the study on (timeframe): If your teen has received any outpatient mental health services, such as an evaluation or treatment (therapy) from a psychologist, social worker, or a counselor, how many visits or sessions?
su_parent7 Integer Recommended Since your last contact with the study on (timeframe): Has your teen received any outpatient mental health services, such as an evaluation or treatment from a psychiatrist? 0::2 0 = No; 1 = Yes; 2 = Do not know
su_parent7a Integer Recommended Since your last contact with the study on (timeframe): If your teen has received any outpatient mental health services, such as an evaluation or treatment from a psychiatrist, how many visits or sessions?
su_parent8 Integer Recommended Since your last contact with the study on (timeframe): Has your teen received services from any other sources, for emotional, behavioral, or substance use problems? 0::2 0 = No; 1 = Yes; 2 = Do not know
su_parent9 Integer Recommended Since your last contact with the study on (timeframe): Has your teen taken any medication for a mental health or behavioral concern? 0::2 0 = No; 1 = Yes; 2 = Do not know
respondent String 20 Recommended Respondent Mother;Father;Parent;Guardian;Teacher;Child;Self;Caregiver;Partner;Other
su_ad1 Integer Recommended Have you been to any Emergency Department (ED) for evaluation since the last time we spoke? 0;1 0 = No; 1 = Yes
su_ad1a Integer Recommended If you have been to the Emergency Department (ED) for evaluation since the last time we spoke, how many times?
su_ad2 Integer Recommended Have you been admitted to any hospital since the last time we spoke? 0;1 0 = No; 1 = Yes
su_ad2a Integer Recommended If you have been admitted to any hospital since the last time we spoke, how many times?
su_ad2b Integer Recommended If you have been admitted to any hospital since the last time we spoke, how many times for psychiatric concerns?
su_ad3 Integer Recommended Have you reached out to a crisis hotline (calling or texting) since the last time we spoke? 0;1 0 = No; 1 = Yes
resource_center_resolve Integer Recommended Access Resolve through Resource Center within app. Resolve is a 24/7 crisis hotline sponsored through Allegheny County and UPMC Western Psychiatric that is available to all Allegheny County residents 0;1;999 0=No; 1=Yes; 999=Not available
prompt_resolve Integer Recommended Access Resolve through prompt after significant EPDS score or indication of self-harm. Resolve is a 24/7 crisis hotline sponsored through Allegheny County and UPMC Western Psychiatric that is available to all Allegheny County residents 0;1;999 0=No; 1=Yes; 999=Not available
referral_care_team Integer Recommended Referral to a clinical care team who use a needs-based approach to connect patients to resources 0;1 0=No; 1=Yes
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

  • Element Name: This is the standard element name
  • Data Type: Which type of data this element is, e.g. String, Float, File location.
  • Size: If applicable, the character limit of this element
  • Required: This column displays whether the element is Required for valid submissions, Recommended for valid submissions, Conditional on other elements, or Optional
  • Description: A basic description
  • Value Range: Which values can appear validly in this element (case sensitive for strings)
  • Notes: Expanded description or notes on coding of values
  • Aliases: A list of currently supported Aliases (alternate element names)
  • For valid elements with shared data, on the far left is a Filter button you can use to view a summary of shared data for that element and apply a query filter to your Cart based on selected value ranges

At the top of this page you can also:

  • Use the search bar to filter the elements displayed. This will not filter on the Size of Required columns
  • Download a copy of this definition in CSV format
  • Download a blank CSV submission template prepopulated with the correct structure header rows ready to fill with subject records and upload

Please email the The NDA Help Desk with any questions.

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