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REPORT CROSSWALK TO STATE
23-DEC-16 01:33Report Date :
Run by :
Report :
CWMS_PROXY
Filename :
Crosswalk Management System
CWMS_PROXY
Crosswalk Report
Page 2 of 54
Status : FN
Start Date : 01-AUG-01End Date :
Follow-up :
Media ID : SATIS-CT
ConnecticutSystem
K
1
2
3
System Transaction Type
State Code
Reporting Date
A
C
D
Add
Change
Delete
Add
Change
Delete
System Tranaction Type
State Abbreviation
Date of submission
-
-
-
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Substance Abuse and Mental Health Services AdministrationCenter for Behavioral Health Statistics and Quality
Connecticut's Treatment Episode Data SetVersion : 1
A
C
D
MMYYYY
CWMS_PROXY
Crosswalk Report
Page 3 of 54
ConnecticutMinimum
K
K
K
K
K
K
1
2
3
4
4
5
State Provider Identifer
Client Identifer (Admission)
Co-Dependent/Collateral
Client Transaction Type
Client Transaction Type
Date of Admission
2
A
A
M
T
X
No
Admission
Admission
Initial admission (MH)
Transfer
Transfer or change in service (MH)
Client
Admission (SA)
Admission (SA)
Initial Admission (MH)
Transfer/Change in Service (SA)
Transfer or Change in Service (MH)
Provider ID
Client identifier
Co-dependent/collateral
Client transaction type
Client transaction type
Date of Admission
-- 1
-- 3
--
--
--
-- 36
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
2
A
A
M
T
X
No longer effective as of: 06-30-2007
1-15 characters
MMDDYYYY
CWMS_PROXY
Crosswalk Report
Page 4 of 54
ConnecticutMinimum
6
7
Prior Treatment Episodes
Principal Source of Referral
0
1
2
3
4
5
7
1
13
14
4
5
6
7
97
0 Previous episodes
1 Previous episodes
2 Previous episodes
3 Previous episodes
4 Previous episodes
5 or more previous episodes
Unknown
Self
Other community referral
Court order
Substance abuse provider
Medical health practitioner
School
Employer/supervisor
Unknown
0 Previous Episodes
1 Previous Episodes
2 Previous Episodes
3 Previous Episodes
4 Previous Episodes
5 Or More Previous Episodes
Unknown
Individual (includes self-referral))
Other Community Referral
Court/Criminal Justice/DUI/DWI
Alcohol/Drug Abuse Provider
Other Health Care Provider
School (Educational)
Employer/Employer Assistance ProgramEAP
Unknown
Number Lifetime prior adm SA treatmnt
Principal Source of Referral
-- 51,52
-- 38
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
0
1
2
3
4
5
7
01
06
07
02
03
04
05
97
CWMS_PROXY
Crosswalk Report
Page 5 of 54
ConnecticutMinimum
7
8
9
Principal Source of Referral
Date of Birth
Gender
01
02
03
04
05
06
07
97
98
99
F
M
Individual/self referral
Alcohol/drug abuse provider
Other health care provider
School
Employer
Other community referral
Court/criminal justice referral/DUI/DWI
Unknown
Not collected
Unspecified
Female
Male
Individual (includes self-referral))
Alcohol/Drug Abuse Provider
Other Health Care Provider
School (Educational)
Employer/Employer Assistance ProgramEAP
Other Community Referral
Court/Criminal Justice/DUI/DWI
Unknown
Not Collected
Unknown
Female
Male
Principal Source of Referral ..
Date of Birth
Sex ..
38
-- 6
12
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
02
03
04
05
06
07
97
98
7
2
1
No longer effective as of:
No longer effective as of:
06-30-2010
06-30-2010
MMDDYYYY
CWMS_PROXY
Crosswalk Report
Page 6 of 54
ConnecticutMinimum
9
10
Gender
Race (Hispanic collected as race to be reported as 97 in Race and 06 in Ethnicit
F
M
U
1
2
4
5
6
98
99
Female
Male
Unknown
White
Black/Africian American
Asian
American Indian/Alaskan
Native Hawaiian or other Pacific Islander
Other
Unspecified
Female
Male
Unknown
White
Black or African American
Asian
American Indian/Alaskan Native ( States using Alaskan Native in 01 use for other
Native Hawaiians or Other Pacific Islanders
Other Single Race
Unknown
Sex
Race ..
-- 12
13
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
2
1
7
05
04
13
02
23
20
97
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 7 of 54
ConnecticutMinimum
10
11
Race (Hispanic collected as race to be reported as 97 in Race and 06 in Ethnicit
Hispanic or Latino Origin ( Ethnicity)
1
2
21
3
4
6
97
98
0
1
2
3
4
5
American Indian/Alaskan
Asian
Two or more races
Black/African American
Native Hawaiian or other Pacific Islander
White
Unspecified
Other
Unspecified
Hispanic - other
Non-Hispanic
Hispanic - Puerto Rican
Hispanic - Mexican
Hispanic - Cuban
American Indian/Alaskan Native ( States using Alaskan Native in 01 use for other
Asian
Two or More Races
Black or African American
Native Hawaiians or Other Pacific Islanders
White
Unknown
Other Single Race
Unknown
Other Specific Hispanic
Not of Hispanic or Latino Origin
Puerto Rican
Mexican
Cuban
Hispanic or Latino - Specific Origin not Specified
Race
Ethnicity
-- 13-17
-- 18
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
02
13
21
04
23
05
97
20
97
04
05
01
02
03
06
CWMS_PROXY
Crosswalk Report
Page 8 of 54
ConnecticutMinimum
12 Education Highest grade completed--
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
No longer effective as of: 06-30-2007
CWMS_PROXY
Crosswalk Report
Page 9 of 54
ConnecticutMinimum
12 Education
0
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
Less than one grade completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
HIghest Years completed
Less Than One Grade Completed
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
12th Grade or GED
1st year of College/Iniversity (Freshman)
2nd year of College/Iniversity (Sophomore)
3rd year of College/Iniversity (Junior)
4th year of College/Iniversity (Senior) or Bachelor's Degree)
Some Post-Graduate Study - Degree not completed
Master's Degree Completed
Post Graduate Study
Education-- 55
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
00
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19-25
CWMS_PROXY
Crosswalk Report
Page 10 of 54
ConnecticutMinimum
12
13
Education
Employment Status
1-25
1-25
97
>25
30
32
34
42
44
46
48
50
52
97
HIghest Years completed
HIghest Years completed
Unknown
Unknown
Full time
Part time
Unemployed
Student
Homemaker
Retired
SSI/SSDI
Inmate of institution
Other reason
Unknown
Grade 1
Grade 2
Unknown
Unknown
Full Time - works 35 or more hours a week- includes military
Part Time - works less tahn 35 hours per week
Unemployed - looking for work in past 30 days or on layoff from job
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Unknown
Education
Employment Status
-- 55
-- 54
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
02
97
97
01
02
03
04
04
04
04
04
04
97
CWMS_PROXY
Crosswalk Report
Page 11 of 54
ConnecticutMinimum
13 Employment Status
0
1
2
3
4
Unspecified, any unacceptable value
Not in labor force
Unemployed
Part time
Full time
Unknown
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Unemployed - looking for work in past 30 days or on layoff from job
Part Time - works less tahn 35 hours per week
Full Time - works 35 or more hours a week- includes military
Employment Status ..12
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
97
04
03
02
01
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 12 of 54
ConnecticutMinimum
14 Substance Problem Codes ( Primary-14A,Secondary-14B, Tertiart-14C)
1
10
11
12
13
14
15
16
17
18
2
3
4
5
6
7
8
Amphetamines
Marijauna/hashish
Methamphetamines
non-prescriptive methadone
Other opiates and synthetics
Other sediatives or hypnotics
Other Stimulants
Over-the-counter
PCP
Tranquilizers
Alcohol
Barbiuates
Benzodiazepine
Cocaine
Crack
Hallucingens
Heroin
Other Amphetamines
Marijuana, Hashish ( includesTHC and other Cannabis Sativa preperations)
Methamphetamine
Non-Prescription Methadone
Other Opiates and Synthetics
Other Non-Barbituate Sedatives or Hypnotics
Other Stimulants
Over-the-Counter
PCP
Other Non-Benzodiazapine Tranquilizers
Alcohol
Barbiturates
Benzodiazepines
Cocaine, Crack
Cocaine, Crack
Hallucinogens
Heroin
Substance Problem Codes - discharge~~65,69,73
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
11
04
10
06
07
16
12
18
08
14
02
15
13
03
03
09
05
CWMS_PROXY
Crosswalk Report
Page 13 of 54
ConnecticutMinimum
14 Substance Problem Codes ( Primary-14A,Secondary-14B, Tertiart-14C)
9
96
Inhalants
Other
Inhalants
Other
Not Collected
None
Unknown
Substance Problem Codes - discharge~~65,69,73
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
17
20
98
01
97
No longer effective as of: 06-30-2007
CWMS_PROXY
Crosswalk Report
Page 14 of 54
ConnecticutMinimum
14 Substance Problem Codes ( Primary-14A,Secondary-14B, Tertiart-14C)
0
1
10
11
12
13
14
15
16
17
18
2
3
4
5
6
7
None
Amphetamines
Marijauna/hashish
Methamphetamines
non-prescriptive methadone
Other opiates and synthetics
Other sediatives or hypnotics
Other Stimulants
Over-the-counter
PCP
Tranquilizers
Alcohol
Barbiuates
Benzodiazepine
Cocaine
Crack
Hallucingens
None
Other Amphetamines
Marijuana, Hashish ( includesTHC and other Cannabis Sativa preperations)
Methamphetamine
Non-Prescription Methadone
Other Opiates and Synthetics
Other Non-Barbituate Sedatives or Hypnotics
Other Stimulants
Over-the-Counter
PCP
Other Non-Benzodiazapine Tranquilizers
Alcohol
Barbiturates
Benzodiazepines
Cocaine, Crack
Cocaine, Crack
Hallucinogens
Substance Problem Codes - discharge~~65,69,73
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
11
04
10
06
07
16
12
18
08
14
02
15
13
03
03
09
CWMS_PROXY
Crosswalk Report
Page 15 of 54
ConnecticutMinimum
14
15
Substance Problem Codes ( Primary-14A,Secondary-14B, Tertiart-14C)
Usual Route of Administration ( Primary-15A, Secondary-15B, Tertiar-15C)
8
9
96
97
0
1
2
3
4
5
Heroin
Inhalants
Other
Unknown
Unspecified
Oral
Smoking
Inhalation
Injection
Other
Heroin
Inhalants
Other
Unknown
Unknown
Oral
Smoking
Inhalation
Injection (IV or intramuscular, intradermal or subcutaneous)
Other
Substance Problem Codes - discharge
Usual Route of Adinistration
~~65,69,73
--66,70,74
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
05
17
20
97
97
01
02
03
04
20
CWMS_PROXY
Crosswalk Report
Page 16 of 54
ConnecticutMinimum
16
17
Frequency of Use ( Primary-16A, Secondary-16B, Tertiary-16C)
Age of First Use (Primary-17A, Secondary-17B, Tertiary-17C)
0
1-3
4-8
9-29
=>30
blank
01-95
>95
Blank
No days
1-3 days
4-8 days
9-29 days
30 or more days
unknown
Age of first use
Unknown
Unknown
No use in the past month
1-3 times in past month
1-2 times per week
3-6 times per week
Daily
Unknown
Age at First Use, in years
Unknown
Unknown
Newborn with a substance dependecy problem
Number of days in last 30
Age of first use
--67,71,75
--68,72,76
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
02
03
04
05
97
01-95
97
97
00
CWMS_PROXY
Crosswalk Report
Page 17 of 54
ConnecticutMinimum
K 18 Type of Services
1
2
3
4
5
6
7
8
Detox - inpatient
Detox - inpatient other than hosp
Rehab/residential-hospital
Rehab/residential-short term
Rehab/residential-long term
Partial hospital
Outpatient - methadone maintenance
Detox - outpatient
Detoxification - Hospital Inpatient ( Detox, 24 hour Service)
Detoxification Free-standing Residential ( Detox, 24 hour Service)
Rehabilitation/Residential - Hospital (other thandetox)
Rehabilitation/Residential - Short-term, ( 30 days or fewer)
Rehabiliation/Residential - Long-term, ( more than 30 days)
Ambulatory - Intensive Outpatient
Ambulatory - Non-Intensive Outpatient
Ambulatory Detoxification
Type of service ..--
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
02
03
04
05
06
07
08
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 18 of 54
ConnecticutMinimum
K 18
19
Type of Services
Medication-Assisted Opioid Therapy
01
02
03
04
05
06
07
08
72
73
74
75
1000
Not=1000
Detox - Hosp Inpatient
Detox - free-standing residential
Rehab/residential - Hospital
Rehab/residential short term
Rehab/residential long term
Ambulatory - Intensive
Ambulatory - non-intensive
Ambulatory - Detox
State psychiatric hospital
SMHA funded/operated community-based program
Residential treatment center
Other psychiatric inpatient
Methadone maintenance
No
Detoxification - Hospital Inpatient ( Detox, 24 hour Service)
Detoxification Free-standing Residential ( Detox, 24 hour Service)
Rehabilitation/Residential - Hospital (other thandetox)
Rehabilitation/Residential - Short-term, ( 30 days or fewer)
Rehabiliation/Residential - Long-term, ( more than 30 days)
Ambulatory - Intensive Outpatient
Ambulatory - Non-Intensive Outpatient
Ambulatory Detoxification
State psychiatric hospital
SMHA funded/operated community based program
Residential treatment center
other psychiatric inpatient
Yes
No
Type of service
Opioid Replacement Therapy (Check care id for methadone)
--
--
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
02
03
04
05
06
07
08
72
73
74
75
1
2
CWMS_PROXY
Crosswalk Report
Page 19 of 54
ConnecticutSupplemental
1
4
4
5
5
Detail Drug Code, Primary
Diagnostic Code (DSM or ICD) field should be coded 999.98 - field 19 replaces i
Diagnostic Code (DSM or ICD) field should be coded 999.98 - field 19 replaces i
Psychiatric Problem in Addition to Alcohol or Drug Problem
Psychiatric Problem in Addition to Alcohol or Drug Problem
98
999.98
999.97
1
2
08
Not collected
Not collected
Unknown
Yes, client has co-occuring substance abuse & mental health problems
No, client does not have co-occuring substance abuse & MH problems
Not collected
Not Collected
Not Collected
Unknown
Yes
No
Uncollected
Not collected
DSM Diagnosis
Prelim Diagnostic Imp (DSM)
Psych problem + alcohol or drug prob
Not collected
-
~ 87,88,89
~ 87,88,89
~
-
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
9998
999.98
999.97
1
2
8
No longer effective as of:
No longer effective as of:
10-23-2014
10-23-2014
CWMS_PROXY
Crosswalk Report
Page 20 of 54
ConnecticutSupplemental
6
6
7
Pregnant at Admission
Pregnant at Admission
Veteran Status
1
2
6
7
N
U
Y
N
U
Y
Currently pregnant (if sex = female)
Not pregnant (if sex = female)
** Not Applicable (if sex = male)
Don't know/unsure
Not pregnant (if sex = female)
Don't know/unsure
Currently pregnant (if sex = female)
No
Unspecified
Yes
Yes - female client was pregnant at admission
No - female client was not pregnant at admission
Not Applicable - use this code for male clients or children in prepuberty age
Unknown
No - female client was not pregnant at admission
Unknown
Yes - female client was pregnant at admission
No
Unknown
Yes
Pregnant at Admission
Pregnant at Admission ..
Veteran Status ..
~
~ 39
~ 28
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
1
2
6
7
2
7
1
2
7
1
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 21 of 54
ConnecticutSupplemental
7 Veteran Status
0, other
1
2
Unspecified
Yes
No
Unknown
Yes
No
Veteran Status8
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
7
1
2
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 22 of 54
ConnecticutSupplemental
8 Living Arrangements
30
32
34
36
38
38
40
40
42
42
44
44
46
46
48
48
52
54
Private residence, client owns/leases
Private residence, friend or relative owns/leases
Single room occupancy (hotel, YMCA, Rooming house)
Private residence, Community agency owns/leases
Residential care home/Board and care
Residential care home/Board and care
Congregate residential care
Congregate residential care
Crisis/Respite bed
Crisis/Respite bed
Skilled Nursing Facility/Nursing Home
Skilled Nursing Facility/Nursing Home
Psychiatric/SA/Medical Inpatient
Psychiatric/SA/Medical Inpatient
Correctional facility
Correctional facility
Homeless
Homeless (including on street)
Independent Living - clients living alone or with others but no supervision
Independent Living - clients living alone or with others but no supervision
Independent Living - clients living alone or with others but no supervision
Independent Living - clients living alone or with others but no supervision
Dependent living: residential care (MH only)
Dependent Living - clients living in a supervised setting
Dependent living: residential care (MH only)
Dependent Living - clients living in a supervised setting
Dependent living: crisis residence (MH only)
Dependent Living - clients living in a supervised setting
Dependent Living - clients living in a supervised setting
Dependent living: residential care (MH only)
Dependent Living - clients living in a supervised setting
Dependent living: institutional setting (MH only)
Dependent Living - clients living in a supervised setting
Dependent living: jail and other institutions under the justice system (MH only)
Homeless - clients with no fixed address; includes homeless shelter
Homeless - clients with no fixed address; includes homeless shelter
Living situation~ 59
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
03
03
03
03
22
02
22
02
42
02
02
22
02
52
02
62
01
01
CWMS_PROXY
Crosswalk Report
Page 23 of 54
ConnecticutSupplemental
8
8
9
9
Living Arrangements
Living Arrangements
Source of Income/Support
Source of Income/Support
97
0, other
1
2
3
98
Unknown
Unspecified
Homeless
Dependent
Independent
Not Collected
Unknown
Unknown
Homeless - clients with no fixed address; includes homeless shelter
Dependent Living - clients living in a supervised setting
Independent Living - clients living alone or with others but no supervision
Not Collected
Wages/Salary
Public Assistance
Unknown
Disability
Other
Retirement/Pension
Living situation
Usual living conditions
Source of Income / Support
Source of Income / Support
~ 59
9
~
~
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
97
97
01
02
03
98
01
02
97
04
20
03
No longer effective as of:
No longer effective as of:
06-30-2010
06-30-2007
CWMS_PROXY
Crosswalk Report
Page 24 of 54
ConnecticutSupplemental
10
11
12
Health Insurance
Expected/Actual Primary Source of Payment
Detailed Not in Labor Force
98
98
01
02
03
04
05
06
97
Not collected
Not collected
Homemaker
Student
Retired
Disabled
Inamte of Institution
Other
Unknown
Not Collected
Not Collected
Homemaker
Student
Retired
Disabled
Inmate of Institution ( Prison or Institution - keeps people out of work force)
Other
Unknown
Not collected
Not collected
Detailed not in labor force
-
-
~
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
98
98
01
02
03
04
05
06
97
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 25 of 54
ConnecticutSupplemental
12
13
Detailed Not in Labor Force
Detailed Criminal Justice Referral Categories
36
38
42
44
46
48
50
96
97
98
Paid but non-competitive work (transitional employment progs)
Paid but non-competitive work (inside txt agency, mobile wk crews, etc)
Student
Homemaker
Retired
SSI/SSDI
Inmate of institution
Other
Unknown
Not collected
Sheltered/non-competitive employment (MH only)
Sheltered/non-competitive employment (MH only)
Student
Homemaker
Retired
Disabled
Inmate of Institution ( Prison or Institution - keeps people out of work force)
Other
Unknown
Not Collected
Detailed not in labor force ...
Not collected
~ 54
-
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
07
07
02
01
03
04
05
06
97
98
CWMS_PROXY
Crosswalk Report
Page 26 of 54
ConnecticutSupplemental
14
14
Marital Status
Marital Status
0,9,99
1
2
3
4
8
1
2
3
4
8
9
96
97
Not entered, Other, Unspecified
Never Married
Married
Separated
Divorced/Annulled
Widowed
Never married
Married
Separated
Divorced/Annulled
Widowed
Civil Union
Other
Unknown
Unknown
Never Married - includes clients who are single or whose
Now Married ( includes those living together as married)
Separated (legally seperated or otherwise absentbecasue of marital discord))
Divorced
Widowed
Never Married - includes clients who are single or whose
Now Married ( includes those living together as married)
Separated (legally seperated or otherwise absentbecasue of marital discord))
Divorced
Widowed
Unknown
Unknown
Unknown
Marital Status
Marital Status ..
~
~ 27
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
97
01
02
03
04
05
01
02
03
04
05
97
97
97
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 27 of 54
ConnecticutSupplemental
15
16
17
Days Waiting to Enter Treatment
Number of Arrests in the 30 Days Prior to Admission
Frequency of Attendance at Self-Help Programs in 30 days prior to Admission
98
0
01-96
97
0
01-50
01-50
01-50
01-50
01-50
97
Not collected
None
01-96
Unknown
None
01-50
01-50
01-50
01-50
01-50
Unknown
Not Collected
Number of Arrests
Number of Arrests
Unknown
No Attendance in past month
About once a week - 4 to 7 times in past 30 days
Some Attendance in past month, but number of times and frequency is unknown
4 or more times a week - 16 to 30 times in past 30 days
less than once a week -1 to 3 times in past 30 days
2 to 3 times a week - 8 to 15 times in past 30 days
Unknown
Not collected
Arrests in 30 days prior to admission
Social Support Voluntary
-
~ 62
~~ 63
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
998
00-96
00-96
97
01
03
06
05
02
04
97
CWMS_PROXY
Crosswalk Report
Page 28 of 54
ConnecticutSupplemental
18
19
Diagnostic Code Set
Diagnostic Code (ICD-10 Form)
1
2
999.9997
999.9998
xxx- - - - -
xxx.- - - -
xxx.x- - -
xxx.xx- -
DSM-IV
ICD-9
Unknown
Not collected
where "-" represents a blank
where "-" represents a blank
where "-" represents a blank
where "-" represents a blank
DSM-IV
ICD-9
Unknown
Not Collected
where "-" represents a blank
where "-" represents a blank.
where "-" represents a blank..
where "-" represents a blank...
Diagnostic Code Set Identifier
Substance Abuse Diagnosis- ICD compatible (in lieu of SuDS 4)
~
~
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
1
2
999.9997
999.9998
xxx_____
xxx.____
xxx.x
xxx.xx__
CWMS_PROXY
Crosswalk Report
Page 29 of 54
ConnecticutMental Health Admissions
1
1
MH Diagnostic Code - a,b,c
MH Diagnostic Code - a,b,c
999.9997
999.9998
xxx- - - - -
xxx.- - - -
xxx.x- - -
xxx.xx- -
999.9997
999.9998
xxx- - - - -
xxx.- - - -
xxx.x- - -
xxx.xx- -
Unknown
Not collected
where "-" represents a blank
where "-" represents a blank
where "-" represents a blank
where "-" represents a blank
Unknown
Not collected
where "-" represents a blank
where "-" represents a blank
where "-" represents a blank
where "-" represents a blank
Unknown
Not Collected
code format.
code format.
code format..
code format...
Unknown
Not Collected
code format.
code format.
code format..
code format...
MH Diagnostic Code - one (ICD-10 compatible)
MH Diagnostic Code - two (ICD-10 compatible)
MHA-1a
MHA-1b
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
999.9997
999.9998
XXX.
XXX.
XXX.X
XXX.XX
999.9997
999.9998
XXX.
XXX.
XXX.X
XXX.XX
CWMS_PROXY
Crosswalk Report
Page 30 of 54
ConnecticutMental Health Admissions
1
2
3
MH Diagnostic Code - a,b,c
SMI/SED
School Attendance Status
999.9997
999.9998
xxx- - - - -
xxx.- - - -
xxx.x- - -
xxx.xx- -
1
4
NULL
8
Unknown
Not collected
where "-" represents a blank
where "-" represents a blank
where "-" represents a blank
where "-" represents a blank
SMI
Not SMI/SED
Unknown
Not collected
Unknown
Not Collected
code format.
code format.
code format..
code format...
SMI
Not SMI/SED
Unknown
Not Collected
MH Diagnostic Code - three (ICD-10 compatible)
SMI/SED Status
School Attendance Status (MH NOM)
MHA-1c
MHA-2
MHA-3
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
999.9997
999.9998
XXX.
XXX.
XXX.X
XXX.XX
1
4
7
8
CWMS_PROXY
Crosswalk Report
Page 31 of 54
ConnecticutMental Health Admissions
4
5
Legal Status at Admission to State Hospital
GAF/CGAS Score
12000
22100
22110
22200
22500
22600
23200
23201
24200
25210
25220
96
NULL
0-100
NULL
Psychiatric Voluntary 17a-506(a)
Competency Restoration 54-56d(h)
Competency Restor TrackII Probate committed 54-56d(h)(2)(A)ii
Not Restorable 54-56d(m)
45 Day WFI Evaluation 17a-582(a)
PSRB Commitment 17a-582(e)(1)
Probate Commitment Psychiatric 17a-498(c)
Probate MH DOC 17a-498(c)
Physicians Emergency Cert. Psychiatric 17a-502(a)
Voluntary from DOC Psychiatric 17a-513(a)
PEC from DOC Psychiatric 17a-514
Not applicable- use this if Type of Treatment MDS18 is not 72
Unknown
GAF / CGAS score
Unknown
Voluntary
Involuntary - criminal
Involuntary - criminal
Involuntary - criminal
Involuntary - criminal
Involuntary - criminal
Involuntary - civil
Involuntary - civil
Involuntary - civil
Voluntary
Involuntary - civil
Not Applicable
Unknown
Score
Unknown
Legal Status at Admission to the State Hospital
GAF / CGAS Score
MHA-4
MHA-5
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
04
04
04
04
04
03
03
03
01
03
96
97
0-100
997
CWMS_PROXY
Crosswalk Report
Page 32 of 54
ConnecticutDischarge/NOMS
1
2
3
4
5
6
System Transaction at Discharge
State Code at Discharge
Reporting Date at Discharge
State Provider Identifer at Discharge
Client Identifier at Discharge
Co-Dependent/Collateral at Discharge
A
C
D
2
Add
Change
Delete
No
Add
Change
Delete
No
System transaction at discharge
State abbreviation
Reporting date
Provider ID at Discharge
Client Identifier discharge
Co-dependent/collateral ..
~~
~~
~~
~~ 1
~~ 3
~~
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
A
C
D
2
MMYYYY
1-15 characters
CWMS_PROXY
Crosswalk Report
Page 33 of 54
ConnecticutDischarge/NOMS
7 Type of Treatment Service/Treatment Setting at Discharge
01
02
03
04
05
06
07
08
72
73
74
75
76
96
Detox - Hosp inpatient
Detox - free-standing residential
Rehab/residential-hospital
Rehab/residential short term
Rehab/residential long term
Ambulatory - intensive
Ambulatory - non-intensive
Ambulatory - detox
State psychiatric hospital
SMHA funded/operated community-based program
Residential treatment center
Other psychiatric inpatient
Institutions under the justice system
Not applicable (use only for codependents (SA) & MH clients)
Detoxification, 24-Hour Service, Hospital Inpatient
Detoxification, 24-Hour Service, Free Standing Residential
Rehabilation/Residential - Hospital (other than detoxification)
Rehabilation/Residential - Short Term (30 Daysor Fewer)
Rehabilation/Residential - Long Term (More than 30 Days)
Ambulatory - Intensive -Outpatient
Ambulatory -Non Intensive -Outpatient
Ambulatory Detoxification
State Psychiatric Hospital
SMHA funded/operated community based program
Residential treatment center
Other psychiatric inpatient
Institutions under justice system
Not Applicable ( use only for codependents or collateral clients (SA) and for MH
Service at discharge~~
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
02
03
04
05
06
07
08
72
73
74
75
76
96
CWMS_PROXY
Crosswalk Report
Page 34 of 54
ConnecticutDischarge/NOMS
7
8
9
Type of Treatment Service/Treatment Setting at Discharge
Date of Last Contact or Data Update
Date of Discharge
1
2
3
4
5
6
7
8
-
-
Detox - inpatient
Detox - inpatient other than hospital
Rehab/residential - hospital
Rehab/residential - short term
Rehab/residential - long term
Partial hospital
Outpatient - methadone maintenance
Detox - outpatient
MMDDYYYY
MMDDYYYY
Detoxification, 24-Hour Service, Hospital Inpatient
Detoxification, 24-Hour Service, Free Standing Residential
Rehabilation/Residential - Hospital (other than detoxification)
Rehabilation/Residential - Short Term (30 Daysor Fewer)
Rehabilation/Residential - Long Term (More than 30 Days)
Ambulatory - Intensive -Outpatient
Ambulatory -Non Intensive -Outpatient
Ambulatory Detoxification
MMDDYYYY
MMDDYYYY
Type of service .
Date of Last Contact
Date of Discharge
~~
~~
~~ 41
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
02
03
04
05
06
07
08
-
-
No longer effective as of: 06-30-2010
MMDDYYYY
CWMS_PROXY
Crosswalk Report
Page 35 of 54
ConnecticutDischarge/NOMS
10 Reason for Discharge, Transfer, or Discontinuance of Treatment
32
34
36
38
38
40
41
42
44
46
48
50
51
96
96
97
Death
Evaluation only
Incarcerated
Inpatient discharge for inpatient medicalTx
Inpatient discharge for inpatient medicalTx
Client discontinued treatment
AMA
Left against advice
Moved out of area
Non-compliance with rules
Recovery plan completed
Released by court
Discharged to new service (facility concurs)
Other
Not applicable (use for MH update record only)
Unknown
Death
Other - includes aging out of MH childrens system, extended placement (condition
Incarerated or released by or to courts
Discharged from the state hospital to acute medical facility for medical service
Transferred to Another Treatment Program or Facility
Dropped out of treatment (lost contact, Left Against Professional Advice
Dropped out of treatment (lost contact, Left Against Professional Advice
Dropped out of treatment (lost contact, Left Against Professional Advice
Other - includes aging out of MH childrens system, extended placement (condition
Ternimated by Facility
Treatment Completed
Incarerated or released by or to courts
Transferred to Another Treatment Program or Facility
Other - includes aging out of MH childrens system, extended placement (condition
Not applicable (use for mH update record only
Unknown
Reason for Discharge~~ 42
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
06
07
05
34
04
02
02
02
07
03
01
05
04
07
96
97
CWMS_PROXY
Crosswalk Report
Page 36 of 54
ConnecticutDischarge/NOMS
10
11
12
Reason for Discharge, Transfer, or Discontinuance of Treatment
Provider Identifier at Admission
Client Identifier at Admission
08
1
10
2
3
4
5
6
7
8
9
Unknown
Treatment completed with referral to anither SA program
Deceased
Treatment completed without referral to anither SA program
Left with program's advice w/o formal referral to another SA progran
Left with program's advice w/o formal referral
Left against clinical advice
Incarcerated
Deceased
Discharge for noncompliance (substanceabuse)
Discharge for noncompliance (non-substance abuse)
Unknown - This code will still be accepted by states shouls use 97 Unknown
Treatment Completed
Other - includes aging out of MH childrens system, extended placement (condition
Treatment Completed
Transferred to Another Treatment Program or Facility
Transferred to Another Treatment Program or Facility
Dropped out of treatment (lost contact, Left Against Professional Advice
Incarerated or released by or to courts
Death
Ternimated by Facility
Ternimated by Facility
Comes from admission file
Comes from admission file
Reason for Discharge ..
Provider ID
Client Identifier discharge
~~
-- 1
~~ 3
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
08
01
07
01
04
04
02
05
06
03
03
-
-
No longer effective as of: 06-30-2010
.
CWMS_PROXY
Crosswalk Report
Page 37 of 54
ConnecticutDischarge/NOMS
13
14
14
15
Co-Depentent/Collateral at Admission
Client Transaction Type (pulled from admission dataset)
Client Transaction Type (pulled from admission dataset)
Date of Admission (pulled from admission dataset)
2
A
A
T
No
Admission
Admission
Transfer
Client
Initial Admission (SA)
Initial Admission (SA)
Transfer or change in service (SA)
Co-dependent/collateral
Client transaction type
Client transaction type
Date of submission
--
--
--
-
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
2
A
A
T
No longer effective as of: 06-30-2007
MMDDYYYY
CWMS_PROXY
Crosswalk Report
Page 38 of 54
ConnecticutDischarge/NOMS
16 Type of Service at Admission (pulled from admission dataset)
1
2
3
4
5
6
7
8
Detox - inpatient
Detox - inpatient other than hosp
Rehab/residential-hospital
Rehab/residential-short term
Rehab/residential-long term
Partial hospital
Outpatient - methadone maintenance
Detox - outpatient
Detoxification, 24-hour service - Hospital Inpatient
Detoxification , 24 hour service , Free-StandingResidential
Rehabilitation/Residential - Hospital (other thanDetoxification)
Rehabilitation/Residential - Short Term (30 days or fewer)
Rehabilitation/Residential - Long Term (more than 30 days)
Ambulatory - Intensive Outpatient
Ambulatory - Non-Intensive Outpatient
Ambulatory Detoxification
Type of service ..--
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
02
03
04
05
06
07
08
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 39 of 54
ConnecticutDischarge/NOMS
16
17
18
Type of Service at Admission (pulled from admission dataset)
Date of Birth (pulled from admission dataset)
Gender (pulled from admission dataset)
01
02
03
04
05
06
07
08
F
M
U
Detox - Hosp Inpatient
Detox - free-standing residential
Rehab/residential - Hospital
Rehab/residential short term
Rehab/residential long term
Ambulatory - Intensive
Ambulatory - non-intensive
Ambulatory - Detox
Female
Male
Unknown
Detoxification, 24-hour service - Hospital Inpatient
Detoxification , 24 hour service , Free-StandingResidential
Rehabilitation/Residential - Hospital (other thanDetoxification)
Rehabilitation/Residential - Short Term (30 days or fewer)
Rehabilitation/Residential - Long Term (more than 30 days)
Ambulatory - Intensive Outpatient
Ambulatory - Non-Intensive Outpatient
Ambulatory Detoxification
Female
Male
Unknown
Type of service
Date of Birth
Sex
--
-- 6
-- 12
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
02
03
04
05
06
07
08
2
1
7
MMDDYYYY
CWMS_PROXY
Crosswalk Report
Page 40 of 54
ConnecticutDischarge/NOMS
18
19
Gender (pulled from admission dataset)
Race (pulled from admission dataset)
99
F
M
1
2
21
3
4
6
97
98
Unspecified
Female
Male
American Indian/Alaskan
Asian
Two or more races
Black/African American
Native Hawaiian or other Pacific Islander
White
Unspecified
Other
Unknown
Female
Male
American Indian
Asian
Two or more races
Black or African American
Native Hawaiian or other Pacific Islander
White
Unknown
Other single race
Sex ..
Race
12
-- 13-17
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
7
2
1
02
13
21
04
23
05
97
20
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 41 of 54
ConnecticutDischarge/NOMS
19
20
Race (pulled from admission dataset)
Ethnicity (pulled from admission dataset)
1
2
4
5
6
98
99
0
1
2
3
4
5
White
Black/Africian American
Asian
American Indian/Alaskan
Native Hawaiian or other Pacific Islander
Other
Unspecified
Unspecified
Hispanic - other
Non-Hispanic
Hispanic - Puerto Rican
Hispanic - Mexican
Hispanic - Cuban
White
Black or African American
Asian
American Indian
Native Hawaiian or other Pacific Islander
Other single race
Unknown
Unknown
Other Specific Hispanic or Latino
Not of Specific Hispanic or Latino Origin
Puerto Rican
Mexican
Cuban
Race ..
Ethnicity
13
-- 18
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
05
04
13
02
23
20
97
97
04
05
01
02
03
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 42 of 54
ConnecticutDischarge/NOMS
21 Substance Problem At Discharge, (Primary, Secondary, Tertiary)
0
1
10
11
12
13
14
15
16
17
18
2
3
4
5
6
7
8
None
Amphetamines
Marijauna/hashish
Methamphetamines
non-prescriptive methadone
Other opiates and synthetics
Other sediatives or hypnotics
Other Stimulants
Over-the-counter
PCP
Tranquilizers
Alcohol
Barbiuates
Benzodiazepine
Cocaine
Crack
Hallucingens
Heroin
None
Other Amphetamines
Marijuana/Hashish
Methampetamine/SPeed
Non-Prescription Methadone
Other Opiates and Synthetics
Other Sedatives or Hypontics
Other Stimulants
Over-The-Counter medicines
PCP- phencyclidine
Other Tranquilizer
Alcohol
Barbiturates
Benzodiazepines
Cocaine/Crack
Cocaine/Crack
Hallucinogens
Heroin
Substance Problem Codes - discharge~~65,69,73
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
11
04
10
06
07
16
12
18
08
14
02
15
13
03
03
09
05
CWMS_PROXY
Crosswalk Report
Page 43 of 54
ConnecticutDischarge/NOMS
21
22
Substance Problem At Discharge, (Primary, Secondary, Tertiary)
Frequency of Use at Discharge (Primary, Secondary, Tertiary)
9
96
97
0
1-3
4-8
9-29
=>30
blank
Inhalants
Other
Unknown
No days (used in past 30 days)
1-3 days
4-8 days
9-29 days
30 or more days
Unknown
Inhalants
Other
Unknown
No Use in the Past Month
1-3 Times in the Past Month
1-2 Times in the Past Week
3-6 Times in the Past Week
Daily
Unknown
Substance Problem Codes - discharge
Frequency of use at discharge
~~65,69,73
~~66,70,74
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
17
20
97
01
02
03
04
05
97
CWMS_PROXY
Crosswalk Report
Page 44 of 54
ConnecticutDischarge/NOMS
23 Living Arrangements at Discharge
30
32
34
36
38
38
40
40
42
42
44
44
46
46
48
48
52
54
Private residence, client owns/leases
Private residence, friend or relative owns/leases
Single room occupancy (hotel, YMCA, rooming house)
Private residence, Community agency owns/leases
Residential care home/board and care (MH only)
Residential care home/Board and care
Congregate residential care (MH only)
Congregate residential care
Crisis/Respite bed (MH only)
Crisis/respite bed
Skilled Nursing Facility/Nursing Home
Skilled Nursing Facility/Nursing Home
Psychiatric/SA/Medical inpatient
Psychiatric/SA/Medical inpatient (MH only)
Correctional facility
Correctional facility (MH only)
Homeless shelter
Homeless (including on street)
Independent Living - clients living alone or with others but no supervision
Independent Living - clients living alone or with others but no supervision
Independent Living - clients living alone or with others but no supervision
Independent Living - clients living alone or with others but no supervision
Dependent living: residential care (MH only)
Dependent Living - clients living in a supervised setting
Dependent living: residential care (MH only)
Dependent Living - clients living in a supervised setting
Dependent living: crisis residence (MH only)
Dependent Living - clients living in a supervised setting
Dependent Living - clients living in a supervised setting
Dependent living: residential care (MH only)
Dependent Living - clients living in a supervised setting
Dependent living: institutional setting (MH only)
Dependent Living - clients living in a supervised setting
Dependent living: jail and other institutions under the justice system (MH only)
Homeless - clients with no fixed address; includes homeless shelter
Homeless - clients with no fixed address; includes homeless shelter
Living arrangment at discharge~~ 59
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
03
03
03
03
22
02
22
02
42
02
02
22
02
52
02
62
01
01
CWMS_PROXY
Crosswalk Report
Page 45 of 54
ConnecticutDischarge/NOMS
23
23
Living Arrangements at Discharge
Living Arrangements at Discharge
97
0, other
1
2
3
Unknown
Unspecified
Homeless
Dependent
Independent
Unknown
Unknown
Homeless - clients with no fixed address; includes homeless shelter
Dependent Living - clients living in a supervised setting
Independent Living - clients living alone or with others but no supervision
Living arrangment at discharge
Usual living conditions
~~ 59
9
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
97
97
01
02
03
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 46 of 54
ConnecticutDischarge/NOMS
24
24
Employment at Discharge
Employment at Discharge
30
32
34
42
44
46
48
50
52
97
98
0
1
2
3
4
Full time
Part time
Unemployed
Student
Homemaker
Retired
SSI/SSDI
Inmate of institution
Other reason
Unspecified, any unacceptable value
Not collected
Unspecified, any unacceptable value
Not in labor force
Unemployed
Part time
Full time
Full Time - works 35 or more hours a week- includes military
Part Time - works less tahn 35 hours per week
Unemployed - looking for work in past 30 days or on layoff from job
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Unknown
Not Collected
Unknown
Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.
Unemployed - looking for work in past 30 days or on layoff from job
Part Time - works less tahn 35 hours per week
Full Time - works 35 or more hours a week- includes military
Employment status at discharge
Employment Status ..
~~ 54
12
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
02
03
04
04
04
04
04
04
97
98
97
04
03
02
01
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 47 of 54
ConnecticutDischarge/NOMS
25 Detailed Not In Labor Force at Discharge
36
38
42
44
46
48
50
96
97
Paid but non-competitive work (transitional employment programs) MHonlyPaid but non-competitive work (inside treatment agency etc) MH only
Student
Homemaker
Retired
SSI/SSDI
Inmate of institution
Other
Unknown
Sheltered/non-competitive employment (MH only)
Sheltered/non-competitive employment (MH only)
Student
Homemaker
Retired
Disabled
Inmate of Institution ( Prison or Institution - keeps people out of work force)
Other
Unknown
Detailed not in labor force .. discharge~~ 54
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
07
07
02
01
03
04
05
06
97
CWMS_PROXY
Crosswalk Report
Page 48 of 54
ConnecticutDischarge/NOMS
25
26
Detailed Not In Labor Force at Discharge
Number of Arrests in 30 Days Priorto Discharge
01
02
03
04
05
06
97
0
01-96
97
Homemaker
Student
Retired
Disabled
Inmate of institution
Other
Unknown
None
01-96
Unknown
Homemaker
Student
Retired
Disabled
Inmate of Institution ( Prison or Institution - keeps people out of work force)
Other
Unknown
Number of Arrests
Number of Arrests
Unknown
Detailed not in labor force .
Number of arrests 30 days prior to disch
~~
~~ 62
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
02
03
04
05
06
97
00-96
00-96
97
No longer effective as of: 06-30-2010
CWMS_PROXY
Crosswalk Report
Page 49 of 54
ConnecticutDischarge/NOMS
27
28
Frequency of Attendance at Self-Help program in the 30 Days Prior to Discharge
Client Transaction Type - Discharge
0
01-50
01-50
01-50
01-50
01-50
97
D
E
U
None
01-50
01-50
01-50
01-50
01-50
Unknown
Discharge (SA client)
Discharge (MH client)
Data Update (MH client)
No Attendance in past month
About once a week - 4 to 7 times in past 30 days
Some Attendance in past month, but number of times and frequency is unknown
4 or more times a week - 16 to 30 times in past 30 days
less than once a week -1 to 3 times in past 30 days
2 to 3 times a week - 8 to 15 times in past 30 days
Unknown
Discharge (SA)
Discharge (MH)
Update (MH)
Social Support Voluntary (Freq self-help)
Client Transaction Type
~ 63
~~
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
01
03
06
05
02
04
97
D
E
U
CWMS_PROXY
Crosswalk Report
Page 50 of 54
ConnecticutMental Health Discharge
1
2
2
Diagnostic Code Set Identifier
MH Diagnostic Code a,b,c
MH Diagnostic Code a,b,c
1
2
999.9997
xxx- - - - -
xxx.x- - -
xxx.xx- -
999.9997
xxx- - - - -
xxx.x- - -
xxx.xx- -
DSM-IV
ICD-9
Unknown
where (-) represents a blank
where (-) represents a blank
where (-) represents a blank
Unknown
where (-) represents a blank
where (-) represents a blank
where (-) represents a blank
DSM-IV
ICD-9
Unknown
Code type.
Code type...
Code type....
Unknown
Code type.
Code type...
Code type....
Diagnostic Code Set Identifier - discharge
MH Diagnostic Code - two (ICD-10 form) - discharge
MH Diagnostic Code - three (ICD-10 form) - discharge
MHD-1
MHD-2b
MHD-2c
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
1
2
999.997
XXX
XXX.X
XXX.XX
999.997
XXX
XXX.X
XXX.XX
CWMS_PROXY
Crosswalk Report
Page 51 of 54
ConnecticutMental Health Discharge
2
3
4
MH Diagnostic Code a,b,c
SMI/SED - Discharge
School Attendance
999.9997
xxx- - - - -
xxx.- - - -
xxx.x- - -
xxx.xx- -
1
4
NULL
8
Unknown
where (-) represents a blank
where (-) represents a blank
where (-) represents a blank
where (-) represents a blank
SMI
Not SMI/SED
Unknown
Not collected (currently reporting only adult data)
Unknown
Code type.
Code type..
Code type...
Code type....
SMI
Not SMI/SED
Unknown
Not Collected
MH Diagnostic Code - one (ICD-10 form) - discharge
SMI/SED Status - discharge
School Attendance Status (MH) - discharge
MHD-2a
MHD-3
MHD-4
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
999.997
XXX
XXX.
XXX.X
XXX.XX
1
4
7
8
CWMS_PROXY
Crosswalk Report
Page 52 of 54
ConnecticutMental Health Discharge
5 Education/Grade level - MH
0
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
1-25
Less than one grade completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
Highest Years completed
less than one school grade or no schooling
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
12th grade or GED
1st year college
2nd year college or Associate's Degree
3rd year college
4th year college or Bachelor's Degree
Post Graduate Study
Grade 1`
Education/Grade Level (MH) - dischargeMHD-5
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
00
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
19-25
01
CWMS_PROXY
Crosswalk Report
Page 53 of 54
ConnecticutMental Health Discharge
5
6
Education/Grade level - MH
GAF/CGAS score - MH (optional)
1-25
1-25
97
0-100
997
Highest Years completed
Highest Years completed
Unknown
GAF / GAS Score
Unknown
Some Postgraduate Study - Degree not completed
Master's Degree Completed
Unknown
Score
Unknown
Education/Grade Level (MH) - discharge
GAF / CGAS Score - discharge
MHD-5
MHD-6
K = Key Field
Treatment Episode Data SetItem No Item Value State System Data
Connecticut's Treatment Episode Data SetVersion : 1
17
18
97
0-100
997
REPORT CROSSWALK TO STATE
Crosswalk Management System
End of Report
