TABLE 1

Definitions of Social Complexity Risk Factors in MN State Administrative Data and Caregiver Survey

Social Complexity Risk FactorDefinition in Administrative DataDefinition in Caregiver Survey
Severe poverty (income ≤50% FPL) (12 mo)Income from all enrolled adults and children with the same case number was summed for the previous 12 mo and reported as a percentage of the FPG. Caregivers were coded as experiencing severe poverty if their FPG income percentage was ≤50%.Not assessed.
CPS involvement (3 y)Children for whom a child neglect/abuse assessment or investigation was completed within the 3 y ending June 30, 1013, as operationalized by the Child Safety and Permanency Division, were coded as receiving a child protection assessment.Not directly assessed; inferred from a response of “foster mother” or “foster father” to the questions “How are you related to [CHILD NAME]?” and “How is (your spouse or partner) related to [CHILD NAME]?”
Limited English proficiency (current)Applicants who checked “yes” to the question “Do you need an interpreter?” on the MHCP enrollment form or wrote in a language other than English in response to the question “What language do you speak most of the time?” were coded as limited English proficiency.US Census item “How well do you speak English?” on a 4-point response scale, coded as 1 = “not at all” or “not well” and 0 = “well” or “very well.” A supplementary item for validation only asked language spoken at home (coded 0 = English, 1 = any other response).
Caregiver physical disability (current)The Johns Hopkins’ Adjusted Clinic Groups Resource Utilization Band (RUB) score of 5 out of 5 (very high resource use) was used as a proxy for parents having a medically complex condition. In addition, applicants who indicated blindness or disability in 1 of the caregivers on the MHCP enrollment form were coded as having physical disability.Maximum of 5 items from the SF-12 Health Survey: whether the caregiver’s physical health limits them from moderate activities or climbing several flights of stairs (coded 1 = “limited a lot” or “limited a little,” 0 = “not limited at all”) and/or caused them to cut down on work or daily activities, accomplish less than they would like, or limited the kind of work or daily activities they could do in the past 4 wk (1 = yes, 0 = no).
Caregiver chemical dependency (18 mo)Caregiver received a chemical dependency diagnosis in past 18 mo, including alcohol dependency syndrome (303.X), drug dependence (304.X), nondependent abuse of drugs (305.X except for tobacco use disorder, 305.1), alcohol- or drug-induced mental disorders (291.X or 292.X), alcoholic gastritis (535.3), or acute alcoholic hepatitis (571.1).Not assessed.
Caregiver severe and persistent mental illness (18 mo)(1) Diagnosis of schizophrenia or schizo-affective disorder (295.X), borderline personality disorder (301.83), major depression disorder (296.2–296.3X), or bipolar disorder (296.0X, and 296.4X–296.8X); andMaximum of 3 individual survey items from the SF-12 Health Survey: whether their mental health caused them to cut down on work or daily activities, accomplish less than they would like, or limited the kind of work or daily activities they could do in the past 4 wk (1 = yes, 0 = no for each).
(2) Receipt of intensive mental illness services, such as inpatient stay, residential treatment, or crisis services: and
(3) Did not receive a developmental disability waiver and did not live in a DD/MR residential facility in past 18 mo.
Child insurance discontinuity ≥3 mo (12 mo)Children who had not reached their first birthday as of June 30, 2013 were coded as having complete coverage due to the “auto-newborn” process in which children automatically receive coverage for their first year of life if their mother has MHCP coverage (or if she enrolls during or shortly after the delivery). For children ages 1–17 y, MHCP enrollment records were reviewed over the 12 mo ending June 30, 2013 and coded for length of any continuous gap in enrollment.One item, “About how many months in the last 12 did your child not have insurance?” A response of 3 or more was coded as insurance discontinuity.
Current homelessness (current)Caregiver indicated homelessness on the MHCP application in response to the item “Check this box if you are homeless.”One item asked whether the family “had one night or more when [they] did not have a place to live” during the previous year. A second item asked caregivers to describe their current living situation; responses were recoded as 0 = stable housing (owning or renting one’s home) and 1 = precarious housing (any other response).
  • Time frames in parentheses in column 1 represent look-back periods for each indicator in the Minnesota state administrative data. Diagnostic codes in administrative data definitions refer to the International Statistical Classification of Diseases, Ninth Revision (ICD-9). FPG, federal poverty guideline; FPL, federal poverty level.