NDTMS Core Dataset ‘F’ Training Regina Lally, Kellie Peters and Michael Wallington Drug Treatment Monitoring Unit

Ground Rules Please respect those around you by not holding individual conversations whilst the sessions are in progress Please put mobiles on silent/vibrate Please take any calls outside of the meeting

Aims Clarify requirements and definitions of Core Data Set F (CDS-F) Clarify DAAT care co-ordination pathways and practicalities surrounding TOP data submission to NDTMS Provide updated information around data quality, reporting and monitoring

New for Core Dataset F Main additions to YP dataset Adult dataset changes are: 1 new field Reference data changes

TOP Care Co-ordination Options: Yes / No To be used from 1st April 2009 To support the monitoring of TOPs completion Agency is care co-ordinator who has current responsibility for completing TOP

Parental Status Reference Data changing from 1st April 2009: All the children live with the client Some of the children live with the client None of the children live with client Not a parent Client declined to answer

Drug Discharge Reasons Successful Completions Treatment completed - drug free Treatment completed - occasional user (not opiates or crack)

Drug Discharge Reasons Transfers Transferred – not in custody Transferred – in custody

Drug Discharge Reasons Incomplete Incomplete – Dropped Out Incomplete – Treatment withdrawn by provider Incomplete – Retained in Custody Incomplete – Treatment Commencement Declined by Client Incomplete – Client Died

Alcohol Discharge Reasons Successful Completions Treatment completed - alcohol free Treatment completed - occasional user

Alcohol Discharge Reasons Transfers Transferred – not in custody Transferred – in custody

Alcohol Discharge Reasons Incomplete Incomplete – Dropped Out Incomplete – Treatment withdrawn by provider Incomplete – Retained in Custody Incomplete – Treatment Commencement Declined by Client Incomplete – Client Died

Adult Alcohol Modalities Tier 3 ALC - Community Prescribing ALC - Structured Psychosocial Intervention ALC - Structured Day Programme ALC - Other Structured Treatment Tier 4 ALC - Inpatient Treatment ALC - Residential Rehabilitation Tier 2 (New) ALC – Brief Interventions Will NOT count towards numbers in Treatment. ‘Other Structured Intervention’ – must be care planned for it to be classed as tier 3 activity.

Consent Clients should give written consent to share information about their care plan. This consent should specifically state which agencies the client consents to have information received about them and which they do not. A form recording the client’s consent should be kept in the notes. Consent should be reviewed at the time of reviewing the care plan. If a client refuses consent – NATMS and TOP should still be completed within your own system, consent flagged as no, and we will receive only minimal non-identifiable data. If the client is not aware that the DAAT would have sight of the attributable data, their row level data cannot be shared with the DAATs.

Confidentiality Agencies should have clear policies about how assessment information and care plans are shared. Good information sharing protocols help the care planning process to be smoother and prevent the hold-ups and misunderstandings that might arise if all the relevant information for the client was not available to practitioners and keyworkers in different agencies. (Good practice in care planning, July 2007 NTA) Part of the assessment process should be establishing with a client how information relating to them may be shared and for what purpose. This may be done as part of the care planning process and should have started at the time of assessment.

NTA Confidentiality Toolkit Confidentiality policy should be clearly explained to client (verbally and written form), before assessment for treatment. Should cover: What information will be collected by the agency When and what information will be shared with other services and organisations Who information will go to and why (NDTMS) When the confidentiality may be breached (NTA Confidentiality Toolkit, pending 2009 NTA)

Questions Anything NDTMS related!

NTA Quarterly Reports Available on NDTMS.net Providers no longer being given access to restricted section DAAT should circulate relevant report to providers

TOP Care Co-ordination Discuss the care pathways and map out the client journey. Look at Where do they enter Structured Treatment Which agencies are they likely to be engaged with Who should be providing TOPs in each situation Think about a variety of scenarios

TOP Feedback

Client Information Agency ID: P0000 First Initial: A Second Initial: W DOB: 22/10/1973 Gender: Male Referral Date: dd/mm/yyyy T3 Assessment Date: dd/mm/yyyy Main Problem Substance: Alcohol PCT of residence: Kent DAT of residence: Kent Postcode: ME14 1HH Referral Source: Self Client Ref: 123 Previously Treated: No Consent for NATMS: Yes Sexuality: Heterosexual Ethnicity: White Local Authority: Maidstone Nationality: GBR - What is the trigger for sending NDTMS data to DTMU? Full postcode / truncated Consent must be populated All fields must be populated to best of client’s knowledge and happy to respond. Not keyworker’s choice. https://www.ndtms.org.uk/emids/cgi-bin/ons_locale.cgi (East Midlands lookup facility for new PCT codes) Nationality codes – are those listed within the ISO 3166-1 Alpha-3 standard - Check on your system, that you have correct options. E.g. BOMIC – not known, british and other are NOT acceptable options. From 1st October 2007, if you are drug and alcohol service, please provide clients presenting with both Drug and Alcohol as a main problem drug. NTA will require a baseline in 07-08, so we hope to be able to provide 6 months worth of data. Consent must be provided, as with all clients and confidentiality will be the same.

Referral Date Definition (referral to agency date) date agency becomes aware that the client is waiting. Date of receipt of phone-call, letter, client walks through door asking to be seen etc.

Care Planning “As soon as possible, the allocated keyworker will ensure that the client undergoes a comprehensive assessment of needs. Following this a comprehensive care plan is drawn up”. (Care Planning Practice Guide, August 2007, NTA) “…service user involvement [is] an integral part of the development of care plans, with the users as the central focus of care planning, review and ongoing treatment.” (Good Practice in Care Planning, July 2007, NTA)

Care Planning Domains Drug & Alcohol Use Care Plan Start Date: dd/mm/yyyy Drug & Alcohol Use Route of Administration of Primary Substance: Oral Age of first use of Primary Substance: 23 Problem Substance Two: Cannabis Problem Substance Three: Amphetamines Unspecified Injecting Status: Never Injected in last 28 Days: No Ever shared: No Drinking Days: 28 Units of Alcohol: 17 NDTMS information that will be captured as part of the care planning process and as the care plan progresses. We have tried to pull the various fields under one of the four care planning domains – the care planning domains continue as a theme on the TOP form. Care Plan Start Date – must be before modality start date! As you can quite clearly see the new data items fit neatly within the Care Plan domains that we (DTMU) have mentioned in previous training sessions. You will also note that ‘units of alcohol’ has appeared, as you may be aware there has been much debate around alcohol collection for a number of years, and this is the first data item that looks at alcohol consumption other that the drug fields. Alcohol is likely to be collected from 1st April 2008, if you are a drug and alcohol agency and wish to submit alcohol data (with the understanding that Alcohol clients will not be counted towards the LDP figure) the DTMU will process this alongside the drug client data. Over the next 12months the DTMU will be contacting alcohol only agencies about engaging with NDTMS. If you complete drinking days, you must populate units of alcohol – otherwise a warning will be created. Drinking days is out of 28 / Units is average daily consumption. If “Drinking Days” completed, “Units of Alcohol” MUST be completed as well “Units of Alcohol” is typical number of units consumed on a drinking day

Care Planning Domains Physical & Psychological Health Hep C Latest Test Date: dd/mm/yyyy Hep C Intervention Status: Offered and accepted Hep C Positive: No Hep B Intervention Status: Offered and accepted Hep B Vaccination Count: One vaccination Previously Hep B Infected: No Referred to Hepatology: No Dual Diagnosis: No For latest hep c test date: If client just knows year, then enter 01/01/yyyy – if they know month and year enter 01/mm/yyyy Should be recorded whether hep c test is offered etc under hep c intervention status. Dual Diagnosis – for those clients who are also in contact with mental health teams. This is simply a yes/no field. This is appearing in quarterly reports – again, populate with yes or no, not blank. Harm reduction is high on the current NTA agenda and are focusing on Hep B / C interventions being offered via NDTMS quarterly reports. Importance of populating the fields to indicate that something has occurred rather than left blank (not offered is the acceptable). Not likely to be as relevant for Alcohol only clients. Report if it is relevant for the client.

Care Planning Domains Social Functioning Accommodation Need: Housing Problem Employment Status: Unemployed Children: 3 Pregnant: Yes Parental Status: All the children live with client NDTMS fields captured under “social functioning” care planning domain Note of options for drop down lists to be handed out. Highlights other needs that may need to be addressed with the client and with partnership agencies. Accommodation need (previously accommodation status) – separate lists for Adult and YP.

Parental Status Reference Data changing from 1st April 2009: All the children live with the client Some of the children live with the client None of the children live with client Not a parent Client declined to answer

Adult Alcohol Modalities Tier 3 ALC - Community Prescribing ALC - Structured Psychosocial Intervention ALC - Structured Day Programme ALC - Other Structured Treatment Tier 4 ALC - Inpatient Treatment ALC - Residential Rehabilitation Tier 2 (New) ALC – Brief Interventions Will NOT count towards numbers in Treatment. ‘Other Structured Intervention’ – must be care planned for it to be classed as tier 3 activity.

Modality Data Referral Date: dd/mm/yyyy T3/4 Assessment Date: dd/mm/yyyy Referral Source: Community Alcohol Team Referral to Modality Date: dd/mm/yyyy Date of First Appointment Offered: dd/mm/yyyy Modality: ALC- Community Prescribing Modality Start Date: dd/mm/yyyy If modality start date is populated and care plan start date is empty a validation message will be returned! Referred to Mod date and Modality are linked – error if one left blank Do not input Mod Start in the future – wait until actually happens. MOD START IS KEY FIELD – now trigger for TOP and Waiting Times. Therefore pay special attention to getting the field right. This is client’s first intervention in the DAAT Treatment System, and therefore by the time you’ve entered the modality start date a care co-ordinator must have been identified and therefore responsible for completing TOPS form.

Treatment Outcomes Profile Short, validated outcome monitoring tool released by the NTA June 2007 Intended for implementation in all Drug services that provide structured Tier 3 & Tier 4 treatments Data to be reported to NDTMS from 1st October 2007 Should be completed at: Modality Start Care Plan Review Discharge Post Discharge [Optional] www.nta.nhs.uk/areas/outcomes_monitoring/ Further information available on NTA website.

Treatment Outcomes Profile Validated for clients with Alcohol as main problem substance. No initial requirement by NTA to complete TOPs at Alcohol Only agencies. Recommended/Encouraged completion of TOP forms. Further information available on NTA website.

TOP NDTMS Data You should aim to ask and complete every question. Do not leave any of the blue boxes blank Enter “NA” if a client refuses to answer a question or cannot recall. Where DAAT areas have incorporated the form into their own paperwork, the questions should be replicated exactly as they appear on the TOP form and need to be input into the NDTMS at the appropriate points in the client treatment. The above points apply to locally adapted paperwork as well.

DAATs should have agreed care co-ordination pathways locally. TOP NDTMS Data Modality Start Date: dd/mm/yyyy [Trigger for first TOP] TOP Date: dd/mm/yyyy TOP Treatment Stage: Treatment Start TOP Care Co-ordination: Yes When multiple agencies are providing treatment, it is envisaged that responsibility for reporting TOP data will lie with the agency responsible for care co-ordination. DAATs should have agreed care co-ordination pathways locally. Where there is more than one agency simultaneously providing treatment, the agency should send copies of the TOP information to other services (subj. to Info Sharing Prot in place and client consent).

TOP NDTMS Data Section 1: Substance Use Alcohol Use: 15 Opiate Use: 0 Crack Use: 0 Cocaine Use: 15 Amphetamine Use: 4 Cannabis Use: 10 Other drug use: 0 Information sought: Number of days out of last 28 client has used each drug. Permissible values: Number in range “0-28” “NA” if client is unable to or refuses to answer question

TOP NDTMS Data Section 2: Injecting Risk Behaviour IV Drug Use: 0 Sharing: N Information sought: Number of days out of last 28 client has injected non-prescribed drugs. Permissible values: Number in range “0-28” “NA” if client is unable to or refuses to answer question Information sought: Has client shared needles or paraphernalia in last 28 days. Permissible values: Y or N “NA” if client is unable to or refuses to answer question

TOP NDTMS Data Section 3: Crime No details of specific crimes should be shared by client with keyworker. General information about type of crimes funding drug or alcohol habit should be shared and recorded to address all client needs and evidence improvement in lifestyle. The information shared with NDTMS is subject to the same confidentiality as all client information currently / previously received. Data is used for performance / outcome monitoring only.

TOP NDTMS Data Section 3: Crime Shop Theft: 18 Drug Selling: 6 Other theft: Y Assault / Violence: N Information sought: Number of days out of last 28 client has been involved in each crime. Permissible values: Number in range “0-28” “NA” if client is unable to or refuses to answer question Information sought: Has client been involved in each crime in last 28 days. Permissible values: Y or N “NA” if client is unable to or refuses to answer question

TOP NDTMS Data Section 4: Health & Social Functioning Psychological Health Status: 9 Paid work: 3 Education: 1 Information sought: Self reported score from scale. Permissible values: Number in range “0-20” “NA” if client is unable to or refuses to answer question Information sought: Number of days out of last 28 client has had paid work or been in education. Permissible values: Number in range “0-28” “NA” if client is unable to or refuses to answer question Client focused. Any queries on scales, refer to Keyworker Guidance – help on extracting accurate info from client.

TOP NDTMS Data Section 4: Health & Social Functioning Physical Health Status: 5 Quality of Life: 4 Acute Housing Problem: N Housing Risk: Y Information sought: Self reported score from scales. Permissible values: Number in range “0-20” “NA” if client is unable to or refuses to answer question Information sought: Client has been homeless / risk of eviction in last 28 days. Permissible values: “Y” or “N” “NA” if client is unable to or refuses to answer question

Modality End / Discharge Data Modality End Date Modality Exit Status Can be entered as modalities are completed, client episode remains open MUST be entered for all modalities on discharge from agency Discharge Date Discharge Reason If a Discharge Date is entered, then a Discharge Reason must be given and vice versa. Discharge information must be reported accurately and in a timely fashion as it is used to monitor successful completions. If agencies want other discharge reasons added, we can put them forward to the NTA on their behalf. Can’t guarantee that it will be added, but we can try.

Complete TOP at discharge from treatment system. Discharge Data and TOP Complete TOP at discharge from treatment system. This should be done face-to-face between keyworker and client where possible May be done over telephone where no other option available (i.e in unplanned discharges). NOT acceptable to complete on clients’ behalf without client present.

LUNCH

Data Collection Purpose Enables national, regional and local-level reporting on alcohol treatment. Supports the National Alcohol Strategy and needs analysis Facilitate policy formulation Supports development of efficient commissioning systems at local level

Planned Performance Monitoring Performance measures for Alcohol Services are being developed now that there is one year of baseline data. Numbers in Treatment Waiting Times Successful completions of treatment

Reporting and Monitoring Monthly www.ndtms.net Quarterly Proposed “Purple Reports”

www.ndtms.net GO THROUGH QUARTERLY PERFORMANCE REPORTS – provide each delegate with their agencies Q3 report.

www.ndtms.net

Quarterly “Purple Reports” For Consultation

Potential Reports What would Commissioners find useful? What would Agency staff find useful? Suggestions???

What should you expect from DTMU? Agency Training and Support: Dedicated Liaison Officers and Database Administrator providing telephone and in-house training on CDS-F dataset. Guidance Documentation: ‘A Rough Guide to the NATMS’ (in development) Monthly Validation and Data Quality Reports: Reporting erroneous client records, requiring correction. Newsletter Access to DTMU documents online www.dtmu.org.uk

DTMU Data Quality Standards All monthly agency submissions must contain at least 100% valid records. All monthly agency submissions must reach 99.9% data quality All fields of CDS-F populated. Files must be in a CSV format. All agencies must submit via the Drug and Alcohol Monitoring System (DAMS): https://www.ndtms.org/dams/

SE DTMU Team Based in Oxford with SEPHO Team consists of: Kellie Peters: Head of Data Management Regina Lally: Manager Michael Wallington: Technical Liaison Sue Dales: Database Administrator Caroline Ridler: Information Analyst Rachel Johnson: Information Analyst Laura Kesseboom: DIR Administrator Lucy Nicholson: DIR Administrator Jo Frank: Project Administrator

ANY QUESTIONS

Kellie.Peters@sepho.nhs.uk Regina.Lally@sepho.nhs.uk