Introduction to Core Data Set J Adult Treatment Simon Morgan Julie Marshall 1 st November 2012

Objectives for today To revisit all of the information required by NDTMS Clarify requirements and definitions of Core Data Set J (CDS J) Reiterate that CDS J is effective from 1 st November 2012 Discuss avoidable data quality issues 2Introduction to Core Data Set J Adult Treatment

NDTMS NDTMS relates to the process of collecting, collating and analysing information from and for those involved in the drug treatment sector. London NDTMS is responsible for collecting data from all drug and alcohol treatment provider agencies commissioned by London DAATs NDTMS evidences your work and the impact of your work Numbers in effective treatment Successful Completions and non-representations Public Health Outcomes Framework (drug and alcohol) NDTMS used to determine funding allocations 3Introduction to Core Data Set J Adult Treatment

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Core Data Set J NDTMS core data set – reference data – Reference data is defined as (relatively) static data. Generally it is employed as a means of validating data entry and will typically be used to control the contents of drop-down lists etc. NDTMS core data set – business definitions for adult drug treatment providers – document establishes the set of data items to be collected by NDTMS. NDTMS core data set – business definitions for adult alcohol treatment providers – document establishes the set of data items to be collected by NDTMS 5Introduction to Core Data Set J Adult Treatment

Core Data Set J The core data set is made up of six data entities: Client information Episode (including regional fields) Time in Treatment Intervention Sub-intervention Treatment Outcome Profile (TOP) 6Introduction to Core Data Set J Adult Treatment

Client Information FINITIAL – the first initial of the clients first name (key field) SINITIAL – the first initial of the clients surname (key field) DOB – the day, month and year that the client was born (key field) SEX – the sex that the client was at birth (key field) Ethnicity – if a client declines to answer then not stated should be used. If a client is not asked, then the field should be left blank. Nationality – country of nationality at birth (all case management systems including DET will have a drop down list box). Not stated is added. 7Introduction to Core Data Set J Adult Treatment

Episode An episode of treatment is a set of interventions with a specific care plan. A client may attend one or more unique interventions of treatment during the same episode of treatment. 8Introduction to Core Data Set J Adult Treatment CLIENT AGENCY 1 EPISODE Referral DateDischarge Date Modality 1 Psychosocial Intervention Modality Start Date Modality End Date AGENCY 2 EPISODE Referral Date Modality 1 Psychosocial Intervention Modality Start Date Modality End Date Modality 2 Recovery Support Modality Start Date Modality End Date Discharge Date

Episode Referral date – the date that the client was referred to the treatment centre for this episode (key field) e.g. the date the referral letter was received, the date a referral phone call was received or the date the client self-referred. Agency code – a unique identifier for the treatment provider that is defined by the regional NDTMS centres (Lxxxx) (key field) Client reference – a unique number of ID allocated by the treatment provider to a client. This must not hold or be composed of attributers which might identify the individual. 9Introduction to Core Data Set J Adult Treatment

Episode – consent for NDTMS Consent – clients should give written/verbal explicit consent to share information about their care plan Consent should be reviewed at the care plan review stage Values are now: No person not consented; Yes person has consented Only clients who have consented to information being submitted to NDTMS will be included in numbers in treatment 10Introduction to Core Data Set J Adult Treatment

Episode Previously treated – has the client ever received structured drug treatment at this or any other treatment provider (Y/N) Post code – the post code of the clients place of residence. Only the truncated post code is submitted to NDTMS i.e. E5 9 If a client states that they are of NFA, then this field is to be left blank 11Introduction to Core Data Set J Adult Treatment

Episode – Accommodation Need TextComments NFA – urgent housing problem Live on streets Use night hostels (night by night basis) Sleep on different friends floor each night Housing problem Staying with friends/family as a short term guest Night winter shelter Direct Access short stay hostel Short term B&B or other hotel Squatting No housing problem Local Authority/Registered Social Landlord rented Private rented; Approved Premises Supported housing/hostel Traveller; Own property; Settled with friends/family 12Introduction to Core Data Set J Adult Treatment

Episode – Parental Status TextComments All the children live with client The client is a parent of one or more children under 18 and all the clients children (who are under 18) reside with them full time. Some of the children live with client The client is a parent of one or more children under 18 and some of the clients children (who are under 18) reside with them, others live full time in other locations. None of the children live with client The client is a parent of one or more children under 18 but none of the clients children (who are under 18) reside with them, they all live in other locations full time. Not a parentThe client is not a parent of any children under 18. Client declined to answer 13Introduction to Core Data Set J Adult Treatment

Episode DAT of residence – the DAT in which the client normally resides If a client states they are NFA then for tier 3 treatment providers, the DAAT of the treatment provider should be used as a proxy; and for tier 4 treatment providers, the referring DAAT should be used as a proxy. PCT of residence – the PCT in which the client resides Local Authority – the local authority in which the client currently resides (as defined by their postcode of their normal residence). Due to partnerships and local authorities not being co-terminous in all cases, when the client is NFA the local authority of the treatment agency should not be used as a proxy. 14Introduction to Core Data Set J Adult Treatment

Episode Problem substance number 1 – the substance that brought the client into treatment at the point of triage Age - (in years) that the client recalls first using the problem substance 1 Route of administration of problem substance 1 – inject, sniff, smoke, oral or other Problem substance 2 and 3 – additional substances that brought the client into treatment at the point of triage. No second drug and No third drug are introduced for data completeness. New drugs Methylone, Mephedrone, Novel Psychoactive substances are introduced NB – poly drug should no longer be used in these fields 15Introduction to Core Data Set J Adult Treatment

Episode Referral source – detailed list in the reference data but new adult codes are Arrest Referral, DIP, Criminal Justice Other, Job Centre Plus and Alcohol codes are Employer, Alcohol Treatment Requirement and Peer. Triage date – the date that the client made a face to face presentation to the treatment provider Care plan start date – date that the care plan was created and agreed with the client for this treatment episode Injecting status – currently injecting; previously injected; never injected or client declined to answer 16Introduction to Core Data Set J Adult Treatment

Episode Data EntryComments 0No children living with client 11 child living with client 22 children living with client 0-30n children living with client 98Client declined to answer 17Introduction to Core Data Set J Adult Treatment

Episode Pregnant – is the client pregnant (Y/N) Drinking days – number of days in the 28 days prior to initial assessment that the client consumed alcohol Units of alcohol – typical number of units consumed on a drinking day in the 28 days prior to initial assessment Dual diagnosis – is the client currently in receipt of mental health care for reasons other than substance misuse 18Introduction to Core Data Set J Adult Treatment

Episode Hep C tested – Yes/No/Not Asked. If Yes, then complete test date Hep C latest test date – this is the date that the client was last tested for Hep C This test may be in the current treatment episode or previous to the episode If the date is not known, use the 1 st of the month If the month is not known, use the 1 st January of the known year 19Introduction to Core Data Set J Adult Treatment

Episode Text Offered and accepted Offered and refused Not offered Assessed as not appropriate to offer 20Introduction to Core Data Set J Adult Treatment Hep C intervention status – whether the client was offered a Hep C test and if that offer was accepted

Episode Hep B vaccination countHep B intervention status Text One vaccination Two vaccinations Three vaccinations Course completed Text Offered and accepted Offered and refused Not offered Assessed as not appropriate to offer Immunised already Acquired immunity 21Introduction to Core Data Set J Adult Treatment

Episode Drug treatment healthcare assessment date – the date that the initial healthcare assessment was completed The full scope of this assessment will vary according to the presenting needs of the client, but should include an initial assessment of the clients physical health and mental health needs TOP care coordination – does the treatment provider currently have care coordination responsibility for the client in regards to completing the TOP information when appropriate during the clients time in structured treatment 22Introduction to Core Data Set J Adult Treatment

Episode Discharge date – the date that the client was discharged ending the current structured treatment episode If a client has had a planned discharge then the date agreed within this plan should be used If a clients discharge was unplanned then the date of last face to face contact with the treatment provider should be used If a client has had no contact with the treatment provider for two months then for NDTMS purposes it is assumed that the client has exited treatment and a discharge date should be returned at this point using the date of the last face to face contact with the client 23Introduction to Core Data Set J Adult Treatment

TextComments Treatment completed – drug-free The client no longer requires structured drug treatment interventions and is judged by the clinician not to be using heroin (or any other opioids) or crack cocaine or any other illicit drug Treatment completed – alcohol-free The client no longer requires structured alcohol interventions and is judged by the clinician and is judged by the clinician to no longer be using alcohol Treatment completed – occasional user The client no longer requires structured drug treatment interventions and is judged by the clinician not to be using heroin (or any other opioids) or crack cocaine. There is evidence of use of other illicit drug use but this is not judged to be problematic or to require treatment Treatment completed – occasional user The client no longer requires structured alcohol treatment interventions. There is evidence of use of alcohol use but this is not judged to be problematic or to require treatment 24Introduction to Core Data Set J Adult Treatment

TextComments Transferred – not in custody A client has finished treatment at this provider but still requires further drug/alcohol interventions and the individual has been referred to an alternative non-prison provider for this. This code should only be used if there is an appropriate referral path and care planned structured drug treatment pathway available Transferred – in custody A client has received a custodial sentence or is on remand and the continuation of structured treatment has been arranged. This will consist of the appropriate onward referral of care planning information and a two way communication between the community and prison treatment provider to confirm assessment and that care planned treatment will be provided as appropriate Incomplete – Dropped Out The treatment provider has lost contact with the client without a planned discharge and activities to re-engage the client back into treatment have not been successful 25Introduction to Core Data Set J Adult Treatment

26Introduction to Core Data Set J Adult Treatment Incomplete – Treatment withdrawn by provider The treatment provider has withdrawn treatment provision from the client. This item could be used, for example, in cases where the client has seriously breached a contract leading to their discharge; it should not be used if the client has simply dropped out Incomplete – Retained in custody The client is no longer in contact with the treatment provider as they are in prison or another secure setting. While the treatment provider has confirmed this, there has been no formal two way communication between the treatment provider and the criminal justice system care provider leading to continuation of the appropriate assessment and care-planned structured drug / alcohol treatment Incomplete – Treatment commencement declined by the client The treatment provider has received a referral and has had a face to face contact with the client after which the client has chosen not to commence a recommended structured drug / alcohol treatment intervention Incomplete – Client died During their time in contact with structured drug / alcohol treatment the client died

Inpatient and Rehab usage only CDS-K TextComments Transferred – programme completed at the residential provider – additional residential treatment required This code should only be used if there is an appropriate referral path and care planned structured treatment pathways are available Transferred – programme completed at the residential provider – additional community treatment required Transferred – programme not completed at the residential provider – additional residential treatment required Transferred – programme not completed at the residential provider – additional community treatment required 27Introduction to Core Data Set J Adult Treatment

Time in Treatment Time in treatment relates to the time spent each week in the entire treatment episode, while the client is in structured treatment and any additional non- structured support alongside. A subsequent time in treatment will be reported when the clients treatment decreases or increases. The Assessment Date is a key field. 14 hours or less – engagement in one or more interventions for 14 hours or less per week More than 14 hours and less than 25 – engagement in one or more interventions for more than 14 and less than 25 hours per week 25 or more hours – engagement in one or more interventions for 25 or more hours per week 28Introduction to Core Data Set J Adult Treatment

Intervention What is an intervention? It is the type of treatment that the client receives (type is a key field) e.g. Psychosocial Intervention. There may be several interventions within a single episode. Only structured treatment submitted to NDTMS is counted towards numbers in effective treatment. 29Introduction to Core Data Set J Adult Treatment

Intervention Types Adult Structured Interventions Pharmacological Intervention Psychosocial Intervention Adult Non-Structured Interventions Recovery Support ALC – Brief Intervention Needle Exchange Outreach Advice & Information 30Introduction to Core Data Set J Adult Treatment

Intervention Intervention Setting – to be used to determine if this intervention is being provided in a different setting to the agency default on DAMS Date referred to modality – the date it was mutually agreed that the client required this modality of treatment (key field) Date of first appointment – the date of the first appointment offered to commence this modality Modality start date – the date that the client started treatment. 31Introduction to Core Data Set J Adult Treatment

Modality end date – the date that treatment ended If the modality has had a planned exit then the date agreed within the care plan should be used. If it was unplanned then the last face to face contact date within the modality should be used Modality exit status Mutually agreed planned exit Clients unilateral unplanned exit Intervention withdrawn 32Introduction to Core Data Set J Adult Treatment

Sub-interventions These describe the treatment provided for each Pharmacological/ Psychosocial / Recovery Support intervention. They are created retrospectively every 6 months and at discharge 6 month reviews are expected from the first intervention start date Sub-interventions should be combined to describe the full package of treatment The Assessment Date of each sub-intervention is a key field 33Introduction to Core Data Set J Adult Treatment

Pharmacological sub-interventions Assessment and Stabilisation Maintenance Withdrawal Relapse Prevention 34Introduction to Core Data Set J Adult Treatment

Psychosocial sub-interventions Motivational Interventions Cognitive and Behavioural Based Relapse Prevention Contingency Management 12-Step Work Family & Social Network Therapy Evidence Based Psychosocial Interventions for co-existing Mental Health Problems Psychodynamic Therapy Counselling – BACP Accredited Other 35Introduction to Core Data Set J Adult Treatment

Recovery Support sub-interventions Peer support involvement Family support Supported work projects Employment support Parenting support Facilitated access to mutual aid Complementary therapies Education & training support Housing support Evidence-based psychosocial interventions to support relapse prevention Evidence- based mental health focused psychosocial interventions to support continued recovery Recovery check-ups Other 36Introduction to Core Data Set J Adult Treatment

Treatment Outcome Profile - TOPs The implementation of the Treatment Outcomes Profile (TOP) in routine clinical practice began from 1 October 2007; its completion and submission via the National Drug Treatment Monitoring System (NDTMS) is requested for all clients (16 and over) accessing tier 3, and 4 structured drug treatment The TOP consists of a short set of simple questions that focus on the four key areas (substance use, injecting behaviour, criminal activity, health and social functioning) that are used to judge improvement during and after treatment. Outcomes from treatment are evidenced by looking at changes in the behaviours recorded over time It is requested that the TOP be completed with all clients at the start of their first treatment modality (Treatment Start TOP) and then around every 26 weeks throughout the treatment journey as part of the care plan review process (Review TOP) and at treatment exit (Treatment Exit TOP) Introduction to Core Data Set J Adult Treatment 37

Treatment Outcome Profile - TOPs TOP date (key field) - All outcome status submitted in this section of the data - set will be associated and stored as being the status as of this date. Note: TOP data should only be collected for young people aged 16 and over. 39Introduction to Core Data Set J Adult Treatment

There are 4 TOP treatment stages 40Introduction to Core Data Set J Adult Treatment Post treatment exit TOP also used after the client is discharged

Substance use in the last 28 days Alcohol Use - Number of days in previous 28 days that client has used alcohol Opiate Use - Number of days in previous 28 days that client has used heroin Crack Use - Number of days in previous 28 days that client has used crack Cocaine Use - Number of days in previous 28 days that client has used powder cocaine Amphetamine Use - Number of days in previous 28 days that client has used amphetamines Cannabis Use - Number of days in previous 28 days that client has used cannabis Other Drug Use - Number of days in previous 28 days that client has used other problem drug 41Introduction to Core Data Set J Adult Treatment

TOPs - Injecting risk behaviour in the last 28 days IV Drug Use - Number of days in previous 28 days that client has injected non prescribed drugs Sharing - Has client shared needles or injecting paraphernalia in last 28 days? 42Introduction to Core Data Set J Adult Treatment

TOPs - Crime in the last 28 days No. of days in previous 28 days that client has been involved in shop theft No. of days in previous 28 days that client has been involved in selling drugs Has client has been involved in theft from or of vehicle, property or been involved in fraud in last 28 days (Y/N) Has client committed assault/violence in last 28 days (Y/N) 43Introduction to Core Data Set J Adult Treatment

TOPs - Health and social functioning Psychological Health Status - Self Reported Score 0-20 Number of days in previous 28 days that client has had paid work Number of days in previous 28 days that client has attended college/education system Has client had acute housing problem (been homeless) in last 28 days Has client been at risk of eviction within past 28 days Physical Health Status - Self Reported Score 0-20 Quality of Life - Self Reported Score Introduction to Core Data Set J Adult Treatment

TOP treatment start – When? For a completely new treatment journey. The client has not received structured treatment at another agency 21 days before starting at the new agency TOPs should be completed 2 weeks either side of the clients first structured modality start 45Introduction to Core Data Set J Adult Treatment

TOP Review – When? Using the modality start date TOP as an anchor point, the review TOP should be completed at least every 26 weeks. 46Introduction to Core Data Set J Adult Treatment

TOP treatment exit – When? Treatment exit TOPs should be completed up to 2 weeks before and up to 2 weeks after the clients discharge date. They should be conducted when the client leaves the treatment system regardless of when the last review TOP was conducted Treatment exit TOPs can be carried out over the telephone if the client does not attend their last appointment 47Introduction to Core Data Set J Adult Treatment

TOP post treatment exit – When? After the client has left the treatment system they can be contacted to review how they are getting on. The Post Treatment Exit TOPs can be completed whenever it is suitable for the client and the Key Worker. This should be approximately 3 months after the clients discharge date 48Introduction to Core Data Set J Adult Treatment

Regional fields Injected in the last 28 days Ever shared (heroin only paraphernalia) Referred to hepatology Previously Hep B infected: Hep C positive: 49Introduction to Core Data Set J Adult Treatment

Regional fields Sexuality Codes Heterosexual Homosexual Bi-Sexual Other Not Recorded 50Introduction to Core Data Set J Adult Treatment

Employment Status Codes Text Regular EmploymentNot receiving benefits Pupil/StudentUnpaid voluntary work Long Term Sick/ Disabled Retired from Paid Work HomemakerNot stated Unemployed and Seeking Work Other Not Known 51Introduction to Core Data Set J Adult Treatment

Data Quality Good quality data is data which provides the most accurate picture of a providers work NDTMS figures are used to determine funding and establish whether a partnership or agency is meeting its targets; it is important to have accurate data There is no acceptable level for data quality; any errors in data need to be resolved 52Introduction to Core Data Set J Adult Treatment

Data Quality There are three main causes of data quality problems: User error Changes to data; when changes are made to key fields, duplicates are created System error; it is important for software providers to stay up to date with changes in the dataset, and for agencies to report any software issues promptly to both suppliers and NDTMS 53Introduction to Core Data Set J Adult Treatment

When a provider submits a file, a validation is performed, the file must score 100% for both data load and data quality before it can be submitted 54Introduction to Core Data Set J Adult Treatment

Data Quality 55Introduction to Core Data Set J Adult Treatment

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Further guidance NDTMS Data Set – Reference Data NDTMS Data Set – Business Definition for Young Peoples Treatment Providers NDTMS Core Data Set – Technical Definitions 57Introduction to Core Data Set J Adult Treatment