Effective treatment. Changing lives Treatment Outcomes Profile (TOP) Level 3 TOP Outcomes Report Important notes November 2009

Effective treatment. Changing lives Contents  Performance management warning Performance management warning  How to use these notes How to use these notes  Examples of how to use these notes Examples of how to use these notes  Eligibility criteria Eligibility criteria  Eligible Partnerships Eligible Partnerships  Outcomes in Problematic Substances Outcomes in Problematic Substances  Outcomes in Substances Used Outcomes in Substances Used  Outcomes in Injecting behaviour Outcomes in Injecting behaviour  Outcomes in Crime Outcomes in Crime  Outcomes in Health and Social Functioning Outcomes in Health and Social Functioning

Effective treatment. Changing lives This is the first level three outcomes report and it should not be used for delivery assurance  The information contained in the Level 3 Outcomes report should NOT be used for the purpose of delivery assurance. This will begin quarter 1 in 2010/11.  Therefore this data is provided for information purposes only because:  There is only one quarters data  There are some small numbers, especially at Provider level (this makes percentage comparisons difficult)  The information has not been adjusted for the differential case mix of client profiles in different partnerships (to ensure like for like comparisons)  No performance metrics have yet been established against which performance could be said to be good or not  All data is RESTRICTED and should not be disseminated beyond the partnership or provider Contents

Effective treatment. Changing lives How to utilise these notes  We have continued to receive requests from the field for guidance on the TOP reports and what they mean  Dense word documents have not proved to be the best way to communicate information. People either don’t have time to read or find them confusing and difficult to follow  This PowerPoint pack aims to communicate the information in a simple, interactive and effective format.  To keep the number of slides needed to communicate all the information the following slides have been animated. This makes the pack difficult to print and you will need to view it in ‘slide show mode’.  Each slide is linked to the contents page, so you can easily navigate through the different sections – just click the contents button in the top right hand corner of any slide and it will take you back  We suggest several ways that this information can be used – these are shown in the slides to follow Contents

Effective treatment. Changing lives This format can be used in a variety of different ways. Two of the most common ways are shown here Print the actual Level 3 Outcomes report not the notes. Open the PowerPoint notes on your PC Select slide show mode Press ‘enter’ to move through the notes You can then go through your report at your own pace in combination with the PowerPoint notes The Level 3 Outcome report notes can be used in the ‘traditional format’ as an aid to a verbal presentation. Or, several reports can be printed and all persons can run through the reports & explanatory notes in a group This might be useful if the information needs to be communicated to a group of people. + = Contents

Effective treatment. Changing lives There are five key eligibility criteria used to define the clients included in the level 3 outcomes  They started a treatment journey in Quarter /09  They were in treatment for at least 6 months  They were to be aged 18 and over at triage  They had a TOP reported within +/- two weeks of starting treatment  They had a TOP reported between 5 and 26 weeks after starting treatment Contents

Effective treatment. Changing lives There are currently 46 Partnerships who have met the eligibility criteria and can access the Level 3 Outcomes Report (all providers in the partnership area also have access) Eligible Partnerships BarnetDudleyLincolnshireStockton-on-Tees Bath and North East Somerset EalingMedway townsTelford and Wrekin BedfordshireEnfieldMiddlesbroughTorbay BirminghamEssexMilton KeynesTower Hamlets Blackburn with DarwenHackneyNewhamTrafford BradfordHammersmith and Fulham North East LincolnshireWakefield City of LondonHartlepoolNorth LincolnshireWaltham Forest CoventryHaveringNottinghamshireWarrington DerbyHertfordshirePlymouthWestminster DevonIsle of WightSalfordYork DoncasterKentSolihull DorsetKingston Upon HullStaffordshire Contents

Effective treatment. Changing lives These figures show the average number of days using a drug – in those who were using it at the Start of treatment – in the 28 days preceding their Review in the 5-26 weeks after treatment started These figures provide a summary of the difference between the average level of use at the Start of treatment compared to the average level of use at Review The first section of the Outcomes report only considers clients who cited a particular drug as problematic at triage These drugs were cited by the client as problematic (Drug 1, 2 or 3) when they started treatment These figures document the number (%) of people who were not using the drug when they entered treatment but who subsequently report using it by the time of the Review ‘Number of valid TOP pairs’ is the number of clients (who said they had a problem with a particular substance) who gave a response on TOP at Start and Review that was between 0 & 28 ‘Number using at baseline’ is the number of people who returned a valid TOP pair who were using 1 to 28 days in the month preceding the Start of treatment ‘% Using at baseline’ is the number of people using a substance divided by the number of valid TOP pairs. It may be prudent to question why this percentage is not 100% These figures represent the average number of days the users of a drug were consuming that drug in the 28 days prior to the Start of treatment. Comparisons with regional and national figures give an estimate of the relative problem in the Partnership Of those who were using a substance at the Start of treatment, this percentage shows the proportion of the group who were not using the drug in the 28 days prior to their Review Are these as expected? Are there large differences here? Are reductions better or worse than regional and national levels? How do abstinence levels compare to regional and national levels? Are these levels as expected? Cannabis use is lower in this Partnership than Regional / National Levels Average reduction in use is less in this Partnership. Is there a reason? What about the other drugs? Contents

Effective treatment. Changing lives These figures show the average number of days using a drug – in those who were using it at the Start of treatment – in the 28 days preceding their Review in the 5-26 weeks after treatment started These figures provide a summary of the difference between the average level of use at the Start of treatment compared to the average level of use at Review These drugs are not dependent on being cited as problematic at Triage These figures document the number (%) of people who were not using the drug when they entered treatment but who subsequently report using it by the time of the Review ‘Number of valid TOP pairs’ is the number of clients (regardless of whether they had a problem with a particular substance) who gave a response on TOP at Start and Review that was between 0 & 28 Of those who were using a substance at the Start of treatment, this percentage shows the proportion of the group who were not using the drug in the 28 days prior to their Review ‘Number using at baseline’ is the number of people who returned a valid TOP pair who were using 1 to 28 days in the month preceding the Start of treatment ‘% Using at baseline’ is the number of people using a substance divided by the number of valid TOP pairs. These figures represent the average number of days the users of a drug were consuming that drug in the 28 days prior to the Start of treatment. Comparisons with regional and national figures give an estimate of the relative problem in the Partnership Section 1 considers all drug use, reported using the TOP. This is not dependent on it being cited as problematic at triage These proportions give information about the prevalence of substances in clients accessing treatment in the Partnership or Provider. One might want to compare these figures against the numbers reported when a drug is cited as problematic e.g. crack Cited as problematic Reported as used Why the large difference? Could some of the 157 be extra ‘crack PDUs’ in this Partnership? Contents

Effective treatment. Changing lives Section 2 reports on injecting risk behaviour and receptive sharing of injecting paraphernalia as reported on the TOP The report on injecting risk behaviour follows the same format as Section 1. The number of pairs that can be analysed The number reporting the behaviour % of injectors is the number reporting injecting over the number of valid pairs % who share is obtained by dividing the numbers of sharers by baseline injectors These two sections give the Partnership (or Provider) Regional and National comparison figures Frequency of injecting Proportion of injectors sharing This section provides a summary of the amount of reduction in the frequency (above) and proportion (below) of injecting and sharing This section shows the proportion of injectors who were no longer injecting by the 6 month review The final section reports the number and % of those who have started to inject Contents

Effective treatment. Changing lives Section 3 reports on the crime information that has been reported using the TOP. Are these levels of reported crime as expected for this Partnership or Provider? How do the frequencies or proportions compare to Regional and National figures? How do reductions compare to Regional and National reductions? Are the levels of those no longer reporting shoplifting or drug selling in line with comparators? Contents

Effective treatment. Changing lives Section 4 reports on the health and social functioning that was reported by clients on the TOP Consider PAID WORK 11.1% of those entering this Partnership were working at the start of treatment They were working just over 21 days on average in the previous 28 At Review, ¼ were no longer working (~¼ of 35 workers is 9) This REDUCED average working by about 6 days BUT 29 individuals started work in the same period This translates into a net gain of 20 workers in this Partnership in 6 months – nearly a 60% increase NB: these figures must be digested slowly Same pattern applies – in this example – to education Acute housing problems and housing risk decrease Health and social functioning also increase by 6 months Contents

Effective treatment. Changing lives Remember this information should not be used for delivery assurance Contents  The information contained in the Level 3 Outcomes report should NOT be used for the purpose of delivery assurance. This will begin quarter 2010/11.  Therefore this data is provided for information purposes only because:  There is only one quarters data  There are some small numbers, especially at Provider level (this makes percentage comparisons difficult)  The information has not been adjusted for the differential case mix of client profiles in different partnerships (to ensure like for like comparisons)  No performance metrics have yet been established against which performance could be said to be good or not  All data is RESTRICTED and should not be disseminated beyond the partnership or provider