1. NDTMS~TOP & YP Services NDTMS~TOP Young People Services April 2009 Jill Smith NEPHO – NDTMS Team

2. NDTMS – Why Bother? Government Drives PSA 14 and 25 (numbers in treatment include YP aged 16-18 in specialist drug or alcohol treatment) as part of the delivery for National Drug Strategy 2008-2011 NTA view –More treatment, better treatment, fairer treatment DAT view –Essential to Needs Analysis process –Informs planning & commissioning –Hidden Harm: ineffective if sparse data input Treatment Service view –Preserve budgets funding treatment –Evidence for effective/innovative practices

3. NDTMS – History Began collecting performance data on treatment of adult problem drug users, then YP drug & alcohol misusers, 2005 YP dataset made available 2006 NTA Memorandum of Understanding Defines roles for delivery assurance of YP Services adult alcohol April 2008 changes re discharge destination, etc August 2008 CDSF – many changes for YP Services

4. NDTMS National Drug (and Alcohol) Treatment Monitoring System –Client details –Episode details –Treatment modality/intervention details –Treatment outcome Profiles (TOP) details –Local Regional fields

5. NDTMS – Core Dataset ‘F’ National Drug (and Alcohol) Treatment Monitoring System Number of fields has expanded and changed Reference options within fields have expanded and changed Additional services completing NDTMS Additional Government Departments involvement Now on Core Dataset F Where to begin?

6. NDTMS – Adult/YP/Alcohol?? Adult, Alcohol or YP Datasets? Transitional arrangements – special needs Adult service working with <18s YP services working with =>18s It is the service, not the client which determines dataset to select WHAT CONSTITUTES YP SERVICES?

7. NDTMS – It is Not…… The YOT ASSET tool is not detailed enough to inform a specialist SM care plan and cannot be used as a comprehensive SM assessment tool YOT targets/performance rules and definitions are different to NDTMS Treatments to address SM as it interrelates with offending behaviour are expected to be included within Psychosocial Interventions and YP Criminal Justice Interventions has been removed Interventions for children with parents who have SM issues should not be recorded unless they relate to the child’s own SM issue

8. NDTMS – It is…… “YP’s specialist SM treatment is a care planned medical, psychosocial or specialist harm reduction intervention aimed at alleviating current harm caused by a YP’s SM”. Foundation for all interventions: Comprehensive assessment Care plan Care Co-ordination by a ‘lead professional’

9. NDTMS – Confidentiality & Consent CONFIDENTIALITY AND CONSENT Various documents supporting YP services are available All services should have clear policies a)Confidentiality and information sharing Agreed by Local Safeguarding Children’s Boards b)Consent to treatment, and c)Child protection

10. NDTMS – Basics All fields should be completed Some fields should be reviewed Some fields should be completed at discharge Some fields can be completed after discharge Garbage in ~ Garbage out Analysis and information jeopardised when fields left blank Basics: Data Completion

11. NDTMS – Basics Basics: Understand the Questions The NTA Business Definition and Reference Data Documentation is important and changes as understanding of usage and meaning develops

12. NDTMS – Basics Basics: Get hold of the documentation NTA WEBSITE FOR DOCUMENTATION:- http://www.nta.nhs.uk/areas/ndtms/core_da ta_set_page.aspx NB: Awaiting revised guidance for young persons' treatment providers

13. NDTMS – YP Interventions 6 YP Interventions First four describe the delivery:- Psychosocial Intervention Specialist Harm Reduction (Including injecting behaviour, overdose and accidental injury advice) Family Work (Only if YP is in specialist SM treatment) Pharmacological Interventions Fifth describes setting: Access to Residential Treatment Sixth is for Tier 2 only (optional) Non structured intervention Use of combined Tier 2 and Tier 3 interventions can lead to performance measurement errors with serious consequences

14. NDTMS –YP YP Dataset 1Dates - Time is of the essence!: More often than not referral date, triage date, care plan start date and intervention start date should be the same for YP services 2Accommodation Need: Specific set of 8 YP codes. If NFA then leave postcode blank but complete DAT of residence for treatment provider (if Tier 3) or referring partnership (if Tier 4) and leave PCT of residence blank

15. NDTMS – YP 3. Parental Status? Now expanded. Includes biological, step-, foster, adoptive, guardians to include any parenting where a client has full or partial parental responsibilities and is living with that child(ren) for a minimum of one month – see separate Appendix K in business definitions. Children defined as <18. All the children live with the client Some of the children live with client None of the children live with client Not a parent Client declined to answer

16. NDTMS – YP 4. Children Living with: Count all children, at all addresses. Include siblings, landlord’s children, etc. Children are defined as <18. Children’s Home: Only count family/siblings living with client 5.Pregnant: Ask! Record N for males. 6.Problem Substance No. 1: The substance that brought YP into treatment – drugs or alcohol. If more than one, provider to determine which is primary.

17. NDTMS – YP 7.Referral Source: Raised focus of attention by DCSF. Now 26 different sources, categorised into 5 groups and providing information about integration of treatment/children and family services. See later. 8.Injecting Status & BBV: Endeavour to complete but record in case notes if assumptions around e.g. non- injecting behaviour are made and questions not asked. New: Assessed as not appropriate to offer 9. Employment Status: 8 options available. Only use Unemployed for adults attending YP services

18. NDTMS – YP 10. Drug treatment health care assessment date: – Young People Treatment providers should only record a date when a young person receives an assessment from a health clinician such as a Nurse, Doctor or Psychiatrist AND when the assessment relates specifically to their substance misuse such as in relation to clinical management, issues arising from injecting behaviour, blood borne viruses or dual diagnosis. Providers should refer to Assessing Y P for substance misuse 2007 for guidance on when it is appropriate for a young person to be assessed by a health clinician. Further guidance in relation to health care assessments for young people will be published alongside the forthcoming harm reduction guidance by the end of 2009.

19. NDTMS – YP 11. TOP: Only complete for YP =>16. NB: use of NA/Zero and collection of crime data. 12. Discharge Date: Date is last face-to-face contact. Discharge c.2 months after DNA and no contact. Note: If client goes into custody for <21 days, then do not discharge but continue episode and there is no need for TOP Exit~TOP Start.

20. NDTMS – Core Dataset ‘F’ a) Treatment Start and Treatment End –YP has lead professional? This refers to the professional who as part of the CAF process has been appointed to act as a single point of contact and coordinate provision for a child and their family when a range of services are involved and an integrated response is required –YP in contact with mental health services? This refers to a young person who is currently in contact with either inpatient or outpatient Mental Health Services 1. New Fields 1 st April 2009

21. NDTMS – Core Dataset ‘F’ a)Treatment Start and Treatment End –YP in contact with YOT? This refers to a young person who is currently in contact with the Youth Offending Team as a result of receiving a reprimand or final warning, acceptable behaviour contract (ABC), anti social behaviour order (ASBO) or community sentence 1. New Fields

22. NDTMS – Core Dataset ‘F’ a) Treatment Start and Treatment End –Involved in Sexual Exploitation? “Children, both male and female, engaging in sexual activities for money, profit, or any other consideration due to coercion or influence by any adult, syndicate or group. The profit could go either to the child or to any third party involved in the transaction.” This refers to a young person’s current involvement, or suspected involvement in activities such as prostitution, production of pornography, or age inappropriate relationships with adults 1. New Fields……

23. NDTMS – Core Dataset ‘F’ a) Treatment Start and Treatment End –Involved in Unsafe drug use? “Substance use related behaviour that disproportionately increases the magnitude of physical, emotional or social harm to the young person taking the substance” Examples include the use of particularly hazardous routes of administration such as injecting; the use of substances in particularly high quantities and/or in combination or the use of substances alone or with older people.” This refers to a young person’s current involvement or suspected involvement in unsafe drug and alcohol related activities such as binge drinking, poly drug use, sharing of injecting equipment, being injected by someone else or solvent abuse 1. New Fields……

24. NDTMS – Core Dataset ‘F’ a) Treatment Start and Treatment End –Involved in Offending? This refers to a young person’s current involvement or suspected involvement in activities which may or may not have come to the attention of the police, YOT or local authority. Examples include stealing money from parents or friends, shoplifting, drug selling, street drinking (in alcohol restricted zones), graffiti and vandalism 1. New Fields……

25. NDTMS – Core Dataset ‘F’ a) Treatment Start and Treatment End –YP Self-harming? “Self - poisoning or self - injury, irrespective of the apparent purpose of the act” This refers to a young person’s current involvement or suspected involvement in activities such as cutting, burning, banging, hair pulling or poisoning. This includes accidental and non - accidental overdose 1. New Fields……

26. NDTMS – Core Dataset ‘F’ b)Treatment Start only –YP Education Status (=<16)? This refers to a young person’s current educational involvement. 1. New Fields…….

27. NDTMS – Core Dataset ‘F’ b)Treatment Start only –YP Involved in unsafe Sex? This refers to a young person’s current or suspected involvement in unsafe sexual activities such as unprotected vaginal, anal or oral sex –YP Parent in SM Treatment? –YP Parent in MH Treatment? These refer to a young person who has one or more parent or guardian currently in contact with treatment services to address their drug or alcohol problems or their mental health problems 1. New Fields…….

28. NDTMS – Core Dataset ‘F’ 1. New Fields……. c)Treatment Exit only –YP has a CAF? This refers to a young person who has been identified as requiring additional needs and assessed using the Common Assessment Framework at the point of discharge –YP safer sex? This refers to a young persons current involvement in unsafe sexual activities such as unprotected vaginal, anal or oral sex at the point of discharge

29. NDTMS – Core Dataset ‘F’ 1. New Fields……. c)Treatment Exit only –YP sexual health interventions? This refers to a young person who has been directly offered, or offered access to a sexual health intervention. These can include STI screening, pre and post test counselling, advice on safer sex, contraception (i.e. condoms), or pregnancy testing

30. NDTMS – Core Dataset ‘F’ 1. New Fields……. c) Treatment Exit only –YP registered with GP This refers to a young person who has registered with a General Practitioner since the point of treatment entry –YP met goals on Care Plan This refers to a young person who has met the main goals of their care plan at treatment exit

31. NDTMS – Core Dataset ‘F’ 2. TOP / Care Coordination flag Does the treatment provider currently have care coordination responsibility for the client in regards to completing the TOP information when appropriate, during the client’s time in structured treatment? One service to manage TOP process (agreed at a local Treatment System level) One set of TOPs for one episode of care Consent for sharing TOP process data

32. NDTMS – Core Dataset ‘F’ 2. TOP / Care Coordination flag Recent enquiry received by NDTMS team: Re top coordination surely ALL providers are required to fill in a care plan for their organization and if they do who decides who is the overall care coordinator? Care Planning is not the same as Care Coordination Decisions about Care Coordination have to be made at a local level and even then there must be ongoing communication between services to ensure all the clients’ needs are being met

33. NDTMS – Core Dataset ‘F’ COMFORT BREAK?……………

34. NDTMS – Core Dataset ‘F’ 3. Reference data changes a) Referral Date/Referred to Intervention Date? Clarification of need for 2-way communication: Referral date: when the service and YP agreed to referral Referred to Intervention Date: when keyworker and YP agreed to treatment Understanding is important as this information is linked to the performance of services in YP being assessed within 5 days of referral.

35. NDTMS – Core Dataset ‘F’ 3. Reference data changes….. b) Referral Source

36. NDTMS – Core Dataset ‘F’ 3. Reference data changes….. b) Referral Source

37. NDTMS – Core Dataset ‘F’ 3. Reference data changes….. b) Referral Source

38. NDTMS – Core Dataset ‘F’ 3. Reference data changes….. b) Referral Source Arrest Referral/DIP &Community Sentence=Removed

39. NDTMS – Core Dataset ‘F’ 3. Reference data changes….. b) Referral Source

40. NDTMS – Core Dataset ‘F’ 3. Reference data changes….. c) Discharge Reason (Separated from Discharge Destination) Please note that different definitions will apply to the above codes depending on the setting of treatment i.e. in YP providers or if the client is being treated primarily for Alcohol. YP Discharge Reason? – Planned

41. NDTMS – Core Dataset ‘F’ 3. Reference data changes….. c) Discharge Reason YP Discharge Reason? - Neutral The distinction between In and Not in Custody may be difficult to determine in some cases – more clarification is being sought.

42. NDTMS – Core Dataset ‘F’ 3. Reference data changes c) Discharge Reason YP Discharge Reason? - Unplanned This option would also have to be used if a client is still known to be using crack/heroin, even occasionally, at the end of care-planned treatment.

43. NDTMS – Core Dataset ‘F’ 3. Reference data changes….. c) Discharge Destination? (YP only)

44. NDTMS – Core Dataset ‘F’ 3. Reference data changes….. c) Discharge Destination? (YP only)……

45. NDTMS – Core Dataset ‘F’ 3. Reference data changes….. d) Employment Status? Removed: Not in Education or Training or employment Attending PRU/Special Schooling arrangements

46. NDTMS – Core Dataset ‘F’ 4. Fields Removed from YP Dataset a) Dual Diagnosis b) Sex Worker c) Sexuality (Picked up through new fields or not appropriate for YP)

47. NDTMS - YP Reminder Do not record parent/carers interventions unless the misuser is a client, has consented to NDTMS and is involved in the intervention.

48. NDTMS - YP Reminder Complete all 3 levels of Substance Misuse which got client into treatment.

49. NDTMS - YP Reminder There will be a revision of the NTA’s recommended Consent and Confidentiality Toolkit. This will be published following final legal advise and consultation – hopefully during April 2009. Do you know where to find it? Do you know what it says now? Has your service incorporated the advice into your own documentation?

50. NDTMS - YP http://www.nepho.org.uk/ndtms THANK YOU!