1. Michael Wallington & Dami Omole Drug Treatment Monitoring Unit
NDTMS Core Dataset G Training for Young People’s Treatment Providers and Commissioners
Michael Wallington & Dami Omole
Drug Treatment Monitoring Unit
April 6, 2017

2. 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
April 6, 2017

3. Aims Clarify the changes to YP items in Core Data Set ‘G’
Clarify consent and confidentiality
Review Data Quality and TOP compliance
Provide information around current reporting and monitoring
Clarify performance measurements and waiting times calculations
April 6, 2017

4. Why is information needed for NDTMS?
The treatment information that you provide to the NDTMS is used for several purposes. Primarily:
Provide information to local, regional and national PSA 14 boards on how the treatment system is helping to reduce harm arising from drug use;
Inform Children’s Services, Children and Young People’s Plans and Joint Strategic Needs Assessments;
Provide evidence on how the young person’s treatment system is meeting local treatment need and also ensure a more outcome focused approach to the understanding of the treatment system;
Monitor the use of resources. This helps ensure equitable funding of drug and alcohol services nationally;
Produce statistics and to support research on drug and alcohol use.
April 6, 2017

5. YP DAAT Profiles:
Available on DTMU website Profiles html
The DTMU DAAT Profiles for Adults and YP for 2008/09 were released in February Electronic copies of these reports can be found on
April 6, 2017

6. Young People Modalities
Tier 3
YP Psychosocial Intervention
YP Harm Reduction Services
YP Family Work
YP Specialist Pharmacological Interventions
Tier 4
YP Access to residential treatment for substance misuse
Tier 2
YP Non-structured intervention
Young People receiving these Tier 3 or 4 interventions will count towards performance targets
Very clear that Psychosocial Interventions can include both one-to-one and group work – it is the care planned element that is key to whether or not it is considered to be T2/3

7. Question: Are you all reporting treatment modalities against individual clients’ episode of treatment?
April 6, 2017

8. CDS ‘G’ Young People Changes to YP data set
April 6, 2017

9. Changes with Core Data Set G
One new data item (Local agency details)
One new YP data item (CLA Location)
YP outcomes updated
YP reference data updated
April 6, 2017

10. New data item: Local agency details
Field to be reviewed by regional team Collected at Modality start Intended to be used to report prescribing on behalf of another agency Possible values: GP, Pharmacist, NDTMS agency code, GP practice code
April 6, 2017

11. Changes to YP data set New field. CLA location Reference data updates
Changes to YP data set New field CLA location Reference data updates Accommodation Need Referral Source YP outcomes updated
April 6, 2017

12. Children Looked After
“Children looked after includes all children being looked after by a local authority including those subject to care orders under section 31 of the Children Act 1989 and those looked after on a voluntary basis through an agreement with their parents under section 20 of the Children Act 1989”
April 6, 2017

13. New data item Data Item: Location of CLA CLA living in care
CLA living in childrens home
CLA living in residential school
CLA living in educational behavioural unit
CLA living in secure childrens home
CLA living out of borough
CLA placed out of borough
CLA living independently in settled accommodation
CLA living independently in unsettled accommodation
CLA living in supported housing
CLA living with Kin Carers
Should only be completed if Accommodation Need is CLA
April 6, 2017

14. Accommodation Need Two old values removed
CLA living in care
CLA out of LA
Introduction of one new value
CLA
If Accommodation Need value is ‘CLA’, the ‘CLA location’ field needs to be populated
April 6, 2017

15. Referral Source One old value removed Introduction of new values
YP Custody
Introduction of new values
Secure Children’s Home
Secure Training Centre
Youth Offender Institute
YP Housing
A number of proposed CDS-G YP referral sources were not included in the final data set (v7.0.3).
These include ‘YP Probation’, ‘Secure Children’s Home (Local Authority)’, ‘Secure Children’s Home (YJB)’ and ‘Adult Services’.
April 6, 2017

16. CDS ‘G’ Reference Data Changes to reference values in line with NHS Data Dictionary16

17. Employment status
Regular Employment Pupil/Student Long term sick or disabled Homemaker Retired from work
Unemployed and seeking work
Not receiving benefits
Unpaid voluntary work
Retired from paid work
Not stated
Other
Not known
‘Long term sick or disabled’, ‘Homemaker’ and ‘Retired from work’ have all been included following expansion of previous ‘Economically inactive’ option.
‘Unemployed and seeking work’, ‘Not receiving benefits’, ‘Unpaid voluntary work’, ‘Retired from paid work’ and ‘Not stated’ have been included following expansion of previous ‘Unemployed’ option.
April 6, 2017

18. Sexuality Gay: renamed to Homosexual
Not Disclosed: renamed to Not Recorded
April 6, 2017

19. Consent Yes the person consented No the person has not consented
To clarify, CONSENT relates to the client’s consent to share their information through NDTMS
April 6, 2017

20. Previously Hep B Infected
Yes has had a previous Hepatitis B infection diagnosed;
No has never had a previous Hepatitis B infection diagnosed;
Not Known
‘Not known’ has been reintroduced
April 6, 2017

21. Hepatitis C Positive Yes is Hepatitis C Positive
No is not Hepatitis C Positive
Not Known
‘Not known’ has been reintroduced
April 6, 2017

22. Injecting Status Previously Injected (but not currently)
Currently Injecting
Never Injected
Client Declined to Answer
April 6, 2017

23. Drug Codes Methylone Mephedrone No Second Drug No Third Drug
Other currently legal highs may be captured as ‘Other stimulant’
April 6, 2017

24. CDS ‘G’ Young People Changes to YP Outcomes
April 6, 2017

25. Changes to YP outcomes
There are some changes to the YP outcomes. These apply to all young people seen at a Young People’s treatment provider and should only be completed by these agencies. YP outcomes have been collected since April 2009.
April 6, 2017

26. Treatment Start Data Item: YP registered with GP at Treatment Start?
Yes No
Not Known 26

27. Treatment Start
Data Item: YP has CAF at Treatment Start?
Yes No 27

28. Treatment Start
Data Item: YP in contact with Learning difficulty services at Treatment Start?
Yes No
Not known 28

29. Treatment Start Data Item: YP Lead Professional at Treatment Start?
Yes No
‘Not known’ is no longer a valid option
‘Not known’ has been removed as an option

30. Treatment Start
Data Item: YP in contact with Mental Health Services at Treatment Start?
Yes No
Not Known

31. Treatment Start Data Item: YP in contact with YOT at Treatment Start
Yes No
Not Known

32. Treatment Start
Data Item: YP involved in Sexual Exploitation at Treatment Start
Yes No

33. Treatment Start
Data Item: YP involved in Self-Harm at Treatment Start?
Yes No
Not Known

34. Treatment Start
Data Item: YP involved in Unsafe Drug Use at Treatment Start?
Yes No

35. Treatment Start
Data Item: YP involved in offending at Treatment Start?
Yes No
Not Known

36. Treatment Start Data Item: YP education status at Treatment Start?
Mainstream Education
Alternative Education
Temporarily Excluded
Permanently Excluded
Persistent Absentee
Apprenticeship or training
Employed
Not in employment or education
Economically Inactive Caring Role
Economically Inactive Health Issue
New reference data options:
6 - Apprenticeship or training
8 - Employed
9 - Not in employment or education
10 - Economically Inactive Caring Role
11 - Economically Inactive Health Issue

37. YP Sexually active at Treatment Start?
“The point of the question is to identify where YP are involved in risky sexual practices, as there are specific interventions these clients should receive. We are however wary of having information on record about how many young people are sexually active, when we do not need to know this information. We think there could be unwelcome media initiated FOI’s, and therefore think that holding such information constitutes a risk. The naming of the field is perhaps unfortunately euphemised, but the definitions do make its meaning and purpose clear.” Feedback from Young People’s team at NTA HQ.
April 6, 2017

38. Treatment Start Data Item: YP Sexually active at Treatment Start?
Yes – unsafe sex
Not asked
At the start of the current treatment episode, is the client sexually active AND engaged in unsafe sex
The field “YP involved in unsafe sex at Treatment Start?” has been renamed “YP Sexually active at Treatment Start”
Options are “Yes – unsafe sex” and “Not asked”. Field should be left blank if not applicable

39. Treatment Start
Data Item: YP parent in Substance Misuse treatment at Treatment Start?
Data Item: YP parent in Mental Health Treatment at Treatment Start
REMOVED FROM DATASET
DO NOT POPULATE

40. Treatment Exit Data Item: YP lead professional at Treatment Exit?
Yes – LP at Drug Agency
Yes – LP not at Drug Agency No
‘Not Known’ is no longer an option
“Not known” has been removed

41. Treatment Exit
Data Item: YP in contact with Mental Health Services at Treatment Exit?
Yes No
Not Known

42. Treatment Exit
Data Item: YP in contact with Learning difficulty services at Treatment Exit?
Yes No
Not Known

43. Treatment Exit Data Item: YP in contact with YOT at Treatment Exit?
Yes No
Not Known

44. YP Sexually active at Treatment Exit?
“The point of the question is to identify where YP are involved in risky sexual practices, as there are specific interventions these clients should receive. We are however wary of having information on record about how many young people are sexually active, when we do not need to know this information. We think there could be unwelcome media initiated FOI’s, and therefore think that holding such information constitutes a risk. The naming of the field is perhaps unfortunately euphemised, but the definitions do make its meaning and purpose clear.” Feedback from Young People’s team at NTA HQ.
April 6, 2017

45. Treatment Exit Data Item: YP Sexually active at Treatment Exit?
Yes – unsafe sex
Not asked
At the start of the current treatment episode, is the client sexually active AND engaged in unsafe sex
The field “YP involved in unsafe sex at Treatment Start?” has been renamed “YP Sexually active at Treatment Start”
Options are “Yes – unsafe sex” and “Not asked”. Field should be left blank if not applicable

46. Treatment Exit
Data Item: YP involved in Sexual Exploitation at Treatment Exit?
Yes No

47. Treatment Exit Data Item: YP involved in Self-Harm at Treatment Exit?
Yes No
Not Known 47

48. Treatment Exit
Data Item: YP involved in unsafe drug use at Treatment Exit?
Yes No 48

49. Treatment Exit Data Item: YP involved in offending at Treatment Exit?
Yes No
Not Known 49

50. Treatment Exit
Data Item: YP has CAF at Treatment Exit?
Yes No 50

51. Treatment Exit
Data Item: YP sexual health interventions at Treatment Exit?
Yes No
Inappropriate Question 51

52. Treatment Exit Data Item: YP registered with GP at Treatment Exit? YesNo
Not Known 52

53. Treatment Exit
Data Item: YP met goals agreed on Care Plan at Treatment Exit?
Yes No 53

54. Discussion
Have your IT systems been updated to collect these data items?
What other potential challenges or barriers exist that may affect the collection of these data items?
e.g. updating paperwork, training staff
April 6, 2017

55. Information Management
April 6, 2017

56. Information Management
Clinicians need to:
Keep patient records;
Ensure appropriate information sharing‚ confidentiality and data protection;
Collect and analyse data; and
Make effective use of information and data;
(Drug Misuse and Dependence: UK guidelines on clinical management‚ 2007)
If a client refuses consent – NDTMS 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.

57. Confidentiality
The same duties of confidentiality apply to children and young people as to adults.
In addition to the usual bases for non-consensual disclosure, information might be shared about a child or young person without consent:
to protect them from a risk of significant harm
when it is in the best interests of a child or young person who does not have the capacity to make a decision about disclosure.
(Drug Misuse and Dependence: UK guidelines on clinical management‚ 2007)
From Orange Book clinical guidance 2007
April 6, 2017

58. Consent
All young peoples’ treatment agencies should have clear policies on: a) Confidentiality and information sharing b) Consent to treatment, and c) Child protection. Policies on confidentiality and consent need to be agreed by Local Safeguarding Children’s Boards which should also provide assistance on these matters. Staff should be familiar with these policies and should act in accordance with them.
Young people’s specialist substance misuse treatment providers should be familiar with the following documents on consent and confidentiality:
• Assessing Young People for Substance Misuse. NTA website, 2007.
• NTA: Essential Elements of a Treatment Service. NTA website, 2005.
• Department of Health: Seeking Consent Working With Children. DH website, 2001.
• Royal College of General Practitioners and Brook Advisory Services. Confidentiality and Young People: Improving teenager’s uptake of sexual and other health advice, 2000.
• SCODA/ Children’s Legal Centre. Young People and Drugs. Drug scope, 1999.
April 6, 2017

59. 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 – NDTMS 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.

60. Consent (2)
In order to provide data to NDTMS, a treatment provider must first request and obtain consent from the client and/or parent or person with parental responsibility. If a treatment provider offers services which do not involve obtaining consent, NDTMS will not be able to accept data relating to the individuals in receipt of those services.
April 6, 2017

61. Consent (3)
Treatment providers should determine whether a young person or their parent or person with responsibility should be asked for consent in relation to reporting to NDTMS according to their protocols for determining a young person’s capacity to give informed consent.
April 6, 2017

62. Confidentiality
All agencies should routinely and explicitly explain their confidentiality and information sharing policy in relation to NDTMS with young people and their parents or carers. Young people entering treatment should sign a confidentiality agreement as part of the care planning process. This confidentiality statement should include details about how the treatment provider will respond to child protection issues if there is concern that a child is thought to be suffering, or to be at risk of suffering, ‘significant harm’. This statement should also identify what information will be reported to NDTMS.
April 6, 2017

63. 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, 2009 NTA)

64. Information Sharing
“Information sharing can be of great value to the direct care of individual patients and may also contribute indirectly to the delivery and effectiveness of the drug treatment system. Information sharing protocols should be consistent with guidance from local Caldicott Guardian and any national guidance‚ and acknowledge that patient consent to disclosure is key in most situations where identifiable information is shared.”
(Drug Misuse and Dependence: UK guidelines on clinical management‚ 2007)
If a client refuses consent – NDTMS 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.

65. Data Sharing Protocols
It is good practice to have data sharing protocols in place that outline how and why data is shared within and between organisations.
Scenarios:
Partnership-wide systems will necessitate information sharing across treatment services and/or Drug and Alcohol Action Teams.
Multi-site service provider software (e.g. Addaction use one system nationally).
Multiple service providers delivering simultaneous treatment to a client‚ irrespective of the software used. This is relevant to TOP data where a service provider should‚ subject to permissions and data sharing protocols‚ send copies of the TOP information to other involved agencies.
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.

66. Discharge Data

67. Discharge Data Discharge Date Discharge Reason Discharge Destination
If a Discharge Date is entered, then a Discharge Reason and Discharge Destination must be given.
Discharge information must be reported accurately and in a timely fashion as it is used to calculate In treatment Rates.
Modality End Date (s) and Modality Exit Status must be populated for discharged clients.

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

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

70. 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

71. Discharge Destination…
Back to Referrer
Generic Children’s Services
Targeted Youth Support
Lead Professional
Alternative Education
Children’s Mental Health Services

72. Discharge Destination (2)
Crime Prevention
Accommodation Services
Other YP Treatment Services
Adult Treatment Services
No Onward Referral
No Referral Required

73. Treatment Outcomes Profile
Refresher for YP services
April 6, 2017

74. What is the TOP? Treatment Outcomes Profile
• An instrument to measure treatment outcomes
• A simple, short set of questions
• To plot clients’ progress through structured treatment - a measure of how well clients do in treatment
• Reported to NDTMS
TOP should be reported for all clients aged 16 and over 74

75. Three types of questions
Yes and no a simple tick for yes or no
Timeline the client recalls the number of days in each of the past four weeks on which they did something, e.g. the number of days they used each substance
Rating scale a 20-point scale from poor to good. Together with the client, mark the scale in an appropriate place 75

76. When should the TOP be completed?
At start of new treatment journey
to capture pre-treatment snapshot of client behaviour and situation
And then every twelve weeks
usually as part of a care plan review - to compare with pre-treatment snapshot and previous quarterly TOP results
(Also on existing clients every twelve weeks)
At Treatment Exit
Three months
Four weeks for Bucks 76

77. 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 77

78. When should the TOP be completed?
Post discharge
if feasible or desirable for service
won’t be performance managed by NTA 78

79. How is TOP useful clinically?
The TOP is a clinically useful tool for monitoring progress and identifying change during treatment
How is TOP useful clinically?
A means of identifying and understanding change for an individual client (comparing TOP scores)
Allows the keyworker to feedback the progress a client has made. The client can see these changes visually (using TOP Progress Tracker). Visual feedback may be more effective than verbal feedback alone
Assistance given in the care planning process; highlighting areas of difficulty that may need addressing to increase the potential treatment gains
Helps summarise the clients current situation and stimulates discussions in clinical meetings and supervision
Provides the keyworker with an additional source of information/evidence that could be used when discussing a specific care plan

80. How to complete the Treatment Outcomes Profile (TOP)
Client identifiers required to prevent double counting in the NDTMS
Record the number of days in which the client has used each drug. A number should always be used (0-28) except when a client declines to answer which should be recorded as ‘NA’
Record the number of days that the client has injected. If the client does not inject record ‘0’. Do NOT use ‘NA’. Also record whether the client has shared by marking the box with a ‘Y’ or ‘N’
Some clients commit crime in order to fund their drug use. An obvious treatment goal is to reduce this activity. Record the number of days (0-28) for section 3a & b and ‘Y’ or ‘N’ if the client has committed crimes (c,d,e,f) in the last 28 days
Circle the rating scales for Psychological, Physical & Quality of Life in accordance to where the client indicates.
Record the number of days paid work and college between (0-28) and only use ‘NA’ if the client declines to answer

81. 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. 81

82. Further Information & clinical tools
This is a very brief introduction to the TOP: more information is available at
This section is a very brief introduction to the TOP and covers only the very basic information that is required to start using the TOP with clients
Further Information & clinical tools
Guidance
TOP reporting protocol: A keyworkers guide
TOP completing TOP as a clinical interview
TOP Progress Tracker guide (DET)
TOP Service user guide
NDTMS practice guide
TOP Managers guide
Clinical Tools
TOP form
TOP form (low ink version)
TOP Progress tracker
Calendar
TOP training pack
All the above information is available at or complete the online order form at Alternatively, or telephone and quote product code

83. TOP and Confidentiality
TOP data submitted via NDTMS will have the same safeguards in relation to confidentiality as any other NDTMS data
This should be carefully explained to the client and local confidentiality agreements should be modified as appropriate to take into account the introduction of TOP into clinical and reporting systems 83

84. The benefits of the TOP continue to be recognised in clinical settings with its application in the UK and abroad having increased
Over the last 12 months the NTA has received several requests from European and International colleagues to use the TOP to measure outcomes in their clinics and countries.
Requests received from
It’s recognised that the TOP benefits from being
Wales
Scotland
Northern Ireland
Italy
Taiwan
Iran
Australia
Chile
Russia
Finland
Canada
Malta
Spain
New Zealand
validated tool
short & easy to complete
Why?
clinically useful tool
captures a wide range of substances
broadly covers all other relevant treatment domains

85. See the NTA website www. nta. nhs. org
See the NTA website for more information on the use of TOP internationally

87. TOP Exceptions
Let’s review the February YP TOP Exceptions that were released on DAMS on 30th March 2010.
Discussion:
Having reviewed the TOP exception reports, what actions need be taken?
February TOP Exceptions were published on DAMS on 30/03/2010.
January TOP Exceptions were published on DAMS on 05/03/2010.
April 6, 2017

88. ANY QUESTIONS 88

89. Performance Management

90.
GO THROUGH QUARTERLY PERFORMANCE REPORTS – provide each delegate with their agencies quarterly report.

91. DAT/AGENCY Quarterly Reports
Available through DAMS (NDTMS upload portal) and restricted section of

92. Data Quality & Data Completeness

93. Objectives Focus on Data Quality Data Completeness
NDTMS Year End Review ( )
Regional Data Quality Initiatives
How to address monthly data quality reports

94. Improving Service Provision
“Drug treatment services are managed using close to “real-time” data provided from the NDTMS and client satisfaction and client outcome data”
(Models of Care: Update 2005, Consultation)

95. DTMU Data Quality Strategy
As part of SLA with NTA‚ an annual data quality strategy has to be produced and signed off by regional and central NTA.
Covers the entire NDTMS dataset.
Sets the data quality targets‚ which are based upon NTA HQ Monthly DQ Metrics.
April 6, 2017

96. NTA Data Completeness Drivers
NTA National Requirements
Percentage completion rate for Parental Status
Percentage completion rate for Children Living With
Hidden Harm
PSA 14 – To prevent substance misuse amongst young people helping to reduce links with crime, disorder, truancy, school failure, physical and mental health problems.
Hep B Vaccination Status responses versus Hep B Intervention status responses
Route of Administration Inject versus Injecting Status
Health Interventions/BBV
PSA 18 – To promote better health and wellbeing of all citizens of society.
Completion of Modality Start
PSA 25 – to deliver a sustained 1% per annum increase (of people held in effective treatment) on baseline during
Completion of Accommodation Need & Employment Status
PSA 16 – to increase the proportion of socially of socially excluded adults in settled accommodation, employment education and trainings. 96

97. DTMU Data Completeness Analysis
DTMU release quarterly data completeness reports by partnership and by agency.
Analysis is based on new presentations only.
Quarterly /10 released end of March / early April. 97

98. Q2 Data Completeness Analysis
Let’s review the Q2 completeness that was released in early February.
What action needs to be taken forward? 98

99. What data quality issues are you facing?
April 6, 2017

100. How can you improve your agency’s overall data quality and data completeness?

101. Suggestions
Before submitting the monthly data submission check to see if all errors/warnings that could have occurred‚ have been addressed;
Where amendments to client details have been made on your database‚ it is very important to notify Sue Dales to ensure that these changes are replicated on the regional NDTMS database.
Ensure that all the fields that can be completed‚ are completed.
April 6, 2017

102. DTMU Data Quality Standards
All monthly agency submissions must contain at least 100% valid records.
All monthly agency submissions must reach 99.5% data quality
All fields of CDS-F populated, if appropriate.
Files must be in a CSV format.
All agencies must submit via the Upload Portal:

103. ANY QUESTIONS Regina.Lally@SPH.nhs.uk Sue.Dales@SPH.nhs.uk

104. Dami.Omole@sph.nhs.uk Michael.Wallington@sph.nhs.uk