1. Effective treatment. Changing livesBuilding recovery in communities Core Data Set J for Adult Drug & Alcohol Treatment Providers October 2012 Simon Morgan Julie Marshall London NDTMS

2. Building recovery in communities CDS J Agenda/Objectives Importance of Data CDS J Rationale/Benefits Treatment Providers Affected CDS J - Whats New Non-Structured Treatment Break - time to review new sub-interventions and new structured treatment definition Practical/Administrative Implications of Changes Public Health England and Confidentiality/Consent

3. Building recovery in communities Importance of Data NDTMS relates to the process of collecting, collating and analysing information from and for those involved in the drug treatment sector 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

4. Building recovery in communities CDS J Rationale/Benefits Modality codes to date have been composed of a mixture of interventions and settings and have sometimes open to different interpretations. This has led to inconsistencies in data recording and difficulties in making comparisons between interventions and in looking at the treatment factors that are positively associated with outcomes. 90% of all psychosocial interventions have been recorded as Other Structured Psychosocial Intervention. To date there has been no code for recovery support interventions provided during structured treatment and no facility to record on- going recovery support provided following structured treatment.

5. Building recovery in communities CDS J Rationale/Benefits Enable services to demonstrate the recovery support interventions they are providing during and following structured treatment, which could be used to help reduce re-presentation rates. Provide assurances to commissioners and policy makers about the breadth of pharmacological interventions being delivered. Demonstrate to policy makers progress on the recovery agenda and the nature of recovery journeys. Provides information that supports the 2010 Drug Strategy goal of helping more people to recover from drug and alcohol dependence, and demonstrates how it is being achieved. Brings the intervention types into closer alignment with those recommended by NICE and the 2007 Clinical Guidelines.

6. Building recovery in communities Treatment Providers Affected CDS J is applicable to all adult drug and alcohol treatment providers and marks the end to different modality lists for drug and alcohol clients YP dataset, processes and reporting to remain as is, with significant changes proposed All clients at YP only providers will not be expected to use CDS J, even those over 18 CDS J to be implemented on 1 st November 2012 for new and existing clients New clients - immediately Existing clients - gradually, but well before 31 March 2013

7. Building recovery in communities CDS J - Whats New Setting Provider level & Intervention level Interventions 3 high level interventions & Multiple sub-interventions Time in Treatment

8. Building recovery in communities Setting - What, When & How Provider level All providers will be assigned one of the above provider settings in DAMS - this will be the provider default setting Intervention level To be completed if provider is recording delivery of interventions in a setting different than the providers default setting e.g. GP Shared Care; 1 - COMMUNITY2 - INPATIENT UNIT3 - PRIMARY CARE 4 - PRISON5 - RESIDENTIAL6 - RECOVERY HOUSE

9. Building recovery in communities Setting - What, When & How Intervention dates Intervention type Setting Mod start = 02/11/12 Psychosocial If the setting field is left blank (as will be in most cases) then the setting of the intervention will be the default provider setting in DAMS The record above indicates that a Psychosocial intervention is occurring in the community (at a provider with a default provider setting of community)

10. Building recovery in communities Setting - What, When & How Intervention dates Intervention type Setting Mod start = 02/11/12 Psychosocial The record above indicates a GP Shared Care approach e.g. a GP is prescribing and the structured psychosocial element is occurring in the community (at a provider with a default provider setting of community) Mod start = 02/11/12 PharmacologicalPrimary Care

11. Building recovery in communities Setting - What, When & How Intervention dates Intervention type Setting Mod start = 02/11/12 Psychosocial Mod start = 02/11/12 Pharmacological Intervention dates Intervention type Setting Mod start = 02/11/12 Psychosocial Mod end = 01/12/12 Pharmacological Mod start = 01/12/12 PharmacologicalPrimary Care The clients script then starts being provided by a GP, so a new intervention record is created, the previous one closed and a new setting created. Setting is left blank here denoting that the setting is the same as that of the provider Setting now denotes that prescribing is happening at a GP surgery

12. Building recovery in communities Interventions - What, When & How Three high level interventions Structured Treatment Interventions: 1 - Pharmacological 2 - Psychosocial Non-structured Treatment Intervention: 3 - Recovery Support

13. Building recovery in communities Interventions - What, When & How High level interventions to be implemented on 1 st November 2012 for new and existing clients New clients - immediate implementation Existing clients - gradual implementation, but before 31 March 2013, as one sub-intervention to be submitted by 31 March 2013 However, existing clients already in prescribing (specialist, GP or alcohol) will not need to update high level intervention, but may need to update setting (e.g. shared care) and will need to ensure psychosocial element is reported separately

14. Building recovery in communities Interventions - What, When & How 1 st November 2012 Specialist Prescribing Intervention started 01/01/2012 As specialist prescribing (old code) was started before 1 st November it continues to be recorded until it ends. However, psychosocial now needs adding. Psychosocial starts 01/11/12 GP Prescribing Intervention started 01/01/2012 Community Provider Psychosocial starts 01/11/12 Community Provider As GP prescribing (old code) was started before 1 st November it continues to be recorded until it ends. However, setting now needs amending to primary care and psychosocial now needs adding.

15. Building recovery in communities 1 st November 2012 Other Structured Intervention As Other Structured Intervention no longer exists it will need to be closed on or around the start of November Psychosocial intervention opened Intervention dates Intervention type Mod End = 01/11/12 Other Structured Exit reason Mutually Agreed The existing Other Structured Intervention is closed on the 1 st November in the usual way with the exit reason being recorded as mutually agreed. On the same day, a new psychosocial intervention is commenced. Interventions - What, When & How Community Provider

16. Building recovery in communities 1 st November 2012 Structured day programme Client A Psychosocial intervention opened The time in treatment will then denote that the client is in a SDP. Recovery support may well also be opened at the same time Inpatient Client B Pharmacological intervention opened The setting will denote that the client is receiving an inpatient intervention Residential Client C Psychosocial intervention opened The setting will denote that the client is receiving residential treatment. Recovery support may well be opened at the same time Psychosocial (any) Client D Psychosocial intervention opened The one high level psychosocial code will replace all the previous ones, with the different types being picked in sub interventions Interventions - What, When & How

17. Building recovery in communities Sub Interventions - What, When & How Pharmacological Basis of Prescribing Assessment & Stabilisation Maintenance Withdrawal Relapse Prevention

18. Building recovery in communities Sub Interventions - What, When & How Psychosocial 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

19. Building recovery in communities Sub Interventions - What, When & How Recovery Support 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 substance misuse relapse prevention Evidence-based mental health focused psychosocial interventions to support continued recovery Recovery check-ups Other

20. Building recovery in communities Sub Interventions - What, When & How Retrospective submission at 6 month intervals Existing clients - assumed start date 1 Nov (1 sub-intervention by 31 Mar 2013 and every 6 months thereafter at care plan review) New clients - 6 month review from intervention start Sub Intervention Assessment Date Should be combined to describe the full package of treatment Submission to be made at point of discharge If client in treatment less than 6 months; or Enough time has passed since the last review to warrant review

21. Building recovery in communities Sub Interventions - What, When & How 1 st November 2012 Specialist Prescribing Intervention started 01/01/2012 The clock for a sub intervention review starts on the 1 st November Client A Client B Psychosocial starts 01/12/12 The clock for a sub intervention review begins at the start of a post November treatment journey Psychosocial starts 01/11/12

22. Building recovery in communities Sub Interventions - What, When & How I Intervention Review 01/02/2013 I Intervention Review 01/02/2013 CBT = yes CM = yes Time in Psychosocial I Intervention Review 01/08/2013 I Intervention Review 01/08/2013 CM = yes Psychodynamic Therapy = yes At each intervention review information is returned about the sub interventions received since the previous review. If it is the first review it will be interventions received since starting treatment or for existing clients, interventions received since November 1st

23. Building recovery in communities Recovery Support - What, When & How Psychosocial starts 01/11/12 Recovery support starts 01/02/13 Recovery support starts a few months later but while the client is still in structured treatment, both are submitted alongside each other in the same way that high level interventions are generally Psychosocial Ends 01/02/13Recovery support starts 01/02/13 Scenario 1 Scenario 2 Psychosocial ends at which point the client continues in the provider receiving recovery support interventions Discharge Recovery support is a non structured intervention that can be delivered alongside structured treatment and/or following structured treatment

24. Building recovery in communities Recovery Support - What, When & How Structured Treatment episode ends 01/02/13 Client discharged from structured treatment Recovery support episode starts 01/02/13 The provider discharges the client from the episode completely using the discharge date and reason The episode of structured treatment has ended on the local software system NDTMS records the client as having completed structured treatment and starting recovery support in the same episode Episode as from point of view of client and local software system Another episode now needs to be opened to denote the client is in recovery support Client discharged from the episode Episode as from point of view of client and local software system From the point of view of NDTMS returns From the point of view of the local software system However, from the point of view of the local software system, creating a new RS episode, post structured treatment, doesnt reflect the clients experience. Consequently, CDS J relies on the ability to attach RS interventions to previous (discharged) structured treatment episodes.

25. Building recovery in communities Recovery Support - What, When & How To add the recovery support interventions there is no need to create a new episode, as these interventions can be attached to previous (discharged) structured treatment episodes. Episode as from point of view of client and local software system Recovery support starts 01/02/13Structured treatment ends 01/02/13 From the point of view of the local software system Discharge

26. Building recovery in communities Recovery Support - What, When & How Psychosocial starts 01/11/12 Recovery support starts 01/02/13 Psychosocial Ends 01/02/13Recovery support starts 01/02/13 Scenario 1 Scenario 2 At every six months post structured treatment reviews are returned Sub interven tion At six month intervals during time in structured treatment reviews are returned Sub interven tion Discharge Sub interven tion

27. Building recovery in communities Time in Treatment - What, When & How Time in treatment relates to the time spent each week in the entire treatment episode, while the client is in structured treatment and not in each different intervention type 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

28. Building recovery in communities Psychosocial Intervention Time in Treatment - What, When & How Psychosocial Intervention The client remains in specialist prescribing for the entire time in the episode never spending more than 14 hours a week in treatment so Time in Treatment does not change Client A Client B I Time in Treatment 01/02/2013 I Time in Treatment 01/02/2013 14 hours or less The client starts in psychosocial (less than 15 hours) and then after three months has alongside it multiple pharmacological and recovery support interventions so that they are now in treatment for just over 15 hours a week. Therefore the time in treatment is updated at this point. Client discharged from episode I Time in Treatment 01/02/2013 I Time in Treatment 01/02/2013 14 hours or less I Time in Treatment 01/05/2013 I Time in Treatment 01/05/2013 More than 14 hours and less than 25 Pharmacological Recovery Support

29. Building recovery in communities Drugs and Alcohol If the client is continuing treatment at the same provider All interventions for drug use are completed Alcohol interventions continue Client discharged from the episode If the treatment continues in the same provider then the episode remains open until treatment is completed or the client leaves. It is important that alcohol is recorded as a second or third presenting substance If the client is continuing treatment elsewhere All interventions for drug use are completed Alcohol interventions start Client discharged as transferred If the alcohol treatment will be provided elsewhere then the first agency should record the client as transferred to the alcohol provider Client discharged from the episode

30. Building recovery in communities Non-Structured Treatment Providers that are offering a care co-ordination function but NO structured treatment interventions should Continue to report to NDTMS if they need to submit TOP data, otherwise there is no need to Use the intervention type Recovery Support to denote when the care co-ordination commenced and ended Submit recovery support sub interventions if providing any of those listed to clients

31. Building recovery in communities Break

32. Building recovery in communities Changes to Administrative Practice for new clients from 1/11/12 Assess structured treatment clients Time in Treatment (includes structured treatment and recovery support) & enter into your NDTMS database Enter Pharmacological/Psychosocial/Recovery Support Intervention Capture in case files whether prescribed clients are being stabilised, maintained, withdrawn or provided with relapse prevention Capture in case files the sub-interventions for psychosocial/recovery support These sub-interventions are entered every 6 months at care plan review and at discharge

33. Building recovery in communities Community Psychosocial example Time in Treatment Assessment Date: 11/11/12 Time in Treatment: More than 14 hours and less than 25 Time in Treatment Assessment Date: 20/02/13 Time in Treatment: 14 hours or less Sub-intervention Assessment Date: 29/03/13 12-Step work: Yes Counselling: Yes Housing Support:Yes Other options: No Psychosocial Intervention 11 th Nov 2012 – 29 th March 2013 Recovery Support Intervention 11 th Nov 2012 – 29 th March 2013

34. Building recovery in communities Community Pharmacological & Psychosocial journey Time in Treatment Assessment Date: 11/11/12 Time in Treatment: More than 14 hours and less than 25 Time in Treatment Assessment Date: 20/02/13 Time in Treatment: 14 hours or less Sub-intervention Assessment Date: 29/03/13 Assessment and Stabilisation: Yes Maintenance:Yes 12-Step work: Yes Counselling: Yes Other options: No Psychosocial Intervention 11 th Nov 2012 – 29 th March 2013 Pharmacological Intervention 11 th Nov 2012 – 29 th March 2013

35. Building recovery in communities Shared Care Pharmacological & Psychosocial journey Time in Treatment Assessment Date: 11/11/12 Time in Treatment: 14 hours or less Sub-intervention Assessment Date: 4/7/13 Maintenance:Yes Withdrawal:Yes Counselling: Yes Other options: No Psychosocial Intervention 11 th Nov 2012 - 4 th July 2013 Default Setting = Community Pharmacological Intervention 11 th Nov 2012 - 4 th July 2013 Setting = Primary Care Sub-intervention Assessment Date: 4/5/13 Maintenance:Yes Counselling: Yes Other options: No

36. Building recovery in communities Rehabilitation Psychosocial example Time in Treatment Assessment Date: 11/11/12 Time in Treatment: 25 or more hours Sub-intervention Assessment Date: 4/4/13 12-Step work: Yes Counselling: Yes Other options: No Psychosocial Intervention 11th Nov 2012 - 4th April 2013 Default Setting = Residential

37. Building recovery in communities Changes to Administrative Practice for existing clients 1/11/12 List all clients currently in structured treatment Assess those clients time in treatment (includes structured treatment and recovery support) and enter into your NDTMS database Enter modality end dates 1/11/12 and Mutually Agreed Planned Exit for old Psychosocial modalities and create Psychosocial Intervention 1/11/12. Also create Psychosocial Intervention dated 1/11/12 for continuing prescribing clients. Capture in case files whether prescribed clients are being stabilised, maintained, withdrawn or provided with relapse prevention Capture in case files the type of psychosocial/recovery support These are entered at care plan review by 31/3/13 and every 6 months thereafter at care plan review and at discharge

38. Building recovery in communities What and When to enter new data from 1/11/12 Which data to enterWhen to enter data Time in TreatmentAll clients in structured treatment need this to be entered at the start of the structured treatment and again at the point that the time boundary changes (not at discharge) – new date for each InterventionOld Psychosocial modalities should be closed Mutually Agreed Planned Exit and new Psychosocial Intervention should be entered with start dates from 1/11/2012 (also add this Intervention for prescribing clients). New Interventions to use are Pharmacological/Psychosocial/Recovery Support Sub-interventionRetrospectively entered after every 6 months in structured treatment or at discharge but definitely enter a sub- intervention by 31/3/2013.

39. Building recovery in communities CDS J Guidance Business definitions and all relevant documents were published in July 2012 http://www.nta.nhs.uk/core-data-set.aspxhttp://www.nta.nhs.uk/core-data-set.aspx CDS J Implementation Guide is a welcome new addition to the supporting documents londonndtms@nta-nhs.org.uk