NTA Patient Placement Criteria (PPC) and Segmentation project

David Best 28.3.2011

Sub-group: PPC and segmentation• Develop, for and with the National Treatment Agency, a

model for the segmentation of the treatment population and the ‘at-need’ group not currently engaged in treatment, in terms of their likely recovery pathways and journeys. This will prepare the way for matching to suitable treatment placement indicators, in the context of the developing recovery framework. Overall, the aims of the group are to agree a process for meaningful segmentation and to utilise this as a way of identifying matching criteria for treatment journeys and ongoing recovery pathways.

• Dr John Marsden (IoP) – PPC• David Best (UWS / Monash) - Segmentation

What is the real purpose?

• CSAT (2009) say that 58% of people with a substance dependence will eventually recover

• Is that right?• Does it apply to the UK?• Who are they?• Is there anything you can do to make that

figure go up or down?

Hypothesis • There are naturally occurring turning points in all

life trajectories – birth of a child, getting a job, getting married, moving house etc

• It is also possible that turning points in trajectories can be ‘induced’, and one of those possible transitions is a successful treatment episode

• It is hypothesised that the reason why some potential turning points are actualised is based on the reserve of recovery capital that the individual possesses

Best and Laudet (2010)

How does this link to segmentation?

• The aim is to use existing resources and materials to identify variables – such as age, gender and drug use profile that may predict recovery outcomes

• To link this to measures of functioning where available – including but not restricted to TOP data

• To link this to aspects of community functioning • And to link this to locality differences in access to

community capital • To create a preliminary model that is hypothesis based

but data driven to create a segmentation

09/10 data on % in stable housing

09/10 data on % abstinent from opiates and crack

09/10 data on % in education or employment

09/10 data on % meeting all 3 criteria

OVERALL MEASURE OF WELLBEING• 3 ‘OBJECTIVE FACTORS’– STABLE HOUSING – NO HEROIN OR CRACK USE– MEANINGFUL ACTIVITY

• 3 ‘SUBJECTIVE FACTORS’– PHYSICAL WELLBEING– PSYCHOLOGICAL WELLBEING– QUALITY OF LIFE

• ALL MADE EQUAL (0-1)• TOTAL SCORE OUT OF 6

Composite recovery capital baseline to six months by DAT

Composite recovery capital baseline to six months by gender

Composite recovery capital baseline to six months by age group

SITE VISITS - PURPOSE

• To map out the recovery communities and systems

• To assess functioning in those in maintained and abstinent recovery

• To test measures of collective recovery capital • To test the overall model of developmental

recovery

WHAT DO WE KNOW ABOUT EACH LOCATION?

LIVERPOOL WIRRAL CALDERDALE

SOCIAL DEPRIVATIONINDEX SCORE

47.0 27.9 23.0

NATIONAL RANKING (OUT OF 354)

1 60 107

OVERALL CRIME PER 1,000 PERSONS

59.1 29.7 50.4

% OF WORKING AGE POPULATIONS ON BENEFITS

25.8% 21.8% 16.1%

INFANT MORTALITY PER 1,000 LIVE BIRTHS

6.5 5.2 6.7

Recovery case studies

OVERALL ABOUT 180 RECOVERY PROTOCOLS COMPLETED IN THREE LOCATIONS

CALDERDALE• 52 interviews conducted • Mean age = 40.8 years• Mean length of recovery time – 39 months• 3/52 reported housing problems • 22/52 reported some level of education and

employment

TOP functioning by group

0-6m in treatment

1-4 years in treatment

4years + in treatment

Recovery group

Physical health

12.8 12.6 12.5 14.4

Psychological health

12.6 12.5 11.9 15.2

Quality of life

13.3 13.4 13.4 15.8

Correlates of recovery time

TIME IN RECOVERY CORRELATED WITH.......

CORRELATION

PSYCHOLOGICAL HEALTH 0.21

PHYSICAL HEALTH 0.15

QUALITY OF LIFE 0.23

DAYS OF ACTIVITY 0.44

Correlates of activity

NUMBER OF DAYS WORKING OR TRAINING CORRELATED WITH .......

CORRELATION

PSYCHOLOGICAL HEALTH 0.55

PHYSICAL HEALTH 0.29

QUALITY OF LIFE 0.36

TIME IN RECOVERY 0.44

PRELIMINARY COMPARISON WITH THE WIRRAL

ENTRY SOURCES

MAINSTREAM TREATMENT

COMMUNITY RECOVERY

VISIBLE RECOVERY

MAINSTREAM

MUTUAL AID

CSMS

CONNECT 3 PROJECT COLTBASEMENT

TTP DETOX

BASEMENT

CRIMJUSTICE OTHERSELF

OVERALL CANDIDATE MODEL • BASELINE OF RC ENABLERS – possibly mediated by gender and age• PERSONAL RECOVERY CAPITAL • SOCIAL RECOVERY CAPITAL

This creates an individual model that is then multiplied against:

• COLLECTIVE RECOVERY CAPITAL IS ASSESSED AS A FRACTION BASED ON:– TREATMENT QUALITY AND ACCESS– RECOVERY CHAMPION VISIBILITY AND ACCESS TO GROUPS – SOCIAL COHESION, DEPRIVATION AND OPPORTUNITY