NDTMS – Core Dataset ‘F’ NDTMS Adult Drug & Alcohol Services Core Dataset ‘F’ February...

NDTMS – Core Dataset ‘F’

NDTMS Adult Drug & Alcohol Services

Core Dataset ‘F’

February 2009

Jill Smith

NEPHO – NDTMS Team


National Drug (and Alcohol) Treatment Monitoring System

Began collecting performance data on treatment of • adult problem drug users, • then YP drug & alcohol misusers, • then adult alcohol

– Client details– Episode details– Treatment modality/intervention details– Treatment outcome Profiles (TOP) details– Local Regional fields


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?


• 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 jeopardisedwhen fields left blank

Basics: Data Completion


Basics: Understand the Questions

The NTA Business Definition and Reference Data Documentation is important and changes as understanding of usage and meaning develops


Basics: Get hold of the documentation

NTA WEBSITE FOR DOCUMENTATION:-

http://www.nta.nhs.uk/areas/ndtms/core_data_set_page.aspx

NB: Awaiting revised guidance for: •Young persons' treatment providers and •Adult alcohol treatment providers


Core Dataset F Changes

1.Young People Service dataset – new fields

2.Treatment Outcomes Profile (TOP) Care Coordination flag

3.Reference items added/removed/changed

4.Fields Removed


a) Treatment Start and Treatment EndYP has lead professional?YP in contact with mental health services?YP in contact with YOT?YP Involved in Sexual Exploitation?YP Involved in Unsafe drug use?YP Involved in Offending?YP Self-harming?

1. New Fields


b)Treatment Start only

YP Education Status (=<16)?YP Involved in unsafe Sex?YP Parent in SM Treatment?YP Parent in MH Treatment?

1. New Fields…….


1. New Fields…….

c) Treatment Exit only

YP has a CAF?YP safer sex?YP sexual health interventions?YP registered with GPYP met goals on Care Plan


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


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


3. Reference data changesa) Adult Drug & Alcohol Interventions

Now expanded to include Community Prescribing for Drug clients.

Community prescribing involves the provision of care-planned specialised drug treatment, which includes the prescribing of drugs to treat drug misuse. The range of community prescribing interventions can include the following:

• Stabilisation on substitute opioids, including dose titration• Prescribing for a sustained period to substitute illicit drugs such as methadone and buprenorphine (maintenance prescribing)• Prescribing for withdrawal from opioids with opioid or non-opioid medications such as buprenorphine or lofexidine (community detoxification)• Prescribing to prevent relapse• Stabilisation and withdrawal from sedatives, such as benzodiazepines• Prescribing for assisted withdrawal from alcohol where appropriate• Treatment for stimulant users, which may include symptomatic prescribing• Non-medical prescribing (by nurses or pharmacists).


3. Reference data changesa) Adult Drug & Alcohol Interventions …

Now expanded to include Community Prescribing for Drug clients.

NB:

Substitute prescribing alone does not constitute drug treatment (NTA expert prescribing group, 2002). A community prescribing intervention should be provided within a care-planned package of care with an identified keyworker. It should be aimed at addressing the range of identified needs. The care plan should address drug and alcohol misuse, health needs, offending behaviour and social functioning.


3. Reference data changesa) Adult Drug & Alcohol Interventions …

Reminder: Specialist Prescribing for Drugs

NB: Specialist prescribing is community prescribing for drug misuse in a specialist

drug service setting, which normally comprises a multidisciplinary substance misuse team. Specialist prescribing interventions normally include comprehensive assessments of drug treatment need and the provision

of a full range of prescribing treatments in the context of care-planned drug treatment. The specialist team should also provide, or provide access to, a range of other care-planned healthcare interventions including psychosocial interventions, a wide range of harm reduction interventions, BBV prevention and vaccination, and abstinence-oriented interventions.


3. Reference data changes

a) Adult Drug & Alcohol Interventions …

New: Brief Interventions for alcohol services

When combining Tier 2 & Tier 3 interventions, besure that the Tier 3 record is clearly differentiatedwithin NDTMS

Use of combined Tier 2 and Tier 3 interventions can lead to performance measurement errors with serious consequences


3. Reference data changesb) Parental Status? Now expanded beyond 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

All new references:• 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


3. Reference data changes…..

b) Children Living With?Age of ‘child’ raised to under 18 – and now collected at

presentation only• No children living with client• 1 child living with client• 2 children living with client• n children living with client• Client declined to answer

c) Hep B & Hep C Status?New: Assessed as not appropriate to offer



d) 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.

Adult Drug Discharge Reason? – Planned

Data Item Definition

Treatment Completed - Drug freeThe client no longer requires structured drug treatment interventions and is judged by the clinician not to be using heroin or crack cocaine or any other illicit drug

Treatment Completed - Occasional user

The client no longer requires structured drug treatment interventions and isjudged by the clinician not to be using heroin or crack cocaine. There is evidence of use of other illicit drug use but this is not judged to be problematic or to require treatment.


3. Reference data changes…..d) Discharge Reason

Adult Drug Discharge Reason? - Neutral


Transferred - Not in Custody

A client has finished treatment at this provider but still requires further structured drug treatment interventions and the individual has been referred to an alternative nonprison provider for this. This code should only be used if there is an appropriate referral path and care planned structured drug treatment pathways are available.

Transferred - In custody

A client has received a custodial sentence or is on remand and a continuation of structured treatment has been arranged. This will consist of the appropriate onward referral of care planning information and a two-way communication between the community and prison treatment provider to confirm assessment and that care planned treatment will be provided as appropriate.


3. Reference data changes…..d) Discharge ReasonAdult Drug Discharge Reason? - Unplanned


Incomplete - Dropped OutThe treatment provider has lost contact with client without a planned discharge and activities to re-engage the client back into treatment have not been successful.

Incomplete - Treatment withdrawn by Provider

The treatment provider has withdrawn treatment provision from the client. This item could be used, for example, in cases where the client has seriously breached a contract leading to their discharge; it should not be used if the client has simply ‘Dropped out’.

Incomplete - Retained in custody

The client is no longer in contact with the treatment provider as they are in prison or another secure setting. While the treatment provider has confirmed this, there has been no formal two-way communication between the treatment provider and the criminal justice system careprovider leading to continuation of the appropriate assessment and care-planned structured drug treatment.

Incomplete - Treatment commencement declined by the client

The treatment provider has received a referral and has had a face-to-face contact with the client after which the client has chosen not to commence a recommended structured drug treatment intervention.

Incomplete - Client Died Data item definition – During their time in contact with structured drug treatment the client died



d) Discharge Reason (Separated from Discharge Destination)

Adult Alcohol Discharge Reason? – Planned


Treatment Completed - Alcohol freeThe client no longer requires structured Alcohol treatment interventions and is judged by the clinician not to be using alcohol.

Treatment Completed - Occasional userThe client no longer requires structured alcohol treatment interventions, there is evidence of use of alcohol use but this is not judged to be problematic or to require treatment.


3. Reference data changes…..d) Discharge Reason

Adult Alcohol Discharge Reason? - Neutral


Transferred - Not in Custody

A client has finished treatment at this provider but still requires further structured alcohol treatment interventions and the individual has been referred to an alternative nonprison provider for this. This code should only be used if there is an appropriate referral path and care planned structured alcohol treatment pathways are available.

Transferred - In custody

A client has received a custodial sentence or is on remand and a continuation of structured treatment has been arranged. This will consist of the appropriate onward referral of care planning information and a two-way communication between the community and prison treatment provider to confirm assessment and that care planned treatment will be provided as appropriate.


3. Reference data changes…..d) Discharge ReasonAdult Alcohol Discharge Reason? - Unplanned


Incomplete - Dropped OutThe treatment provider has lost contact with client without a planned discharge and activities to re-engage the client back into treatment have not been successful.

Incomplete - Treatment withdrawn by Provider

The treatment provider has withdrawn treatment provision from the client. This item could be used, for example, in cases where the client has seriously breached a contract leading to their discharge; it should not be used if the client has simply ‘Dropped out’.

Incomplete - Retained in custody

The client is no longer in contact with the treatment provider as they are in prison or another secure setting. While the treatment provider has confirmed this, there has been no formal two-way communication between the treatment provider and the criminal justice system careprovider leading to continuation of the appropriate assessment and care-planned structured alcohol treatment.

Incomplete - Treatment commencement declined by the client

The treatment provider has received a referral and has had a face-to-face contact with the client after which the client has chosen not to commence a recommended structured alcohol treatment intervention.

Incomplete - Client Died Data item definition – During their time in contact with structured alcohol treatment the client died


3. Reference data changes…..j) Employment Status?Removed: Not in Education or Training or employment

Attending PRU/Special Schooling arrangementsYP Adults

Regular Employment this refers to employment which is regular and sustained.

Pupil/Student

this refers to education which is regular and sustained and is provided by a school, further education college or university. Young people who receive education from a specialist service in response to specialist needs including problem behaviour or difficulties with standard educational environments should refer to code 8 below.

Economically Inactive

this refers to young people and adults or are not currently in education or employment outside the home either because they have a role within the home as a parent or carer or because they have reached retirement age or because they have health or mental health issues which currently prevent them form working or studying.

Unemployedthis refers to adults who have the capacity to work and who are not currently in regular and sustained employment.

Other this refers to any activity which is not described by other codes

Not Knowntreatment services should endeavour to find out how young people spend their time, if this has not been possible, this code should be used.

Cross reference with Appendix I of YP Business Definitions


4. Fields Removed from YP Dataset

a) Dual Diagnosisb) Sex Workerc) Sexuality

(Picked up through new fields or not appropriate for YP)

But still being collected in Adult Drug & Alcohol services

Alcohol and the North East

THANK YOU!

NDTMS – Core Dataset ‘F’ NDTMS Adult Drug & Alcohol Services Core Dataset ‘F’ February...

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