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
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