NDTMS Core Dataset G Training for Treatment Providers and Commissioners

1. NDTMS Core Dataset G Training for Treatment Providers and Commissioners Drug Treatment Monitoring Unit March 2010

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

3. Aims • Clarify the changes in Core Data Set ‘G’ • Clarify consent and confidentiality • Review Data Quality and TOP compliance • Provide information around current reporting and monitoring • Clarify numbers in effective treatment, successful completions and waiting times calculations

4. Essential Elements of Treatment Provision • The needs of all drug misusers should be assessed across the four domains of drug and alcohol misuse health social functioning and criminal involvement. • All drug misusers entering structured drug treatment should have a care or treatment plan which is regularly reviewed. • A named individual should manage and deliver aspects of the patient’s care or treatment plan. • (Source: Drug Misuse and Dependence: UK guidelines on clinical management‚ 2007)

5. Why is information needed for NDTMS? • The drug and alcohol treatment information that you provide to the NDTMS is used for several purposes. Primarily used for: • Assess the number of individuals attending drug and alcohol services in order to monitor the progress of the national drug and alcohol strategies; • Evaluate the efficiency and effectiveness of drug and alcohol treatment provision‚ including treatment outcomes for clients. • Monitor the use of resources. This helps ensure equitable funding of drug and alcohol services nationally. • Provide a local and regional picture of drug and alcohol clients and their needs‚ which will assist service commissioners such as DAATs‚ PCTs and local authorities in planning and developing better drug and alcohol treatment services that are more appropriate to their geographical area. • Produce statistics and to support research on drug and alcohol use‚ treatment or general public.

6. DAAT Profile: 2008-09 • http://www.dtmu.org.uk/DAT Profiles 2008-09.html

7. Changes with Core Data Set G • One new data item • Modalities updated in line with Orange Book clinical guidance • Reference data items updated in line with NHS data dictionary • YP outcomes updated

8. 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

9. CDS ‘G’ Treatment InterventionsUpdated options

10. Updated treatment interventions • Modalities updated in line with Orange Book clinical guidance • “The SCAN consensus document on inpatient treatment (SCAN, 2006) defined the core work of an inpatient unit as comprising assessment, stabilisation and detoxification (or assisted withdrawal). Although these may be combined during a patient’s stay, the patient’s plan of care should usually identify one task as the principal purpose of administration” • Proposals to modify the codes used to record the types of drug treatment being provided on the National Drug Treatment Monitoring System – July 2009

11. Outreach Advice and Information Needle Exchange Aftercare Tier 2 Adult Drug Modalities Clients receiving these Tier 2 interventions will NOT count for performance targets

12. Tier 3 Adult Drug Modalities • Specialist Prescribing • GP Prescribing • Behavioural Couples Therapy • Family Therapy • Contingency Management (drug specific) • Psychosocial Intervention to address common mental disorders • Other Formal Psychosocial Therapy • Structured Day Programme • Other Structured Intervention Clients receiving these Tier 3 interventions will count for performance targets

13. Psychosocial interventions • Behavioural couples therapy • Family therapy • Contingency management (drug specific) • Psychosocial interventions to address common mental disorders • Other formal psychosocial therapy (e.g. community reinforcement approach or social behaviour network therapy)

14. Behavioural couples therapy • Behavioural couples therapy is a specific psychosocial intervention that should only be available for use with clients who have an established relationship and a drug-free partner willing to engage in treatment. • The focus is on the client’s drug use and should consist of at least twelve weekly sessions.

15. Family therapy • Family therapy is a structured psychosocial intervention that is delivered by a competent clinician. • The focus is on discussion with families relating to the sources of stress associated with drug misuse and aims to support and promote the family in developing more effective coping behaviours. • Family therapy should only be recorded under this code when the client is actively involved in the intervention. This does not reflect family work that is done where the service user is not engaged in the intervention.

16. Contingency management (drug specific) • Structured behavioural programmes using incentives to reinforce changes in behaviour. • Behaviour changes incentivised for people receiving methadone maintenance treatment include reduced illicit drug use and/or increased engagement with services. • Behaviour changes incentivised for people who primarily misuse stimulants include reduced illicit drug use, abstinence and/or increased engagement with services.

17. Psychosocial interventions to address common mental disorders • Many drug users also have considerable co-morbid problems, particularly common mental health problems such as anxiety and depression. • There is evidence that a range of evidence-based psychosocial interventions can be beneficial for a wide range of mental disorders. • Such disorders may include: depression (NICE, 2007b); anxiety (NICE, 2007c); post traumatic stress disorder (NICE, 2005a); eating disorders (NICE, 2004); obsessive compulsive disorder (NICE, 2005b); antenatal and postnatal mental health (NICE, 2007d) • Psychosocial interventions to address these disorders range from, for example, guided self help and brief interventions for mild forms of problems to cognitive behavioural therapy and social support for more moderate forms. • All psychosocial intervention to address common mental disorders should be recorded using this code regardless of their intensity.

18. Other formal psychosocial therapy • (e.g. community reinforcement approach or social behaviour network therapy) • This includes other psychosocial therapies that are used in drug treatment and beneficial for some clients as they are practical and broad-based techniques. • Psychosocial therapies recorded under this category will include the Community Reinforcement Approach and Social Behaviour Network Therapy.

19. Inpatient Treatment Assessment Only Inpatient Treatment Stabilisation Inpatient Treatment Detoxification (assisted withdrawal) Residential Rehabilitation Tier 4 Adult Drug Modalities Clients receiving these Tier 4 interventions will count for performance targets

20. Inpatient treatment • Inpatient treatment Assessment Only • Inpatient treatment Stabilisation • Inpatient treatment Detoxification

21. Inpatient treatment Assessment Only • Individuals with drug and alcohol dependence present with a wide range of psychiatric, physical and social problems. • Substance misuse services provide a comprehensive assessment of these needs and formulate a treatment care plan to tackle them. • A hospital setting permits a higher level of medical observation, supervision and safety for service users needing more intensive forms of care. Specific tasks of the IPU may include: • • Assessment of substance use • • Assessment of mental health • • Assessment of physical health • • Assessment of social problems • These should be undertaken as described in the Inpatient Treatment of Drug and Alcohol Misusers in the National Health Service – Scan consensus project (2006). • This document is available at using the following link. • http://www.scan.uk.net/docstore/SCAN_Inpatient_Consensus_project_document_FINAL.pdf

22. Inpatient treatment Stabilisation • There is considerable evidence that the number of service users with more complex problems (coexisting physical and mental illness, dependence on more than one substance) is increasing. Such cases can be managed in a community setting, but the IPU setting permits a high level of medical observation, supervision and safety for service users needing more intensive forms of care. • The IPU should have care pathways, clinical protocols, and sufficient human and physical resources to offer the following range of stabilisation procedures: • 1. Dose titration • 2. Dose titration on injectable opioid medication • 3. Stabilisation on maintenance therapy • 4. Combination assisted withdrawal/stabilisation

23. Inpatient treatment Detoxification • Assisted withdrawal should only be encouraged as the first step in a longer treatment process, and needs to be integrated with relapse prevention or rehabilitation treatment programmes which can be provided in the NHS or independent/non-statutory sector. • Withdrawal in an IPU setting offers better opportunities for clinicians to ensure compliance with medication and to manage complications. IPU admission also offers a major opportunity to recruit service users into longer-term treatment to reduce the risk of relapse back into regular drug or alcohol use. • The IPU should have care pathways, clinical protocols, and sufficient human and physical resources to offer assisted withdrawal for a wide range of single and poly-drug and alcohol misuse problems.

24. Tier 4 ALC - Inpatient Treatment ALC - Residential Rehabilitation Adult Alcohol Modalities • Tier 3 • ALC - Community Prescribing • ALC - Structured Psychosocial Intervention • ALC - Structured Day Programme • ALC - Other Structured Treatment • Tier 2 • ALC – Brief Interventions • Will NOT count towards numbers in Treatment.

25. Tier 2 YP Non-structured intervention Tier 4 YP Access to residential treatment for substance misuse Young People Modalities • Tier 3 • YP Psychosocial Intervention • YP Harm Reduction Services • YP Family Work • YP Specialist Pharmacological Interventions Young People receiving these Tier 3/4 interventions will count towards performance targets

26. Question: Are you all reporting treatment modalities against individual clients episode of treatment?

27. CDS ‘G’ Reference DataChanges to reference values in line with NHS Data Dictionary

28. Employment status Unemployed and seeking work Not receiving benefits Unpaid voluntary work Retired from paid work Not stated Other Not known • Regular Employment • Pupil/Student • Long term sick or disabled • Homemaker • Retired from work

29. Sexuality • Gay: renamed toHomosexual • Not Disclosed: renamed to Not Recorded

30. Consent • Yes the person consented • No the person has not consented

31. 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

32. Hepatitis C Positive • Yes is Hepatitis C Positive • No is not Hepatitis C Positive • Not Known

33. Injecting Status • Previously Injected (but not currently) • Currently Injecting • Never Injected • Client Declined to Answer

34. Referral Sources (Drug & Alcohol) • Arrest Referral / DIP is now: • Arrest Referral • DIP • Custody Service has been removed

35. Referral Sources (Alcohol Only) • Employer • ATR (Alcohol Treatment Requirement) • Peer

36. Drug Codes • Methylone • Mephedrone • No Second Drug • No Third Drug

37. CDS ‘G’ Young People Changes to YP Outcomes

38. 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. • YP NDTMS Event: 31st March‚ YMCA Guildford

39. Information Management

40. 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)

41. 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)

42. Data Sharing Protocols • Having data sharing protocols in place‚ that outline how and why data is shared within and between organisations‚ is good practice. • Scenarios: • DAT Wide Systems: this 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 agencies.

43. 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.

44. 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)

45. Discharge Data

46. DischargeData • Discharge Date • Discharge Reason • If a Discharge Date is entered, then a Discharge Reason must be given and vice versa. • Discharge information must be reported accurately and in a timely fashion as it is used to calculate In treatment Rates. • Modality End Date (s) must be populated for discharged clients.

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

48. Drug Discharge Reasons • Transfers • Transferred – not in custody • Transferred – in custody

49. 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

50. Planned Discharge Project • The DTMU are currently providing support to a national exercise around Planned and Unplanned Discharges being undertaken by the Regional NTA Teams.  The number of unplanned discharges is rising, a trend which the NTA is keen to address immediately.  • In order to enable the agencies to investigate individual unplanned discharges, the DTMU have made available a spreadsheet which contains the attributable level data for unplanned discharges only for your service, thus the total number of discharges will be less than the summary sheet, which includes planned discharge reasons.