Transcript Slide 1

NDTMS in Prisons Training
Presented by Maddie Ardern-Blowen & Hayley Smith
Introductions
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South East NDTMS Team
Team consists of:
Laura Hunt: NDTMS Deputy Manager
Lucy Nicholson: Senior Data Manager –NDTMS Community Lead
Maddie Ardern-Blowen: Prison Support Officer
Hayley Smith: Prison Support Officer
Sue Dales: Data Manager
Zdenka Vockova: Information Analyst
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What should be reported to NDTMS
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Specialist treatment for substance misuse (includes a care planned medical
or psychological intervention aimed at resolving dependence or reducing
harm)
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Treatment Interventions (modalities) for both Adults and Young People (YP)
under the age of 18. The categories of Adult drug treatment modalities,
Adult alcohol treatment modalities and Young Persons (under 18) treatment
modalities
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Non-structured treatment, i.e. low level interventions, should not be reported
to NDTMS, with the exception of brief interventions work with alcohol
clients. If prisons wish to include low level interventions in their extracts the
data will not appear in any central reporting or contribute to numbers in
effective treatment
NDTMS - In Prison Training
Why does this data need to be collected?
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Enables monitoring and reporting on drug and alcohol treatment to support
the performance management of prison treatment activity
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Enables National and local level reporting to support the National Drug
Strategy and local needs analysis
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Supports policy formulation
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Help develop more efficient commissioning systems
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NDTMS Software
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The NDTMS dataset will be extracted from the DET (Data Entry Tool) or a
similar case management tool.
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This information is then transmitted to the SE NDTMS team through a
secure website called DAMS (Drug and Alcohol Monitoring System)
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The SE NDTMS Team will be responsible for training and supporting teams
to use DAMS and DET.
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Questions
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What data will be collected
Client Details
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Treatment
Episode
Details
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Treatment
Modality
(intervention)
Details
Care Plan
Review Details
(for clients on
opioid
maintenance
only)
Discharge &
Exit Reasons
Data Items – Clients details
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Client’s first name initial: K
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Client’s surname initial: B
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Date of Birth: 17/02/1975
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Sex of Client (at birth): Male
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Ethnicity: White British
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Nationality: GBR
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What data will be collected
Client Details
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Treatment
Episode
Details
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Treatment
Modality
(intervention)
Details
Care Plan
Review Details
(for clients on
opioid
maintenance
only)
Discharge &
Exit Reasons
Data Items – Episode Details
Initial reception date: 01/01/2014
Reception date: 20/01/2014
Client Prison number: NOMS ID
Consent for NDTMS: Yes
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Confidentiality & Consent Version 6.3
All Substance Misuse Treatment Providers should have clear policies on:
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Confidentiality and information sharing
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Consent to treatment
The process:
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Clients need to sign a confidentiality agreement as part of the care planning
process
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Clients should be aware of what information is reported to NDTMS and how
it’s used
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All providers should routinely and explicitly explain their confidentiality and
information sharing policy in relation to NDTMS with clients
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PHE have developed a Confidentiality Toolkit (available on their website)
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Data Items – Episode Details
Triage Date: 20/01/2014
Care Plan Started Date: 20/01/2014
Injecting Status:
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Currently injecting
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Previously injected
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Never injected
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Declined to answer
*Drinking days: Out of last 28 days
*Units of Alcohol: Units consumed on a typical drinking day
*NB – Drinking days and units must be completed for clients with Alcohol as
primary drug
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Data Items - Episode Details
Postcode: OX4 2GX
DAT of Residence: J09B
Problem Substance No. 1: Heroin
Problem Substance No. 2: Crack (option no second drug)
Problem Substance No. 3: Alcohol – Spirits – (option no third drug)
Transferred from (Prison): If applicable
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Data Items – Episode Details
•Pregnant? – Yes/No
•Parental Status- To clarify reference values:
N.B. Includes
biological parents,
step parents, foster
parents, adoptive
parents and
guardians.
* To qualify for
these options the
minimum period of
co-habitation is one
month
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Children (under 18) Living with Client
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What data will be collected
Client Details
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Treatment
Episode
Details
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Treatment
Modality
(intervention)
Details
Care Plan
Review Details
(for clients on
opioid
maintenance
only)
Discharge &
Exit Reasons
Treatment Modality Details
Treatment Modality: Opioid Maintenance
Modality Start Date: 02/06/2013
Modality End Date: 20/07/2013 - The date that the client had the last contact in
which that specific modality was delivered – this could be the last session they
attended before they dropped out or the last session as agreed in the care
plan with the key worker
Modality Exit Status: Mutually agreed planned exit
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Adult Drug Modalities - Overview
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Opioid Reduction
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Opioid Maintenance
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Other Clinical Intervention
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Psychosocial Intervention Mental Disorder
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Other Formal Psychosocial Therapy
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Structured Day Programme
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Other Structured Intervention
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Opioid Reduction
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Should be used where the client’s care plan objective is reduction with a
commitment to becoming drug free
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Every review of the client’s care plan should indicate that the substitute
dosage is being reduced- if the dosage is not reduced over 2 or more
reviews then this modality should be ended and ‘opioid maintenance’
should be started
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The modality start date is the date of dispensing the first dose of medication
where reduction is the aim
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Opioid Maintenance
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Requirement that all periods of extended prescribing whether maintenance
or gradual reduction are reviewed every three months as a minimum
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Where longer term prescribing is offered (sentenced over 26 weeks) it
should be explained that at an appropriate time there will be the expectation
that the prisoner works towards reduction, and that abstinence remains the
ultimate goal – The Recovery Agenda
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The modality start date is the date of the dispensing of the first does of
medication on a maintenance script
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Other Clinical Interventions
This modality should be used to record the following treatment interventions:
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Detoxification from benzodiazepines
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Detoxification from opiates using a non-opiate agonist
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Prescribing of naltrexone prior to release from prison
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Re-induction onto opiate substitution treatment prior to release
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The modality start date is the date of dispensing the first dose of medication
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Clinical Treatment – wrap around care
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Whilst receiving clinical substance misuse treatment interventions the
prisoner should also be receiving structured sessions with a key worker or
other substance misuse worker to address their drug (and alcohol) misuse,
health related issues, offending behaviour and social functioning as well as
access to other educational and rehabilitation opportunities to assist them
with achieving abstinence.
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Psychosocial Intervention Mental Disorder
Many drug users also suffer considerably with common mental health problems
including; depression, anxiety, post traumatic stress disorder, eating
disorders, OCD, antenatal and postnatal mental health
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This modality can be used to record where, for example, guided self help
and brief interventions for mild problems to cognitive behavioural therapy
and social support for more moderate forms are delivered
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All psychosocial interventions to address common mental disorder should
be recorded using this modality regardless of their intensity
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The modality start date is the date of the first formal and time limited
appointment
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Other Formal Psychosocial Therapy
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This modality category includes therapies that are used in drug treatment
that are beneficial for some clients as they are practical and broad based
techniques such as-
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Community Reinforcement Approach
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Social Behaviour Network Therapy
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The modality start date is the date of the first formal and time limited
appointment
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Structured Day Programme
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Should be used to record a range of programmes where a client must
attend for a fixed period of time
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Programmes should follow a set timetable and include group work,
psychosocial interventions, educational and life skills activities
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Majority of drug treatment programmes fall into this category, including 12step, Therapeutic communities and PASRO
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Less extensive or less structured ‘day care’ provided in the context of a
structured care plan should be recorded under ‘Other Structured
Intervention’
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The modality start date is the date programme starts
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Other Structured Intervention
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Use to record a package of interventions set out in the client’s care planincluding emotional and psychological support, advice and information, harm
reduction support, educational and life-skills- this modality may be particularly
relevant for clients that have existing mental health problems
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Includes as a minimum regular planned therapeutic sessions with key-worker
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Will probably be used more frequently for non-opiate drug misusers
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Can be used to record regular key-working sessions delivered in order to keep a
client engaged while they are waiting to start another intervention
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Should be used to record where client’s are receiving ‘day care’ rather than ‘day
programme’
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The modality start date is the date of the first formal and time-limited key worked
appointment
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Questions
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Adult Alcohol Modalities - Overview
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Alcohol – Prescribing
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Alcohol – Structured Psychosocial Intervention
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Alcohol – Other Structured Treatment
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Alcohol – Brief Intervention (non-structured)
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Alcohol - Prescribing
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Prescribing of drugs to treat alcohol misuse
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Should capture the following:
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Medications to promote abstinence or prevent relapse, including sensitising agents
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Medications for treating withdrawal symptoms during medically assisted alcohol
withdrawal
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Nutritional supplements as a harm reduction measure for heavy drinkers and highdose parental thiamin for the treatment of Wernicke’s encephalopathy and its
prevention
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Medications for reducing craving for alcohol should only be prescribed alongside
psychosocial treatment
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The modality start date is the date of dispensing the first dose of medication
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Alcohol – Structured Psychological
Intervention
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Clearly defined, evidence based interventions delivered as part of the
client’s care plan, which assist the client to reduce their alcohol
consumption
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Can be delivered on an individual basis or in a group setting
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Can include cognitive-behavioural therapy, motivational enhancement
therapy, 12 – step therapy, coping and skills training, social behaviour and
network therapy
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Psychosocial interventions differ from advice/information or other lowthreshold support
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The modality start date is the date of the first formal and time-limited key
worked appointment
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Alcohol – Other Structured Treatment
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To record less clearly defined counselling in the context of a structured care
plan (e.g. day care)
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To record a range of other interventions being delivered to meet care plan
needs, for example:
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Regular sessions with a key worker to address a range of social and health
related needs
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Ongoing support following alcohol withdrawal to maintain abstinence as part
of the care plan
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A short period of care-planned regular brief interventions to address
problem alcohol misuse
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The modality start date is the date of the first formal and time-limited key
worked appointment
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Alcohol – Brief Intervention
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Prison teams have the option to be able to record where clients may be
receiving brief interventions to tackle hazardous and harmful drinking
behaviour
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Should be used to record both brief and extended brief interventions:
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Can consist of either a short session of structured brief advice or a longer
more motivationally based session (extended brief intervention). Both aim to
help someone reduce their alcohol consumption or abstain and can be
carried out by non-alcohol specialists
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The modality start date is the date of the first face-to-face contact where a
simple or extended brief intervention has been delivered
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Young Person’s Treatment Modalities Overview
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Specialist Pharmacological Interventions
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Specialist Harm Reduction
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Counselling
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Cognitive Behavioural Therapy
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Motivational Interviewing
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Relapse Prevention
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Family Work
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Specialist Pharmacological
Interventions
Include prescribing for detoxification, stabilisation and symptomatic relief of
substance misuse as well as prescribing of medications to prevent relapse
The modality start date is the date of dispensing the first dose of medication
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Specialist Harm Reduction
Should include services to manage:
• Injecting – advice and information on injecting practice, access to appropriate
testing and treatment for BBV
• Overdose- advice and information to prevent overdose, particularly in terms of
overdose associated with poly drug use
• Accidental injury- advice and information to ensure that measures to identify
and prevent substance misuse related injuries
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YP Psychosocial Interventions
May be provided:
• To treat substance misuse including alcohol or co-occurring mental health disorders
• Alone or in addition to harm reduction or pharmacological interventions
• The modality start date is the date of the first formal appointment
The Psychosocial interventions have been broken down into five types for
reporting on Young People
PLEASE NOTE: If a client turns 18 whilst in structured treatment then their YP
modalities should continue to be reported until they come to a natural end. If they
start a new modality after turning 18 then the Adult modalities should be used.
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1. Counselling
Counselling is a process in which a counsellor holds face to face talks
with a young person to help him or her to solve a problem, or help
improve that person’s attitude, behaviour (substance misuse).
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2. Cognitive Behavioural Therapy
Cognitive behavioural therapy is a psychotherapeutic talking therapy
that aims to solve problems concerning dysfunctional emotions,
behaviours and cognitions through a goal-oriented, systematic
approach.
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3. Motivational Interviewing
Motivational interviewing is a brief psychotherapeutic intervention.
For substance misusers, the aim is to help individuals reflect on their
substance use in the context of their own values and goals and
motivate them to change.
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4. Relapse Prevention
Relapse-prevention CBT focuses on helping drug users to develop
skills to identify situations or states where they are most vulnerable
to drug use, to avoid high-risk situations, and to use a range of
cognitive and behavioural strategies to cope more effectively with
these situations.
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5. Family Work
Family work includes interventions that use psychosocial methods to support
parents, carers and other family members to manage the impact of a young
person’s substance misuse, and enable them to better support the young
person in their family. This includes work with siblings, grandparents, foster
carers, etc.
*Note: family work should only be reported to NDTMS if and when a
young person who is a member of the family receiving family work is
currently accessing specialist substance misuse young people’s
treatment services and should be reported using the young person’s
attributors.
Family work that does not involve the young person can be recorded locally but
should not be reported to NDTMS.
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What data will be collected
Client Details
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Treatment
Episode
Details
NDTMS - In Prison Training
Treatment
Modality
(intervention)
Details
Care Plan
Review Details
(for clients on
opioid
maintenance
only)
Discharge &
Exit Reasons
Adult Only
Care Plan Review Details continued
Care Plan Review Date: 01/02/2012
Reason for continuing maintenance: All clients receiving opioid maintenance for
13 weeks or more and who will continue to do so after the current care plan
review will require a reason to be recorded
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Clients Continuing Opioid Maintenance
The permissible values are as follows:
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Concerned over injecting drug use in prison
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Medical reason (Including mental health)
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Ongoing short term remand
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Impending significant events, e.g. release, court appearance, transfer to
another prison
NDTMS - In Prison Training
Care Plan Review Details
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Teams need to report care plan review dates only for clients who are in
receipt of substitute prescribing, excluding reviews held within first 4 weeks
of treatment start this is to ensure that the three monthly (13 week) reviews
as set out in the guidance is monitored nationally
This will be monitored in your quarterly performance reports
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Prescribing, the Problem
2010 Drug Strategy:
‘substitute prescribing continues to have a role to play in the treatment of
heroin dependence, both in stabilizing drug use and supporting
detoxification.’
‘However, for too many people currently on a substitute prescription, what
should be the first step on the journey to recovery risks ending there. This
must change.’
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What data will be collected
Client Details
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Treatment
Episode
Details
NDTMS - In Prison Training
Treatment
Modality
(intervention)
Details
Care Plan
Review Details
(for clients on
opioid
maintenance
only)
Discharge &
Exit Reasons
Modality Exit Reasons
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Discharge Data:
Discharge Date: 22/06/2013
Discharge reason: Transferred in Custody
Prison exit date: 23/06/2013
Prison exit reason: Transferred
Prison exit destination: Select from a drop down list
Referral on Release Status: Referred to CJIT
Pre-release review date: 22/06/2013
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Discharge Codes/Reasons
Planned Exits:
 Treatment Completed – Drug Free
 Treatment Completed – Alcohol Free
 Treatment Completed – Occasional User (not heroin or crack)
Transfers:
 Transferred – in custody
 Transferred – not in custody
Unplanned Exits:
 Incomplete – Dropped out
 Incomplete – Treatment withdrawn by provider
 Incomplete – Treatment commenced declined by client
 Incomplete – Client died
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Prison Exit Reasons/codes
• Released
• Transferred
• Died
• Absconded
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Referral on Release Status
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Referred to CJIT
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Referred to treatment provider
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Referred to both
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No onward referral
NDTMS - In Prison Training
Questions
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Contact Details:
[email protected]
01865 334 703 / 07796 261674
[email protected]
01865 334790 / 07917 072445
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