Transcript Slide 1

2009 DIR Training - Prisons
February - March 2009
The forms, their purpose and
the data collection systems
What is the DIR?
 A suite of forms for capturing information on clients in contact with
substance misuse treatment services via the criminal justice system.
Forms used in prisons are:
• Drug Interventions Record (DIR)
• Initial Contact Form
• Activity Form
 The DIR was developed to support effective sharing of information
about clients between organisations involved in their care, and to
collect information for monitoring and research purposes
 Completed in the community by CJITs and in prisons by Healthcare /
CARATs for all clients assessed aged 18+ in England & Wales
Purpose of the DIR
 Three main purposes:
Continuity of Care
SMTA Form
• To facilitate and improve
standards of continuity of
care for clients and
minimise duplication of
assessment as clients
move between the
community and prisons
and vice versa
• Collects a standard set of
information that can be
shared and understood by
workers nationally
• DIR is the SMTA form
used in prisons
• NB. When a client has
been referred in from
another prison or
community, and a DIR
has been received a new
DIR must not be
completed, instead an
Activity Form (section 1,2
& 4) must be completed
Monitoring and
Research
• Data is used for the
performance assurance
of IDTS & DIP
• From April this will
extend to informing
PSA 25
• Local interrogation of
DIRWeb provides
information for
managing performance
and informing
commissioning
Who completes the forms in prisons?
 Both Healthcare and CARATs
 As a minimum Healthcare must complete the first 6 sections of
the DIR if a client undergoes an SMTA*
 Healthcare and CARATs should work together to ensure that the
DIR is completed, and accurately reflects what treatment the client
has started
 Any significant changes whilst a client is being case managed must
be recorded on an Activity Form, including any new treatment
information – again Healthcare need to be involved to ensure all
treatment interventions are captured
* If client refuses to engage with CARATs then Healthcare will need to complete up to, and
including, Section 8 (form cannot be ‘exited’ before Section 8).
How does the M&R data get processed for prisons?
 Forms are completed by workers and posted to a data management
centre (5 across England)
 Forms entered into a live web-based system called ‘DIRWeb’
 Once a month the centre extracts data held in DIRWeb into its
national database, the DIP Management Information System (DMIS)
 All central reporting comes from data held in DMIS - this includes
extracts of prisons data that will be matched with NDTMS
Forms
DIRWeb
DMIS
Reports
What is DIRWeb?
 DIRWeb is the “live” IT system that the forms are entered into for prisons
and most CJITs
 DIRWeb is accessible over the internet (Prison service intranet)
 Client records held in DIRWeb for a particular prison can be viewed by that
prison (but not by others) – data could be used in local needs analysis e.g.
profiling of clients - ethnicity, drug misuse etc
 The website has a Help page with User Guides for the site and also acts as
a communication point for the community and prisons
 For read-only access to your data please contact the DIRWeb
Administrator for a login and password: Ade Lett, Interventions
Substance Misuse Group, MoJ, Phone 01902 703 207 or email:
[email protected]
What is DIRWeb?
Who processes the forms?
Data management centre
Regions covered
Liverpool John Moores University, Centre East, North East, West Midlands,
for Public Health
Yorkshire & Humber, North West Merseyside & Cheshire
South East Public Health Observatory
South East
South West Public Health Observatory
South West
University of Manchester, National Drug
North West - Cumbria & Lancashire
Evidence Centre
London NDTMS team, National Treatment London, East Midlands
Agency
Phone number
0151 231 4386
01865 334 725
01179 706 474
0161 275 1662
020 7261 8211
Problems with data collection so far
 Correct form completion process not being followed
 Activity Forms not being used routinely, or in some prisons, at all
 Information gaps, e.g. treatment interventions delivered are not being
recorded
 Cases not being closed when clients are released (requires an
Activity Form to be completed) – prison caseloads on DMIS /
DIRWeb are over-inflated as they still include clients that have been
released
The impact of the above is that performance reporting is
not accurately reflecting the work that prisons are doing
with clients
Questions
Form completion and process
The forms
 The forms used in prisons are:
 Initial Contact Form (ICF)
 Drug Interventions Record (DIR)
 Activity Form (AF)
Summary of rules for use
Initial
Contact
Form
= Meaningful contact but no SMTA
= SMTA only OR SMTA + CSMA + care plan
DIR
Activity
Form
= Treatment updates for client on caseload OR
Client transferred in (already has a DIR) OR
Client suspended, closed or re-engaged
ICF
 A one-page form to be completed when a non-caseload client has
been referred to CARATs and CARATs have made a meaningful
contact with the client which does not progress to SMTA
 Meaningful contact = worker has provided to the client, on a one-toone basis, an explanation of the substance misuse services being
offered, including confidentiality and consent, and harm min advice
 ICF includes 3 sections – form completion details, client details,
contact details (includes reason client did not have an SMTA)
 If the client agrees to a SMTA the DIR must be completed instead
 A new “green” ICF will be brought in after 1st April - nationality
DIR
 The DIR is completed by both the Community and Prisons
 Used as a tool for continuity of care (blue side) and monitoring and
research (green side)
 In addition to the SMTA the DIR also records the next steps, e.g.:
 non-structured interventions delivered to address immediate needs
 whether client needs further intervention
 whether client agrees to that further intervention
 client transferred elsewhere prior to CSMA
 CSMA
 full care plan, including treatment interventions started
DIR - sections
 The DIR has 9 sections plus a consent section for Continuity of Care
- the 9 sections cover:
Section
1
Form completion details
2
Client details & immediate action
3
Contact details
4
SMTA details
5
Legal profile
6
Drug and alcohol use
7
Social needs profile - housing, finance, parental status, employment, and
immediate actions (non-structured interventions in prisons)
8
Further intervention needed / accepted
Details of any client transfer prior to CSMA
9
Care plan and caseload - CSMA, full care plan, treatment and nontreatment interventions started
DIR – what is changing from 1st April?
 Client ‘Nationality at birth’ added to Section 2 – this requires a 3-letter
country code e.g. GBR
 Section 6 drug misuse & treatment:
 6.2 changed – tick up to 3 drugs used with Drug 1 recorded as the
main drug, and record the frequency for each of the drugs ticked
(maximum of 3)
 New question (6.2b) - Route of administration of Drug 1 – inject,
sniff, smoke etc
 6.4 changed to ‘What age did you start using Drug 1?’
 6.6 changed to ‘What is your injecting status?’ – never, current,
previous
 6.15 changed to ‘Has a first night initial clinical intervention been
provided by a doctor?’ – Yes or No, if Yes tick ‘prescribed
methadone’ or ‘prescribed other’
DIR – what is changing from 1st April?
 New question at 7.13 to record any non-structured treatment
interventions delivered to address immediate needs which cannot
wait until CSMA – list includes harm reduction, overdose
management, brief intervention for alcohol, crack awareness & other
 Additional tick box added to 8.1 to indicate where the client does not
need further intervention because a CSMA is not required but low
level interventions have been provided
DIR – rules for completion
 The DIR must only be completed when:
 The client is new to DIP and agrees to a SMTA
or
 The client has been referred in from the community (CJIT) or
another prison but NO DIR has been received
 Where a prisoner has accessed CARATs in a previous prison the
sending prison must send on the DIR within 5 days of release,
ideally with the prisoner and along with any other relevant case
notes. The receiving prison must check whether the DIR has
been received – a new DIR MUST NOT be opened unless the
previous case has been closed
DIR – rules for completion
 Not all fields need to be completed by both prisons and the
community, fields that are specific to one or the other are denoted as
follows:
P – For use by PRISON workers ONLY
C – For use by CJIT workers ONLY
 Prisons have 20 working days from the SMTA date to complete the
DIR before sending off the M&R side for data entry – this should
allow for the CSMA and care plan to be captured before sending off
DIR – key stages
 DIR stages from SMTA to CSMA & Care Plan:
SMTA complete
and client needs
further
intervention
(8.1 = Yes)
OR
SMTA completed
but client does
NOT need further
intervention –
e.g. low-level
interventions met
(8.1 = No)
Client agrees to
further
intervention
(8.2 = Yes)
CSMA completed
with client
(9.1 = Yes)
Client transferred
to CJIT or
another prison
prior to CSMA
(8.6 / 8.8)
Care plan
agreed with
client post-CSMA
(9.3 = Yes)
Any subsequent
significant events
for these clients
are to be
recorded on an
Activity Form
DIR – Exit points
 There are a number of ‘EXIT’ points on the DIR – this is where the
form completion stops because the client is not moving onto the next
stage
 e.g. the client has had an SMTA but refused further intervention, or
is being released prior to CSMA and therefore referred to their CJIT
 Exit points occur in section 8 and 9 of the DIR and are marked
 When an EXIT point is reached no further questions should be
completed, the M&R side of the form must be separated and sent to
the data entry centre. The Continuity of Care (blue) side must be
keep on the CARATs case file for future reference if the client later
engages
DIR – Summary of Exit points
EXIT points post-SMTA
but prior to CSMA
8.1 - Client does not
need further
intervention
8.2 - Client does not
agree to further
intervention
8.6 - Client
transferred to CJIT
8.8 – Client
transferred to
another prison
EXIT point at CSMA
EXIT point postCSMA
9.1 - CSMA has not
been completed
because the client
has disengaged from
services
9.3 – Care plan
has not been
agreed with client
DIR - CSMA & care plan
 If a client was identified in the SMTA as needing further intervention
(8.1 = Yes) and agreed to further intervention (8.2 = Yes) a CSMA
must be arranged
 A full care plan (9.3) cannot be agreed without a CSMA
 If the client is unable to attend the CSMA because they will be / have
been released CARATs must refer the client to their local CJIT and
complete 8.6, recording the code of the DAT they have been referred
to – this is an Exit point, so no further sections of the DIR should be
completed
 If a CSMA has not been attended because the client was in custody
less than one month, the CJIT should be contacted (as above) and
8.6 completed (Exit) – 9.1 should NOT be completed
DIR - Caseload
 Once a client has a CSMA completed AND has agreed a care plan (9.1
& 9.3 both = Yes) they are now considered to be “on the caseload”
 NB. Clients who have a SMTA, with or without some low-level
interventions, but do not go onto CSMA and care plan are NOT on
the caseload of the prison – these are “Triage” clients, not “Active”
clients
 Clients that have agreed an initial care plan with CARATs can be
determined from the new data field 7.13, but if they do not go on to
CSMA & full care plan they are NOT on the caseload
 Whilst “on the caseload” (as defined above) any subsequent significant
events that happen to the client must be recorded on an Activity Form
 Under IDTS a client is considered to be “in treatment” once they are “on
the caseload”
DIR - data
 From the DIR M&R data we can determine:
 How many clients needed further intervention (i.e. CSMA)?
 How many clients did not need further intervention but low-level
interventions delivered?
 How many clients agreed to further intervention?
 How many clients were transferred elsewhere prior to CSMA?
 How many CSMAs have been completed?
 How many clients with a CSMA agreed a care plan?
Questions
Activity Form
 The AF is for Monitoring & Research purposes only
 The specific aim of the AF is to record significant or key events for a
client who is already on your caseload (client has had CSMA & care
plan) or a client transferred from another prison or CJIT
 When to use the AF:
 To update information on the treatment interventions delivered to a
client on your caseload (Section 1,2 & 3)
 To record info about a client transferred into the prison from another
prison or the community, where the DIR has been received (Section
1,2 & 4)
 To re-engage a previously suspended client, or to suspend or close a
client (Section 1,2 & 5)
Activity Form – the sections
1. Form completion
2. About the client
3. Client is already on the CARATs caseload
 records care plan review date
 records structured treatment interventions in the current care plan that
have ended
 records treatment interventions which have commenced as part of
current care plan
Activity Form – the sections
4. Client transferred from another CARAT/CJIT





records the substances misused that brought the client into treatment
records first night clinical intervention
CSMA
Care Plan
records treatment interventions which have commenced
Activity Form – the sections
5. Client re-engagement, case suspension or closure




client re-engaged & reason
case suspension & reason
case closure & reason
records structured treatment interventions that have ended as a result of
the suspension / closure
Activity Form – what is changing from 1st April?
 Client ‘Nationality at birth’ added to Section 2 – this requires a 3-letter
country code e.g. GBR
 Section 3 changes:
 Care plan review date is to be recorded at 3.1 if client’s treatment need
changes (3.3) or client’s treatment completes / stops (3.2)
 New question (3.2) to record the end dates for structured treatment
intervention/s in the current care plan and to record the “exit status” of the
intervention – planned, unplanned or intervention withdrawn
(3.2 is a requirement of NDTMS – NDTMS need to know the start and end
dates of all structured interventions)
 3.3 is to record the commencement dates of any treatment interventions
(structured and non-structured) delivered as part of the current care plan
which have started since the DIR was sent off (or AF sent off if the client
was transferred in)
Activity Form – what is changing from 1st April?
 Section 4 and 5 is now merged into one Section. The new Section 4
includes two new questions:
 4.2a – Which substance misused by the client brought them into
treatment? Tick up to 3 substances, with Drug 1 the most relevant
 4.2b ‘Has a first night initial clinical intervention been provided by a
doctor?’ (clients coming from community) – Yes or No, if Yes tick
‘prescribed methadone’ or ‘prescribed other’
 New Section 5 (re-engage / suspend / close) has minor changes to
case closures reasons and a new question at 5.7 to capture the end
dates and exit status of any interventions ended as a result of case
suspension or closure – when a a client is suspended, transferred or
released all “open” interventions in a given prison must be closed off
Activity Form – why is it important
 Enables us to see how effectively clients are moved between
community and prison teams (and vice versa), and between prisons
 Provides information on the range of treatment interventions
delivered to clients whilst they are in prison
 Without information collected on the AF we cannot determine, for
example:
 how effectively you are working to get offenders into treatment
 what your actual “in treatment” caseload is
 what volume of clients you are referring to the community on
release
How the Activity Form works
Client had SMTA + CSMA + care plan
in this prison:
DIR
= client on “Active”
caseload of the prison
Activity
Form
(1,2 & 3)
Record changes to
treatment
Client had SMTA in another prison or
CJIT – DIR completed elsewhere:
DIR
DIR sent on to this
(receiving) prison
Activity
Form
(1,2 & 4)
Record client transfer
Activity
Form
(1,2 & 5)
Record:
Case closure
Case suspension
Case re-engaged
Activity Form – some rules for use (1)
 Any clients with a CARATs file who have not had a CSMA and full
care plan must NOT have the Activity Form completed for them as
they are not seen as “Active” on DIRWeb, except in the following
circumstances:
1. The client has transferred from another prison or the community –
their transfer must be recorded under AF Section 4
2. The client had an SMTA in a given prison but did not agree to
further intervention, or disengaged prior to CSMA and full care
plan, but then later agrees to engage with the CARATs in that
prison – these clients may be “re-engaged” by completing AF
Section 5.1 & 5.2 so long as they have a CSMA and care plan –
they will then be taken onto the “Active” caseload
Activity Form – some rules for use (2)
 Re-engagement: If a client previously disengaged, or completed their
previous care plan but needs re-engagement for pre-release planning, they
can be “re-engaged” using an Activity Form – this takes them back onto the
“Active” caseload. Re-engagement assumes they have had a CSMA and
agreed a new care plan
 A client can only be “re-engaged” (AF Section 5.1 & 5.2) if:
1. They have previously been suspended from the “Active” caseload within
the same prison
2. They have chosen to re-engage following an earlier decision not to
engage in the CSMA and care plan process in that same prison – they
must have a CSMA and care plan to be re-engaged, this also applies to
pre-release planning
 Clients suspended in a previous prison and transferred cannot be “reengaged” by the receiving prison, they must be taken onto the receiving
prison’s caseload via AF Section 4
Activity Form – some rules for use (3)
 Suspensions and closures:
 A client can only be suspended or closed if the client had a CSMA
and had agreed a full care plan, i.e. they have to have been “Active”
 Suspending an “Active” client: Complete sections 1, 2 and 5.3
(date suspended), 5.4 (reasons for suspension) and 5.7 (to close off
any open treatment interventions that have stopped, if not already
recorded via a previous AF Section 3)
 Closing an “Active” or “Suspended” client: All clients released or
transferred who were on the “Active” caseload or “Suspended”
caseload (N.B. as defined above) must have their case closed at
release or transfer to another prison (AF Section 1, 2 and 5.5 – 5.7)
Activity Form – some rules for use (4)
 A client should be suspended from the “Active” caseload of a given
prison (AF Section 1, 2, 5.3, 5.4 and 5.7) if:
 They have disengaged from CARATs
 They are unable to engage due to incapacity
 They have completed their care plan and no further treatment is
required at present
 No work takes place with the client whilst they are suspended (other
than attempts to re-engage them in treatment, if they had
disengaged)
 If a suspended client requires pre-release work they must be “reengaged” (AF 5.1 & 5.2)
Activity Form – recording client transfers
 How should client transfers to the
community be recorded?
 CARATs contact CJIT as part of
pre-release planning*
 On release the client’s case must
be closed by CARATs: complete
AF section 1, 2 & 5.5 - 5.7
 5.6 = tick “Client transferred from
prison to CJIT” and record DAT
code of CJIT client is going to
CARATs record case closure
and transfer to CJIT
(AF 1, 2 & 5.5-5.7)
CJIT receives referral and
records whether client has
been “picked up” in community
(CJIT completes an AF)
* CARATs send copy of prison DIR, if there is one, and any other relevant info to CJIT SPOC
Activity Form – recording client transfers
 How should client transfers from the
community to prison be recorded?
 CJIT should contact prison SPOC to
alert Healthcare / CARATs of client’s
arrival
 If client was assessed by CJIT they
should send copy of DIR to the prison
 The receiving prison should review the
DIR and complete Activity Form
Section 1, 2 & 4
 The prison must not complete a new
DIR if they have received one from the
CJIT
CJIT contact prison SPOC and
send copy of DIR
Healthcare / CARATs review
DIR and complete AF 1, 2 & 4
Activity Form – recording client transfers
 How should client transfers to other prisons be recorded?
 Prison to Prison transfers follows very similar process and
similar form completion
 CARATs transferring the client close the case, completing
Activity Form 1, 2 & 5.5-5.7, tick 5.6 “Client transferred to
another prison”, recording the DIP prison code of the prison the
client is being transferred to
 Healthcare / CARATs at receiving prison complete an Activity
Form when they receive the client, filling in Sections 1, 2 & 4,
and not a new DIR
Activity Form – Exit points
 There are two ‘EXIT’ points on the Activity Form under Section 4 –
client transferred from another CARAT/CJIT:
1. The client does not have a current CSMA at transfer (4.3=No) and
one is not going to be completed for them (4.3 EXIT)
2. The client has a CSMA but they have not agreed a care plan since
transfer (4.5 EXIT)
 From this point the form completion stops because the client is not
moving onto the next stage with this prison – the client is not taken
onto the “Active” caseload
Forms recap
 What form, When:
Initial
Contact
Form
When client has a meaningful contact but does not go
onto SMTA
When client undergoes SMTA
DIR
Activity
Form
When client is transferred in and already has a DIR
from elsewhere
OR
To provide treatment updates on caseload clients
OR
To suspend, re-engage or close a case
Caseload definition
 A client’s caseload status is defined as follows:
Or
“Active”
“Suspended”
DIR 9.3
AF Section 5.3
Care plan agreed = Yes
Date case suspended
AF Section 4.5
Care plan agreed = Yes
Or
AF Section 5.1
Client re-engaged
 Caseload status is determined by the most recent of the dates above
for that client
Questions
Scenarios – working in groups
Outline
 3 scenarios to discuss in groups for total of 25 mins
 Groups to be comprised of two prisons together, with each
group having the EDC, Healthcare Manager and CARATs
Manager from each of the two establishments
Questions
Recording treatment interventions
on the forms
Recording prisons treatment on the forms
 Substance misuse treatment delivered in prisons must be recorded
on the DIR and / or Activity Form where applicable
 It is important that CARATs and Healthcare work together to
ensure that the information is completed, and accurately
reflects what treatment the client has received
 This information is analysed and used in the performance assurance
for IDTS, and will be used in the measurement of PSA 25 on
numbers in effective treatment across the community and prisons
Recording prisons treatment on the forms
 The forms contain treatment questions in the following fields:
DIR
Activity Form
Question 6.15
Questions 3.2 and 3.3
Question 7.13
Questions 4.2b and 4.6
Question 9.5
Question 5.7
How should treatment be recorded on the forms?
 DIR – SMTA
 DIR 6.15: Has a first night initial clinical intervention been provided
by a doctor – tick Yes or No, if Yes record if prescribed methadone
or other
How should treatment be recorded on the forms?
 DIR – SMTA
 DIR 7.13: Tick any low level treatment interventions delivered to
address immediate needs prior to CSMA
How should treatment be recorded on the forms?
 DIR – Care plan post-CSMA
 DIR 9.5: If care plan agreed with client (9.3) and treatment is to be
delivered or has commenced as part of care plan, complete this
section
How should treatment be recorded on the forms?
 Activity Form - client already on caseload
 AF 3.2: If a client is already on this prison’s caseload and any
treatment interventions in the current care plan have since ended,
record end date and exit status here
How should treatment be recorded on the forms?
 Activity Form - client already on caseload
 AF 3.3: If a client is already on this prison’s caseload and any
additional treatment interventions have started since the care plan
was agreed (e.g. after DIR sent off for data entry), record here
How should treatment be recorded on the forms?
 Activity Form - client transferred in
 AF 4.2b: If a client has been transferred from a CJIT or another
prison, tick here whether any first night initial clinical intervention
has been provided by a doctor
How should treatment be recorded on the forms?
 Activity Form - client transferred in
 AF 4.6: If a client has completed a CSMA and agreed a care plan
following transfer from a CJIT or another prison, any new treatment
interventions started must be recorded here
How should treatment be recorded on the forms?
 Activity Form - client transferred in – key points
 Once a client that has transferred in from another prison or CJIT
and has agreed a care plan with the current prison (post-CSMA),
with AF section 1,2 & 4 completed, they are now deemed “on the
caseload” under the DIR process
 4.6. allows you to record any treatment commencement dates that
occur around the time the care plan was agreed
 Any updates to their treatment from this point forward must be
recorded on an AF completing sections 1,2 & 3, as for any client on
caseload, until they are closed off or suspended
How should treatment be recorded on the forms?
 Activity Form - all clients suspended or closed
 AF 5.7: If a client’s case is suspended or closed all ‘open’
structured treatment interventions must be “closed off” i.e. have
their end date and exit status recorded (last page of AF)
Summary – treatment recording
 All treatment interventions must be recorded where applicable
 For a client “on caseload” (i.e. CSMA and care plan) anything new or
changed in the treatment interventions delivered to that client must
be recorded on an Activity Form
 Once a structured intervention has been completed the ‘end date’
and exit status must be recorded on an Activity Form (AF 3.2)
 If a client is suspended or closed (due to release), record the date the
treatment intervention(s) finished (AF 5.7)
Questions