Transcript Core Data Set J monthly presentations

Introduction to Core Data Set J
Adult Treatment
Simon Morgan [email protected]
Julie Marshall [email protected]
[email protected]
1st November 2012
Objectives for today
• To revisit all of the information required by NDTMS
• Clarify requirements and definitions of Core Data Set J (CDS J)
• Reiterate that CDS J is effective from 1st November 2012
• Discuss avoidable data quality issues
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Introduction to Core Data Set J Adult Treatment
NDTMS
• NDTMS relates to the process of collecting, collating and analysing
information from and for those involved in the drug treatment sector.
• London NDTMS is responsible for collecting data from all drug and alcohol
treatment provider agencies commissioned by London DAATs
• NDTMS evidences your work and the impact of your work
• Numbers in effective treatment
• Successful Completions and non-representations
• Public Health Outcomes Framework (drug and alcohol)
• NDTMS used to determine funding allocations
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Introduction to Core Data Set J Adult Treatment
http://www.nta.nhs.uk/core-data-set.aspx
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Introduction to Core Data Set J Adult Treatment
Core Data Set J
• NDTMS core data set – reference data – Reference data is defined as
(relatively) static data. Generally it is employed as a means of validating
data entry and will typically be used to control the contents of drop-down
lists etc.
• NDTMS core data set – business definitions for adult drug treatment
providers – document establishes the set of data items to be collected by
NDTMS.
• NDTMS core data set – business definitions for adult alcohol treatment
providers – document establishes the set of data items to be collected by
NDTMS
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Core Data Set J
The core data set is made up of six data entities:
• Client information
• Episode (including regional fields)
• Time in Treatment
• Intervention
• Sub-intervention
• Treatment Outcome Profile (TOP)
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Client Information
• FINITIAL – the first initial of the client’s first name (key field)
• SINITIAL – the first initial of the client’s surname (key field)
• DOB – the day, month and year that the client was born (key field)
• SEX – the sex that the client was at birth (key field)
• Ethnicity – if a client declines to answer then ‘not stated’ should be used. If
a client is not asked, then the field should be left blank.
• Nationality – country of nationality at birth (all case management systems
including DET will have a drop down list box). ‘Not stated’ is added.
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Episode
An episode of treatment is a set of interventions with a specific care plan. A
client may attend one or more unique interventions of treatment during the
same episode of treatment.
CLIENT
AGENCY 1
AGENCY 2
EPISODE
EPISODE
Referral Date
Discharge Date
Referral Date
Discharge Date
Modality 1
Modality 1
Psychosocial
Intervention
Modality
Start Date
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Psychosocial
Intervention
Modality
End Date
Introduction to Core Data Set J Adult Treatment
Modality
Start Date
Modality 2
Recovery Support
Modality Modality
End Date Start Date
Modality
End Date
Episode
• Referral date – the date that the client was referred to the treatment centre
for this episode (key field)
e.g. the date the referral letter was received, the date a referral phone call
was received or the date the client self-referred.
• Agency code – a unique identifier for the treatment provider that is defined
by the regional NDTMS centres (Lxxxx) (key field)
• Client reference – a unique number of ID allocated by the treatment provider
to a client. This must not hold or be composed of attributers which might
identify the individual.
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Episode – consent for NDTMS
• Consent – clients should give written/verbal explicit consent to share
information about their care plan
• Consent should be reviewed at the care plan review stage
• Values are now: No person not consented; Yes person has consented
Only clients who have consented to information being submitted to NDTMS will
be included in numbers in treatment
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Episode
• Previously treated – has the client ever received structured drug treatment
at this or any other treatment provider (Y/N)
• Post code – the post code of the client’s place of residence. Only the
truncated post code is submitted to NDTMS i.e. E5 9
If a client states that they are of NFA, then this field is to be left blank
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Introduction to Core Data Set J Adult Treatment
Episode – Accommodation Need
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Text
Comments
NFA – urgent
housing
problem
Live on streets
Use night hostels (night by night basis)
Sleep on different friend’s floor each night
Housing
problem
Staying with friends/family as a short term guest
Night winter shelter
Direct Access short stay hostel
Short term B&B or other hotel
Squatting
No housing
problem
Local Authority/Registered Social Landlord rented
Private rented; Approved Premises
Supported housing/hostel
Traveller; Own property; Settled with friends/family
Introduction to Core Data Set J Adult Treatment
Episode – Parental Status
Text
Comments
All the children live
with client
The client is a parent of one or more children under 18
and all the client’s children (who are under 18) reside
with them full time.
Some of the
children live with
client
The client is a parent of one or more children under 18
and some of the client’s children (who are under 18)
reside with them, others live full time in other locations.
None of the
children live with
client
The client is a parent of one or more children under 18
but none of the client’s children (who are under 18)
reside with them, they all live in other locations full time.
Not a parent
The client is not a parent of any children under 18.
Client declined to
answer
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Introduction to Core Data Set J Adult Treatment
Episode
• DAT of residence – the DAT in which the client normally resides
If a client states they are NFA then for tier 3 treatment providers, the DAAT
of the treatment provider should be used as a proxy; and for tier 4 treatment
providers, the referring DAAT should be used as a proxy.
• PCT of residence – the PCT in which the client resides
• Local Authority – the local authority in which the client currently resides (as
defined by their postcode of their normal residence). Due to partnerships
and local authorities not being co-terminous in all cases, when the client is
NFA the local authority of the treatment agency should not be used as a
proxy.
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Introduction to Core Data Set J Adult Treatment
Episode
• Problem substance number 1 – the substance that brought the client into
treatment at the point of triage
• Age - (in years) that the client recalls first using the problem substance 1
• Route of administration of problem substance 1 – inject, sniff, smoke, oral or
other
• Problem substance 2 and 3 – additional substances that brought the client
into treatment at the point of triage. No second drug and No third drug are
introduced for data completeness.
• New drugs Methylone, Mephedrone, Novel Psychoactive substances are
introduced
NB – poly drug should no longer be used in these fields
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Introduction to Core Data Set J Adult Treatment
Episode
• Referral source – detailed list in the reference data but new adult codes are
Arrest Referral, DIP, Criminal Justice Other, Job Centre Plus and Alcohol
codes are Employer, Alcohol Treatment Requirement and Peer.
• Triage date – the date that the client made a face to face presentation to the
treatment provider
• Care plan start date – date that the care plan was created and agreed with
the client for this treatment episode
• Injecting status – currently injecting; previously injected; never injected or
client declined to answer
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Introduction to Core Data Set J Adult Treatment
Episode
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Data Entry
Comments
0
No children living with client
1
1 child living with client
2
2 children living with client
0-30
n children living with client
98
Client declined to answer
Introduction to Core Data Set J Adult Treatment
Episode
• Pregnant – is the client pregnant (Y/N)
• Drinking days – number of days in the 28 days prior to initial assessment
that the client consumed alcohol
• Units of alcohol – typical number of units consumed on a drinking day in the
28 days prior to initial assessment
• Dual diagnosis – is the client currently in receipt of mental health care for
reasons other than substance misuse
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Episode
• Hep C tested – Yes/No/Not Asked. If Yes, then complete test date
• Hep C latest test date – this is the date that the client was last tested for Hep
C
This test may be in the current treatment episode or previous to the episode
If the date is not known, use the 1st of the month
If the month is not known, use the 1st January of the known year
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Episode
Hep C intervention status – whether
the client was offered a Hep C test
and if that offer was accepted
Text
Offered and accepted
Offered and refused
Not offered
Assessed as not appropriate
to offer
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Introduction to Core Data Set J Adult Treatment
Episode
Hep B vaccination count
Hep B intervention status
Text
Text
One vaccination
Offered and accepted
Two vaccinations
Offered and refused
Three vaccinations
Not offered
Course completed
Assessed as not appropriate to offer
Immunised already
Acquired immunity
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Introduction to Core Data Set J Adult Treatment
Episode
• Drug treatment healthcare assessment date – the date that the initial
healthcare assessment was completed
The full scope of this assessment will vary according to the presenting needs
of the client, but should include an initial assessment of the client’s physical
health and mental health needs
• TOP care coordination – 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
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Introduction to Core Data Set J Adult Treatment
Episode
• Discharge date – the date that the client was discharged ending the current
structured treatment episode
• If a client has had a planned discharge then the date agreed within this
plan should be used
• If a client’s discharge was unplanned then the date of last face to face
contact with the treatment provider should be used
• If a client has had no contact with the treatment provider for two months
then for NDTMS purposes it is assumed that the client has exited
treatment and a discharge date should be returned at this point using the
date of the last face to face contact with the client
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Text
Comments
Treatment
completed –
drug-free
The client no longer requires structured drug treatment
interventions and is judged by the clinician not to be using
heroin (or any other opioids) or crack cocaine or any other
illicit drug
Treatment
completed –
alcohol-free
The client no longer requires structured alcohol interventions
and is judged by the clinician and is judged by the clinician to
no longer be using alcohol
Treatment
completed –
occasional
user
The client no longer requires structured drug treatment
interventions and is judged by the clinician not to be using
heroin (or any other opioids) 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
Treatment
completed –
occasional
user
The 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
Introduction to Core Data Set J Adult Treatment
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Text
Comments
Transferred –
not in custody
A client has finished treatment at this provider but still
requires further drug/alcohol interventions and the individual
has been referred to an alternative non-prison provider for
this. This code should only be used if there is an appropriate
referral path and care planned structured drug treatment
pathway available
Transferred –
in custody
A client has received a custodial sentence or is on remand
and the 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
Incomplete –
Dropped Out
The treatment provider has lost contact with the client without
a planned discharge and activities to re-engage the client
back into treatment have not been successful
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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 care provider
leading to continuation of the appropriate assessment and
care-planned structured drug / 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
drug / alcohol treatment intervention
Incomplete – Client
died
During their time in contact with structured drug / alcohol
treatment the client died
Introduction to Core Data Set J Adult Treatment
Inpatient and Rehab usage only CDS-K
Text
Comments
Transferred – programme completed at the
residential provider – additional residential
treatment required
This code should only be used
if there is an appropriate referral
path and care planned
structured treatment pathways
are available
Transferred – programme completed at the
residential provider – additional community
treatment required
Transferred – programme not completed at
the residential provider – additional
residential treatment required
Transferred – programme not completed at
the residential provider – additional
community treatment required
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Introduction to Core Data Set J Adult Treatment
Time in Treatment
Time in treatment relates to the time spent each week in the entire treatment
episode, while the client is in structured treatment and any additional nonstructured support alongside. A subsequent time in treatment will be reported
when the client’s treatment decreases or increases. The Assessment Date is a
key field.
• 14 hours or less – engagement in one or more interventions for 14 hours or
less per week
• More than 14 hours and less than 25 – engagement in one or more
interventions for more than 14 and less than 25 hours per week
• 25 or more hours – engagement in one or more interventions for 25 or
more hours per week
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Intervention
What is an intervention? It is the type of treatment that the client receives (type
is a key field) e.g. Psychosocial Intervention.
There may be several interventions within a single episode.
Only structured treatment submitted to NDTMS is counted towards
numbers in effective treatment.
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Intervention Types
Adult Structured Interventions
• Pharmacological Intervention
• Psychosocial Intervention
Adult Non-Structured Interventions
• Recovery Support
• ALC – Brief Intervention
• Needle Exchange
• Outreach
• Advice & Information
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Intervention
• Intervention Setting – to be used to determine if this intervention is being
provided in a different setting to the agency default on DAMS
• Date referred to modality – the date it was mutually agreed that the client
required this modality of treatment (key field)
• Date of first appointment – the date of the first appointment offered to
commence this modality
• Modality start date – the date that the client started treatment.
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Modality end date – the date that treatment ended
If the modality has had a planned exit then the date agreed within the care plan
should be used. If it was unplanned then the last face to face contact date
within the modality should be used
Modality exit status
• Mutually agreed planned exit
• Clients’ unilateral unplanned exit
• Intervention withdrawn
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Sub-interventions
These describe the treatment provided for each Pharmacological/ Psychosocial
/ Recovery Support intervention. They are created retrospectively every 6
months and at discharge
6 month reviews are expected from the first intervention start date
Sub-interventions should be combined to describe the full package of treatment
The Assessment Date of each sub-intervention is a key field
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Pharmacological sub-interventions
• Assessment and Stabilisation
• Maintenance
• Withdrawal
• Relapse Prevention
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Psychosocial sub-interventions
• Motivational Interventions
• Cognitive and Behavioural Based Relapse Prevention
• Contingency Management
• 12-Step Work
• Family & Social Network Therapy
• Evidence Based Psychosocial Interventions for co-existing Mental Health
Problems
• Psychodynamic Therapy
• Counselling – BACP Accredited
• Other
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Recovery Support sub-interventions
• Peer support involvement
• Family support
• Supported work projects
• Employment support
• Parenting support
• Facilitated access to mutual aid
• Complementary therapies
• Education & training support
• Housing support
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• Evidence-based psychosocial
interventions to support relapse
prevention
• Evidence- based mental health
focused psychosocial interventions
to support continued recovery
• Recovery check-ups
• Other
Treatment Outcome Profile - TOPs
 The implementation of the Treatment Outcomes Profile (TOP) in routine
clinical practice began from 1 October 2007; its completion and submission
via the National Drug Treatment Monitoring System (NDTMS) is requested for
all clients (16 and over) accessing tier 3, and 4 structured drug treatment
 The TOP consists of a short set of simple questions that focus on the four key
areas (substance use, injecting behaviour, criminal activity, health and social
functioning) that are used to judge improvement during and after treatment.
Outcomes from treatment are evidenced by looking at changes in the
behaviours recorded over time
 It is requested that the TOP be completed with all clients at the start of their
first treatment modality (Treatment Start TOP) and then around every 26
weeks throughout the treatment journey as part of the care plan review
process (Review TOP) and at treatment exit (Treatment Exit TOP)
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Treatment Outcome Profile - TOPs
 TOP date (key field) - All outcome status submitted in this section of the data
- set will be associated and stored as being the status as of this date.
Note: TOP data should only be collected for young people aged 16 and
over.
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There are 4 TOP treatment stages
Post treatment exit TOP also used after the client is discharged
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Substance use in the last 28 days
 Alcohol Use - Number of days in previous 28 days that client has used
alcohol
 Opiate Use - Number of days in previous 28 days that client has used
heroin
 Crack Use - Number of days in previous 28 days that client has used crack
 Cocaine Use - Number of days in previous 28 days that client has used
powder cocaine
 Amphetamine Use - Number of days in previous 28 days that client has
used amphetamines
 Cannabis Use - Number of days in previous 28 days that client has used
cannabis
 Other Drug Use - Number of days in previous 28 days that client has used
other problem drug
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TOPs - Injecting risk behaviour in the
last 28 days
 IV Drug Use - Number of days in previous 28 days that client has injected
non prescribed drugs
 Sharing - Has client shared needles or injecting paraphernalia in last 28
days?
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TOPs - Crime in the last 28 days
 No. of days in previous 28 days that client has been involved in shop theft
 No. of days in previous 28 days that client has been involved in selling drugs
 Has client has been involved in theft from or of vehicle, property or been
involved in fraud in last 28 days (Y/N)
 Has client committed assault/violence in last 28 days (Y/N)
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TOPs - Health and social functioning
 Psychological Health Status - Self Reported Score 0-20
 Number of days in previous 28 days that client has had paid work
 Number of days in previous 28 days that client has attended
college/education system
 Has client had acute housing problem (been homeless) in last 28 days
 Has client been at risk of eviction within past 28 days
 Physical Health Status - Self Reported Score 0-20
 Quality of Life - Self Reported Score 0-20
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TOP treatment start – When?
 For a completely new treatment journey. The client has not
received structured treatment at another agency 21 days
before starting at the new agency
 TOPs should be completed 2 weeks either side of the client’s
first structured modality start
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TOP Review – When?
 Using the modality start date TOP as an anchor point, the review TOP should be
completed at least every 26 weeks.
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TOP treatment exit – When?
 Treatment exit TOPs should be completed up to 2 weeks before and up to 2 weeks
after the client’s discharge date. They should be conducted when the client leaves
the treatment system regardless of when the last review TOP was conducted
 Treatment exit TOPs can be carried out over the telephone if the client does not
attend their last appointment
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TOP post treatment exit – When?
 After the client has left the treatment system they can be contacted to review
how they are getting on. The Post Treatment Exit TOPs can be completed
whenever it is suitable for the client and the Key Worker. This should be
approximately 3 months after the client’s discharge date
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Regional fields
 Injected in the last 28 days
 Ever shared (heroin only paraphernalia)
 Referred to hepatology
 Previously Hep B infected:
 Hep C positive:
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Regional fields
Sexuality Codes
Heterosexual
Homosexual
Bi-Sexual
Other
Not Recorded
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Employment Status Codes
Text
Regular Employment
Not receiving benefits
Pupil/Student
Unpaid voluntary work
Long Term Sick/
Disabled
Retired from Paid Work
Homemaker
Not stated
Unemployed and
Seeking Work
Other
Not Known
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Data Quality
 Good quality data is data which provides the most accurate picture of a
provider’s work
 NDTMS figures are used to determine funding and establish whether a
partnership or agency is meeting it’s targets; it is important to have accurate
data
 There is no ‘acceptable level’ for data quality; any errors in data need to be
resolved
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Data Quality
 There are three main causes of data quality problems:
• User error
• Changes to data; when changes are made to ‘key fields’, duplicates
are created
• System error; it is important for software providers to stay up to date
with changes in the dataset, and for agencies to report any software
issues promptly to both suppliers and NDTMS
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When a provider submits a file, a validation is performed, the file
must score 100% for both data load and data quality before it can
be submitted
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Data Quality
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Further guidance
 www.nta.nhs.uk
 http://www.nta.nhs.uk/core-data-set.aspx
NDTMS Data Set – Reference Data
NDTMS Data Set – Business Definition for Young People’s
Treatment Providers
NDTMS Core Data Set – Technical Definitions
 [email protected]
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