Transcript 3. Reference data changes….. - North East Public Health Observatory

NDTMS – Core Dataset ‘F’
NDTMS
Adult Drug & Alcohol Services
Core Dataset ‘F’
February 2009
Jill Smith
NEPHO – NDTMS Team
NDTMS – Core Dataset ‘F’
National Drug (and Alcohol) Treatment Monitoring System
Began collecting performance data on treatment of
• adult problem drug users,
• then YP drug & alcohol misusers,
• then adult alcohol
– Client details
– Episode details
– Treatment modality/intervention details
– Treatment outcome Profiles (TOP) details
– Local Regional fields
NDTMS – Core Dataset ‘F’
National Drug (and Alcohol) Treatment Monitoring System
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Number of fields has expanded and changed
Reference options within fields have expanded and
changed
Additional services completing NDTMS
Additional Government Departments involvement
Now on Core Dataset F
Where to begin?
NDTMS – Core Dataset ‘F’
Basics: Data Completion
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All fields should be completed
Some fields should be reviewed
Some fields should be completed at discharge
Some fields can be completed after discharge
• Garbage in ~ Garbage out
Analysis and information jeopardised
when fields left blank
NDTMS – Core Dataset ‘F’
Basics: Understand the Questions
The NTA Business Definition and Reference Data
Documentation is important and changes as
understanding of usage and meaning develops
NDTMS – Core Dataset ‘F’
Basics: Get hold of the documentation
NTA WEBSITE FOR DOCUMENTATION:-
http://www.nta.nhs.uk/areas/ndtms/core_da
ta_set_page.aspx
NB: Awaiting revised guidance for:
•Young persons' treatment providers and
•Adult alcohol treatment providers
NDTMS – Core Dataset ‘F’
Core Dataset F Changes
1. Young People Service dataset – new fields
2. Treatment Outcomes Profile (TOP) Care
Coordination flag
3. Reference items added/removed/changed
4. Fields Removed
NDTMS – Core Dataset ‘F’
1. New Fields
a) Treatment Start and Treatment End
YP has lead professional?
YP in contact with mental health services?
YP in contact with YOT?
YP Involved in Sexual Exploitation?
YP Involved in Unsafe drug use?
YP Involved in Offending?
YP Self-harming?
NDTMS – Core Dataset ‘F’
1. New Fields…….
b) Treatment Start only
YP
YP
YP
YP
Education Status (=<16)?
Involved in unsafe Sex?
Parent in SM Treatment?
Parent in MH Treatment?
NDTMS – Core Dataset ‘F’
1. New Fields…….
c) Treatment Exit only
YP
YP
YP
YP
YP
has a CAF?
safer sex?
sexual health interventions?
registered with GP
met goals on Care Plan
NDTMS – Core Dataset ‘F’
2. TOP / Care Coordination flag
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?
One service to manage TOP process
(agreed at a local Treatment System level)
One set of TOPs for one episode of care
Consent for sharing TOP process data
NDTMS – Core Dataset ‘F’
2. TOP / Care Coordination flag
Recent enquiry received by NDTMS team:
Re top coordination surely ALL providers are required to fill in
a care plan for their organization and if they do who decides
who is the overall care coordinator?
Care Planning is not the same as Care Coordination
Decisions about Care Coordination have to be made at a local
level and even then there must be ongoing communication
between services to ensure all the clients’ needs are being met
NDTMS – Core Dataset ‘F’
3. Reference data changes
a) Adult Drug & Alcohol Interventions
Now expanded to include Community Prescribing for Drug clients.
Community prescribing involves the provision of care-planned specialised
drug treatment, which includes the prescribing of drugs to treat drug misuse.
The range of community prescribing interventions can include the following:
• Stabilisation on substitute opioids, including dose titration
• Prescribing for a sustained period to substitute illicit drugs such as
methadone and buprenorphine (maintenance prescribing)
• Prescribing for withdrawal from opioids with opioid or non-opioid
medications such as buprenorphine or lofexidine (community detoxification)
• Prescribing to prevent relapse
• Stabilisation and withdrawal from sedatives, such as benzodiazepines
• Prescribing for assisted withdrawal from alcohol where appropriate
• Treatment for stimulant users, which may include symptomatic prescribing
• Non-medical prescribing (by nurses or pharmacists).
NDTMS – Core Dataset ‘F’
3. Reference data changes
a) Adult Drug & Alcohol Interventions …
Now expanded to include Community Prescribing for Drug clients.
NB:
Substitute prescribing alone does not constitute drug treatment (NTA expert
prescribing group, 2002). A community prescribing intervention should be
provided within a care-planned package of care with an identified keyworker.
It should be aimed at addressing the range of identified needs. The care plan
should address drug and alcohol misuse, health needs, offending behaviour
and social functioning.
NDTMS – Core Dataset ‘F’
3. Reference data changes
a) Adult Drug & Alcohol Interventions …
Reminder: Specialist Prescribing for Drugs
NB:
Specialist prescribing is community prescribing for drug misuse in a specialist
drug service setting, which normally comprises a multidisciplinary substance
misuse team. Specialist prescribing interventions normally include
comprehensive assessments of drug treatment need and the provision
of a full range of prescribing treatments in the context of care-planned drug
treatment. The specialist team should also provide, or provide access to, a
range of other care-planned healthcare interventions including psychosocial
interventions, a wide range of harm reduction interventions, BBV prevention
and vaccination, and abstinence-oriented interventions.
NDTMS – Core Dataset ‘F’
3. Reference data changes
a) Adult Drug & Alcohol Interventions …
New: Brief Interventions for alcohol services
When combining Tier 2 & Tier 3 interventions, be
sure that the Tier 3 record is clearly differentiated
within NDTMS
Use of combined Tier 2 and Tier 3 interventions can
lead to performance measurement errors with
serious consequences
NDTMS – Core Dataset ‘F’
3. Reference data changes
b) Parental Status?
Now expanded beyond biological, step-, foster, adoptive,
guardians to include any parenting where a client has full or partial
parental responsibilities and is living with that child(ren) for a
minimum of one month – see separate Appendix K in business
definitions
All new references:
• All the children live with the client
• Some of the children live with client
• None of the children live with client
• Not a parent
• Client declined to answer
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
b) Children Living With?
Age of ‘child’ raised to under 18 – and now collected at
presentation only
• No children living with client
• 1 child living with client
• 2 children living with client
• n children living with client
• Client declined to answer
c) Hep B & Hep C Status?
New: Assessed as not appropriate to offer
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
d) Discharge Reason (Separated from Discharge Destination)
Please note that different definitions will apply to the above codes
depending on the setting of treatment i.e. in YP providers or if the
client is being treated primarily for Alcohol.
Adult Drug Discharge Reason? – Planned
Data Item
Treatment Completed - Drug free
Treatment Completed - Occasional user
Definition
The client no longer requires structured drug treatment
interventions and is judged by the clinician not to be using
heroin or crack cocaine or any other illicit drug
The client no longer requires structured drug treatment
interventions and isjudged by the clinician not to be using
heroin 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.
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
d) Discharge Reason
Adult Drug Discharge Reason? - Neutral
Data Item
Transferred - Not in Custody
Transferred - In custody
Definition
A client has finished treatment at this provider but still requires further
structured drug treatment interventions and the individual has been
referred to an alternative nonprison provider for this. This code should only
be used if there is an appropriate referral path and care planned structured
drug treatment pathways are available.
A client has received a custodial sentence or is on remand and a
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.
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
d) Discharge Reason
Adult Drug Discharge Reason? - Unplanned
Data Item
Incomplete - Dropped Out
Definition
The treatment provider has lost contact with client without a planned
discharge and activities to re-engage the client back into treatment have
not been successful.
The treatment provider has withdrawn treatment provision from the client.
Incomplete - Treatment withdrawn by This item could be used, for example, in cases where the client has
Provider
seriously breached a contract leading to their discharge; it should not be
used if the client has simply ‘Dropped out’.
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
Incomplete - Retained in custody
the treatment provider and the criminal justice system careprovider leading
to continuation of the appropriate assessment and care-planned structured
drug treatment.
Incomplete - Treatment
The treatment provider has received a referral and has had a face-to-face
commencement declined by the
contact with the client after which the client has chosen not to commence a
client
recommended structured drug treatment intervention.
Incomplete - Client Died
Data item definition – During their time in contact with structured drug
treatment the client died
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
d) Discharge Reason (Separated from Discharge Destination)
Adult Alcohol Discharge Reason? – Planned
Data Item
Definition
The client no longer requires structured Alcohol treatment interventions and
Treatment Completed - Alcohol free
is judged by the clinician not to be using alcohol.
The client no longer requires structured alcohol treatment interventions,
Treatment Completed - Occasional user
there is evidence of use of alcohol use but this is not judged to be
problematic or to require treatment.
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
d) Discharge Reason
Adult Alcohol Discharge Reason? - Neutral
Data Item
Transferred - Not in Custody
Transferred - In custody
Definition
A client has finished treatment at this provider but still requires further
structured alcohol treatment interventions and the individual has been
referred to an alternative nonprison provider for this. This code should only
be used if there is an appropriate referral path and care planned structured
alcohol treatment pathways are available.
A client has received a custodial sentence or is on remand and a
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.
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
d) Discharge Reason
Adult Alcohol Discharge Reason? - Unplanned
Data Item
Incomplete - Dropped Out
Definition
The treatment provider has lost contact with client without a planned
discharge and activities to re-engage the client back into treatment have
not been successful.
The treatment provider has withdrawn treatment provision from the client.
Incomplete - Treatment withdrawn by This item could be used, for example, in cases where the client has
Provider
seriously breached a contract leading to their discharge; it should not be
used if the client has simply ‘Dropped out’.
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
Incomplete - Retained in custody
the treatment provider and the criminal justice system careprovider leading
to continuation of the appropriate assessment and care-planned structured
alcohol treatment.
Incomplete - Treatment
The treatment provider has received a referral and has had a face-to-face
commencement declined by the
contact with the client after which the client has chosen not to commence a
client
recommended structured alcohol treatment intervention.
Incomplete - Client Died
Data item definition – During their time in contact with structured alcohol
treatment the client died
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
j) Employment Status?
Cross reference with
Appendix I of YP
Business Definitions
Removed: Not in Education or Training or employment
Attending PRU/Special Schooling arrangements
Regular Employment
Pupil/Student
Economically Inactive
Unemployed
Other
Not Known
this refers to employment which is regular and sustained.
this refers to education which is regular and sustained and is provided by a
school, further education college or university. Young people who receive
education from a specialist service in response to specialist needs
including problem behaviour or difficulties with standard educational
environments should refer to code 8 below.
this refers to young people and adults or are not currently in education or
employment outside the home either because they have a role within the
home as a parent or carer or because they have reached retirement age or
because they have health or mental health issues which currently prevent
them form working or studying.
this refers to adults who have the capacity to work and who are not
currently in regular and sustained employment.
this refers to any activity which is not described by other codes
treatment services should endeavour to find out how young people spend
their time, if this has not been possible, this code should be used.
YP
Adults
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NDTMS – Core Dataset ‘F’
4. Fields Removed from YP Dataset
a) Dual Diagnosis
b) Sex Worker
c) Sexuality
(Picked up through new fields or not appropriate for YP)
But still being collected in Adult Drug & Alcohol services
Alcohol and the North East
THANK YOU!