Introduction to Core Data Set J Adult Treatment Simon Morgan [email protected] Julie Marshall [email protected] [email protected]@[email protected]

Introduction to Core Data Set JAdult TreatmentSimon Morgan [email protected] Marshall [email protected]@phe.gov.uk

1st November 2012

mailto:[email protected]



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

2 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


http://www.nta.nhs.uk/core-data-set.aspx




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


Core Data Set JThe 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)


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.


EpisodeAn 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

EPISODE

Referral Date Discharge Date

Modality 1Psychosocial Intervention

Modality Start Date

Modality End Date

AGENCY 2

EPISODE

Referral Date

Modality 1Psychosocial Intervention

Modality Start Date

Modality End Date

Modality 2Recovery Support

Modality Start Date

Modality End Date

Discharge 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.


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


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


Episode – Accommodation NeedText Comments

NFA – urgent housing problem

Live on streetsUse night hostels (night by night basis)Sleep on different friend’s floor each night

Housing problem

Staying with friends/family as a short term guestNight winter shelterDirect Access short stay hostelShort term B&B or other hotelSquatting

No housing problem

Local Authority/Registered Social Landlord rentedPrivate rented; Approved PremisesSupported housing/hostelTraveller; Own property; Settled with friends/family


Episode – Parental StatusText 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


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.


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


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


EpisodeData 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


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


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


EpisodeText

Offered and accepted

Offered and refused

Not offered

Assessed as not appropriate to offer


Hep C intervention status – whether the client was offered a Hep C test and if that offer was accepted

EpisodeHep B vaccination count Hep B intervention status

Text

One vaccination

Two vaccinations

Three vaccinations

Course completed

Text

Offered and accepted

Offered and refused

Not offered

Assessed as not appropriate to offer

Immunised already

Acquired immunity


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


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


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


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



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

Inpatient and Rehab usage only CDS-KText 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


Time in TreatmentTime in treatment relates to the time spent each week in the entire treatment episode, while the client is in structured treatment and any additional non-structured 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


InterventionWhat 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.


Intervention TypesAdult Structured Interventions

•Pharmacological Intervention

•Psychosocial Intervention

Adult Non-Structured Interventions

•Recovery Support

•ALC – Brief Intervention

•Needle Exchange

•Outreach

•Advice & Information


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.


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


Sub-interventionsThese 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


Pharmacological sub-interventions• Assessment and Stabilisation

• Maintenance

• Withdrawal

• Relapse Prevention


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


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

• 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)

Introduction to Core Data Set J Adult Treatment37

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.


There are 4 TOP treatment stages


Post treatment exit TOP also used after the client is discharged

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


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?


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)


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


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


TOP Review – When? Using the modality start date TOP as an anchor point, the review TOP should be completed at least every 26 weeks.


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


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


Regional fields Injected in the last 28 days Ever shared (heroin only paraphernalia) Referred to hepatology

Previously Hep B infected:

Hep C positive:


Regional fieldsSexuality Codes

Heterosexual

Homosexual

Bi-Sexual

Other

Not Recorded


Employment Status CodesText

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


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


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


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


Data Quality



Further guidance www.nta.nhs.uk


NDTMS Data Set – Reference Data

NDTMS Data Set – Business Definition for Young People’s Treatment Providers

NDTMS Core Data Set – Technical Definitions

[email protected]


http://www.nta.nhs.uk/



Documents

Introduction to Core Data Set J Adult Treatment Simon Morgan [email protected] Julie Marshall [email protected] [email protected]@[email protected]