The DESDE-LTC System for coding and

mapping mental health services

Dr Mencía Ruiz Gutiérrez-Colosía

menciaruiz@uloyola.es

PART I

Introduction. Units of analysis

Short biography

3

• 1994 – BIOMED – EPCAT Team

• 1997 – Development of services assessment methodology and instruments

• EPCAT battery: ESDS, ESMS, ICMHC

• 1999- International use (It / Sp)

• 2000 – Beecham & Munizza Acta Psych Scand Suppl 2000

• 2002 – Ministry of Health & Welfare (Spain) –

• Adaptation to Disab. Services DESDE

• 2005/7 – MHEEN-II/EPCAT – ESMS-II

• 2008 – eDESDE-LTC

• 2009 – Finland MHS (Lancet, 2009)

• 2013 – DESDE-LTC (EAHC, European Commission)

• Salvador-carulla et al, 2013

• 2013 – REFINEMENT Project-

• Salvador-Carulla et al., 2014

• 2014 Use of the Atlas for evidence informed policy in Catalonia and the Basque Country

• 2015 – First Atlas of Integrated MH Care in Australia

What is a Service?

5

What is a Hospital?

- Transferability and terminological variability:

• Names of the services do not reflect their

main activity (Hospital – Day Hospital –

crisis houses-medical homes)

- Commensurability: • Diff. units of analysis, lack of comparison like

with like . We cannot merge:

Service Providers

Interventions

Activities

Culture of care

Main Problems when Assessing Services:

• 1st We identify the minimal unit of production or care (Basic Stable inputs of

Care-BSIC) or CARE TEAMS

To overcome these limitations…

2nd We label them

according to their Main

Type of Care (MTC)

they provide

8

Is the minimal set of inputs organised for care delivery.

It is usually composed of an administrative unit with an organised

set of structures and professionals that provide local care within a

catchment area.

BSIC is the minimal micro-level system of care provision. Within

the production model (input-process-output), BSIC refer only to

provision of care and not to other inputs (products and devices) or

to procedures (intervention).

The functions provided by the BSIC are described by smaller unit

of analysis called “Main Type of Care”.

BSIC- Basic Stable Input of Care

DEFINE THE AREA: TARGET POPULATION: >20% OF THE CLIENTS HAVE MH ISSUES

• Criterion A: To have its own professional staff.

• Criterion B: All activities are used by the same users

• Criterion C: Time continuity (more than 3 years)

• Criterion D: Organizational stability

• Criterion E: The service is registered as an independent legal organisation (with its own companytax code or an official register). This register is separate and not as a part of a meso-organisation(for example a service of rehabilitation within a general hospital)

→ IF NOT:

• Criterion F: The service has its own administrative unit and/or secretary’s office and fulfils twoadditional descriptors (see below)

→ IF NOT:

• Criterion G: The service fulfils 3 additional descriptors:

» G1. To have its own premises and not as part of other facility (e.g. a hospital)

» G2. Separate financing and specific accountancy

» G3. Separated documentation when in a meso-organization

BSIC- Inclusion Criteria

10

MTC is the main DESCRIPTOR of the “generic care

function” provided by the service. These generic care

functions describe a basic activity carried out in the

BSIC, which has been selected for allowing service

comparison across different territories in an iterative

process by a series of European expert groups within

the consecutive ESMS/DESDE projects.

MTC- Main Type of Care

11

First Level- Status of the user: crisis situation or not.

Second Level- Type general of care: home & mobile/non-

mobile, hospital/non-hospital

Third Level- Intensity of care: High, medium, low.

Fourth Level- Subtype of care: health-related, social-

related, work-related…

Fifth Level- Additional qualifiers

MTC- Levels

PART II

The coding system

Defining catchment areas

• Macro level

• H0: Pan-national level

• H0.1 Global: World

• H0.2 Pan-national: For instance: Americas, PAHO, WHO region, European Union

• H1: National level

• H1.1 Large countries For instance: Chile, USA

• H1.2 Small countries (Typically below 1 million population) For instance: Belize, Andorra

• H2: Regional level (typically 5.000.000 – 500.000 population.)

• H2.1 States and regions within a country For instance: Bío-Bío (Chile), Texas (USA),

Mexico D.F (Mexico)

• H2.2 Provinces, counties For instance: Miami Dade County (Florida, USA), Vizcaye

(Basque Country, Spain)

• H2.3 Metropolitan urban areas For instance: Mexico city (Mexico), Santiago de Chile

(Chile), Barcelona (Spain)

14

• Meso Level

• H3.1 Health districts

• For instance: Talcahuano (Bío-Bío, Chile), Western Sydney (New South Wales, Australia)

• H3.2 Catchment Areas for a reference General Hospital

• For instance: Hospital of Concepción (Bío-Bío, Chile), Hospital of Basurto (Basque Country,

Spain) (approx. 700.000 to 200.000 inhabs.)

• H3.3 Other Jurisdictions larger than Catchment Areas for a reference Specialized Care

Centre (H4.1) and lower than Catchment Areas for a reference General Hospital (H3.2)

• For instance: Catchment area of the Day Hospital of Uribe (Basque Country, Spain)

• Micro level

• H4.1 Catchment Area for a reference Specialized Community Centre

• For instance: COSAM Mental Health Community Centre (Chile), USMC Mental Health

Community Centre (Andalusia, Spain) (approx. 120.000 to 20.000 inhabs)

• H4.2 Other Jurisdictions larger than the Minimum Local Health Administrative Area

(H5.1) and lower than Meso level areas (H3.3)

• H5.1 Minimum Local Health Administrative Area

• For instance: Catchment Area of a Primary Care Centre (approx. 50.000 to 10.000 inhabs)

• H5.2 Other jurisdictions smaller than H4

• For instance: Postal codes and census areas in urban districts

Defining catchment areas

The code used to classify the “service” can be split in 4 components

Component 1: Age GROUP

AGE group: main target group

• GX All age groups

• NX None/undetermined

• CX Child & Adolescents (e.g 0-17 years old)

• AX Adult (>17 years old)

• OX Old > 64

• CC Only children (e.g 0-12 years old)

• CY Adolescents and young adults (e.g 12-25)

• CA Only adolescent (e.g 12-17 years old)

• TC Period from child to adolescent (e.g 8-12 years old)

• TA Period from adolescent to adult (e.g 16-25 years old)

• TO Period from Adult to old (e.g 60- 70 years old)

Component 2: Diagnostic Group

• ICD-T When there is not a specific diagnostic group defined bythe care team or it covers all types of disorders

• [X] When the care team includes all types of an ICD section theletter of the section will be coded. For example [F] for mentaldisorders.

• [Fx-x] When there is a general category but the specificdiagnosis is not identified:

• [F70-79] Intellectual disability

• [Fx] When there is a specific diagnosis described in the careteam (i.e [F50] for Anorexia)

• ICF-X Functional problems (mild, moderate, severe)

• Social Needs: Homelesness Z59.0, extreme poverty Z59.5 etc.

GUIDANCE AND ASSESSMENT

INFORMATION

INFORMATION FOR CARE

COMMUNICATION

PERSONAL ACCOMPANIMENT

CASE COORDINATION

PHYSICAL MOBILITY

OTHER ACCESSIBILITY CARE

ACCESIBILITY TO CARE

NON-PROFESSIONAL STAFF

PROFESSIONAL STAFF

SELF-HELP AND VOLUNTARY

CARE

HOME & MOBILE

NON MOBILE

ACUTE

HOME & MOBILE

NON MOBILE

NON ACUTE

(Continuing care)

OUTPATIENT CARE

EPISODIC

CONTINUOS

ACUTE

WORK

WORK RELATED ACTIVITIES

NON-WORK STRUCTURED CARE

NON STRUCTURED CARE

NON ACUTE

DAY CARE

24 HOURS PHYSICIAN COVER

NON 24H PHYSICIAN COVER

ACUTE

24H PHYSICIAN COVER

NON 24H PHYSICIAN COVER

OTHER RESIDENTIAL

NON ACUTE

(Programmed Availability)

RESIDENTIAL CARE

LONG TERM CARE

Component 3: DESDE-LTC CODEINFORMATION: guidance/ assessment/ information

WITHOUT follow up (e.g. information about availability of

services)

ACESSIBILITY: access to care WITHOUT direct

provision of care related to needs (e.g. access to

employment)

SELF CARE/VOLUNTARY: non-paid staff (e.g. Alcoholic

anonymous)

DAY CARE: the person spends the day at the facility

(e.g. day hospital or social club)

OUTPATIENT: contact with the person in a limited period

of time (eg. visit with the GP).

RESIDENTIAL: the person sleeps at the facility (eg.

acute unit -hostel)

The information branch is used for facilities that provide

clients with information and/or assessment of their needs.

Services providing information are not involved in

subsequent monitoring/follow-up or direct provision of care

Information I

Information I

General

I1.0

Health related

I1.1

Education related

I1.2.1

Social and culture related

I1.2.2

Work related

I1.2.3

Other care

I1.2.4

Non health related

I1.2

GUIDANCE AND ASSESSMENT

I1

Face to face

I2.1.1

Other interactive

I2.1.2

Interactive

I2.1

Non interactive

I2.2

INFORMATION

I2

INFORMATION

(I)

The accessibility branch classifies facilities whose main aim

is to facilitate accessibility to care for clients with long term

care needs. These services, however, do not provide any

therapeutic care.

Accesibility A

Accesibility A

Case Finding

A0

Communication

A1

Physical mobility

A2

Personal accompaniment

A3

Health related

A4.1.1

Non health related

A4.1.2

Acute Care

A4.1

High Intensity

A4.2.1

Medium

A4.2.2

Low intensity

A4.2.3

Non-acute Care

A4.2

Case coordination

A4

Health related

A5.1

Education & Training related

A5.2

Social & Culture related

A5.3

Work related

A5.4

Housing related

A5.5

Other accessibility care

A5

ACCESSIBILITY TO CARE

(A)

Self-help and Voluntary Care: These codes are

used for facilities which aim to provide clients with

support, self-help or contact, with un-paid staff

that offer any type of care as described above

(i.e. residential, day, outpatient, accessibility or

information).

Self-help and volunteer S

Self-help and volunteer S

S. Information on Care

S1.1

S. Accesibility to Care

S1.2

S. Outpatient Care

S1.3

S. Day Care

S.1.4

S. Residential Care

S1.5

NON PROFESSIONAL STAFF

S1

S. Information on Care

S2.1

S. Accesibility to Care

S2.2

S. Outpatient Care

S2.3

S. Day Care

S2.4

S. Residential Care

S2.5

PROFESSIONAL STAFF

S2

SELF-HELP AND VOLUNTEER CARE

The outpatient care branch is used to code

facilities which (i) involve contact between staff

and clients for some purpose related to the

management of their condition and associated

clinical and social needs and (ii) are not

provided as a part of delivery of residential or

day services, as defined above.

Outpatient care O

Outpatient care O

Health related care

O1.1

Other care

O1.2

24 HOURS

O1

Health related care

O2.1

Other care

O2.2

LIMITED HOURS

O2

HOME & MOBILE

Health related care

O3.1

Other care

O3.2

24 HOURS

O3

Health related care

O4.1

Other care

O4.2

LIMITED HOURS

O4

NON MOBILE

ACUTE

3/6 days/week

O5.1.1

7 days/week

O5.1.2

7 d/w includ overnight

O5.1.3

Health related care

O5.1

3/6 days/week

O5.2.1

7 days/week

O5.2.2

7 d/w includ overnight

O5.2.3

Other care

O5.2

HIGH INTENSITY

O5

Health related care

O6.1

Other care

O6.2

MEDIUM INTENSITY

O6

Health related care

O7.1

Other care

O7.2

LOW INTENSITY

O7

HOME & MOBILE

Health related care

O8.1

Other care

O8.2

HIGH INTENSITY

O8

Health related care

O9.1

Other care

O9.2

MEDIUM INTENSITY

O9

Health rel care

O10.1

Other care

O10.2

LOW INTENSITY

O10

LOW AND NON MOBILE OTHER NON-ACUTE

O11

NON ACUTE

(Continuing Care)

OUTPATIENT CARE

• Day Care: facilities which (i) are normally available to

several clients at a time (rather than delivering

services to individuals one at a time); (ii) provide

some combinations of treatment for problems related

to long-term care needs (e.g. providing structured

activities or social contact/and or support); (iii) have

regular opening hours during which they are normally

available; and (iv) expect clients to stay at the facility

beyond the periods during which they have face to

face contact with staff

Day Care D

Day Care D

HIGH INTENSITY

D0.1

OTHER INTENSITY

D0.2

EPISODIC

D0

HIGH INTENSITY

D1.1

OTHER INTENSITY

D1.2

CONTINUOUS

D1

ACUTE

Ordinary employment

D2.1

Other work

D2.2

HIGH INTENSITY

D2

Ordinary employment

D6.1

Other work

D6.2

LOW INTENSITY

D6

WORK

Time Limited

D3.1

Time Indefinite

D3.2

HIGH INTENSITY

D3

Time Limited

D7.1

Time Indefinite

D7.2

LOW INTENSITY

D7

WORK RELATED CARE

Health related care

D4.1

Education related care

D4.2

Social and cultural

related care

D4.3

Other non-work structured care

D4.4

HIGH INTENSITY

D4

Health related care

D8.1

Education related care

D8.2

Social and cultural

related care

D8.3

Othernon-work structured care

D8.4

LOW INTENSITY

D8

NON-WORK STRUCTURED CARE

Other day care -structured

D5.1

Other day care -non structured

D5.2

HIGH INTENSITY

D5

Other day care -structured

D9.1

Other day care -non structured

D9.2

LOW INTENSITY

D9

NON STRUCTURED CARE OTHER NON-ACUTE

D10

NON ACUTE

DAY CARE

Residential care: The codes related to residential

care are used to classify facilities which provide

beds overnight for clients for a purpose related to

the clinical and social management of their health

condition. It is important to note that clients do not

make use of such services simply because they are

homeless or unable to reach home.

Residential care R

Residential care R

NON-HOSPITAL

R0

High intensity Surveillance

R1

Medium intensity for very short stays

R2.1Medium intensity other stays

R2.2

Medium intensity

R2

HOSPITAL

24H PHYSICIAN COVER

Hospital

R3.0

Health related care

R3.1.1

Social care

R3.1.2.1Other Support

R3.1.2.2

Other care

R3.1.2

Non hospital

R3.1

NON 24H PHYSICIAN COVER

R3

ACUTE

TIME LIMITED

R4

INDEFINITE STAY

R6

HOSPITAL

TIME LIMITED

R5

INDEFINITE STAY

R7

NON-HOSPITAL

24H PHYSICIAN COVER

Less than 4 weeks

R8.1

Over 4 weeks

R8.2

24 HOURS SUPPORT

R8

Less than 4 weeks

R9.1

Over 4 weeks

R9.2

DAYLY SUPPORT

R9

Less than 4 weeks

R10.1

Over 4 weeks

R10.2

LOWER SUPPORT

R10

TIME LIMITED

24 HOURS SUPPORT

R11

DAYLY SUPPORT

R12

LOWER SUPPORT

R13

INDEFINITE STAY

NON 24H PHYSICIAN COVER

Acute

R14.1

Ocassional or intermitent

R14.2

Time limited

R14.3

Indefinite Stay

R14.4

OTHER RESIDENTIAL CARE

R14

NON ACUTE

RESIDENTIAL CARE

COMPONENT 4: Qualifiers“a” Acute care (complementary)

This qualifier describes acute care which is provided for users in a crisis situation within a non-

acute, non-residential setting (branches “O” and “D”) but which does not fit criteria for a

separate MTC. As an example, this may be relevant to differentiate ambulatory facilities with

the capacity to provide acute in working hours care as an ordinary activity from those

ambulatory centres that do not provide acute care at all.

“b” Bundled care

This qualifier describes episode-related care provision, usually provided for non-acute patients

within a time limited plan (e.g. three months of brief psychotherapy). The ‘b’ qualifier is only

assigned when at least 80% of the care provided in the facility is short- time limited and

episode-related.

“c” Closed care

This qualifier describes secluded MTCs with high level of security which is provided under

locked doors. Usually these units are for crime & justice users or persons with mental illness

with high risk for themselves or others. The availability of a single room for seclusion within an

acute ward does not qualify the care team as closed care.

COMPONENT 4: Qualifiers

“d” Domiciliary care

This additional code describes BSICs provided at the home of the user and nowhere else. If a

service (BSIC) provides mobile home care as part of a broader or more general activity it should

not be coded as "d".

“e” eCare

This qualifier includes all care services relying on modern information and communication

technologies (ICTs) (e.g. telecare/telemedicine, teleconsultation, teleradiology, telemonitoring).

Specialist technical devices for healthcare professionals (robotics and advanced systems for

diagnosis and surgery; simulation and modelling devices; healthcare grids, tools for training) are

NOT included in this coding.

When an outpatient SCT is provided using teleconsultation, the ‘e’ can be added at the end of the

DESDE-LTC code to differentiate this care team from face-to face care teams. (e.g. O81.e)

COMPONENT 4: Qualifiers

“f” Far-away

This qualifier describes care teams available for a defined population but too distant to be

accessed on a routine basis. This additional descriptor does not depend on the distance of the care

team from an individual patient but from a target population quarter (e.g. a municipality). The

suggested cut-offs for assigning this code are as follows: 1) Residential care teams: 100 kms; 2)

Out-patient non-mobile: 70 kms; 3) Day care: 50 kms. This coding is not intended for mobile

outpatient care teams or for eHealth. For example the hospital acute ward assigned for a rural area

is in a city 130 kms away from the main location in the rural area; or the assigned day care centre

for this area is located in a town 70 kms away from the rural area).

“g” Group

This qualifier refers to outpatient services where most of their care is provided through group

activities (typically over 80% of their overall care activity).This excludes family therapy.

COMPONENT 4: Qualifiers

“f” Far-away

This qualifier describes care teams available for a defined population but too distant to be

accessed on a routine basis. This additional descriptor does not depend on the distance of the care

team from an individual patient but from a target population quarter (e.g. a municipality). The

suggested cut-offs for assigning this code are as follows: 1) Residential care teams: 100 kms; 2)

Out-patient non-mobile: 70 kms; 3) Day care: 50 kms. This coding is not intended for mobile

outpatient care teams or for eHealth. For example the hospital acute ward assigned for a rural area

is in a city 130 kms away from the main location in the rural area; or the assigned day care centre

for this area is located in a town 70 kms away from the rural area).

“g” Group

This qualifier refers to outpatient services where most of their care is provided through group

activities (typically over 80% of their overall care activity).This excludes family therapy.

“h” Care provided in a hospital setting

Describes non-residential care (“O”, “D”) provided in a meso-organisation registered as a “hospital” but

which is not related to acute residential care (e.g. an outpatient unit or a day hospital placed in a hospital

setting as to differentiate these BSICs from similar units placed in the community). Also describes non

acute residential care normally found in the community (R8-R13). This code excludes “Long-Term

Institutional Care settings which are coded as “I”.

“i” Institutional care

This additional code describes residential BSICs characterised by indefinite stay for a defined population

group, which usually have over 100 beds and which is described as “Institutional care”. This code is

relevant for better describing residential care in the main target population groups: “C”, “E”, “ID” and “MD”.

This additional code may provide relevant information with regard to the balance of care in specific areas

such as mental health, intellectual disabilities or age, where large long-term residential care characterised

an “institutional” care model (for example acute, time-limited and indefinite stay: R2.i, R4.i, R6.i).

COMPONENT 4: Qualifiers

“j” Justice care

This additional describes facilities which main aim is to provide crime & justice users (securityor prison hospitals, surveillance wards for patients under crime & justice custody, physicaldisability and psychiatric units in prisons and regional security units). These units may be codedin an independent tree due to the special characteristics of the target population.

“l” Liaison care

This qualifier describes liaison” MTCs where specific consultation and care is provided for asubgroup of users from a different main target population (e.g., liason psychiatric care teams foroncology patients) usually located in another area of care (e.g. outpatient consultation onIntellectual Disabilities to a general medical care team or consultation on mental disorders tothe general medical care teams of a hospital). A liason care team provided to inpatients fromother wards within the same general hospital will be counted as low mobility outpatient care.

This qualifier excludes activities of care which are part of the other care team (e.g. psychologycare provided by a psychologist within the oncology unit) will not be counted as a liason careteam.

A special attention should be paid to whether these facilities fulfil criteria for SCT or MTCs andare not care units or care programmes within a care team

COMPONENT 4: Qualifiers

“m” Case management

This qualifier describes SCTs which main aim is defined as management, planning,coordination or navigation of care but which also include several forms of clinical care aspart of the coordination of their activity (e.g., the care team typically provides therapeuticcounselling as part of its case management activities). These care teams cannot becoded as A4 but should be differentiated from other outpatient care teams. These careteams may include intensive case management, assertive outreach, assertivecommunity treatment, disease management, or even personalised care.

A special attention should be paid to whether these facilities fulfil criteria for SCT orMTCs and are not care units or care programmes within a care team.

“n” Novel

This additional code describes hospital BSICs of recent creation in health complex orcommunity centres that not fulfil criteria for typical hospitals.

COMPONENT 4: Qualifiers

‘o’ ‘On call’ Physician

This additional code describes residential care provided by a physician on call. The physician is

not formally on duty at the centre part of the day, usually at night. Services on call are used at

least 4 times a week.

‘p’ Primary care (Specialized Care provided in a primary care centre)

This qualifier describes specialised ambulatory care provided at the “primary care centre” by a

qualified specialist from the specialised care centre.

q Quite

This qualifier indicates that the main attribute of the MTC (e.g., mobility, intensity) is significantly

higher/greater than for other care teams coded in the same MTC. For example, a “q” qualifier in a

“low mobility” MTC indicates that the mobility of the care team is at the higher rank within the “low

mobility” group (typically between 20 and 49% of the overall activitity perfomed in the centre). A

“q” qualifier in the “high mobility” MTC indicates that the mobility of the care team is higher within

the “high mobility” group (typically between 80 and 98% of the overall activity performed in the

centre).

COMPONENT 4: Qualifiers

“r” Reference main type care in an area

This additional code describes the main and/or official referral service for an MTC provided at the

catchment area, in areas where care has been sectorised. This optional coding is particularly relevant in

mental health to differentiate the reference mental health centre from other outpatient units in the same

catchment area, or the referral acute hospital service from other acute units which could also be used be

the same target group within the catchment area.

“s” Specialised care

This additional code describes BSICs for a specific subgroup within the target population attended at the

catchment area (e.g. services for Elderly persons with Alzheimer’s disease within the “E” group, or

services for Eating Disorders within the “MD” group).

“t” Tributary

This qualifier describes satellite units of care dependent from a main care team. Typically the team

itinerates to different settings where they provide care on a regular basis (e.g. Royal Flying Doctors care

team in rural Australia), or part of the team is permanently in the setting but it does not qualify as a SCT

due to its dependency from the headquarters (e.g., satellite ambulatory mental health centres in Girona -

Spain).

COMPONENT 4: Qualifiers

“u” Unitary

This additional code describes single-handed BSICs where care is delivered by a health care

professional (psychiatrist, psychologist, nurse).

“v” Variable

This qualifier is used when the code applied at the moment of the interview could vary significantly in

days or weeks (from example from acute outpatient care to non acute). This depends on the capacity

of the service to provide the type of care described by the code due to fluctuations in the demand or

the supply capacity. For example a crisis accommodation team for homeless or a crisis domestic

violence refuge may fluctuate in its capacity of providing acute care within 24 hours depending on the

demand and the availability of places. This code can be also applied to services under transition due

to a health reform, a change in the whole financing system or social care, or the development of a new

disability scheme.

COMPONENT 4: Qualifiers

41

“w” Whole

This qualifier indicates that the service only provides the extreme

level of the activity described by MTC. For example in “low

mobility” MTCs a “w” qualifier indicates that there is no mobility

of the staff so this care team is entirely “non- mobile”. On the

contrary when this code is applied to a “high mobile” MTC it

indicates that all the activity of the care team is mobile. For

example the “w” qualifier attached to a low mobile outpatient

service indicates that this service is fully non-mobile (O9), whilst

the same qualifier applied to a mobile service (O6) indicates that

100% of its activity is mobile. Likewise a “w” qualifier attached to

an “S” code indicates that a self-support service is exclusively

run by un-paid peers.

COMPONENT 4: Qualifiers

42

DESDE-LTC is a decision support tool for planning of social and health

care systems.

It is necessary to transform the information collected using DESDE-LTC

into meaningful knowledge that can be used in evidence informed policy

planning.

In order to do that we should use advanced techniques that incorporate

expert knowledge (EbCA: expert-based cooperative analysis),

visualitation tools (GIS: Geographic information systems), and a new

data analysis procedures (KDD: Knowledge discovery from Data).

DESDE-LTC information should be combined with other sources of data

(social and demographic data, utilisation of services, costs, consumer

preferences, etc.)

DESDE-LTC and evidence informed planning

43

DESDE inventory provides useful information to planning such as:

- Standardised description of care.

- Target population: age, type of disabilities, dependency, social

exclusion, etc.

- Availability of service delivery.

- Placement capacity (places and beds).

- Workforce capacity (FTE of professionals in health and social care).

- Geographical location.

- Other information (funding sources, type of management, etc.).

DESDE information

44

Social and health care profiles

• Analysis of the balance of care (e.g. social and

health system).

• Analysis of clusters of health care delivery.

• Graphical visualisations to incorporate tacit expert

knowledge.

• Improve policy decision making through the

identification of strengths, gaps and weaknesses of

the local care system.

45

Distribution of the DESDE Main Branch for people with

lived experience of mental illness in Western Sydney

Main branch profile

33.8

6

58.6

11 93

46

Description of mental health professionals in Catalonia (Spain)

Workforce profile by Main Types of care

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

advocat

ref/aux_tutel·les

fisio

tra_soc

ter_ocu

t_integ

ped/psicoped

logo

educador

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47

Evolution of the local delivery system

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D1 D4.1 D3.2,D2.2

D4.3. D1*

2002

2006

2010

Evolution of the availability of Day Care in

Catalonia (Spain)

PART III

Guided Cases

49

Established and registered as a public centre in the mental health system in 1992. It consists of a two floor building of 1800 sq. m. divided

into two workshops, the administration office, one room for specific care (psychology, nurse etc.) and a dining room where users eat their

meals. Currently the total amount of users enrolled at the centre is 120 adults, (there is a waiting list of people that are accepted when

there is a vacancy); 73 of them with a main diagnosis of mental disorders and the rest with a dual diagnosis of intellectual disability and

mental disorder.

The motive for work is not profit (they are not paid), but rather work as an element of quality of life, work that brings more equal options,

that means higher degree of humanity and respect of rights. In the manufacture they cooperate with numerous companies and develop

their own attractive programme. In this way they acquire the majority of resources for covering the material costs, awards, trips and

vacations, cultural and sport activities. Smaller, but also important source of income represent donations from benefactors.Their own

manufacture programme consists of paper goods and hand embroidering products. The price of products is comparable, the quality very

good. Besides developing of hand skills, this kind of products also enable work-creativity.

The staff is composed of 7 qualified professionals (2 social workers, 1 nurse, 1 psychologist, 2 occupational therapists, 1 administrative)

plus 3 volunteers, usually university students, that monitor the workshops. Users work 5 days a week from 9 am to 2 pm.

GUIDED CASE 1

• CRITERION A: To have its own professional staff

• CRITERION B: All activities are used by the same users

• CRITERION C: Time continuity

• CRITERION D: Organizational stability

• CRITERION E: The care team is registered as an independent legal organisation (with its own company tax codeor an official register). This register is separate and not as a part of a meso-organisation (for example a careteam of rehabilitation within a general hospital) → IF NOT:

• CRITERION F: The care team has its own administrative unit and/or secretary’s office and fulfils two additionaldescriptors of criterion G (below) → IF NOT:

The care team must fulfil the 3 descriptors of criterion G• CRITERION G: additional descriptors of the structured care organization:

G1. To have its own premises and not as part of other facility (e.g. a hospital)G2. Separate financing and specific accountancyG3. Separated documentation when in a meso-organization

Decision 1: Unit of analysis ¿Is it aBSIC/SCP?

“Established and registered

as a public centre in the MH

system”

“7 qualified professionals”

“Manufacture”

“Since 1992”

DIAGNOSIS

-ICF code for functioning problem-ICD-10 for mental disorder

Decision 2: Target population

VISTA- b210-b229AUDICIÓN- b230-b249PARÁLISIS CEREBRAL-G80-83DAÑO CEREBRAL SOBREVENIDO- T90, I60-69DROGODEPENDENCIA- F10-19VIH- B20-b24PERSONAS EN SITUACIÓN DE EXCLUSIÓN SOCIAL- (marginados sin hogar)- Z59MALTRATO- T74 SITUACIONES DE RIESGO EN LA INFANCIA-Z5-7INFANCIA Y ADOLESCENCIA CXINFANCIA Cc

MAYORES ALZHEIMER- F00MAYORES DEMENCIA- F00-03TRASTORNOS MENTALES- F0-9TRASTORNOS DEL ESPECTRO AUTISTA-F84TRASTORNO DE CONDUCTA- F0-9DISCAPACIDAD INTELECTUAL- F70-79GRAVEMENTE AFECTADAS CON DISCAPACIDAD INTELECTUAL- F70-F79DISCAPACIDAD FÍSICA- b7DISCAPACIDAD FÍSICA GRAVEMENTE AFECTADOS- b7, 3-4DISCAPACIDAD NO ESPECIFICADA- ICFxDEPENDENCIA- ICF 3-4DISCPACIDAD SENSORIAL- b2

AGE GROUP

GX All age groups

NX None/undetermined

CX Child & Adolescents (e.g. 0-17)

CC Only children (e.g. 0-11)

CA Only adolescent (e.g. 12 – 17)

CY Adolescents and young adults (e.g. 12-25)

AX Adult (e.g. 18-65)

AY Young adults (e.g. 18-25)

AO Older Adults (e.g. 50- 65)

OX Older than 65

TC Transition from child to adolescent (e.g. 8-13)

TA Transition from adolescent to adult (e.g. 16-25)

TO Transition from adult to old (e.g. 55-70)

Decisión 3: ¿What typology of care provides the service (MTC)

INFORMATION: guidance/ assessment/ information WITHOUT follow up

ACESSIBILITY: access to care WITHOUT direct provision of care related to needs

SELF CARE/VOLUNTARY: non-paid staff

DAY CARE: (i) are normally available to several clients at a time (rather than delivering services to

individuals one at a time); (ii) provide some combinations of treatment for problems related to long-term

care needs (e.g. providing structured activities or social contact/and or support); (iii) have regular

opening hours during which they are normally available; and (iv) expect clients to stay at the facility

beyond the periods during which they have face to face contact with staff

OUTPATIENT: (i) involve contact between staff and clients for some purpose related to the

management of their condition and associated clinical and social needs and (ii) are not provided as a

part of delivery of residential or day services, as defined above(eg. visit with the GP).

RESIDENTIAL: The codes related to residential care are used to classify facilities which provide beds

overnight for clients for a purpose related to the clinical and social management of their health

condition. Users keep their homes.

“users work Monday to

Friday from 9am to 2pm”

Decision 3: Aditional MTC?

• The additional main activity is critical to differentiate

the BSIC from other related BSICs both from the

perspective of users and managers

• The care team fulfils criteria for time continuity and

same staff but there are multiple user groups

(activities are provided to users different from the

target group that defines the BSIC)

GUIDANCE AND ASSESSMENT

INFORMATION

INFORMATION FOR CARE

COMMUNICATION

PERSONAL ACCOMPANIMENT

CASE COORDINATION

PHYSICAL MOBILITY

OTHER ACCESSIBILITY CARE

ACCESIBILITY TO CARE

NON-PROFESSIONAL STAFF

PROFESSIONAL STAFF

SELF-HELP AND VOLUNTARY

CARE

HIGH MOBILE

LOW MOBILE

ACUTE

HIGH MOBILE

LOW MOBILE

NON ACUTE

(Continuing care)

OUTPATIENT CARE

EPISODIC

CONTINUOS

ACUTE

WORK

WORK RELATED ACTIVITIES

NON-WORK STRUCTURED CARE

NON STRUCTURED CARE

NON ACUTE

DAY CARE

24 HOURS PHYSICIAN COVER

NON 24H PHYSICIAN COVER

ACUTE

24H PHYSICIAN COVER

NON 24H PHYSICIAN COVER

OTHER RESIDENTIAL

NON ACUTE

(Programmed Availability)

RESIDENTIAL CARE

LONG TERM CARE

DECISION 4: ¿What kind of Day care: acute or non-acute?

A C U T E

P a t i e n t s i n c r i s i s s i t u a t i o n . R e c e i v e c a r e i n 7 2 h o r 4 w e e k s

N O N - A C U T E

D o e s n o t f u l l f i l c r i t e r ia f o r a c u t e

D A Y C A R E

Day care, non-acute: D3, D4, D5, D7, D8, D9, D10

DECISION 5: ¿what kind of non acute day care provides: work,

work-related, structured non work related, non structured, other

WORK

Users are paied

WORK RELATED

Users not paid or less than 50%

NON-WORK STRUCTURED DAY CARE

Non-work structured activities

NON-STRUCTURED DAY CARE

25% of activities are non-struc

Day care, non-acute, work-related: D3, D7

HIGH INTENSITY

Equivalent to 4 half days per week

LOW INTENSITY

Less than 4 half days per week

Day care, non-acute, work-related, high intensity: D3.1, D3.2

DECISION 6: ¿what kind of non acute, work-related, day care

provides: high intensity, low intensity?

TIME LIMITED

Activity has a time limit

INDEFINITE TIME

Activity with no fixed time limit

Day care, non-acute, work-related, high intensity, indefinite time: D3.2

DECISION 7: ¿what kind of non acute, work-related, high

intensity, day care provides: time limited or time indefinite?

HIGH INTENSITY

D0.1

OTHER INTENSITY

D0.2

EPISODIC

D0

HIGH INTENSITY

D1.1

OTHER INTENSITY

D1.2

CONTINUOUS

D1

ACUTE

Ordinary employment

D2.1

Other work

D2.2

HIGH INTENSITY

D2

Ordinary employment

D6.1

Other work

D6.2

LOW INTENSITY

D6

WORK

Time Limited

D3.1

Time Indefinite

D3.2

HIGH INTENSITY

D3

Time Limited

D7.1

Time Indefinite

D7.2

LOW INTENSITY

D7

WORK RELATED CARE

Health related care

D4.1

Education related care

D4.2

Social and cultural

related care

D4.3

Other non-work structured care

D4.4

HIGH INTENSITY

D4

Health related care

D8.1

Education related care

D8.2

Social and cultural

related care

D8.3

Othernon-work structured care

D8.4

LOW INTENSITY

D8

NON-WORK STRUCTURED CARE

Other day care -structured

D5.1

Other day care -non structured

D5.2

HIGH INTENSITY

D5

Other day care -structured

D9.1

Other day care -non structured

D9.2

LOW INTENSITY

D9

NON STRUCTURED CARE OTHER NON-ACUTE

D10

NON ACUTE

DAY CARE

FINAL CODE: AX-[F0-9][F70-F79]-D3.2