Core Dataset J - Changes

1. Core Dataset J - Changes Implementation November 2012

2. Core Dataset J – Agenda • This presentation covers: • Reason for changes in dataset • Which services are affected • When the changes are to be implemented • What items are being removed • What items are being introduced: • Setting (at Agency and intervention level) • Pharmacological and Basis of prescribing • Psychosocial and sub interventions • Recovery Support and sub interventions • Time in Treatment • New process for joint Drug and Alcohol clients • Implications for new and existing clients

3. Core Dataset J – Why Change? • Previously: • Interventions were a mixture of interventions and settings • 90% of all Psychosocial recorded as ‘Other Psychosocial’ • open to interpretation • potential for inconsistencies in recording • difficulty in making comparisons • difficulties in evidencing treatment factors positively associated with outcomes • No facility to evidence intensity of treatment provided • No facility to evidence recovery support provided: • either during structured treatment or • after structured treatment

4. Core Dataset J – Why Change? • Opportunities • To evidence delivery supporting the 2010 Drug Strategy goal of helping people to recover • Bring intervention types into closer alignment with NICE and 2007 Clinical Guidelines • Facilitate greater use of mapping techniques by providers • Provide greater detail about treatment delivery itself • Assist with re-presentation rates by evidencing recovery support both during and post structured treatment • Demonstrate progress on the recovery agenda and the nature of recovery journeys to policy makers

5. Core Dataset J – Why Change? • More Opportunities • To revisit definition of structured treatment • To address issue re care-coordination vs treatment • For clients receiving community treatment • For clients receiving residential treatment • To expand recording of NDTMS across ‘hard-to-reach’ services e.g. hospital beds, etc. • To more accurately reflect ‘real’ processes around • the delivery of combined drug and alcohol treatment • the delivery of unstructured and structured treatment

6. Core Dataset J – Who and When? • Who? • Not YP Providers • YP dataset, processes and reporting unaffected • Even those with clients aged over 18 • All adult services providing Drug or Alcohol Treatment • When? • To be implemented 1st November 2012 • New clients – immediately • Existing (open) clients – gradually but before 31/03/2013, including 1 sub intervention review

7. Core Dataset J – What’s out? • INTERVENTIONS REMOVED • 2 Specialist Prescribing • 3 GP Prescribing • 81 Behavioural Couples Therapy • 82 Family Therapy • 83 Contingency Management • 84 Psychosocial Mental Disorder • 85 Other Formal Psycho Therapy • 5 Structured Day Programme • 6 Residential Rehabilitation • 7 Aftercare • …./ 12 Other Structured Intervention 87 Inpatient Tt Assessment 88 Inpatient Tt Stabilisation 89 Inpatient Tt Detox 70 ALC – Inpatient Tt ALC – Residential Rehab ALC – Community Prescribing ALC – Structured Psychosocial ALC – Structured Day Programme ALC – Other Structured Tt

8. Core Dataset J – What’s new? • Setting • Agency level • Intervention level Interventions Restricted to only 3 ‘high level’ interventions (with sub intervention reviews) Time in Treatment Recorded at each agency (separately) at episode level

9. Core Dataset J – What’s new? • Setting All NDTMS agencies will be registered under one setting in DAMs agency table but a field is also available at intervention level Input Setting field at intervention level if: Delivering in multiple settings OR Recording delivery by other service(s) **The setting is now part of the intervention structure so there can be multiple (same) interventions reported but at a different setting **Reporting of treatment at non-NDTMS recording agencies is now encouraged

10. Core Dataset J – What’s new? • Interventions • Three ‘high level’ interventions • All require additional information: • Pharmacological • Basis of prescribing • Psychosocial and Recovery Support • listing of interventions c. 6 monthly (?)

11. Core Dataset J – What’s new? • Interventions • Pharmacological • Encompasses all prescribing but excludes ANY Psychosocial delivery • Requires additional ‘sub intervention’ information re intention • Requires date of commencement/change in intention • Options are:- • Withdrawal • Maintenance • Stabilisation • Relapse Prevention

12. Core Dataset J – What’s new? • Interventions • Psychosocial • Includes ALL Psychosocial delivery (not assumed in any other intervention) • Requires additional ‘sub-intervention’ information re specific delivery Sub interventions need to be reviewed and updated c.6 monthly • 9 Options are: • Motivational Interventions Contingency Mgt Counselling • Family & Social network For co-existing mental health • Psychodynamic therapy 12-step work Other • Cognitive & Behavioural based relapse prevention

13. Core Dataset J – What’s new? • Interventions • Recovery Support • A high level intervention describing ‘unstructured’ treatment • Can be used alongside, before/after Pharmacological/Psychosocial • Different rules for ending of modality/discharging from structured Tt • 13 Options are: • Peer Support Access to Mutual Aid Family Support • Parenting Support Employment Support Housing Support • Ed & Training Support Supported work/volunteering • Recovery Check-ups Relapse prevention Mental Health • Complementary Therapies Other

14. CDS-J – Recovery SupportA client’s possible experience Recovery Support is a non-structured intervention which can be delivered alongside structured treatment and also following structured treatment i.e.:- Scenario 1: Pharmacological Intervention Starts 01/10/12 and continues…….. Recovery Support starts 01/02/13 Recovery Support starts a few months later but while the client is still in structured treatment, both are submitted alongside each other in the same way that high level interventions are. Scenario 2: Pharmacological Ends 01/02/13 Recovery Support Starts 01/02/13 Prescribing ends and the client continues in treatment receiving Recovery Support interventions from this provider

15. CDS-J – Recovery SupportSystem handling of unstructured treatment post structured treatment From the point of view of NDTMS returns (data extracts): The provider discharges the client from the episode using the appropriate Discharge Date and Discharge Reason but then continues by opening a new episode for Recovery Support Client discharged from episode) NDTMS records the client as having completed structured treatment and starting recovery support as a separate episode BUT From the point of view of the client’s experience: They perceive they are receiving one episode of care Structured Tx episode ends 01/02/13 Recovery Support episode starts 01/02/13 Client continues in the episode Keeping Structured and Unstructured Treatment recording

16. CDS-J Recovery SupportNew NDTMS functionality to reflecting Clients’ experience CDS-J will allow the recording of the end of structured treatment through recording Discharge Date and Discharge Reason but also allow the episode to remain open whilst Recovery Support continues. Treatment episode continues from client’s perspective Structured Treatment ends 01/02/13 Recovery Support starts 01/02/13 Client continues in the episode To add the Recovery Support interventions there is no need to close down the episode and reopen it again as these interventions can be attached to previous structured treatment episode Also, if Recovery Support is already open, the Structured Treatment can be discharged and the Recovery Support intervention can remain open. Treatment episode continues from client’s perspective Structured Treatment ends 01/02/13 Recovery Support starts 01/09/12

17. CDS-J Recovery SupportRe-presentation to Structured Treatment If a client is open in Recovery Support only, then returns for Structured Treatment , Recovery Support must be ended and a new episode opened for the Structured Treatment (and also for Recovery Support if it is to continue alongside the new Structured Treatment) Treatment episode does not continue from client’s perspective – new assessment would be required Structured Treatment ends 01/02/13 Recovery Support Starts 01/02/13 Episode Ends Recovery Support Ends 01/04/13 New episode Opens Structured Treatment Restarts Recovery Support Reopens 01/04/13

18. Core Dataset J – What’s new? • Time in Treatment • Three bandings of intensity • Measured at a single agency • Measured as a total of all active ‘high level’ interventions • Each change is ‘date-stamped’ to indicate when change occurred • Updated until the episode is discharged

19. Core Dataset J – D & A New Process • Drugs and Alcohol • Interventions • Use of same interventions for both sets of clients with the exception of old Tier 2 interventions: • AlcoholDrugs • ALC- Brief Intervention Advice & Information • Needle Exchange • Outreach • Requirement to use 1/2/3 drug fields appropriately to evidence all problematic substance misuse.

20. Core Dataset J – D & A New Process • Drugs and Alcohol • Discharge • If a D & A client is continuing treatment at the same provider: • Do not discharge the episode until all problematic substance misuse • (Drugs or Alcohol) have been treated (else treatment is incomplete) • If a D & A client is continuing treatment elsewhere: • Service A will discharge the episode with Transfer Not in Custody • Service B will discharge completely (hopefully) at the end of treatment for all problematic substance misuse A client can only be discharged from treatment when there is no ongoing structured treatment need (anywhere) for drugs or alcohol

21. Core Dataset J – D & A New Process If the client is continuing treatment at the same agency:- Client discharged from all treatment All interventions for drug use are completed Alcohol interventions continue If the treatment continues in the same provider then the episode remains open until treatment is completed or the client leaves. It is important that alcohol is recorded as second or third presenting substance. Client discharged from all treatment Client discharged as transferred All interventions for drug use are completed Alcohol interventions start (elsewhere) If the alcohol treatment will be provided elsewhere then the first agency should record the client as transferred to the alcohol provider

22. Core Dataset J – Old/New Clients • Pre 1st November 2012 • Treatment Services • Agree Setting with NEPHO/NDTMS team • Ensure processes are in place to capture: • changes in basis of prescribing • changes in time in treatment • delivery of individual Psychosocial sub interventions • delivery of individual Recovery Support sub interventions • Agree with commissioner and other treatment system partners requirements for recording of existing delivery where old intervention choice is being removed

23. Core Dataset J – Old/New Clients • Post 1st November 2012 • Agency • Update Agency Setting (NEPHO/NDTMS) • New Episodes • Use new Interventions • Use Intervention level Setting field if necessary • Input Time in Treatment • Complete at least one sub intervention review for:- • Basis of Prescribing • Psychosocial delivery • Recovery Support delivery • As appropriate before 31/03/13

24. Core Dataset J – Old/New Clients • Before 31st March 2013 • Open Episodes (1 of 3) • Old Prescribing Interventions • No need to change intervention • Input Time in Treatment (update when required) • Verify if Setting is appropriate • (Is Agency level OK or need to input at intervention level?) • If setting changes, will need to close intervention and reopen same intervention with new setting • If same intervention delivered in 2 settings will need to have 2 (same) interventions open with different settings • Complete at least 1 sub intervention review before 31/03/13 • Assumed start date for the first review will be 01/10/12

25. Core Dataset J – Old/New Clients • Before 31st March 2013 • Open Episodes (2 of 3) • Old Psychosocial Interventions • No need to change intervention • Input Time in Treatment (update when required) • Verify if Setting is appropriate • (Is Agency level OK or need to input at intervention level?) • If setting changes, will need to close intervention and reopen same intervention with new setting • If same intervention delivered in 2 settings will need to have 2 (same) interventions open with different settings • Create at least 1 sub intervention review before 31/03/13 • Assumed start date for the first review will be 01/10/12

26. Core Dataset J – Old/New Clients • Before 31st March 2013 • Open Episodes (3 of 3) • Old Interventions (all those now removed) • Must end old intervention and open with new intervention asap • Input Time in Treatment (update when required) • Verify if Setting is appropriate • (Is Agency level OK or need to input at intervention level?) • If setting changes, will need to close intervention and reopen same intervention with new setting • If same intervention delivered in 2 settings will need to have 2 (same) interventions open with different settings • Create at least 1 sub intervention review before 31/03/13 • Assumed start date for the first review will be 01/10/12

27. Core Dataset J – Help! • NTA Documentation: • http://www.nta.nhs.uk/core-data-set.aspx • Business Definitions x 2 (Separate for Drugs and Alcohol) • Implementation Guide • NEPHO Documentation/Materials: • www.nepho.org.uk/ndtms • CDS-J Presentation • CDS-J Input and Reference sheets • CDS-J Partnership Event Workshop Workbooks • (Through the Training window)

28. Core Dataset J ? • EASY!