Transcript Slide 1

Back to Basics NDTMS Training
Presented By:
Regina Lally and Lucy Nicholson
Drug Treatment Monitoring Unit
DTMU is delivered by Solutions for Public Health
Confidential & Proprietary, Copyright 2010, Solutions for Public Health
Ground Rules
• Please respect those around you by not
holding individual conversations whilst the
sessions are in progress
• Please put mobiles on silent/vibrate
• Please take any calls outside of the meeting
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Objectives
• Introduce NDTMS Core Data Set
• Introduce Waiting Times and Treatment
Journeys.
• Focus on Treatment Outcomes Profile
• Provide a brief overview of performance
reports
• Explain how data quality errors occur
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The Role of the DTMU
The role of the South East Drug Treatment
Monitoring Unit (DTMU) is to communicate the
ever-changing data collation agenda to key
stakeholders, whilst supporting drug treatment
agencies in the collection and management of
client data.
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SE NDTMS Team
Based in Oxford
Team consists of:
Kellie Peters
Regina Lally:
Sue Dales:
Lucy Nicholson:
Marta Szczepaniak:
Rachel Johnson:
Head of Data Management
Manager
Data Manager
Data Manager
Information Analyst
Information Analyst
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NTA-DTMU Relationship
Department
of Health
NDEC
ONS
NTA
Regional
NTA
Abbreviation Guide
DAAT: Drug & Alcohol
Action Teams
DTMU
DTMU: Drug Treatment
Monitoring Unit
DAAT
NTA: National Treatment
Agency
NDEC: National Drug
Evidence Centre
Agency
Agency
Agency
ONS: Office of National
Statistics
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Client Treatment Journey Diagram
Client makes contact with a service provider (Tier 1, 2 or 3)
Engagement
Screening and briefing initial risk assessment
Delivery
Triage and brief initial risk assessment
Completion/
Maintenance /
Reintegration
Key working conducted in conjunction with care
planned phase of the treatment journey
Initial care plan focusing on engagement and initial needs (if required)
Comprehensive assessment and risk assessment
(may involve other service providers)
Comprehensive care plan developed by key worker and client.
Goals identified in one or more of the four key domains
Delivery phase of treatment journey (in conjunction with key working)
Care plan review (if more than one agency/service involved in care
delivery then all involved in care plan review)
Treatment completion or maintenance
to include further work to assist client integration into the community
Discharge plan
Discharge plan implemented
Discharge
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NDTMS Data Items
Client Information
Episode Information
Modality
Information
TOP
Information
Episode Information
Modality
Information
TOP
Information
Modality
Information
TOP
Information
Modality
Information
TOP
Information
Modality
Information
TOP
Information
Modality
Information
TOP
Information
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Key Fields
Agency ID: P0000
Referral Date: 10/06/2011
Assessment Date: 13/06/2011
First Initial: A
Main Problem Substance: Heroin
Second Initial: W
DAT of residence: West Sussex
DOB: 22/10/1973
Local Authority: Worthing
Gender: Male
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Referral Date Definition
• Referral date:
• (referral to agency date) date when the agency
becomes aware that the client is waiting.
• Date of receipt of phone-call, letter, client walks
through door asking to be seen etc.
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Other Client Information
Client Ref: 123
Ethnicity: Indian
Nationality: IND
Postcode: ME14 1HH
GP Practice Code: A00000
Referral Source: Self
Previously Treated: No
Consent for NDTMS: Yes
PCT of residence: Worthing
and Arun PCT
Sexuality: Not Recorded
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Consent
Clients should give written consent to share
information about their care plan. This consent should
specifically state which agencies the client consents to
have information received about them and which they
do not. A form recording the client’s consent
should be kept in the notes. Consent should be
reviewed at the time of reviewing the care plan.
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Confidentiality
• Agencies should have clear policies about how
assessment information and care plans are shared.
• Good information sharing protocols help the care
planning process to be smoother and prevent the holdups and misunderstandings that might arise if all the
relevant information for the client was not available to
practitioners and key workers in different agencies.
(Good practice in care planning, July 2007 NTA)
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NTA Confidentiality Toolkit
Confidentiality policy should be clearly explained
to client (verbally and written form), before
assessment for treatment.
Should cover:
• What information will be collected by the agency
• When and what information will be shared with
other services and organisations
• Who information will go to and why (NDTMS)
• When the confidentiality may be breached
(NTA Confidentiality Toolkit, 2009 NTA)
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Client Treatment Journey Diagram
Client makes contact with a service provider (Tier 1, 2 or 3)
Engagement
Screening and briefing initial risk assessment
Delivery
Triage and brief initial risk assessment
Completion/
Maintenance /
Reintegration
Key working conducted in conjunction with care
planned phase of the treatment journey
Initial care plan focusing on engagement and initial needs (if required)
Comprehensive assessment and risk assessment
(may involve other service providers)
Comprehensive care plan developed by key worker and client.
Goals identified in one or more of the four key domains
Delivery phase of treatment journey (in conjunction with key working)
Care plan review (if more than one agency/service involved in care
delivery then all involved in care plan review)
Treatment completion or maintenance
to include further work to assist client integration into the community
Discharge plan
Discharge plan implemented
Discharge
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Care Planning
“As soon as possible, the allocated key worker will
ensure that the client undergoes a comprehensive
assessment of needs. Following this a comprehensive
care plan is drawn up”.
“…all clients need a comprehensive care plan if they are
to receive standard treatment interventions”.
(Care Planning Practice Guide, August 2006, NTA)
ALL CLIENTS THAT START A MODALITY MUST
HAVE A CARE PLAN START DATE – THIS IS
MONITORED WITHIN THE NTA QUARTERLY
PERFORMANCE REPORTS
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Care Planning Domains
Care Plan Start Date: 13/06/2011
Drug & Alcohol Use
Route of Administration of Primary Substance: Oral
Age of first use of Primary Substance: 23
Problem Substance Two: Alcohol
Problem Substance Three: Amphetamines Unspecified
Injecting Status: Never
Injected in last 28 Days: No
Ever shared: No
Drinking Days: 28
Units of Alcohol: 50
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Care Planning Domains
Physical & Psychological Health
Hep C Tested: Yes
Hep C Latest Test Date: 01/01/2011
Hep C Intervention Status: Offered and accepted
Hep C Positive: No
Hep B Intervention Status: Offered and accepted
Hep B Vaccination Count: One vaccination
Previously Hep B Infected: No
Referred to Hepatology: No
Dual Diagnosis: No
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Care Planning Domains
Social Functioning
Employment Status: Unemployed
Accommodation Need: Housing Problem
Children: 3
Pregnant: Yes
Parental Status: Not a parent
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Parental Status
To clarify reference values:
All the children live with the client*
Some of the children live with the client*
None of the children live with client
Not a parent
Client declined to answer
*Co-habiting for a minimum of one month
Children = under 18
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Drug Treatment
Healthcare Assessment
“As part of their assessment and care plan, all drug users
require a general healthcare assessment, which appraises
and responds to...their risk of…injecting-related wound
infection, blood borne viruses, overdose… sexually
transmitted disease or poor dental health..”
NTA General Healthcare Assessment Guidance,
August 2006, NTA
THIS FIELD IS MONITORED WITHIN THE NTA
QUARTERLY PERFORMANCE REPORTS
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Client Treatment Journey Diagram
Client makes contact with a service provider (Tier 1, 2 or 3)
Engagement
Screening and briefing initial risk assessment
Delivery
Triage and brief initial risk assessment
Completion/
Maintenance /
Reintegration
Key working conducted in conjunction with care
planned phase of the treatment journey
Initial care plan focusing on engagement and initial needs (if required)
Comprehensive assessment and risk assessment
(may involve other service providers)
Comprehensive care plan developed by key worker and client.
Goals identified in one or more of the four key domains
Delivery phase of treatment journey (in conjunction with key working)
Care plan review (if more than one agency/service involved in care
delivery then all involved in care plan review)
Treatment completion or maintenance
to include further work to assist client integration into the community
Discharge plan
Discharge plan implemented
Discharge
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Modality Data
Referral Date: 10/06/2011
Triage Date: 13/06/2011
Referral Source: Self
Referral Date: 05/08/2011
Triage Date: 13/08/2011
Referral Source: GP
Referral to Modality Date: 10/06/2011
Date of First Appointment Offered:
20/06/2009
Modality: Family Therapy
Referral to Modality Date: 02/07/2011
Date of First Appointment Offered:
01/09/2011
Modality: Specialist Prescribing
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Date Referred to Modality
This date for the first modality / intervention should be thought of as
the date a client is first referred for Tiers 3 or 4 treatment.
This field will also be used to record the start of the wait for any
subsequent modalities / interventions within the episode. It should
again be used as defined within the waiting times guidance notes,
as the date that the referral for this subsequent modality /
intervention was agreed with the client.
Waiting times for Tiers 3 and 4 will be measured from the date
entered in this field.
If Modality is entered, Date Referred to Modality must be present
and vice versa.
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Date of First Appointment Offered
This is the first suitable appointment date for the
modality/intervention, as agreed with the client.
The date of first appointment offered may be the same as the actual
modality / intervention start date, but this may not always be the
case (e.g.. if the client fails to attend the first appointment).
Enter date of first appointment offered when it is actually offered to
the client.
Do not enter Modality start date until the client actually attends
an appointment.
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Modality Data
Referral to Modality Date: 10/06/2011
Date of First Appointment Offered: 20/06/2011
Modality: Other Formal Psychosocial Therapy
Modality Start Date: 20/06/2011
Modality End Date: 25/09/2011
Modality Exit Status: Mutually agreed planned exit
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Client Treatment Journey Diagram
Client makes contact with a service provider (Tier 1, 2 or 3)
Client wait starts as referred to
Tx system
Screening and briefing initial risk assessment
Triage and brief initial risk assessment
Wait for 1st
Modality
Key working conducted in conjunction with care
planned phase of the treatment journey
Initial care plan focusing on engagement and initial needs (if required)
Comprehensive assessment and risk assessment
(may involve other service providers)
Client offered appointment to
start modality and accepts.
Comprehensive care plan developed by key worker and client.
Goals identified in one or more of the four key domains
Delivery phase of treatment journey (in conjunction with key working)
Client attends appointment &
starts first modality.
End of wait
Care plan review (if more than one agency/service involved in care
delivery then all involved in care plan review)
Treatment completion or maintenance
to include further work to assist client integration into the community
Discharge plan
Discharge plan implemented
Discharge
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Waiting Times
Referral to Modality Date: 10/06/2011
Date of First Appointment Offered: 20/06/2011
Modality: Other Formal Psychosocial Therapy
Modality Start Date: 20/06/2011
Referral to Modality Date: 02/07/2011
Date of First Appointment Offered: 01/09/2011
Modality: Specialist Prescribing
Modality Start Date: 07/09/2011
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Waiting Time:
10 days
Waiting
Time:
61 days
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Client Treatment Journey Diagram
Client makes contact with a service provider (Tier 1, 2 or 3)
Screening and briefing initial risk assessment
Triage and brief initial risk assessment
Key working conducted in conjunction with care
planned phase of the treatment journey
Initial care plan focusing on engagement and initial needs (if required)
Comprehensive assessment and risk assessment
(may involve other service providers)
Comprehensive care plan developed by key worker and client.
Goals identified in one or more of the four key domains
Delivery phase of treatment journey (in conjunction with key working)
Care plan review (if more than one agency/service involved in care
delivery then all involved in care plan review)
Treatment completion or maintenance
to include further work to assist client integration into the community
Client & key worker agree
subsequent modality. Wait starts.
Date referred to modality
Client offered appointment &
accepts
Wait for subsequent
modality
Client misses appointment.
End of Wait
Assuming…
Discharge plan
Client starts modality at next /
future agreed appointment.
Discharge plan implemented
Discharge
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Waiting Times:
Subsequent Interventions
Referral to Modality Date: 30/06/2011
Date of First Appointment Offered: 07/07/2011
(Subsequent) Modality: Residential Rehabilitation
Modality Start Date: 07/07/2011
Referral to Modality Date: 30/09/2011
Date of First Appointment Offered: 08/11/2011
(Subsequent) Modality: Structured Day Programme
Modality Start Date: 08/11/2011
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Waiting Time:
7 days
Waiting Time:
39 days
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Inpatient treatment Assessment Only
Individuals with drug and alcohol dependence present with a wide range of
psychiatric, physical and social problems.
Substance misuse services provide a comprehensive assessment of these needs and
formulate a treatment care plan to tackle them.
A hospital setting permits a higher level of medical observation, supervision and safety
for service users needing more intensive forms of care. Specific tasks of the IPU may
include:
• Assessment of substance use
• Assessment of mental health
• Assessment of physical health
• Assessment of social problems
These should be undertaken as described in the Inpatient Treatment of Drug and
Alcohol Misusers in the National Health Service – Scan consensus project (2006).
This document is available at using the following link.
http://www.scan.uk.net/docstore/SCAN_Inpatient_Consensus_project_document_FINAL.pdf
July 6, 2015
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Inpatient treatment Stabilisation
There is considerable evidence that the number of service users with more complex
problems (coexisting physical and mental illness, dependence on more than one
substance) is increasing. Such cases can be managed in a community setting, but the
IPU setting permits a high level of medical observation, supervision and safety for
service users needing more intensive forms of care.
The IPU should have care pathways, clinical protocols, and sufficient human and
physical resources to offer the following range of stabilisation procedures:
1. Dose titration
2. Dose titration on injectable opioid medication
3. Stabilisation on maintenance therapy
4. Combination assisted withdrawal/stabilisation
July 6, 2015
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Inpatient treatment Detoxification
Assisted withdrawal should only be encouraged as the first step in a longer treatment
process, and needs to be integrated with relapse prevention or rehabilitation treatment
programmes which can be provided in the NHS or independent/non-statutory sector.
Withdrawal in an IPU setting offers better opportunities for clinicians to ensure
compliance with medication and to manage complications. IPU admission also offers a
major opportunity to recruit service users into longer-term treatment to reduce the risk
of relapse back into regular drug or alcohol use.
The IPU should have care pathways, clinical protocols, and sufficient human and
physical resources to offer assisted withdrawal for a wide range of single and polydrug and alcohol misuse problems.
July 6, 2015
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Inpatient treatment
• Inpatient treatment Assessment Only
• Inpatient treatment Stabilisation
• Inpatient treatment Detoxification
July 6, 2015
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Psychosocial interventions
•
Behavioural couples therapy
•
Family therapy
•
Contingency management (drug specific)
•
Psychosocial interventions to address common
mental disorders
•
Other formal psychosocial therapy (e.g. community
reinforcement approach or social behaviour network
therapy)
•
Structured Day Programme
July 6, 2015
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Other Adult Modalities
• Specialist prescribing
• GP Prescribing
• Residential Rehabilitation
July 6, 2015
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Adult Alcohol Modalities
Tier 3
Tier 4
• ALC - Community
Prescribing
• ALC - Structured
Psychosocial Intervention
• ALC - Structured Day
Programme
• ALC - Other Structured
Treatment
ALC - Inpatient Treatment
ALC - Residential Rehabilitation
Tier 2 (New)
• ALC – Brief Interventions
• Will NOT count towards
numbers in Treatment.
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Continuity of care planning
If a client is transferred, either to another
agency or from secondary to primary care, the
care plan can be forwarded to the new service
or practitioner to facilitate communication.
This can be done using the written care plan
record.
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Client Treatment Journey Diagram
Client makes contact with a service provider (Tier 1, 2 or 3)
Engagement
Screening and briefing initial risk assessment
Delivery
Triage and brief initial risk assessment
Completion/
Maintenance /
Reintegration
Key working conducted in conjunction with care
planned phase of the treatment journey
Initial care plan focusing on engagement and initial needs (if required)
Comprehensive assessment and risk assessment
(may involve other service providers)
Comprehensive care plan developed by key worker and client.
Goals identified in one or more of the four key domains
Delivery phase of treatment journey (in conjunction with key working)
Care plan review (if more than one agency/service involved in care
delivery then all involved in care plan review)
Treatment completion or maintenance
to include further work to assist client integration into the community
Discharge plan
Discharge plan implemented
Discharge
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Discharge Data
Discharge Date
Discharge Reason
If a Discharge Date is entered, then a Discharge
Reason must be given and vice versa.
Discharge information must be reported accurately
and in a timely fashion as it is used to calculate In
treatment Rates.
Modality End Date (s) must be populated for
discharged clients.
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Drug Discharge Reasons
Successful Completions
• Treatment completed - drug free
• Treatment completed - occasional user (not
opiates or crack)
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Drug Discharge Reasons
Transfers
• Transferred – not in custody
• Transferred – in custody
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Drug Discharge Reasons
Incomplete
• Incomplete – Dropped Out
• Incomplete – Treatment withdrawn by provider
• Incomplete – Retained in Custody
• Incomplete – Treatment Commencement
Declined by Client
• Incomplete – Client Died
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Alcohol Discharge Reasons
Successful Completions
• Treatment completed - alcohol free
• Treatment completed - occasional user
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Alcohol Discharge Reasons
Transfers
• Transferred – not in custody
• Transferred – in custody
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Alcohol Discharge Reasons
Incomplete
• Incomplete – Dropped Out
• Incomplete – Treatment withdrawn by provider
• Incomplete – Retained in Custody
• Incomplete – Treatment Commencement
Declined by Client
• Incomplete – Client Died
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What is the TOP?
Treatment Outcomes Profile
• An instrument to measure treatment outcomes
• A simple, short set of questions
• To plot clients’ progress through structured
treatment - a measure of how well clients do in
treatment
• Reported to NDTMS
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Treatment Outcomes Profile
Validated for clients with Alcohol as main
problem substance.
No requirement by NTA to complete TOPs at
Alcohol Only agencies.
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When should the TOP be completed?
At start of new treatment journey
• to capture pre-treatment snapshot of client behaviour and
situation
And then every three months
• usually as part of a care plan review - to compare with
pre-treatment snapshot and previous quarterly TOP results
(Also on existing clients every three months)
At Treatment Exit
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Discharge Data and TOP
Complete TOP at discharge from treatment
system
This should be done face-to-face between key worker
and client where possible
May be done over telephone where no other option
available (i.e. in unplanned discharges)
NOT acceptable to complete on clients’ behalf without
client present
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Confidentiality
TOP data submitted via NDTMS will have the same
safeguards in relation to confidentiality as any
other NDTMS data
This should be carefully explained to the client and
local confidentiality agreements should be
modified as appropriate to take into account the
introduction of TOP into clinical and reporting
systems
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Three types of questions
Yes and no
a simple tick for yes or no
Timeline
the client recalls the number of
days in each of the past four
weeks on which they did
something, e.g. the number of
days they used heroin
Rating scale
a 20-point scale from poor to good.
Together with the client, mark the
scale in an appropriate place
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Completion and non-responses
Ask every question, complete every blue box
Enter "NA" in the blue box:
• if client refuses to answer a question
• or if, even after prompting, client cannot recall
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TOP NDTMS Data
You should aim to ask
and complete every
question.
Do not leave any of the
blue boxes blank
Enter “NA” if a client
refuses to answer a
question or cannot
recall.
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TOP NDTMS Data
Modality Start Date: 09/09/2011 [Trigger for first TOP]
TOP Date: 09/09/2011
TOP Treatment Stage: Treatment Start
TOP Care Co-ordination: Yes
When multiple agencies are providing treatment, it is
envisaged that responsibility for reporting TOP data will lie
with the agency responsible for
care co-ordination.
DAATs should have agreed care co-ordination pathways locally.
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TOP NDTMS Data
Section 1: Substance Use
Alcohol Use: 15
Opiate Use: 0
Crack Use: 0
Cocaine Use: 15
Amphetamine Use: 4
Cannabis Use: 10
Other drug use: 0
Information sought:
Number of days out of last 28 client
has used each drug.
Permissible values:
Number in range “0-28”
“NA” if client is unable to or refuses
to answer question
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TOP NDTMS Data
Section 2: Injecting Risk Behaviour
Injecting Drug Use: 0
Information sought:
Number of days out of last 28 client has injected non-prescribed
drugs.
Permissible values:
Number in range “0-28”
“NA” if client is unable to or refuses to answer question
Sharing: N
Information sought:
Has client shared needles or paraphernalia in last 28 days.
Permissible values:
Y or N
“NA” if client is unable to or refuses to answer question
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TOP NDTMS Data
Section 3: Crime
No details of specific crimes should be shared by client with
keyworker
General information about type of crimes funding drug or
alcohol habit should be shared and recorded to address all
client needs and evidence improvement in lifestyle
The information shared with NDTMS is subject to the same
confidentiality as all client information currently and
previously received
Data is used for performance / outcome monitoring only
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Section 3: Crime
Needs special handling concerning
confidentiality e.g.
“I am now going to move on to ask you some questions
about things you may have done in the past four weeks that
are against the law. Clients have obvious concerns about
confidentiality and I want to stress that we ask all our clients
these questions - as do treatment services all over the
country and the information is used to help us see if and
how treatment leads to change in crime. I am not asking for
any details - just general information about how often or
whether you did certain things.”
- TOP Key worker Guidance, NTA
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TOP NDTMS Data
Section 3: Crime
Shop Theft: 18
Drug Selling: 6
Information sought:
Number of days out of last 28 client has been involved in each crime.
Permissible values:
Number in range “0-28”
“NA” if client is unable to or refuses to answer question
Other theft: Y
Assault / Violence: N
Information sought:
Has client been involved in each crime in last 28 days.
Permissible values:
Y or N
“NA” if client is unable to or refuses to answer question
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TOP NDTMS Data
Section 4: Health & Social Functioning
Psychological Health Status: 9
Information sought:
Self reported score from scale.
Permissible values:
Number in range “0-20”
“NA” if client is unable to or refuses to answer question
Paid work: 3
Education: 1
Information sought:
Number of days out of last 28 client has had paid work or been in education.
Permissible values:
Number in range “0-28”
“NA” if client is unable to or refuses to answer question
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TOP NDTMS Data
Section 4: Health & Social Functioning
Physical Health Status: 5
Quality of Life: 4
Information sought:
Self reported score from scales.
Permissible values:
Number in range “0-20”
“NA” if client is unable to or refuses to answer question
Acute Housing Problem: N
Housing Risk: Y
Information sought:
Client has been homeless / risk of eviction in last 28 days.
Permissible values:
“Y” or “N”
“NA” if client is unable to or refuses to answer question
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ANY QUESTIONS
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Report Purpose
Identify monthly / quarterly progress against
yearly targets
Delivery Assurance at DAAT and Agency Level
Assist in Service or Contract Reviews
Agencies can access copies of their quarterly
reports on DAMS under the reports section
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Key Definitions
In Effective Treatment
Clients in contact with Tier 3 / 4 Services:
Modality start date has been populated
In treatment for 12+ weeks from Triage date
Planned discharge if prior to 12 weeks • Treatment Completed Drug Free OR
• Treatment Completed (occasional user)
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Key Definitions
Opiate and/or Crack User (OCU)
Client presenting with opiates and / or crack cocaine as their
main, 2nd or 3rd drug
Clients of all ages are included
Where Alcohol is indicated to be the main drug, the client is
excluded from the calculation even if opiates and / or crack
cocaine are indicated as 2nd or 3rd drugs.
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Key Definitions
Age is calculated at mid-point of the financial
year: 30th September
Adult
Clients 18 or over on this day are counted as adults
Young Person
Clients 17 or under on this day are counted as Young People
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Key Definitions
Year to Date (YTD)
Start of current financial year (1st April) to latest
quarter end
Reporting Period (Dates Given)
Usually 12 months
e.g. 01/07/07 – 30/06/2008
Current Quarter
Beginning to end of quarter being reported on
e.g. Quarter 2 = 1st July – 30th September
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Key Definitions
Figures may be based on:
Individuals
e.g. PDUs in Effective Treatment
Episodes
e.g. Planned Exits from Treatment System
Modalities / Interventions
e.g. Waiting Times
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Stop… Think…
Differing criteria for figures usually means that
numbers can not be added/subtracted to make
another number
Cohort of clients being considered changes
throughout the different areas of the reports
Agencies may not report exactly as
commissioned, so unexpected figures may
indicate erroneous reporting
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Access to…
NDTMS.net
Administered by NDEC
Contact through “Contact Us” link on website: www.ndtms.net
DAMS
Administered by DTMU for SE Region
Contact Sue Dales: [email protected]
South East Secure Drop Box
Administered by DTMU for SE Region
Contact Sue Dales: [email protected]
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www.ndtms.net
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Improving Service Provision
“Drug treatment services are managed using
close to “real-time” data provided from the
NDTMS and client satisfaction and client
outcome data”
(Models of Care: Update 2005, Consultation)
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How can you improve your
agency’s data quality percentage?
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DTMU Data Quality Standards
All monthly agency submissions must contain at
least 100% valid records.
All monthly agency submissions must reach 99.5%
data quality
All fields of CDS-H populated, if appropriate.
Files must be in a CSV format.
All agencies must submit via the Drug & Alcohol
Monitoring System:
https://www.ndtms.org/dams/
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ANY QUESTIONS
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