Transcript Slide 1

NDTMS~TOP & YP Services
NDTMS~TOP
Young People Services
April 2009
Jill Smith
NEPHO – NDTMS Team
NDTMS – Why Bother?
• Government
• Drives PSA 14 and 25 (numbers in treatment include YP aged
16-18 in specialist drug or alcohol treatment) as part of the
delivery for National Drug Strategy 2008-2011
• NTA view
– More treatment, better treatment, fairer treatment
• DAT view
– Essential to Needs Analysis process
– Informs planning & commissioning
– Hidden Harm: ineffective if sparse data input
• Treatment Service view
– Preserve budgets funding treatment
– Evidence for effective/innovative practices
NDTMS – History
Began collecting performance data on treatment of
• adult problem drug users,
• then YP drug & alcohol misusers,
• 2005 YP dataset made available
• 2006 NTA Memorandum of Understanding
Defines roles for delivery assurance of YP Services
• adult alcohol April 2008
• changes re discharge destination, etc August 2008
• CDSF – many changes for YP Services
NDTMS
National Drug (and Alcohol) Treatment Monitoring System
– Client details
– Episode details
– Treatment modality/intervention details
– Treatment outcome Profiles (TOP) details
– Local Regional fields
NDTMS – Core Dataset ‘F’
National Drug (and Alcohol) Treatment Monitoring System
•
•
•
•
•
Number of fields has expanded and changed
Reference options within fields have expanded and
changed
Additional services completing NDTMS
Additional Government Departments involvement
Now on Core Dataset F
Where to begin?
NDTMS – Adult/YP/Alcohol??
WHAT CONSTITUTES YP SERVICES?
Adult, Alcohol or YP Datasets?
• Transitional arrangements – special needs
• Adult service working with <18s
• YP services working with =>18s
It is the service, not the client
which determines dataset to select
NDTMS – It is Not……
• The YOT ASSET tool is not detailed enough to inform a specialist
SM care plan and cannot be used as a comprehensive SM
assessment tool
• YOT targets/performance rules and definitions are different to
NDTMS
• Treatments to address SM as it interrelates with offending
behaviour are expected to be included within Psychosocial
Interventions and YP Criminal Justice Interventions has been
removed
• Interventions for children with parents who have SM issues should
not be recorded unless they relate to the child’s own SM issue
NDTMS – It is……
“YP’s specialist SM treatment is a care planned
medical, psychosocial or specialist harm reduction
intervention aimed at alleviating current harm caused by
a YP’s SM”.
Foundation for all interventions:
• Comprehensive assessment
• Care plan
• Care Co-ordination by a ‘lead professional’
NDTMS – Confidentiality & Consent
CONFIDENTIALITY AND CONSENT
• Various documents supporting YP services are
available
• All services should have clear policies
a) Confidentiality and information sharing
• Agreed by Local Safeguarding Children’s Boards
b) Consent to treatment, and
c) Child protection
NDTMS – Basics
Basics: Data Completion
•
•
•
•
All fields should be completed
Some fields should be reviewed
Some fields should be completed at discharge
Some fields can be completed after discharge
• Garbage in ~ Garbage out
Analysis and information jeopardised
when fields left blank
NDTMS – Basics
Basics: Understand the Questions
The NTA Business Definition and Reference Data Documentation is
important and changes as understanding of usage and meaning develops
NDTMS – Basics
Basics: Get hold of the documentation
NTA WEBSITE FOR DOCUMENTATION:http://www.nta.nhs.uk/areas/ndtms/core_da
ta_set_page.aspx
NB: Awaiting revised guidance for
young persons' treatment providers
NDTMS – YP Interventions
• 6 YP Interventions
• First four describe the delivery:• Psychosocial Intervention
• Specialist Harm Reduction (Including injecting
behaviour, overdose and accidental injury advice)
• Family Work (Only if YP is in specialist SM treatment)
• Pharmacological Interventions
• Fifth describes setting:
• Access to Residential Treatment
• Sixth is for Tier 2 only (optional)
• Non structured intervention
Use of combined Tier 2 and Tier 3 interventions can lead to performance
measurement errors with serious consequences
NDTMS –YP
YP Dataset
1 Dates - Time is of the essence!:
More often than
not referral date, triage date, care plan start date and
intervention start date should be the same for YP services
2 Accommodation Need: Specific set of 8 YP codes.
NFA then leave postcode blank but complete DAT of
residence for treatment provider (if Tier 3) or referring
partnership (if Tier 4) and leave PCT of residence blank
If
NDTMS – YP
3. Parental Status?
Now expanded. Includes biological, step-, foster, adoptive,
guardians to include any parenting where a client has full or partial
parental responsibilities and is living with that child(ren) for a
minimum of one month – see separate Appendix K in business
definitions. Children defined as <18.
• All the children live with the client
• Some of the children live with client
• None of the children live with client
• Not a parent
• Client declined to answer
NDTMS – YP
4. Children Living with:
Count all children, at all addresses. Include siblings,
landlord’s children, etc. Children are defined as <18.
Children’s Home: Only count family/siblings living with client
5. Pregnant: Ask! Record N for males.
6. Problem Substance No. 1: The substance that
brought YP into treatment – drugs or alcohol. If more
than one, provider to determine which is primary.
NDTMS – YP
7. Referral Source: Raised focus of attention by DCSF.
Now 26 different sources, categorised into 5 groups and
providing information about integration of
treatment/children and family services. See later.
8. Injecting Status & BBV: Endeavour to complete but
record in case notes if assumptions around e.g. noninjecting behaviour are made and questions not asked.
New: Assessed as not appropriate to offer
9. Employment Status: 8 options available. Only use
Unemployed for adults attending YP services
NDTMS – YP
10. Drug treatment health care assessment date: –
Young People Treatment providers should only record a date when a
young person receives an assessment from a health clinician such as
a Nurse, Doctor or Psychiatrist AND when the assessment relates
specifically to their substance misuse such as in relation to clinical
management, issues arising from injecting behaviour, blood borne
viruses or dual diagnosis. Providers should refer to Assessing Y P for
substance misuse 2007 for guidance on when it is appropriate for a
young person to be assessed by a health clinician.
• Further guidance in relation to health care assessments for young
people will be published alongside the forthcoming harm reduction
guidance by the end of 2009.
NDTMS – YP
11. TOP: Only complete for YP =>16. NB: use of NA/Zero
and collection of crime data.
12. Discharge Date: Date is last face-to-face contact.
Discharge c.2 months after DNA and no contact.
Note: If client goes into custody for <21 days, then do not
discharge but continue episode and there is no need for
TOP Exit~TOP Start.
NDTMS – Core Dataset ‘F’
1. New Fields 1st April 2009
a) Treatment Start and Treatment End
– YP has lead professional?
This refers to the professional who as part of the CAF
process has been appointed to act as a single point of
contact and coordinate provision for a child and their
family when a range of services are involved and an
integrated response is required
– YP in contact with mental health services?
This refers to a young person who is currently in contact
with either inpatient or outpatient Mental Health Services
NDTMS – Core Dataset ‘F’
1. New Fields
a) Treatment Start and Treatment End
– YP in contact with YOT?
This refers to a young person who is currently in contact
with the Youth Offending Team as a result of receiving a
reprimand or final warning, acceptable behaviour
contract (ABC), anti social behaviour order (ASBO) or
community sentence
NDTMS – Core Dataset ‘F’
1. New Fields……
a) Treatment Start and Treatment End
– Involved in Sexual Exploitation?
“Children, both male and female, engaging in sexual
activities for money, profit, or any other consideration
due to coercion or influence by any adult, syndicate or
group. The profit could go either to the child or to any
third party involved in the transaction.”
This refers to a young person’s current involvement, or
suspected involvement in activities such as prostitution,
production of pornography, or age inappropriate
relationships with adults
NDTMS – Core Dataset ‘F’
1. New Fields……
a) Treatment Start and Treatment End
– Involved in Unsafe drug use?
“Substance use related behaviour that disproportionately
increases the magnitude of physical, emotional or social
harm to the young person taking the substance”
Examples include the use of particularly hazardous routes
of administration such as injecting; the use of substances
in particularly high quantities and/or in combination or
the use of substances alone or with older people.”
This refers to a young person’s current involvement or
suspected involvement in unsafe drug and alcohol related
activities such as binge drinking, poly drug use, sharing of
injecting equipment, being injected by someone else or
solvent abuse
NDTMS – Core Dataset ‘F’
1. New Fields……
a) Treatment Start and Treatment End
– Involved in Offending?
This refers to a young person’s current involvement or
suspected involvement in activities which may or may not
have come to the attention of the police, YOT or local
authority. Examples include stealing money from parents
or friends, shoplifting, drug selling, street drinking (in
alcohol restricted zones), graffiti and vandalism
NDTMS – Core Dataset ‘F’
1. New Fields……
a) Treatment Start and Treatment End
– YP Self-harming?
“Self - poisoning or self - injury, irrespective of the
apparent purpose of the act”
This refers to a young person’s current involvement or
suspected involvement in activities such as cutting,
burning, banging, hair pulling or poisoning. This includes
accidental and non - accidental overdose
NDTMS – Core Dataset ‘F’
1. New Fields…….
b) Treatment Start only
– YP Education Status (=<16)?
This refers to a young person’s current educational
involvement.
Mainstream education
Alternative education
Temporarily excluded
Permanently excluded
Persistent absentee
includes schools, academies and further education colleges
includes schooling delivered within a pupil referral unit or home setting
refers to young people currently excluded from school on a temporary
basis for a fixed term (no more than 45 days a year)
refers to young people currently excluded from school where alternative
schooling arrangements have not yet been made
NDTMS – Core Dataset ‘F’
1. New Fields…….
b) Treatment Start only
– YP Involved in unsafe Sex?
This refers to a young person’s current or suspected
involvement in unsafe sexual activities such as
unprotected vaginal, anal or oral sex
– YP Parent in SM Treatment?
– YP Parent in MH Treatment?
These refer to a young person who has one or more
parent or guardian currently in contact with treatment
services to address their drug or alcohol problems or
their mental health problems
NDTMS – Core Dataset ‘F’
1. New Fields…….
c) Treatment Exit only
– YP has a CAF?
This refers to a young person who has been identified
as requiring additional needs and assessed using the
Common Assessment Framework at the point of
discharge
– YP safer sex?
This refers to a young persons current involvement in
unsafe sexual activities such as unprotected vaginal,
anal or oral sex at the point of discharge
NDTMS – Core Dataset ‘F’
1. New Fields…….
c) Treatment Exit only
– YP sexual health interventions?
This refers to a young person who has been directly
offered, or offered access to a sexual health
intervention. These can include STI screening, pre and
post test counselling, advice on safer sex, contraception
(i.e. condoms), or pregnancy testing
NDTMS – Core Dataset ‘F’
1. New Fields…….
c) Treatment Exit only
– YP registered with GP
This refers to a young person who has registered with a
General Practitioner since the point of treatment entry
– YP met goals on Care Plan
This refers to a young person who has met the main
goals of their care plan at treatment exit
NDTMS – Core Dataset ‘F’
2. TOP / Care Coordination flag
Does the treatment provider currently have care coordination
responsibility for the client in regards to completing the TOP
information when appropriate, during the client’s time in structured
treatment?
One service to manage TOP process
(agreed at a local Treatment System level)
One set of TOPs for one episode of care
Consent for sharing TOP process data
NDTMS – Core Dataset ‘F’
2. TOP / Care Coordination flag
Recent enquiry received by NDTMS team:
Re top coordination surely ALL providers are required to fill in
a care plan for their organization and if they do who decides
who is the overall care coordinator?
Care Planning is not the same as Care Coordination
Decisions about Care Coordination have to be made at a local
level and even then there must be ongoing communication
between services to ensure all the clients’ needs are being met
NDTMS – Core Dataset ‘F’
• COMFORT BREAK?……………
NDTMS – Core Dataset ‘F’
3. Reference data changes
a) Referral Date/Referred to Intervention Date?
• Clarification of need for 2-way communication:
• Referral date: when the service and YP agreed to referral
• Referred to Intervention Date: when keyworker and YP
agreed to treatment
Understanding is important as this information is linked to the
performance of services in YP being assessed within 5 days of
referral.
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
b) Referral Source
Child and Family Services
CLA - Children Looked After
Children and Family Services
Universal Education
Alternative Education
Targeted Youth Support
Outreach
Helpline (NEW)
Referrals from main stream or universal educational
services such as schools, colleges and universities
Referrals from Pupil Referral Units and other alternative
education services for excludees and truants and or any
young people who cannot access universal education
provision for any reason
Referrals from services providing prevention or early
intervention or support services for vulnerable young
people.
Services which provide active outreach to address
homelessness, anti-social behaviour, or sex work and
other issues
Referrals from help lines apart from FRANK and other
local or regional substance misuse initiatives
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
b) Referral Source
Health and Mental Health Services
GP
Direct referrals from General Medical Practitioners who
are not formally part of a treatment provider
A&E (NEW)
Accident and Emergency
Hospital (CHANGED)
Referrals from Hospitals not including A&E departments
Non Child Mental Health
Mental health services such as adult psychiatric and
Services
psychological services; private psychiatric and
psychological services and third sector mental health or
advocacy services for people with mental health needs
Primary Care (NEW)
Children’s Mental Health
Services
School Nurse (NEW)
Referrals from services delivered by health care
professionals such as practice nurses, midwives and
pharmacists in general medical settings such as walk in
centres and pharmacies
Both inpatient and outpatient Child and Adolescent
Mental Health Services. This includes referrals from
mental health services that work across the age range
(i.e.16 - 25) such as early interventions teams
Referrals from services delivered by registered nurses
within the school setting
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
b) Referral Source
Substance Misuse Services
Adult Treatment Provider
Services providing drug or alcohol treatment services
predominantly for those aged 18 years or older. This
includes needle exchange programmes and other
services to address adult substance misuse.
Young People’s Treatment
Services providing specialist substance misuse
Provider
treatment services pre-dominantly for those under 18.
Non Treatment substance
misuse services
Referrals from young people specific services providing
universal, targeted or early interventions to address
substance misuse. Young people specific services which
provide both treatment and non - treatment
interventions should use this code when referring clients
to the treatment elements of their programmes.
FRANK (NEW/CHANGED)
Referrals from the Talk to FRANK helpline
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
b) Referral Source
Arrest Referral/DIP &Community Sentence=Removed
Criminal Justice
Crime Prevention
(CHANGED)
YOT (NEW)
Custody Service
Post Custody
Services working with young people identified as at risk
of offending and who are not due to attend court and
are not currently under sentence such as Youth
Inclusion Programmes (YIPs), Youth Inclusion Support
Panels (YISPs) or any arrest referral schemes in
operation
Referrals from Youth Offending Teams for clients who
are expecting to receive treatment as part of court
ordered sentence arrangements
Custodial providers for young people who are currently
on a custodial sentence and expect to be receiving
substance misuse treatment from a NDTMS registered
community provider whilst in custody.
Services such as YOTs, RAPs or custodial providers of
young people who are currently on a custodial sentence
and are about to commence a community sentence.
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
b) Referral Source
Family and Friends
Self
Relative (NEW)
Concerned Others (NEW)
Website (NEW)
Young person with treatment needs has sought
treatment.
Parents, siblings other relatives
Carers, friends, boyfriends or girlfriends who are
connected to the young person in a personal rather than
a professional capacity have referred the young person
to treatment.
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
c) Discharge Reason (Separated from Discharge Destination)
Please note that different definitions will apply to the above codes
depending on the setting of treatment i.e. in YP providers or if the
client is being treated primarily for Alcohol.
YP Discharge Reason? – Planned
Treatment Completed Drug Free
this refers to a young person who no longer requires a structured drug
treatment intervention and is not using any substance. This includes
alcohol. It is likely that young people successfully leaving treatment will
continue to drink alcohol. Even if this is done within recommended alcohol
limits the young person should not be recorded in this section. See 2
below.
Treatment Completed
Occasional User (not
heroin or crack)
this refers to a young person who no longer requires a structured drug
treatment intervention There is evidence of occasional drug and/or alcohol
use (not heroin or crack) but this is not judged to be problematic
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
c) Discharge Reason
YP Discharge Reason? - Neutral
Transferred-Not in
Custody
Transferred-In Custody
The distinction between
In and Not in Custody
may be difficult to
determine in some
cases – more
clarification is being
sought.
this refers to a young person who has finished at this treatment provider
but still has a treatment need so is referred onto another community based
treatment provider. This code should only be used if the young person is
transferred from one specialist treatment provider to the another in a care
planned way
this refers to a young person who has received a custodial sentence or is
on remand and a continuation of structured treatment has been arranged.
This will consist of the appropriate onward referral and a two-way
communication between the community and secure setting to confirm
assessment and that care planned treatment will be provided as
appropriate
NDTMS – Core Dataset ‘F’
3. Reference data changes
c) Discharge Reason
YP Discharge Reason? - Unplanned
This option would also have to
be used if a client is still known
to be using crack/heroin, even
occasionally, at the end of
care-planned treatment.
the treatment provider has withdrawn treatment provision from the client.
Incomplete
This item could be used in cases where the client has seriously breached a
Treatment Withdrawn by
contract leading to their discharge. It should not be used if the client has
Provider
simply ‘dropped out’ see below
the treatment provider has lost contact with the client without a planned
Incomplete
discharge and activities to re-engage the client back into treatment have
Dropped Out
not been successful
Incomplete
Retained in Custody
Incomplete
Treatment
Commencement
Declined by the Client
Incomplete
Client died
the client is no longer with the treatment provider as they are in a secure
setting such as a Youth Offending Institution, Secure Training Setting or
Secure Children’s Home. While the treatment provider has confirmed this,
there has been no formal two-way communication between the treatment
provider and the criminal justice care provider leading to continuation of the
appropriate assessment and care-planned structured drug treatment
the treatment provider has had face to face contact with the client after
which the client has chosen not to commence a recommended structured
drug treatment intervention
during their time in contact with structured drug treatment the client died
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
c) Discharge Destination? (YP only)
These options refer to a young person, who at the end of the treatment episode is referred:Back to Referrer
back to the lead agency that originally referred them into specialist treatment
Generic Children’s Services onto Children and Family, Child Looked After or Universal Education services.
onto services providing prevention, early intervention or support for vulnerable
young people. This includes generic youth services providing Information, Advice
Targeted Youth Support
and Guidance, and targeted services such as Connexions and Positive Activities
for Young People
onto a Lead Professional. As part of the CAF process a lead professional takes
the lead to coordinate provision and acts as a single point of contact for a child
Lead Professional
and their family when a range of services are involved and an integrated
response is required
onto education services for young people who cannot access universal education
Alternative Education
provision for any reason.
this inpatient or outpatient Child and Adolescent Mental Health Services. This
Children’s Mental Health
includes referrals from mental health services that work across the age range
Services
(i.e.16-25) such as early interventions teams
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
c) Discharge Destination? (YP only)……
These options refer to a young person, who at the end of the treatment episode is referred:onto services working with young people identified as at risk of offending and who
Crime prevention
are not due to attend court and are not currently under sentence such as YIPs,
YISPs or any arrest referral schemes in operation
onto accommodation services specifically commissioned to meet the needs of
Accommodation Services
young people such as supported housing
onto services providing drug or alcohol treatment services predominantly for
Adult Treatment Provider
those aged 18 or over. This includes needle exchange programmes and other
services to address adult substance misuse
Other YP Treatment Service onto another young persons specialist treatment service
No Onward Referral
No Referral Required
is not referred back or onto other services at the end of the treatment episode.
who at the end of the treatment episode does not require an onward referral.
NDTMS – Core Dataset ‘F’
3. Reference data changes…..
d) Employment Status?
Removed: Not in Education or Training or employment
Attending PRU/Special Schooling arrangements
Regular Employment
Pupil/Student
Economically Inactive
Unemployed
Other
Not Known
this refers to employment which is regular and sustained.
this refers to education which is regular and sustained and is provided by a
school, further education college or university. Young people who receive
education from a specialist service in response to specialist needs
including problem behaviour or difficulties with standard educational
environments should refer to code 8 below.
this refers to young people and adults or are not currently in education or
employment outside the home either because they have a role within the
home as a parent or carer or because they have reached retirement age or
because they have health or mental health issues which currently prevent
them form working or studying.
this refers to adults who have the capacity to work and who are not
currently in regular and sustained employment.
this refers to any activity which is not described by other codes
treatment services should endeavour to find out how young people spend
their time, if this has not been possible, this code should be used.
YP
Adults











NDTMS – Core Dataset ‘F’
4. Fields Removed from YP Dataset
a) Dual Diagnosis
b) Sex Worker
c) Sexuality
(Picked up through new fields or not appropriate for YP)
NDTMS - YP
Reminder
Do not record parent/carers interventions
unless the misuser is a client, has
consented to NDTMS and is involved in the
intervention.
NDTMS - YP
Reminder
Complete all 3 levels of Substance Misuse
which got client into treatment.
NDTMS - YP
Reminder
There will be a revision of the NTA’s recommended
Consent and Confidentiality Toolkit. This will be
published following final legal advise and
consultation – hopefully during April 2009.
• Do you know where to find it?
• Do you know what it says now?
• Has your service incorporated the advice into
your own documentation?
NDTMS - YP
http://www.nepho.org.uk/ndtms
THANK YOU!