Transcript Slide 1

Core Data Set J Training
NDTMS SOUTH WEST PROVIDERS
September 2012
South West Public Health Observatory
The NDTMS-SW Team:
• Georgia Norris – Regional Manager
• Aileen McLoughlin – Improvement and
Development Manager
• Hayley Smith – Data Administrator
• Kadiann Weir-Da Costa – Data Analyst (part time)
• Sally Martin – Data Quality Co-ordinator (Training)
• Kate Kelly - Data Quality Co-ordinator (Training)
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Interventions
3 new over-arching interventions
• Pharmacological (code 94)
• Psychosocial
(code 95)
• Recovery Support (code 96)
Sub
Interventions
Provide more detail for each intervention
• Pharmacological: 4 options (basis for prescribing)
• Psychosocial: 9 options (treatment types)
• Recovery Support: 13 options
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Setting
• Each provider will be asked to chose a setting
• Ability to over-ride if treatment is delivered in
a different setting
Time in
Treatment
• Total time in treatment per week at provider
Data Returns
• Returns (6 monthly minimum) for subinterventions (via your DAMS submission)
• Time in treatment returns at start of
treatment and any change of intensity (via
your DAMS submission)
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• Previous modality codes were a mix of interventions and
settings e.g. Residential Rehabilitation or Structured Day
Care. This made comparison difficult.
• 90% of all Psychosocial interventions have been recorded
as “Other Psychosocial intervention”.
• Not possible to record the intensity of treatment.
• Not possible to record all types of recovery support during
or following structured treatment.
The changes have been considered and approved by a group of clinical experts
following public consultation. The changes are a compromise between a data
wish list and practicalities.
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DRUG STRATEGY 2010 Reducing Demand, Restricting Supply,
Building Recovery
“A fundamental difference between this strategy and those that have gone
before is that instead of focusing primarily on reducing the harms caused
by drug misuse, our approach will be to go much further and offer every
support for people to choose recovery as an achievable way out of
dependency”
Rt. Hon Theresa May, MP, Home Secretary
• Data will now contain information to support the goals of the 2010 Drug
Strategy and to demonstrate progress on the recovery agenda.
• Better alignment with the interventions recommended
by NICE and the 2007 Clinical Guidelines.
• More detail on the type of treatment being delivered will
allow direct comparisons between interventions.
• Identification of factors positively associated with recovery
such as intensity of treatment or packages of interventions.
• Services will be able to demonstrate the recovery support
provided.
• Setting will give a more accurate picture of delivery
practice.
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• All Adult Drug and Alcohol clients in treatment on or after 1st
November 2012.
• Young People dataset, processes and reporting are to
remain unchanged.
• Changes to the Young People dataset are to be
implemented as Core Data Set K in April 2013 or later.
• YP providers are not expected to adopt Core Data Set J
even for over 18 year olds.
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South West Public Health Observatory
A new definition structured treatment will be
introduced at the same time as CDS-J
Structured drug and alcohol treatment consists of a comprehensive
package of concurrent or sequential specialist drug and alcohol
focused interventions. It addresses multiple or more severe needs that
would not be expected to respond, or have already not responded, to
less intensive or non-specialist interventions alone. Structured
treatment requires a comprehensive assessment of need, and is
delivered according to a recovery care plan, which is regularly reviewed
with the client. The plan sets out clear goals which include change to
substance use, and how other client needs will be addressed in one or
more of the following domains: physical health; psychological health;
and social well-being, including when appropriate, criminal involvement
and offending.
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Structured Treatment Definition: Staffing and
Partnership working
All interventions must be delivered by appropriately trained
and competent staff, within supervision and clinical
governance structures. Structured drug and alcohol
treatment provides integrated access to specialist medical
assessment and intervention, and works jointly with mental
& physical health services, and safeguarding & family
support services according to need.
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Structured Treatment Definition: As a package of
care
In addition to core pharmacological and psychosocial
interventions that are provided alongside, or integrated
within, the key-working or case management function of
structured treatment, service users should be provided with
the following as appropriate: harm reduction advice and
information; BBV screening and immunisation; advocacy;
appropriate access and referral to healthcare and health
monitoring; and crisis and risk management support.
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South West Public Health Observatory
• Now used to report prescribing only.
• Psychosocial treatment integral or in addition to
prescribing will now be reported separately.
• Recovery support that is integral to prescribing will be
reported separately.
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Code Current modality
2
Specialist Prescribing
3
GP Prescribing
87
Inpatient Treatment Assessment Only
88
Inpatient Treatment Stabilisation
89
Inpatient Treatment Detoxification
70
ALC – Inpatient Treatment
72
ALC – Community Prescribing
NEW
code
94
New Intervention
Pharmacological Intervention
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Existing clients open in prescribing (Specialist, GP or
ALC-Community) will not need to be updated:
Client A
Specialist Prescribing Intervention started 01/01/2012
As specialist prescribing (old code) was
If the client is receiving any
started before 1st November it
psychosocial interventions as part of
continues to be recorded until it ends.
their prescribing you will need to open
The system (DAMS or Provider
a CDS-J psychosocial intervention
Software) will ‘map’ over only
separately.
Specialist, GP, and Alc-Community
prescribing modalities to
‘Pharmacological’ intervention. 1st November 2012
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All other Inpatient modalities need to be updated as
soon as possible on or after 1st November 2012:
Client B
Inpatient Modality ends 10/11/2012
Any inpatient modalities that are
expected to end on or soon after 1st
November do not need to be
changed but can be closed naturally .
Psychosocial starts 10/11/2012
If the client then starts a
psychosocial (or other)
intervention after 1st November
you will need to use the new core
dataset J codes.
1st November 2012
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Prescribing intention options:
Assessment & Stabilisation
Maintenance
Withdrawal
Relapse Prevention
Definitions for all sub-interventions are available in the Business Definitions
and in your packs.
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• All clients currently receiving a old psychosocial modality will
need to have that modality closed and a new psychosocial
intervention opened.
• All clients with a pharmacological intervention would be
expected to be reporting a separate psychosocial intervention.
• May include use of ‘psychosocial mapping’ (e.g. ITEP). This is
not reported separately as it is a delivery tool, not an
intervention in itself.
• Other structured treatment (‘OSI’) that is considered to be
structured treatment should be reported as a psychosocial
intervention.
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Code
Current modality
NEW code
6
Residential Rehabilitation
12
Other Structured Intervention
71
ALC - Residential Rehabilitation
73
ALC – Structured Psychosocial Intervention
74
ALC – Structured Day Programme
75
ALC – Other Structured Treatment
81
Behavioural Couples Therapy
82
Family Therapy
83
Contingency Management (drug specific)
84
Psychosocial Intervention (Mental Disorder)
85
Other Formal Psychosocial Therapy
5
Structured Day Programme
95
New Intervention
Psychosocial Intervention
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All existing psychosocial modalities will need to be
closed and a new psychosocial intervention opened:
Client A
Psychosocial intervention opened
Family therapy
As Family therapy no longer exists it will
need to be closed in or around the start of
November
1st November 2012
Modality End
Modality Type
Exit reason
01/11/12
Family therapy
Mutually Agreed
The existing modality is closed on the 1st November with the exit reason being recorded
as mutually agreed. On the same day a new CDS J psychosocial intervention is started.
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More examples....
Client A
Structured day
programme
Psychosocial intervention opened
The ‘time in treatment’ will then denote that the client is
in a SDP.
Client B
Psychosocial intervention opened
Residential
The ‘setting’ will denote that the client is receiving
residential treatment.
Client C
Other structured
treatment
Psychosocial intervention opened
1st November 2012
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Motivational Interventions
Contingency Management (Substance Misuse Specific)
Family and Social Network Interventions
Cognitive and Behavioural based relapse prevention
interventions (substance misuse focused)
Evidence-based psychological intervention for coexisting mental health problems
Psychodynamic Therapy
12-step work
Counselling – BACP Accredited
Other Psychosocial
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• Can be reported during or following structured treatment.
• OSI that is not considered to be structured treatment
should be reported as recovery support.
Code
Current modality
7
Aftercare
12
Other Structured Intervention
75
ALC – Other Structured Intervention
NEW
code
96
New Intervention
Recovery Support Intervention
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Peer Support involvement
Facilitated access to Mutual Aid
Family Support
Parenting Support
Housing Support
Employment Support
Education and Training Support
Supported Work projects
Recovery checkups
Evidence-based psychosocial interventions to support relapse prevention
Complimentary Therapies
Evidence-based Mental Health Psychosocial Interventions to support continued recovery
Other Recovery Support
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All existing clients receiving an ‘OSI’ modality will
need to be considered separately to determine if they
are receiving ‘structured treatment’
Client A
OSI
As OSI no longer exists it will need to be
closed in or around the start of
November if structured treatment
continues.
Client B
OSI
Psychosocial intervention opened
And a new CDSJ Intervention opened
Recovery Support opened
If no structured treatment being
And a new CDSJ Intervention opened
delivered it will need to be closed in or
around the start of November with
appropriate exit reason and discharge
1st November 2012
date.
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Code
Current modality
10
Advice and Information
76
ALC – Brief Intervention
8
Needle Exchange
9
Outreach
Notes
Do not report in South West
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Workshop One – Old to new
•
•
•
•
Scenarios on recording and changing modality types.
Which modalities need to change?
Which do not?
How to do it?
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• The aim of the setting field is to identify where the
intervention is being delivered:– at your normal provider setting; or
– elsewhere
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All providers will be registered under one of these settings in the agency
table that sits in DAMS. This will be your treatment provider type setting
‘default’.
name code Permissible Responses Data attached
ent
r type
1
2
3
4
5
6
Community
Inpatient Unit
Primary Care
Prison
Residential
Recovery House
Agency table on DA
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Where the setting for an intervention is different to the
treatment provider type (in the agency table on DAMS) an
alternative setting can be recorded as part of the intervention.
Field name code Permissible Responses Data attached to:
Intervention
Setting
1
2
3
4
5
6
Community
Inpatient Unit
Primary Care
Prison
Residential
Recovery House
Intervention
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How to record interventions delivered in more than
one setting at the same provider.
A client is receiving a psychosocial intervention in the community
and a script from the GP (shared care). The provider setting is
registered as ‘community’ on DAMS.
Intervention start
date
Intervention
type
Setting
01/12/2012
Pharmacological
Primary Care
02/12/2012
Psychosocial
Setting is recorded
as Primary Care to
over-ride the
default provider
setting.
Setting is left
blank because it
is the default
provider setting.
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South West Public Health Observatory
• The aim of this item is to capture the time spent in treatment per week
at your provider.
The calculation includes:
• Time spent in recovery support if in conjunction with structured
treatment interventions
• The actual time should be rounded up to the nearest whole hour,
i.e. 14.5 hours to 15 hours.
NB: If a client is in recovery support only then ‘time in treatment’
does not need to be reported.
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Can be a combination of
interventions
Intensity
Hours per week in one or more interventions
Standard
14 hours or less
High
More than 14 but less than 25
Very High
25 or more
Can be residential or nonresidential rehabilitation or
those previously recorded
as structured
24.5
hours day
is
programmes
Therefore when a time in treatment of
‘rounded up’ to 25 hours it would place your client in the
very high intensity.
South West Public Health Observatory
South West Public Health Observatory
• Data Returns are a new reporting method and will be required for the
following:– Time in Treatment
• At start of structured treatment and whenever there is a change
of time in treatment intensity during the episode.
– Sub Interventions
• Report sub interventions at least 6 monthly.
• Report all sub interventions that the client has received since the
last return.
• Report any open Pharmacological, Psychosocial and Recovery
Support sub-interventions on the same return.
• Recovery Support can be reported post discharge.
NB: Returns are in addition to TOPS but can be done at the same time if convenient.
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• Sample time in treatment and sub intervention forms are
provided in your training packs.
• These may be paper forms or on-line forms or just
additional fields to complete on your software system.
• The actual data will be submitted to NDTMS as part of your
normal monthly upload to DAMS.
• The form of implementation is a local decision.
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South West Public Health Observatory
Field Name
Permissible Responses
NDTMS Extract
Header
Time in Treatment
Assessment Date
KEY FIELD
Standard Date
TITDATE
Time in Treatment
Threshold
• 14 hours or less
• more than 14 and less than 25 hours
• 25 or more hours
TITREAT
Time in treatment returns are not needed where client is
only in Recovery Support.
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Time in treatment is reported at the start of the episode:
Client A
I
Psychosocial Intervention
Client discharged
from episode
Time in Treatment
01/02/2013
14 hours or less
The client remains in psychosocial interventions for the entire time in the
episode never spending more than 14 hours a week in treatment so Time
in Treatment does not change.
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And whenever the intensity of treatment changes while the
clients remains in structured treatment …
Client B
Pharmacological Intervention
Psychosocial
Recovery Support
Time in Treatment
01/02/2013
Time in Treatment
01/05/2013
14 hours or less
More than 14 and less
than 25 hours
The client starts in prescribing and psychosocial (14 hours or less) and
then after three months has increased psychosocial treatment and
recovery support interventions so that they are now in treatment for over
14 hours per week. The time in treatment is updated at this point to
reflect the change in intensity.
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Time in Treatment Return on DET
Mandatory field
Select Time in Tx
If Time in Tx
increases or
decreases with the
addition of new
interventions/sub
interventions, or
closure of others,
change the Time in
Tx field to reflect
this and put new
date in Time in Tx
Assessment Date
field.
Each return must
have different date
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South West Public Health Observatory
Sub-intervention returns must be submitted at least 6 monthly or on discharge. They
report all sub-interventions received since the last return and not just current subinterventions.
Date of Sub-intervention return
NDTMS Extract Header
Sub Intervention Assessment Date KEY FIELD Standard Date SUBMODDT
Pharmacological
Prescribing intention:
Permissible
Responses
NDTMS Extract
Header
Assessment & Stabilisation
Yes/No
PHSTBL
Maintenance
Yes/No
PHMAIN
Withdrawal
Yes/No
PHWTH
Relapse Prevention
Yes/No
PHRELPR
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Psychosocial
Permissible
Responses
NDTMS Extract
Header
Motivational Interventions
Yes/No
PSYMOTI
Contingency Management (Substance Misuse Specific)
Yes/No
PSYCNMG
Family and Social Network Interventions
Yes/No
PSYFSNI
Cognitive and Behavioural based relapse prevention
interventions (substance misuse focused)
Yes/No
PSYCGBH
Evidence-based psychological intervention for coexisting mental health problems
Yes/No
PSYMNTH
Psychodynamic Therapy
Yes/No
PSYDNM
12-step work
Yes/No
PSYSTP
Counselling – BACP Accredited
Yes/No
PSYCOUN
Other Psychosocial
30 char max
PSYOTHR
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Recovery Support
Permissible
Responses
NDTMS Extract
Header
Peer Support involvement
Yes/No
RECPEER
Facilitated access to Mutual Aid
Yes/No
RECMAID
Family Support
Yes/No
RECFMSP
Parenting Support
Yes/No
RECPRNT
Housing Support
Yes/No
RECHSE
Employment Support
Yes/No
RECEMP
Education and Training
Yes/No
RECEDUT
Supported Work projects
Yes/No
RECWPRJ
Recovery checkups
Yes/No
RECCHKP
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Field Name
Permissible
Responses
NDTMS Extract
Header
Evidence-based psychosocial interventions to
support relapse prevention
Yes/No
RECRLPP
Complimentary Therapies
Yes/No
RECCMPT
Evidence-based Mental Health Psychosocial
Interventions to support continued recovery
Yes/No
RECGNH
Other Recovery Support
Free text
(30 char max)
RECOTH
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Sub Intervention Return on DET
Mandatory field
May have more
than one
intervention
All options
available with
yes/no options –
all to be
completed.
Default ‘No’
‘Other’ field for
manual
completion if not
covered by
options available
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For all existing and new clients, data returns will be expected at
six month intervals (as a minimum) for as long as the client
remains in treatment
I
Pharmacological Intervention
Intervention Review
01/02/2013
Intervention Review
01/08/2013
Stabilisation = yes
Maintenance = yes
Maintenance = yes
Withdrawal = yes
• For each intervention return information is recorded about the sub
interventions received since the previous return.
• If it is the first return it will be interventions received since starting treatment.
• For existing clients, interventions received since November 1st .
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Clients in treatment for less than six months: the sub
intervention return should be submitted at discharge
Start
Psychosocial
01/02/2013
Time in
Psychosocial
Client
discharged
01/05/ 2013
Intervention Review
01/05/2013
CBT = yes
CM = yes
Providers will need to identify all the psychosocial sub interventions
that the client has received by the time of discharge and ensure this
data is submitted to NDTMS in the next upload.
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A year in treatment – post 1/11/2012:
Psychosocial
3 sub-interventions
Time in Tx 19 hours
Returns: Time in Tx only
TiT = high
12
Month
11
Month
Discharge
10
9
Month
Month
8
7
Month
Month
6
4
Month
Month
3
Month
5
2
Month
Month
1
Start
Month
Episode of Treatment
Sub Intervention
Return due
1 sub–intervention Sub Intervention
Time in Tx now 9
Return due
hours
Returns: Time in Tx
TiT = standard
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South West Public Health Observatory
While recovery support is a non structured intervention, it can be
delivered alongside structured treatment and also following
structured treatment:
Scenario 1
Psychosocial starts 01/11/12 and ends 01/04/2013
Recovery support starts 01/02/13
It will be possible to leave a recovery support intervention open while at the
same time closing off the structured treatment episode by entering a
discharge date and reason.
Scenario 2
Psychosocial ends 01/02/13
Recovery support starts 01/02/13
Even though the episode is closed with a discharge date and reason, it is
possible to append a recovery support intervention to the closed episode.
Recovery Support Returns sent to NDTMS 6 monthly (minimum).
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The sub interventions will be recorded for recovery support at the
same time as any structured interventions whilst the two are
running concurrently
Scenario 1
Psychosocial starts 01/10/12
Recovery support starts 01/02/13
Returns at six
monthly
intervals
(minimum)
while in
structured
treatment
Psychosocial &
Recovery Support
Returns
Psychosocial &
Recovery Support
Returns
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If running consecutively …
Psychosocial ends
01/02/13
Recovery support starts 01/02/13
Discharge
Scenario
2
Psychosocial
Return
Psychosocial
Return at discharge
from structured
treatment
Post structured
treatment
returns for
Recovery
Recovery Support
Support
Return
minimum 6
monthly
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If a client receiving recovery support requires structured
treatment again then a NEW episode needs to be opened.
Structured
Treatment closed
Recovery support intervention
closed as further structured
Treatment needed
The first episode is closed and the
recovery support intervention is
appended to it.
New structured
Treatment episode
The client is identified as now
needing structured treatment
so the recovery intervention is
closed and a new structured
treatment episode
commenced.
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South West Public Health Observatory
• Current Recording:
Inpatient Treatment Detoxification modality
• NEW Core Dataset J Recording:
Intervention = Pharmacological (SI = withdrawal)
Intervention = Psychosocial (SI = motivational intervention)
Intervention = Recovery Support (SI = peer support )
Time in treatment = very high
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• Current Recording:
ALC – Structured Day Programme modality
• NEW Core Dataset J Recording:
Intervention = Psychosocial
(SI = cognitive & behavioural interventions )
Intervention = Recovery Support (SI = housing support )
Time in treatment = high
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WORKSHOP TWO – Data Returns
• Data returns; when and how to report to NDTMS
• An example of how a typical client episode will fit into CDS
J definitions (please see pack)
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FINAL SESSION
•
•
•
Action plans
Any remaining questions
Key issues to take back or
resolve?
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Help is at hand:
current guidance on NTA website:
www.nta.nhs.uk/core-data-set.aspx
Please visit our website:
www.swpho.nhs.uk/ndtms
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