Core Dataset J - Changes

Delivering independent intelligence for health and wellbeingDelivering independent intelligence for health and wellbeing

Core Dataset J - Changes

Implementation November 2012

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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:

o Setting (at Agency and intervention level)o Pharmacological and Basis of prescribingo Psychosocial and sub interventionso Recovery Support and sub interventionso Time in Treatment

• New process for joint Drug and Alcohol clients• Implications for new and existing clients

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Core Dataset J – Why Change?

Previously:Interventions were a mixture of interventions and settings90% 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 outcomesNo facility to evidence intensity of treatment providedNo facility to evidence recovery support provided:• either during structured treatment or• after structured treatment

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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

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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

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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 TreatmentWhen?To be implemented 1st November 2012• New clients – immediately• Existing (open) clients – gradually but before 31/03/2013, including

1 sub intervention review

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Core Dataset J – What’s out?

12 Other Structured Intervention 87 Inpatient Tt Assessment 88 Inpatient Tt Stabilisation 89 Inpatient Tt Detox70 ALC – Inpatient Tt71 ALC – Residential Rehab 72 ALC – Community Prescribing73 ALC – Structured Psychosocial74 ALC – Structured Day Programme

75 ALC – Other Structured Tt

INTERVENTIONS REMOVED2 Specialist Prescribing3 GP Prescribing81 Behavioural Couples Therapy82 Family Therapy83 Contingency Management84 Psychosocial Mental Disorder85 Other Formal Psycho Therapy5 Structured Day Programme6 Residential Rehabilitation7 Aftercare

…./

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Core Dataset J – What’s new?

Setting•Agency level•Intervention level

InterventionsRestricted to only 3 ‘high

level’ interventions(with sub intervention reviews)

Time in TreatmentRecorded at each agency

(separately) at episode level

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Core Dataset J – What’s new?

SettingCOMMUNITY INPATIENT UNIT PRIMARY CAREPRISON RESIDENTIAL RECOVERY HOUSE

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 settingsOR 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

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Core Dataset J – What’s new?

InterventionsPharmacological Psychosocial Recovery Support

Three ‘high level’ interventions

All require additional information:Pharmacological• Basis of prescribing

Psychosocial and Recovery Support• listing of interventions c. 6 monthly (?)

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Core Dataset J – What’s new?

InterventionsPharmacological Psychosocial Recovery Support

Pharmacological

Encompasses all prescribing but excludes ANY Psychosocial delivery Requires additional ‘sub intervention’ information re intentionRequires date of commencement/change in intention Options are:-

• Withdrawal• Maintenance• Stabilisation• Relapse Prevention

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Core Dataset J – What’s new?

InterventionsPharmacological Psychosocial Recovery Support

PsychosocialIncludes 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 CounsellingFamily & Social network For co-existing mental healthPsychodynamic therapy 12-step work OtherCognitive & Behavioural based relapse prevention

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Core Dataset J – What’s new?

InterventionsPharmacological Psychosocial Recovery Support

Recovery SupportA high level intervention describing ‘unstructured’ treatmentCan be used alongside, before/after Pharmacological/PsychosocialDifferent rules for ending of modality/discharging from structured Tt13 Options are:

Peer Support Access to Mutual Aid Family SupportParenting Support Employment Support Housing SupportEd & Training Support Supported work/volunteeringRecovery Check-ups Relapse prevention Mental HealthComplementary Therapies Other

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CDS-J – Recovery SupportA client’s possible experience

Prescribing ends and the client continues in treatment receiving Recovery Support interventions from this provider

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.

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

Scenario 2:Pharmacological Ends 01/02/13

Recovery Support Starts 01/02/13

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CDS-J – Recovery SupportSystem handling of unstructured treatment post structured treatment

Client discharged from episode)

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

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

Keeping Structured and Unstructured Treatment recording

Structured Tx episode ends 01/02/13 Recovery Support episode starts 01/02/13

Client continues in the episode

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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.

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 episodeAlso, if Recovery Support is already open, the Structured Treatment can be discharged and the Recovery Support intervention can remain open.

Client continues in the episode

Treatment episode continues from client’s perspective

Structured Treatment ends 01/02/13 Recovery Support starts 01/02/13

Structured Treatment ends 01/02/13

Treatment episode continues from client’s perspective

Recovery Support starts 01/09/12

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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)

Structured Treatment ends01/02/13

Treatment episode does not continue from client’s perspective – new assessment would be required

New episode Opens

Structured Treatment Restarts

Recovery Support Reopens01/04/13

Episode Ends

Recovery Support Ends

01/04/13

Recovery Support Starts 01/02/13

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Core Dataset J – What’s new?

Time in Treatment<15 hours 15-24 hours >24 hours

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

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Core Dataset J – D & A New Process

Drugs and AlcoholInterventionsUse of same interventions for both sets of clients with the exception of old Tier 2 interventions:

Alcohol DrugsALC- Brief Intervention Advice & Information

Needle ExchangeOutreach

Requirement to use 1/2/3 drug fields appropriately to evidence all problematic substance misuse.

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Core Dataset J – D & A New Process

Drugs and AlcoholDischargeIf 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

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Core Dataset J – D & A New Process

All interventions for drug use are completed

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.

If the client is continuing treatment at the same agency:-

All interventions for drug use are completed

Alcohol interventions continue

Client discharged from all treatment

Client discharged

as transferred

Alcohol interventions start (elsewhere)

Client discharged from all treatment

If the alcohol treatment will be provided elsewhere then the first agency should record the client as transferred to the alcohol provider

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Core Dataset J – Old/New Clients

Pre 1st November 2012Treatment Services• Agree Setting with NEPHO/NDTMS team• Ensure processes are in place to capture:o changes in basis of prescribingo changes in time in treatmento delivery of individual Psychosocial sub interventionso 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

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Core Dataset J – Old/New Clients

Post 1st November 2012AgencyUpdate 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

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Core Dataset J – Old/New Clients

Before 31st March 2013Open 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

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Core Dataset J – Old/New Clients

Before 31st March 2013Open 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

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Core Dataset J – Old/New Clients

Before 31st March 2013Open 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

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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/ndtmsCDS-J PresentationCDS-J Input and Reference sheetsCDS-J Partnership Event Workshop Workbooks(Through the Training window)

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Core Dataset J

EASY!?