Effective treatment. Changing livesBuilding recovery in communities Core Data Set J for Adult Drug & Alcohol Treatment Providers October 2012 Simon Morgan.

Effective treatment. Changing lives

Building recovery in communities

Core Data Set J for Adult Drug & Alcohol Treatment ProvidersOctober 2012

Simon MorganJulie MarshallLondon NDTMS


CDS J Agenda/Objectives

Importance of Data CDS J Rationale/Benefits Treatment Providers Affected CDS J - What’s New Non-Structured Treatment Break - time to review new sub-interventions and new structured

treatment definition Practical/Administrative Implications of Changes Public Health England and Confidentiality/Consent


Importance of Data

NDTMS relates to the process of collecting, collating and analysing information from and for those involved in the drug treatment sector

NDTMS evidences your work and the impact of your work Numbers in Effective Treatment Successful Completions and Non-representations Public Health Outcomes Framework (drug and alcohol)

NDTMS used to determine funding allocations


CDS J Rationale/Benefits

Modality codes to date have been composed of a mixture of interventions and settings and have sometimes open to different interpretations.

This has led to inconsistencies in data recording and difficulties in making comparisons between interventions and in looking at the treatment factors that are positively associated with outcomes.

90% of all psychosocial interventions have been recorded as Other Structured Psychosocial Intervention.

To date there has been no code for recovery support interventions provided during structured treatment and no facility to record on-going recovery support provided following structured treatment.


CDS J Rationale/Benefits

Enable services to demonstrate the recovery support interventions they are providing during and following structured treatment, which could be used to help reduce re-presentation rates.

Provide assurances to commissioners and policy makers about the breadth of pharmacological interventions being delivered.

Demonstrate to policy makers progress on the recovery agenda and the nature of recovery journeys.

Provides information that supports the 2010 Drug Strategy goal of helping more people to recover from drug and alcohol dependence, and demonstrates how it is being achieved.

Brings the intervention types into closer alignment with those recommended by NICE and the 2007 Clinical Guidelines.


Treatment Providers Affected

CDS J is applicable to all adult drug and alcohol treatment providers and marks the end to different modality lists for drug and alcohol clients

YP dataset, processes and reporting to remain as is, with significant changes proposed All clients at YP only providers will not be expected to use CDS J, even

those over 18

CDS J to be implemented on 1st November 2012 for new and existing clients New clients - immediately Existing clients - gradually, but well before 31 March 2013


CDS J - What’s New


Setting - What, When & How

Provider level All providers will be assigned one of the above provider settings in DAMS - this

will be the provider default setting

Intervention levelTo be completed if provider is recording delivery of interventions in a setting

different than the providers default setting e.g. GP Shared Care;

1 - COMMUNITY 2 - INPATIENT UNIT 3 - PRIMARY CARE

4 - PRISON 5 - RESIDENTIAL 6 - RECOVERY HOUSE



Intervention dates Intervention dates Intervention type

Intervention type SettingSetting

Mod start = 02/11/12 Psychosocial

If the setting field is left blank (as will be in most cases) then the setting of the intervention will be the default provider setting in DAMS

The record above indicates that a Psychosocial intervention is occurring in the community (at a provider with a default provider setting of community)






The record above indicates a GP Shared Care approach e.g. a GP is prescribing and the structured psychosocial element is occurring in the community (at a provider with a default provider setting of community)

Mod start = 02/11/12 Pharmacological Primary Care






Mod start = 02/11/12 Pharmacological




Mod end = 01/12/12 Pharmacological

Mod start = 01/12/12 Pharmacological Primary Care

The clients script then starts being provided by a GP, so a new intervention record is created, the previous one closed and a new setting created.

Setting is left blank here denoting that the setting is the same as that of the provider

Setting now denotes that prescribing is happening at a GP surgery


Interventions - What, When & How

Three ‘high level’ interventions

Structured Treatment Interventions:1 - Pharmacological2 - Psychosocial

Non-structured Treatment Intervention:3 - Recovery Support



‘High level’ interventions to be implemented on 1st November 2012 for new and existing clients New clients - immediate implementation Existing clients - gradual implementation, but before 31 March

2013, as one sub-intervention to be submitted by 31 March 2013

However, existing clients already in prescribing (specialist, GP or alcohol) will not need to update high level intervention, but may need to update setting (e.g. shared care) and will need to ensure psychosocial element is reported separately



1st November 2012

Specialist Prescribing Intervention started 01/01/2012

As specialist prescribing (old code) was started before 1st November it continues to be recorded until it ends. However, psychosocial now needs adding.

Psychosocial starts 01/11/12

GP Prescribing Intervention started 01/01/2012

Community Provider


Community Provider

As GP prescribing (old code) was started before 1st November it continues to be recorded until it ends. However, setting now needs amending to primary care and psychosocial now needs adding.


1st November 2012

Other Structured Intervention

As Other Structured Intervention no longer exists it will need to be closed on or around the start of November

Psychosocial intervention opened


Intervention type

Mod End = 01/11/12 Other Structured

Exit reason Exit reason

Mutually Agreed

The existing Other Structured Intervention is closed on the 1st November in the usual way with the exit reason being recorded as mutually agreed. On the same day, a new psychosocial intervention is commenced.


Community Provider


1st November 2012

Structured day programmeClient A Psychosocial intervention opened

The ‘time in treatment’ will then denote that the client is in a SDP. Recovery support may well also be opened at the same time

Inpatient Client B Pharmacological intervention opened The ‘setting’ will denote that the client is receiving an inpatient intervention

Residential Client C Psychosocial intervention openedThe ‘setting’ will denote that the client is receiving residential treatment. Recovery support may well be opened at the same time

Psychosocial (any) Client D Psychosocial intervention openedThe one high level psychosocial code will replace all the previous ones, with the different types being picked in sub interventions



Sub Interventions - What, When & How Pharmacological

Basis of Prescribing Assessment & Stabilisation Maintenance Withdrawal Relapse Prevention


Sub Interventions - What, When & How Psychosocial

Motivational Interventions Cognitive and Behavioural Based Relapse Prevention Contingency Management 12-Step Work Family & Social Network Therapy Evidence Based Psychosocial Interventions for Co-existing Mental

Health Problems Psychodynamic Therapy Counselling - BACP Accredited Other


Sub Interventions - What, When & How Recovery Support

Peer support involvement Family support Supported work projects Employment support Parenting support Facilitated access to mutual

aid Complementary therapies Education & training support Housing support

Evidence-based psychosocial interventions to support substance misuse relapse prevention

Evidence-based mental health focused psychosocial interventions to support continued recovery

Recovery check-ups Other


Sub Interventions - What, When & How

Retrospective submission at 6 month intervals Existing clients - assumed start date 1 Nov (1 sub-intervention by

31 Mar 2013 and every 6 months thereafter at care plan review) New clients - 6 month review from intervention startSub Intervention Assessment Date

Should be combined to describe the full package of treatment

Submission to be made at point of discharge If client in treatment less than 6 months; orEnough time has passed since the last review to warrant review



1st November 2012

Specialist Prescribing Intervention started 01/01/2012

The ‘clock’ for a sub intervention review starts on the 1st November

Client A

Client B Psychosocial starts 01/12/12

The ‘clock’ for a sub intervention review begins at the start of a post November treatment journey




I

Intervention Review01/02/2013

I


CBT = yesCM = yes

Time in Psychosocial



I


I


CM = yesPsychodynamic Therapy

= yes

At each intervention review information is returned about the sub interventions received since the previous review. If it is the first review it will be interventions received since starting treatment or for existing clients, interventions received since November 1st


Recovery Support - What, When & How


Recovery support starts 01/02/13

Recovery support starts a few months later but while the client is still in structured treatment, both are submitted alongside each other in the same way that high level interventions are generally

Psychosocial Ends 01/02/13 Recovery support starts 01/02/13

Scenario 1

Scenario 2

Psychosocial ends at which point the client continues in the provider receiving recovery support interventions

Recovery support is a non structured intervention that can be delivered alongside structured treatment and/or following structured treatment



Structured Treatment episode ends 01/02/13

Client discharged from structured treatment

Recovery support episode starts 01/02/13

The provider discharges the client from the episode completely using the discharge date and reason

The episode of structured treatment has ended on the local software system

NDTMS records the client as having completed structured treatment and starting recovery support in the same episode

Episode as from point of view of client and local software system

Another episode now needs to be opened to denote the client is in recovery support

Client discharged from the episode


From the point of view of NDTMS returns

From the point of view of the local software system

However, from the point of view of the local software system, creating a new RS episode, post structured treatment, doesn’t reflect the clients experience. Consequently, CDS J relies on the ability to attach RS interventions to previous (discharged) structured treatment episodes.



To add the recovery support interventions there is no need to create a new episode, as these interventions can be attached to previous (discharged) structured treatment episodes.


Recovery support starts 01/02/13Structured treatment ends 01/02/13

From the point of view of the local software system




Recovery support starts 01/02/13

Psychosocial Ends 01/02/13 Recovery support starts 01/02/13

Scenario 1

Scenario 2

At every six months post structured treatment reviews are returned

Sub interven

tion

Sub interven

tion

At six month intervals during time in structured treatment reviews are returned

Sub interven

tion

Sub interven

tion


Time in Treatment - What, When & How

Time in treatment relates to the time spent each week in the entire treatment episode, while the client is in structured treatment and not in each different intervention type

14 hours or less – Engagement in one or more interventions for 14 hours or less per week

More than 14 hours and less than 25 – Engagement in one or more interventions for more than 14 and less than 25 hours per week.

25 or more hours – Engagement in one or more interventions for 25 or more hours per week


Psychosocial Intervention

Time in Treatment - What, When & How

Psychosocial Intervention

The client remains in specialist prescribing for the entire time in the episode never spending more than 14 hours a week in treatment so Time in Treatment does not change

Client A

Client B

I

Time in Treatment 01/02/2013

I


14 hours or less

The client starts in psychosocial (less than 15 hours) and then after three months has alongside it multiple pharmacological and recovery support interventions so that they are now in treatment for just over 15 hours a week. Therefore the time in treatment is updated at this point.

Client discharged fromepisode

I


I


14 hours or less

ITime in Treatment

01/05/2013

ITime in Treatment

01/05/2013

More than 14 hours and less than 25

Pharmacological

Recovery Support


Drugs and Alcohol

If the client is continuing treatment at the same provider

All interventions for drug use are completed Alcohol interventions continue


If the treatment continues in the same provider then the episode remains open until treatment is completed or the client leaves . It is important that alcohol is recorded as a second or third presenting substance

If the client is continuing treatment elsewhere

All interventions for drug use are completed

Alcohol interventions start

Client discharged as transferred

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



Non-Structured Treatment

Providers that are offering a care co-ordination function but NO structured treatment interventions should

Continue to report to NDTMS if they need to submit TOP data, otherwise there is no need to

Use the intervention type ‘Recovery Support’ to denote when the care co-ordination commenced and ended

Submit recovery support sub interventions if providing any of those listed to clients


Break


Changes to Administrative Practice for new clients from 1/11/12

Assess structured treatment clients’ Time in Treatment (includes structured treatment and recovery support) & enter into your NDTMS database

Enter Pharmacological/Psychosocial/Recovery Support Intervention Capture in case files whether prescribed clients are being stabilised,

maintained, withdrawn or provided with relapse prevention Capture in case files the sub-interventions for

psychosocial/recovery support These sub-interventions are entered every 6 months at care plan

review and at discharge


Community Psychosocial example

Time in Treatment Assessment Date: 11/11/12Time in Treatment: More than 14 hours and less than 25

Time in Treatment Assessment Date: 20/02/13Time in Treatment: 14 hours or less

Sub-intervention Assessment Date: 29/03/1312-Step work: YesCounselling: YesHousing Support: YesOther options: No

Psychosocial Intervention 11th Nov 2012 – 29th March 2013 Recovery Support Intervention 11th Nov 2012 – 29th March 2013


Community Pharmacological & Psychosocial journey

Time in Treatment Assessment Date: 11/11/12Time in Treatment: More than 14 hours and less than 25


Sub-intervention Assessment Date: 29/03/13Assessment and Stabilisation: YesMaintenance: Yes12-Step work: YesCounselling: YesOther options: No

Psychosocial Intervention 11th Nov 2012 – 29th March 2013

Pharmacological Intervention 11th Nov 2012 – 29th March 2013


Shared Care Pharmacological & Psychosocial journey


Sub-intervention Assessment Date: 4/7/13Maintenance: YesWithdrawal: YesCounselling: YesOther options: No

Psychosocial Intervention 11th Nov 2012 - 4th July 2013 Default Setting = Community

Pharmacological Intervention 11th Nov 2012 - 4th July 2013Setting = Primary Care

Sub-intervention Assessment Date: 4/5/13Maintenance: YesCounselling: YesOther options: No


Rehabilitation Psychosocial example

Time in Treatment Assessment Date: 11/11/12Time in Treatment: 25 or more hours

Sub-intervention Assessment Date: 4/4/1312-Step work: YesCounselling: YesOther options: No

Psychosocial Intervention 11th Nov 2012 - 4th April 2013

Default Setting = Residential


Changes to Administrative Practice for existing clients 1/11/12

List all clients currently in structured treatment Assess those clients’ time in treatment (includes structured treatment

and recovery support) and enter into your NDTMS database Enter modality end dates 1/11/12 and Mutually Agreed Planned Exit

for old Psychosocial modalities and create Psychosocial Intervention 1/11/12. Also create Psychosocial Intervention dated 1/11/12 for continuing prescribing clients.

Capture in case files whether prescribed clients are being stabilised, maintained, withdrawn or provided with relapse prevention

Capture in case files the type of psychosocial/recovery support These are entered at care plan review by 31/3/13 and every 6 months

thereafter at care plan review and at discharge


What and When to enter new data from 1/11/12

Which data to enter When to enter data

Time in Treatment All clients in structured treatment need this to be entered at the start of the structured treatment and again at the point that the time boundary changes (not at discharge) – new date for each

Intervention Old Psychosocial modalities should be closed Mutually Agreed Planned Exit and new Psychosocial Intervention should be entered with start dates from 1/11/2012 (also add this Intervention for prescribing clients). New Interventions to use are Pharmacological/Psychosocial/Recovery Support

Sub-intervention Retrospectively entered after every 6 months in structured treatment or at discharge but definitely enter a sub-intervention by 31/3/2013.


CDS J Guidance

Business definitions and all relevant documents were published in July 2012 http://www.nta.nhs.uk/core-data-set.aspx

CDS J ‘Implementation Guide’ is a welcome new addition to the supporting documents

[email protected]

Effective treatment. Changing livesBuilding recovery in communities Core Data Set J for Adult Drug & Alcohol Treatment Providers October 2012 Simon Morgan.

Documents

communities setting

treatment slide

setting different

providers default setting

setting field

recovery support interventions

recovery house slide

psychosocial interventions