Effective treatment. Changing lives
Building recovery in communities
Core Data Set J for Adult Drug & Alcohol Treatment ProvidersOctober 2012
Simon MorganJulie MarshallLondon NDTMS
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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
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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
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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.
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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.
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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
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CDS J - What’s New
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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
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Setting - What, When & How
Intervention dates Intervention type Setting
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)
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Setting - What, When & How
Intervention dates Intervention type Setting
Mod start = 02/11/12 Psychosocial
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
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Setting - What, When & How
Intervention dates Intervention type Setting
Mod start = 02/11/12 Psychosocial
Mod start = 02/11/12 Pharmacological
Intervention dates Intervention type Setting
Mod start = 02/11/12 Psychosocial
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
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Interventions - What, When & How
Three ‘high level’ interventions
Structured Treatment Interventions:1 - Pharmacological2 - Psychosocial
Non-structured Treatment Intervention:3 - Recovery Support
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Interventions - What, When & How
‘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
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Interventions - What, When & How
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
Psychosocial starts 01/11/12
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.
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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 dates Intervention type
Mod End = 01/11/12 Other Structured
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.
Interventions - What, When & How
Community Provider
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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
Interventions - What, When & How
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Sub Interventions - What, When & How Pharmacological
Basis of Prescribing Assessment & Stabilisation Maintenance Withdrawal Relapse Prevention
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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
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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
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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
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Sub Interventions - What, When & How
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
Psychosocial starts 01/11/12
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Sub Interventions - What, When & How
I
Intervention Review01/02/2013
CBT = yesCM = yes
Time in Psychosocial
Time in Psychosocial
Time in Psychosocial
I
Intervention Review01/08/2013
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
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Recovery Support - What, When & How
Psychosocial starts 01/11/12
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
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Recovery Support - What, When & How
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
Episode as from point of view of client and local software system
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.
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Recovery Support - What, When & How
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.
Episode as from point of view of client and local software system
Recovery support starts 01/02/13Structured treatment ends 01/02/13
From the point of view of the local software system
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Recovery Support - What, When & How
Psychosocial starts 01/11/12
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
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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
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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
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
Time in Treatment 01/02/2013
14 hours or less
ITime in Treatment
01/05/2013
More than 14 hours and less than 25
Pharmacological
Recovery Support
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Drugs and Alcohol
If the client is continuing treatment at the same provider
All interventions for drug use are completed Alcohol interventions continue
Client discharged from the episode
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
Client discharged from the episode
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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
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Break
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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
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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
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Community Pharmacological & Psychosocial journey
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: 29/03/13Assessment 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
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Shared Care Pharmacological & Psychosocial journey
Time in Treatment Assessment Date: 11/11/12Time in Treatment: 14 hours or less
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
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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
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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
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What and When to enter new data from 1/11/12
Which data to enter When to enter dataTime 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.
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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