Core Data Set J for Adult Drug & Alcohol Treatment Providers

1. Core Data Set J for Adult Drug & Alcohol Treatment Providers October 2012 Simon Morgan Julie Marshall London NDTMS

2. 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

3. 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

4. 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.

5. 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.

6. TreatmentProvidersAffected • 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

7. CDS J - What’s New

8. 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 level • To be completed if provider is recording delivery of interventions in a setting different than the providers default setting e.g. GP Shared Care;

9. 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)

10. Setting - What, When & How Intervention dates Intervention type Setting Mod start = 02/11/12 Psychosocial Mod start = 02/11/12 Pharmacological Primary Care • 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)

11. Setting - What, When & How Intervention dates Intervention type Setting Setting is left blank here denoting that the setting is the same as that of the provider Mod start = 02/11/12 Psychosocial Mod start = 02/11/12 Pharmacological 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. Intervention dates Intervention type Setting Mod start = 02/11/12 Psychosocial Setting now denotes that prescribing is happening at a GP surgery Mod end = 01/12/12 Pharmacological Mod start = 01/12/12 Pharmacological Primary Care

12. Interventions - What, When & How • Three ‘high level’ interventions • Structured Treatment Interventions: 1 - Pharmacological 2 - Psychosocial • Non-structured Treatment Intervention: 3 - Recovery Support

13. 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

14. Interventions - What, When & How Community Provider Specialist Prescribing Intervention started 01/01/2012 Psychosocial starts 01/11/12 As specialist prescribing (old code) was started before 1st November it continues to be recorded until it ends. However, psychosocial now needs adding. Community Provider GP Prescribing Intervention started 01/01/2012 Psychosocial starts 01/11/12 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

15. Interventions - What, When & How Community Provider Other Structured Intervention Psychosocial intervention opened As Other Structured Intervention no longer exists it will need to be closed on or around the start of November 1st November 2012 Intervention dates Intervention type Exit reason Mod End = 01/11/12 Other Structured 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.

16. Interventions - What, When & How Structured day programme Psychosocial intervention opened Client A 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 Pharmacological intervention opened Client B The ‘setting’ will denote that the client is receiving an inpatient intervention Residential Psychosocial intervention opened Client C The ‘setting’ will denote that the client is receiving residential treatment. Recovery support may well be opened at the same time Psychosocial (any) Psychosocial intervention opened Client D The one high level psychosocial code will replace all the previous ones, with the different types being picked in sub interventions 1st November 2012

17. Sub Interventions - What, When & How Pharmacological • Basis of Prescribing • Assessment & Stabilisation • Maintenance • Withdrawal • Relapse Prevention

18. 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

19. Sub Interventions - What, When & How Recovery 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 • Peer support involvement • Family support • Supported work projects • Employment support • Parenting support • Facilitated access to mutual aid • Complementary therapies • Education & training support • Housing support

20. 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 start • Sub 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; or • Enough time has passed since the last review to warrant review

21. Sub Interventions - What, When & How Client A Specialist Prescribing Intervention started 01/01/2012 Psychosocial starts 01/11/12 The ‘clock’ for a sub intervention review starts on the 1st November Psychosocial starts 01/12/12 Client B The ‘clock’ for a sub intervention review begins at the start of a post November treatment journey 1st November 2012

22. Sub Interventions - What, When & How I Intervention Review 01/02/2013 I Intervention Review 01/08/2013 Time in Psychosocial Time in Psychosocial Time in Psychosocial CBT = yes CM = yes CM = yes Psychodynamic 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

23. Recovery Support - What, When & How • Recovery support is a non structured intervention that can be delivered alongside structured treatment and/or following structured treatment Psychosocial starts 01/11/12 Scenario 1 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 Discharge Psychosocial Ends 01/02/13 Recovery support starts 01/02/13 Scenario 2 Psychosocial ends at which point the client continues in the provider receiving recovery support interventions

24. RecoverySupport - What, When & How From the point of view of NDTMS returns The provider discharges the client from the episode completely using the discharge date and reason NDTMS records the client as having completed structured treatment and starting recovery support in the same episode Structured Treatment episode ends 01/02/13 Recovery support episode starts 01/02/13 Client discharged from structured treatment From the point of view of the local software system The episode of structured treatment has ended on the local software system Another episode now needs to be opened to denote the client is in recovery support Episode as from point of view of client and local software system Episode as from point of view of client and local software system Client discharged from the episode 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.

25. Recovery Support - What, When & How From the point of view of the local software system Episode as from point of view of client and local software system Structured treatment ends 01/02/13 Recovery support starts 01/02/13 Discharge 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.

26. Recovery Support - What, When & How Psychosocial starts 01/11/12 Scenario 1 Recovery support starts 01/02/13 Sub intervention Sub intervention At six month intervals during time in structured treatment reviews are returned Discharge Psychosocial Ends 01/02/13 Recovery support starts 01/02/13 Scenario 2 At every six months post structured treatment reviews are returned Sub intervention Sub intervention

27. 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

28. Time in Treatment - What, When & How I Time in Treatment 01/02/2013 Client A Client discharged from episode Psychosocial Intervention 14 hours or less 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 I Time in Treatment 01/05/2013 I Time in Treatment 01/02/2013 Client B Psychosocial Intervention Pharmacological 14 hours or less More than 14 hours and less than 25 Recovery Support 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.

29. 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 Client discharged from the episode If the alcohol treatment will be provided elsewhere then the first agency should record the client as transferred to the alcohol provider

30. 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

31. Break

32. 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

33. Community Psychosocial example Recovery Support Intervention 11th Nov 2012 – 29th March 2013 Psychosocial Intervention 11th Nov 2012 – 29th March 2013 Time in Treatment Assessment Date: 20/02/13 Time in Treatment: 14 hours or less Time in Treatment Assessment Date: 11/11/12 Time in Treatment: More than 14 hours and less than 25 Sub-intervention Assessment Date: 29/03/13 12-Step work: Yes Counselling: Yes Housing Support: Yes Other options: No

34. Community Pharmacological & Psychosocial journey Pharmacological Intervention 11th Nov 2012 – 29th March 2013 Psychosocial Intervention 11th Nov 2012 – 29th March 2013 Time in Treatment Assessment Date: 20/02/13 Time in Treatment: 14 hours or less Time in Treatment Assessment Date: 11/11/12 Time in Treatment: More than 14 hours and less than 25 Sub-intervention Assessment Date: 29/03/13 Assessment and Stabilisation: Yes Maintenance: Yes 12-Step work: Yes Counselling: Yes Other options: No

35. Shared Care Pharmacological & Psychosocial journey Pharmacological Intervention 11th Nov 2012 - 4th July 2013 Setting = Primary Care Psychosocial Intervention 11th Nov 2012 - 4th July 2013 Default Setting = Community Sub-intervention Assessment Date: 4/5/13 Maintenance: Yes Counselling: Yes Other options: No Time in Treatment Assessment Date: 11/11/12 Time in Treatment: 14 hours or less Sub-intervention Assessment Date: 4/7/13 Maintenance: Yes Withdrawal: Yes Counselling: Yes Other options: No

36. Rehabilitation Psychosocial example Psychosocial Intervention 11th Nov 2012 - 4th April 2013 Default Setting = Residential Time in Treatment Assessment Date: 11/11/12 Time in Treatment: 25 or more hours Sub-intervention Assessment Date: 4/4/13 12-Step work: Yes Counselling: Yes Other options: No

37. 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

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

39. 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 • londonndtms@nta-nhs.org.uk