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DTMU is delivered by Solutions for Public Health Proprietary, Copyright 2010, Solutions for Public Health

NDTMS Core Dataset G Training for Treatment Providers and Commissioners

Drug Treatment Monitoring Unit

March 2010

DTMU is delivered by Solutions for Public Health (SPH). © Copyright SPH, 2010

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Ground Rules

• Please respect those around you by not holding individual conversations whilst the sessions are in progress

• Please put mobiles on silent/vibrate• Please take any calls outside of the meeting


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April 11, 2023

Aims

• Clarify the changes in Core Data Set ‘G’• Clarify consent and confidentiality • Review Data Quality and TOP compliance• Provide information around current reporting

and monitoring• Clarify numbers in effective treatment,

successful completions and waiting times calculations


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Essential Elements of Treatment Provision• The needs of all drug misusers should be

assessed across the four domains of drug and alcohol misuse health social functioning and criminal involvement.

• All drug misusers entering structured drug treatment should have a care or treatment plan which is regularly reviewed.

• A named individual should manage and deliver aspects of the patient’s care or treatment plan.

(Source: Drug Misuse and Dependence: UK guidelines on clinical management‚ 2007)

April 11, 2023


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Why is information needed for NDTMS?The drug and alcohol treatment information that you provide to the

NDTMS is used for several purposes. Primarily used for:

• Assess the number of individuals attending drug and alcohol services in order to monitor the progress of the national drug and alcohol strategies;

• Evaluate the efficiency and effectiveness of drug and alcohol treatment provision‚ including treatment outcomes for clients.

• Monitor the use of resources. This helps ensure equitable funding of drug and alcohol services nationally.

• Provide a local and regional picture of drug and alcohol clients and their needs‚ which will assist service commissioners such as DAATs‚ PCTs and local authorities in planning and developing better drug and alcohol treatment services that are more appropriate to their geographical area.

• Produce statistics and to support research on drug and alcohol use‚ treatment or general public.

April 11, 2023


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DAAT Profile: 2008-09 http://www.dtmu.org.uk/DAT Profiles 2008-09.html

April 11, 2023


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Changes with Core Data Set G

• One new data item• Modalities updated in line with Orange Book

clinical guidance• Reference data items updated in line with

NHS data dictionary• YP outcomes updated

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New data item: Local agency detailsField to be reviewed by regional team

Collected at Modality start

Intended to be used to report prescribing on behalf of another agency

Possible values:

GP, Pharmacist,

NDTMS agency code,

GP practice code

April 11, 2023


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CDS ‘G’ Treatment InterventionsUpdated options

April 11, 2023


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Updated treatment interventionsModalities updated in line with Orange Book clinical guidance

“The SCAN consensus document on inpatient treatment (SCAN, 2006) defined the core work of an inpatient unit as comprising assessment, stabilisation and detoxification (or assisted withdrawal). Although these may be combined during a patient’s stay, the patient’s plan of care should usually identify one task as the principal purpose of administration”

Proposals to modify the codes used to record the types of drug treatment being provided on the National Drug Treatment Monitoring System – July 2009

April 11, 2023


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Tier 2 Adult Drug Modalities

Outreach

Advice and Information

Needle Exchange

Aftercare

Clients receiving these Tier 2 interventions will NOT count for performance targets


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Tier 3 Adult Drug Modalities• Specialist Prescribing• GP Prescribing• Behavioural Couples Therapy• Family Therapy• Contingency Management (drug specific)• Psychosocial Intervention to address

common mental disorders• Other Formal Psychosocial Therapy• Structured Day Programme• Other Structured Intervention

Clients receiving these Tier 3 interventions will count for performance targets


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Psychosocial interventions• Behavioural couples therapy

• Family therapy

• Contingency management (drug specific)

• Psychosocial interventions to address common mental disorders

• Other formal psychosocial therapy (e.g. community reinforcement approach or social behaviour network therapy)

April 11, 2023


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Behavioural couples therapy• Behavioural couples therapy is a specific

psychosocial intervention that should only be available for use with clients who have an established relationship and a drug-free partner willing to engage in treatment.

• The focus is on the client’s drug use and should consist of at least twelve weekly sessions.

April 11, 2023


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Family therapyFamily therapy is a structured psychosocial intervention that is delivered by a competent clinician.

The focus is on discussion with families relating to the sources of stress associated with drug misuse and aims to support and promote the family in developing more effective coping behaviours.

Family therapy should only be recorded under this code when the client is actively involved in the intervention. This does not reflect family work that is done where the service user is not engaged in the intervention.

April 11, 2023


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Contingency management (drug specific)

Structured behavioural programmes using incentives to reinforce changes in behaviour.

Behaviour changes incentivised for people receiving methadone maintenance treatment include reduced illicit drug use and/or increased engagement with services.

Behaviour changes incentivised for people who primarily misuse stimulants include reduced illicit drug use, abstinence and/or increased engagement with services.

April 11, 2023


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Psychosocial interventions to address common mental disorders

Many drug users also have considerable co-morbid problems, particularly common mental health problems such as anxiety and depression.

There is evidence that a range of evidence-based psychosocial interventions can be beneficial for a wide range of mental disorders.

Such disorders may include: depression (NICE, 2007b); anxiety (NICE, 2007c); post traumatic stress disorder (NICE, 2005a); eating disorders (NICE, 2004); obsessive compulsive disorder (NICE, 2005b); antenatal and postnatal mental health (NICE, 2007d)

Psychosocial interventions to address these disorders range from, for example, guided self help and brief interventions for mild forms of problems to cognitive behavioural therapy and social support for more moderate forms.

All psychosocial intervention to address common mental disorders should be recorded using this code regardless of their intensity.

April 11, 2023


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Other formal psychosocial therapy(e.g. community reinforcement approach or social behaviour network therapy)

This includes other psychosocial therapies that are used in drug treatment and beneficial for some clients as they are practical and broad-based techniques.

Psychosocial therapies recorded under this category will include the Community Reinforcement Approach and Social Behaviour Network Therapy.

April 11, 2023


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Tier 4 Adult Drug Modalities•Inpatient Treatment Assessment Only•Inpatient Treatment Stabilisation•Inpatient Treatment Detoxification (assisted withdrawal)

•Residential Rehabilitation

Clients receiving these Tier 4 interventions will count for performance targets


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Inpatient treatment• Inpatient treatment Assessment Only

• Inpatient treatment Stabilisation

• Inpatient treatment Detoxification

April 11, 2023


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Inpatient treatment Assessment OnlyIndividuals with drug and alcohol dependence present with a wide range of psychiatric, physical and social problems.

Substance misuse services provide a comprehensive assessment of these needs and formulate a treatment care plan to tackle them.

A hospital setting permits a higher level of medical observation, supervision and safety for service users needing more intensive forms of care. Specific tasks of the IPU may include:

• Assessment of substance use• Assessment of mental health• Assessment of physical health• Assessment of social problems

These should be undertaken as described in the Inpatient Treatment of Drug and Alcohol Misusers in the National Health Service – Scan consensus project (2006).

This document is available at using the following link.

http://www.scan.uk.net/docstore/SCAN_Inpatient_Consensus_project_document_FINAL.pdf

April 11, 2023


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Inpatient treatment StabilisationThere is considerable evidence that the number of service users with more complex problems (coexisting physical and mental illness, dependence on more than one substance) is increasing. Such cases can be managed in a community setting, but the IPU setting permits a high level of medical observation, supervision and safety for service users needing more intensive forms of care.

The IPU should have care pathways, clinical protocols, and sufficient human and physical resources to offer the following range of stabilisation procedures:

1. Dose titration

2. Dose titration on injectable opioid medication

3. Stabilisation on maintenance therapy

4. Combination assisted withdrawal/stabilisation

April 11, 2023


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Inpatient treatment DetoxificationAssisted withdrawal should only be encouraged as the first step in a longer treatment process, and needs to be integrated with relapse prevention or rehabilitation treatment programmes which can be provided in the NHS or independent/non-statutory sector.

Withdrawal in an IPU setting offers better opportunities for clinicians to ensure compliance with medication and to manage complications. IPU admission also offers a major opportunity to recruit service users into longer-term treatment to reduce the risk of relapse back into regular drug or alcohol use.

The IPU should have care pathways, clinical protocols, and sufficient human and physical resources to offer assisted withdrawal for a wide range of single and poly-drug and alcohol misuse problems.

April 11, 2023


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Adult Alcohol Modalities

Tier 4•ALC - Inpatient Treatment•ALC - Residential Rehabilitation

Tier 3• ALC - Community

Prescribing• ALC - Structured

Psychosocial Intervention

• ALC - Structured Day Programme

• ALC - Other Structured Treatment

Tier 2• ALC – Brief Interventions

Will NOT count towards numbers in Treatment.


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Young People Modalities

Tier 2YP Non-structured intervention

Tier 4YP Access to residential treatment for substance misuse

Tier 3• YP Psychosocial

Intervention

• YP Harm Reduction Services

• YP Family Work

• YP Specialist Pharmacological Interventions

Young People receiving these Tier 3/4 interventions will count towards performance targets


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Question: Are you all reporting treatment modalities against individual clients episode of treatment?

April 11, 2023


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CDS ‘G’ Reference Data Changes to reference values in line

with NHS Data Dictionary


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Employment status

Regular Employment

Pupil/Student

Long term sick or disabled

Homemaker

Retired from work

April 11, 2023

Unemployed and seeking work

Not receiving benefits

Unpaid voluntary work

Retired from paid work

Not stated

Other

Not known


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Sexuality• Gay: renamed to Homosexual

• Not Disclosed: renamed to Not Recorded

April 11, 2023


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Consent

• Yes the person consented• No the person has not consented

April 11, 2023


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Previously Hep B Infected

• Yes has had a previous Hepatitis B infection diagnosed;

• No has never had a previous Hepatitis B infection diagnosed;

• Not Known

April 11, 2023


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Hepatitis C Positive

• Yes is Hepatitis C Positive• No is not Hepatitis C Positive• Not Known

April 11, 2023


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Injecting Status

• Previously Injected (but not currently)• Currently Injecting• Never Injected• Client Declined to Answer

April 11, 2023


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Referral Sources (Drug & Alcohol)

• Arrest Referral / DIP is now:• Arrest Referral• DIP

• Custody Service has been removed

April 11, 2023


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Referral Sources (Alcohol Only)

• Employer• ATR (Alcohol Treatment Requirement)• Peer

April 11, 2023


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Drug Codes

• Methylone• Mephedrone• No Second Drug• No Third Drug

April 11, 2023


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CDS ‘G’ Young People Changes to YP Outcomes

April 11, 2023


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Changes to YP outcomes

There are some changes to the YP outcomes.

These apply to all young people seen at a Young People’s treatment provider and should only be completed by these agencies.

YP outcomes have been collected since April 2009.

•YP NDTMS Event: 31st March‚ YMCA Guildford

April 11, 2023


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April 11, 2023

Information Management


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Information ManagementClinicians need to:• Keep patient records;• Ensure appropriate information

sharing‚ confidentiality and data protection;• Collect and analyse data; and• Make effective use of information and data;

(Drug Misuse and Dependence: UK guidelines on clinical management‚ 2007)


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Information Sharing“Information sharing can be of great value to the

direct care of individual patients and may also contribute indirectly to the delivery and effectiveness of the drug treatment system. Information sharing protocols should be consistent with guidance from local Caldicott Guardian and any national guidance‚ and acknowledge that patient consent to disclosure is key in most situations where identifiable information is shared.”

(Drug Misuse and Dependence: UK guidelines on clinical management‚ 2007)


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Data Sharing ProtocolsHaving data sharing protocols in place‚ that outline how and why

data is shared within and between organisations‚ is good practice.

Scenarios:

• DAT Wide Systems: this will necessitate information sharing across treatment services and/or Drug and Alcohol Action Teams;

• Multi-site service provider software (e.g. Addaction use one system nationally):

• Multiple service providers delivering simultaneous treatment to a client‚ irrespective of the software used. This is relevant to TOP data where a service provider should‚ subject to permissions and data sharing protocols‚ send copies of the TOP information to other agencies.


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ConsentClients should give written consent to share information about their care plan. This consent should specifically state which agencies the client consents to have information received about them and which they do not. A form recording the client’s consent should be kept in the notes. Consent should be reviewed at the time of reviewing the care plan.


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NTA Confidentiality ToolkitConfidentiality policy should be clearly explained to client (verbally and written form), before assessment for treatment.

Should cover:• What information will be collected by the

agency• When and what information will be shared

with other services and organisations• Who information will go to and why (NDTMS)• When the confidentiality may be breached

(NTA Confidentiality Toolkit, 2009 NTA)


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Discharge Data


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Discharge DataDischarge Date

Discharge Reason• If a Discharge Date is entered, then a Discharge Reason must be given

and vice versa.• Discharge information must be reported accurately and in a timely

fashion as it is used to calculate In treatment Rates.• Modality End Date (s) must be populated for discharged clients.


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Drug Discharge Reasons

Successful CompletionsTreatment completed - drug freeTreatment completed - occasional user (not opiates or crack)


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Drug Discharge Reasons

TransfersTransferred – not in custodyTransferred – in custody


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Drug Discharge ReasonsIncompleteIncomplete – Dropped OutIncomplete – Treatment withdrawn by providerIncomplete – Retained in CustodyIncomplete – Treatment Commencement Declined by ClientIncomplete – Client Died


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Planned Discharge ProjectThe DTMU are currently providing support to a national exercise

around Planned and Unplanned Discharges being undertaken by the Regional NTA Teams. The number of unplanned discharges is rising, a trend which the NTA is keen to address immediately.

In order to enable the agencies to investigate individual unplanned discharges, the DTMU have made available a spreadsheet which contains the attributable level data for unplanned discharges only for your service, thus the total number of discharges will be less than the summary sheet, which includes planned discharge reasons.


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Alcohol Discharge Reasons

Successful CompletionsTreatment completed - alcohol freeTreatment completed - occasional user


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TransfersTransferred – not in custodyTransferred – in custody


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IncompleteIncomplete – Dropped OutIncomplete – Treatment withdrawn by providerIncomplete – Retained in CustodyIncomplete – Treatment Commencement Declined by ClientIncomplete – Client Died


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April 11, 2023

Treatment Outcomes ProfileRefresher


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What is the TOP?

Treatment Outcomes Profile

• An instrument to measure treatment outcomes

• A simple, short set of questions

• To plot clients’ progress through structured treatment - a measure of how well clients do in treatment

• Reported to NDTMS


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All clinicians using the TOP should know the following 5 key messages

TOP: Key factsClinical usefulnessValidation


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The TOP is a clinically useful tool for monitoring progress and identifying change during treatment

How is TOP useful

clinically?

A means of identifying and understanding change for an individual client (comparing TOP scores)

Allows the keyworker to feedback the progress a client has made. The client can see these changes visually (using TOP Progress Tracker). Visual feedback may be more effective than verbal feedback alone

Assistance given in the care planning process; highlighting areas of difficulty that may need addressing to increase the potential treatment gains

Helps summarise the clients current situation and stimulates discussions in clinical meetings and supervision

Provides the keyworker with an additional source of information/evidence that could be used when discussing a specific care plan


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How to complete the Treatment Outcomes Profile (TOP)

Client identifiers required to prevent double

counting in the NDTMSRecord the number of days in which the client has used each drug. A number should always be used (0-28) except when a

client declines to answer which should be recorded as ‘NA’

Record the number of days that the client has

injected. If the client does not inject record ‘0’. Do NOT use ‘NA’.

Also record whether the client has shared by

marking the box with a ‘Y’ or ‘N’

Some clients commit crime in order to fund their drug use. An

obvious treatment goal is to reduce this activity. Record the

number of days (0-28) for section 3a & b and ‘Y’ or ‘N’ if the client has committed crimes (c,d,e,f) in

the last 28 days

Circle the rating scales for Psychological, Physical &

Quality of Life in accordance to where the

client indicates.

Record the number of days paid work and

college between (0-28) and only use ‘NA’ if the

client declines to answer


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Three types of questions

Yes and no a simple tick for yes or no

Timeline the client recalls the number of days in each of the past four weeks on which they did something, e.g. the number of days they used heroin

Rating scale a 20-point scale from poor to good. Together with the client, mark the scale in an appropriate place


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Completion and non-responses

Ask every question, complete every blue box

Enter "NA" in the blue box:

• if client refuses to answer a question

• or if, even after prompting, client cannot recall


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TOP NDTMS Data

You should aim to ask and complete every question.

Do not leave any of the blue boxes blank

Enter “NA” if a client refuses to answer a question or cannot recall.


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When should the TOP be completed?

At start of new treatment journey

• to capture pre-treatment snapshot of client behaviour and situation

And then every three months

• usually as part of a care plan review - to compare with pre-treatment snapshot and previous quarterly TOP results

(Also on existing clients every three months)

At Treatment Exit


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This is a very brief introduction to the TOP: more information is available at www.nta.nhs.uk/

This section is a very brief introduction to the TOP and covers only the very basic information that is required to start using the TOP with clients

All the above information is available at

http://www.nta.nhs.uk/areas/outcomes_monitoring/default.aspx or complete the online order form at www.nta.nhs.uk. Alternatively, email [email protected] or telephone 08701 555 455 and quote product code

Further Information & clinical tools

Guidance

TOP reporting protocol: A keyworkers guide

TOP completing TOP as a clinical interview

TOP Progress Tracker guide (DET)

TOP Service user guide

NDTMS practice guide

TOP Managers guide

Clinical Tools

TOP form

TOP form (low ink version)

TOP Progress tracker

Calendar

TOP training pack



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Discharge Data and TOP

Complete TOP at discharge from treatment system

This should be done face-to-face between keyworker and client where possible

May be done over telephone where no other option available (i.e. in unplanned discharges)

NOT acceptable to complete on clients’ behalf without client present


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Post discharge

• if feasible or desirable for service

• won’t be performance managed by NTA

When should the TOP be completed?


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TOP and Confidentiality

TOP data submitted via NDTMS will have the same safeguards in relation to confidentiality as any other NDTMS data

This should be carefully explained to the client and local confidentiality agreements should be modified as appropriate to take into account the introduction of TOP into clinical and reporting systems


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The benefits of the TOP continue to be recognised in clinical settings with its application in the UK and abroad having increased

Over the last 12 months the NTA has received several requests from European and International colleagues to use the TOP to measure outcomes in their clinics and countries.

validated tool

clinically useful tool

short & easy to complete

captures a wide range of substances

broadly covers all other relevant treatment domains

Wales ScotlandNorthern IrelandItalyTaiwanIranAustralia ChileRussiaFinlandCanadaMaltaFinlandSpainNew Zealand

Requests received from It’s recognised that the TOP benefits from being

Why?


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See the NTA website www.nta.nhs.org.uk for more information on the use of TOP internationally


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TOP Exceptions

• Let’s review the January TOP Exceptions that were released on DAMS on 5th March 2010.

• What action needs to be taken forward?

April 11, 2023


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ANY QUESTIONS


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Performance Management


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www.ndtms.net


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DAT/AGENCY Quarterly Reports


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Data Quality & Data Completeness


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Objectives

Focus on Data QualityData Completeness

NDTMS Year End Review (2009-10)

Regional Data Quality Initiatives

How to address monthly data quality reports


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Improving Service Provision

“Drug treatment services are managed using close to “real-time” data provided from the NDTMS and client satisfaction and client outcome data”

(Models of Care: Update 2005, Consultation)


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DTMU Data Quality Strategy• As part of SLA with NTA‚ an annual data

quality strategy has to be produced and signed off by regional and central NTA.

• Covers the entire NDTMS dataset.• Sets the data quality targets‚ which are based

upon NTA HQ Monthly DQ Metrics.

April 11, 2023


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NTA Data Completeness DriversNTA National Requirements

Percentage completion rate for Parental StatusPercentage completion rate for Children Living With

Hidden HarmPSA 14 – To prevent substance misuse amongst young people helping to reduce links with crime, disorder, truancy, school failure,

physical and mental health problems.Hep B Vaccination Status responses versus Hep B Intervention status responsesRoute of Administration Inject versus Injecting Status

Health Interventions/BBVPSA 18 – To promote better health and wellbeing of all citizens of society.

Completion of Modality StartPSA 25 – to deliver a sustained 1% per annum increase (of people held in effective treatment) on 2007-08 baseline during 2008-11

Completion of Accommodation Need & Employment StatusPSA 16 – to increase the proportion of socially of socially excluded adults in settled accommodation, employment education and

trainings.


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DTMU Data Completeness Analysis

• DTMU release quarterly data completeness reports by partnership and by agency.

• Analysis is based on new presentations only.

• Quarterly 3 2009/10 to be released in March.


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Q2 Data Completeness Analysis

• Let’s review the Q2 completeness that was released in early February.

• What action needs to be taken forward?


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What data quality issues are you facing?

April 11, 2023


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How can you improve your agency’s overall data quality

and data completeness?


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DTMU Answers• Before submitting the monthly data submission check to

see if all errors/warnings that could have occurred‚ have been addressed;

• Where amendments to client details have been made on your database‚ it is very important to notify Sue Dales to ensure that these changes are replicated on the regional NDTMS database.

• Ensure that all the fields that can be completed‚ are completed.

April 11, 2023


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DTMU Data Quality Standards

All monthly agency submissions must contain at least 100% valid records.

All monthly agency submissions must reach 99.5% data quality

All fields of CDS-F populated, if appropriate.

Files must be in a CSV format.

All agencies must submit via the Upload Portal: https://www.ndtms.org/dams/


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ANY QUESTIONS

[email protected]

[email protected]

[email protected]

[email protected]


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[email protected] [email protected]@sph.nhs.uk [email protected]

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