Michael Wallington & Dami Omole Drug Treatment Monitoring Unit NDTMS Core Dataset G Training for Young People’s Treatment Providers and Commissioners Michael Wallington & Dami Omole Drug Treatment Monitoring Unit April 6, 2017

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 April 6, 2017

Aims Clarify the changes to YP items in Core Data Set ‘G’ Clarify consent and confidentiality Review Data Quality and TOP compliance Provide information around current reporting and monitoring Clarify performance measurements and waiting times calculations April 6, 2017

Why is information needed for NDTMS? The treatment information that you provide to the NDTMS is used for several purposes. Primarily: Provide information to local, regional and national PSA 14 boards on how the treatment system is helping to reduce harm arising from drug use; Inform Children’s Services, Children and Young People’s Plans and Joint Strategic Needs Assessments; Provide evidence on how the young person’s treatment system is meeting local treatment need and also ensure a more outcome focused approach to the understanding of the treatment system; Monitor the use of resources. This helps ensure equitable funding of drug and alcohol services nationally; Produce statistics and to support research on drug and alcohol use. April 6, 2017

YP DAAT Profiles: 2008-09 Available on DTMU website http://www.dtmu.org.uk/DAT Profiles 2008-09.html The DTMU DAAT Profiles for Adults and YP for 2008/09 were released in February 2010. Electronic copies of these reports can be found on www.dtmu.org.uk. April 6, 2017

Young People Modalities Tier 3 YP Psychosocial Intervention YP Harm Reduction Services YP Family Work YP Specialist Pharmacological Interventions Tier 4 YP Access to residential treatment for substance misuse Tier 2 YP Non-structured intervention Young People receiving these Tier 3 or 4 interventions will count towards performance targets Very clear that Psychosocial Interventions can include both one-to-one and group work – it is the care planned element that is key to whether or not it is considered to be T2/3

Question: Are you all reporting treatment modalities against individual clients’ episode of treatment? April 6, 2017

CDS ‘G’ Young People Changes to YP data set April 6, 2017

Changes with Core Data Set G One new data item (Local agency details) One new YP data item (CLA Location) YP outcomes updated YP reference data updated April 6, 2017

New data item: Local agency details Field 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 6, 2017

Changes to YP data set New field. CLA location Reference data updates Changes to YP data set New field CLA location Reference data updates Accommodation Need Referral Source YP outcomes updated April 6, 2017

Children Looked After “Children looked after includes all children being looked after by a local authority including those subject to care orders under section 31 of the Children Act 1989 and those looked after on a voluntary basis through an agreement with their parents under section 20 of the Children Act 1989” April 6, 2017

New data item Data Item: Location of CLA CLA living in care CLA living in childrens home CLA living in residential school CLA living in educational behavioural unit CLA living in secure childrens home CLA living out of borough CLA placed out of borough CLA living independently in settled accommodation CLA living independently in unsettled accommodation CLA living in supported housing CLA living with Kin Carers Should only be completed if Accommodation Need is CLA April 6, 2017

Accommodation Need Two old values removed CLA living in care CLA out of LA Introduction of one new value CLA If Accommodation Need value is ‘CLA’, the ‘CLA location’ field needs to be populated April 6, 2017

Referral Source One old value removed Introduction of new values YP Custody Introduction of new values Secure Children’s Home Secure Training Centre Youth Offender Institute YP Housing A number of proposed CDS-G YP referral sources were not included in the final data set (v7.0.3). These include ‘YP Probation’, ‘Secure Children’s Home (Local Authority)’, ‘Secure Children’s Home (YJB)’ and ‘Adult Services’. April 6, 2017

CDS ‘G’ Reference Data Changes to reference values in line with NHS Data Dictionary 16

Employment status Regular Employment Pupil/Student Long term sick or disabled Homemaker Retired from work Unemployed and seeking work Not receiving benefits Unpaid voluntary work Retired from paid work Not stated Other Not known ‘Long term sick or disabled’, ‘Homemaker’ and ‘Retired from work’ have all been included following expansion of previous ‘Economically inactive’ option. ‘Unemployed and seeking work’, ‘Not receiving benefits’, ‘Unpaid voluntary work’, ‘Retired from paid work’ and ‘Not stated’ have been included following expansion of previous ‘Unemployed’ option. April 6, 2017

Sexuality Gay: renamed to Homosexual Not Disclosed: renamed to Not Recorded April 6, 2017

Consent Yes the person consented No the person has not consented To clarify, CONSENT relates to the client’s consent to share their information through NDTMS April 6, 2017

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 ‘Not known’ has been reintroduced April 6, 2017

Hepatitis C Positive Yes is Hepatitis C Positive No is not Hepatitis C Positive Not Known ‘Not known’ has been reintroduced April 6, 2017

Injecting Status Previously Injected (but not currently) Currently Injecting Never Injected Client Declined to Answer April 6, 2017

Drug Codes Methylone Mephedrone No Second Drug No Third Drug Other currently legal highs may be captured as ‘Other stimulant’ April 6, 2017

CDS ‘G’ Young People Changes to YP Outcomes April 6, 2017

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. April 6, 2017

Treatment Start Data Item: YP registered with GP at Treatment Start? Yes No Not Known 26

Treatment Start Data Item: YP has CAF at Treatment Start? Yes No 27

Treatment Start Data Item: YP in contact with Learning difficulty services at Treatment Start? Yes No Not known 28

Treatment Start Data Item: YP Lead Professional at Treatment Start? Yes No ‘Not known’ is no longer a valid option ‘Not known’ has been removed as an option

Treatment Start Data Item: YP in contact with Mental Health Services at Treatment Start? Yes No Not Known

Treatment Start Data Item: YP in contact with YOT at Treatment Start Yes No Not Known

Treatment Start Data Item: YP involved in Sexual Exploitation at Treatment Start Yes No

Treatment Start Data Item: YP involved in Self-Harm at Treatment Start? Yes No Not Known

Treatment Start Data Item: YP involved in Unsafe Drug Use at Treatment Start? Yes No

Treatment Start Data Item: YP involved in offending at Treatment Start? Yes No Not Known

Treatment Start Data Item: YP education status at Treatment Start? Mainstream Education Alternative Education Temporarily Excluded Permanently Excluded Persistent Absentee Apprenticeship or training Employed Not in employment or education Economically Inactive Caring Role Economically Inactive Health Issue New reference data options: 6 - Apprenticeship or training 8 - Employed 9 - Not in employment or education 10 - Economically Inactive Caring Role 11 - Economically Inactive Health Issue

YP Sexually active at Treatment Start? “The point of the question is to identify where YP are involved in risky sexual practices, as there are specific interventions these clients should receive. We are however wary of having information on record about how many young people are sexually active, when we do not need to know this information. We think there could be unwelcome media initiated FOI’s, and therefore think that holding such information constitutes a risk. The naming of the field is perhaps unfortunately euphemised, but the definitions do make its meaning and purpose clear.” Feedback from Young People’s team at NTA HQ. April 6, 2017

Treatment Start Data Item: YP Sexually active at Treatment Start? Yes – unsafe sex Not asked At the start of the current treatment episode, is the client sexually active AND engaged in unsafe sex The field “YP involved in unsafe sex at Treatment Start?” has been renamed “YP Sexually active at Treatment Start” Options are “Yes – unsafe sex” and “Not asked”. Field should be left blank if not applicable

Treatment Start Data Item: YP parent in Substance Misuse treatment at Treatment Start? Data Item: YP parent in Mental Health Treatment at Treatment Start REMOVED FROM DATASET DO NOT POPULATE

Treatment Exit Data Item: YP lead professional at Treatment Exit? Yes – LP at Drug Agency Yes – LP not at Drug Agency No ‘Not Known’ is no longer an option “Not known” has been removed

Treatment Exit Data Item: YP in contact with Mental Health Services at Treatment Exit? Yes No Not Known

Treatment Exit Data Item: YP in contact with Learning difficulty services at Treatment Exit? Yes No Not Known

Treatment Exit Data Item: YP in contact with YOT at Treatment Exit? Yes No Not Known

YP Sexually active at Treatment Exit? “The point of the question is to identify where YP are involved in risky sexual practices, as there are specific interventions these clients should receive. We are however wary of having information on record about how many young people are sexually active, when we do not need to know this information. We think there could be unwelcome media initiated FOI’s, and therefore think that holding such information constitutes a risk. The naming of the field is perhaps unfortunately euphemised, but the definitions do make its meaning and purpose clear.” Feedback from Young People’s team at NTA HQ. April 6, 2017

Treatment Exit Data Item: YP Sexually active at Treatment Exit? Yes – unsafe sex Not asked At the start of the current treatment episode, is the client sexually active AND engaged in unsafe sex The field “YP involved in unsafe sex at Treatment Start?” has been renamed “YP Sexually active at Treatment Start” Options are “Yes – unsafe sex” and “Not asked”. Field should be left blank if not applicable

Treatment Exit Data Item: YP involved in Sexual Exploitation at Treatment Exit? Yes No

Treatment Exit Data Item: YP involved in Self-Harm at Treatment Exit? Yes No Not Known 47

Treatment Exit Data Item: YP involved in unsafe drug use at Treatment Exit? Yes No 48

Treatment Exit Data Item: YP involved in offending at Treatment Exit? Yes No Not Known 49

Treatment Exit Data Item: YP has CAF at Treatment Exit? Yes No 50

Treatment Exit Data Item: YP sexual health interventions at Treatment Exit? Yes No Inappropriate Question 51

Treatment Exit Data Item: YP registered with GP at Treatment Exit? Yes No Not Known 52

Treatment Exit Data Item: YP met goals agreed on Care Plan at Treatment Exit? Yes No 53

Discussion Have your IT systems been updated to collect these data items? What other potential challenges or barriers exist that may affect the collection of these data items? e.g. updating paperwork, training staff April 6, 2017

Information Management April 6, 2017

Information Management Clinicians 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) If a client refuses consent – NDTMS and TOP should still be completed within your own system, consent flagged as no, and we will receive only minimal non-identifiable data. If the client is not aware that the DAAT would have sight of the attributable data, their row level data cannot be shared with the DAATs.

Confidentiality The same duties of confidentiality apply to children and young people as to adults. In addition to the usual bases for non-consensual disclosure, information might be shared about a child or young person without consent: to protect them from a risk of significant harm when it is in the best interests of a child or young person who does not have the capacity to make a decision about disclosure. (Drug Misuse and Dependence: UK guidelines on clinical management‚ 2007) From Orange Book clinical guidance 2007 April 6, 2017

Consent All young peoples’ treatment agencies should have clear policies on: a) Confidentiality and information sharing b) Consent to treatment, and c) Child protection. Policies on confidentiality and consent need to be agreed by Local Safeguarding Children’s Boards which should also provide assistance on these matters. Staff should be familiar with these policies and should act in accordance with them. Young people’s specialist substance misuse treatment providers should be familiar with the following documents on consent and confidentiality: • Assessing Young People for Substance Misuse. NTA website, 2007. • NTA: Essential Elements of a Treatment Service. NTA website, 2005. • Department of Health: Seeking Consent Working With Children. DH website, 2001. • Royal College of General Practitioners and Brook Advisory Services. Confidentiality and Young People: Improving teenager’s uptake of sexual and other health advice, 2000. • SCODA/ Children’s Legal Centre. Young People and Drugs. Drug scope, 1999. April 6, 2017

Consent Clients 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. If a client refuses consent – NDTMS and TOP should still be completed within your own system, consent flagged as no, and we will receive only minimal non-identifiable data. If the client is not aware that the DAAT would have sight of the attributable data, their row level data cannot be shared with the DAATs.

Consent (2) In order to provide data to NDTMS, a treatment provider must first request and obtain consent from the client and/or parent or person with parental responsibility. If a treatment provider offers services which do not involve obtaining consent, NDTMS will not be able to accept data relating to the individuals in receipt of those services. April 6, 2017

Consent (3) Treatment providers should determine whether a young person or their parent or person with responsibility should be asked for consent in relation to reporting to NDTMS according to their protocols for determining a young person’s capacity to give informed consent. April 6, 2017

Confidentiality All agencies should routinely and explicitly explain their confidentiality and information sharing policy in relation to NDTMS with young people and their parents or carers. Young people entering treatment should sign a confidentiality agreement as part of the care planning process. This confidentiality statement should include details about how the treatment provider will respond to child protection issues if there is concern that a child is thought to be suffering, or to be at risk of suffering, ‘significant harm’. This statement should also identify what information will be reported to NDTMS. April 6, 2017

NTA Confidentiality Toolkit Confidentiality 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)

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) If a client refuses consent – NDTMS and TOP should still be completed within your own system, consent flagged as no, and we will receive only minimal non-identifiable data. If the client is not aware that the DAAT would have sight of the attributable data, their row level data cannot be shared with the DAATs.

Data Sharing Protocols It is good practice to have data sharing protocols in place that outline how and why data is shared within and between organisations. Scenarios: Partnership-wide systems 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 involved agencies. Part of the assessment process should be establishing with a client how information relating to them may be shared and for what purpose. This may be done as part of the care planning process and should have started at the time of assessment.

Discharge Data

Discharge Data Discharge Date Discharge Reason Discharge Destination If a Discharge Date is entered, then a Discharge Reason and Discharge Destination must be given. Discharge information must be reported accurately and in a timely fashion as it is used to calculate In treatment Rates. Modality End Date (s) and Modality Exit Status must be populated for discharged clients.

Drug Discharge Reasons Successful Completions Treatment completed - drug free Treatment completed - occasional user (not opiates or crack)

Drug Discharge Reasons Transfers Transferred – not in custody Transferred – in custody

Drug Discharge Reasons Incomplete Incomplete – Dropped Out Incomplete – Treatment withdrawn by provider Incomplete – Retained in Custody Incomplete – Treatment Commencement Declined by Client Incomplete – Client Died

Discharge Destination… Back to Referrer Generic Children’s Services Targeted Youth Support Lead Professional Alternative Education Children’s Mental Health Services

Discharge Destination (2) Crime Prevention Accommodation Services Other YP Treatment Services Adult Treatment Services No Onward Referral No Referral Required

Treatment Outcomes Profile Refresher for YP services April 6, 2017

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 TOP should be reported for all clients aged 16 and over 74

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 each substance Rating scale a 20-point scale from poor to good. Together with the client, mark the scale in an appropriate place 75

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 twelve weeks usually as part of a care plan review - to compare with pre-treatment snapshot and previous quarterly TOP results (Also on existing clients every twelve weeks) At Treatment Exit Three months Four weeks for Bucks 76

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 77

When should the TOP be completed? Post discharge if feasible or desirable for service won’t be performance managed by NTA 78

How is TOP useful clinically? 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

How to complete the Treatment Outcomes Profile (TOP) Client identifiers required to prevent double counting in the NDTMS Record 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

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. Where DAAT areas have incorporated the form into their own paperwork, the questions should be replicated exactly as they appear on the TOP form and need to be input into the NDTMS at the appropriate points in the client treatment. The above points apply to locally adapted paperwork as well. 81

Further Information & clinical tools 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 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 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 nta@prolog.uk.com or telephone 08701 555 455 and quote product code

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 83

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. Requests received from It’s recognised that the TOP benefits from being Wales Scotland Northern Ireland Italy Taiwan Iran Australia Chile Russia Finland Canada Malta Spain New Zealand validated tool short & easy to complete Why? clinically useful tool captures a wide range of substances broadly covers all other relevant treatment domains

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

TOP Exceptions Let’s review the February YP TOP Exceptions that were released on DAMS on 30th March 2010. Discussion: Having reviewed the TOP exception reports, what actions need be taken? February TOP Exceptions were published on DAMS on 30/03/2010. January TOP Exceptions were published on DAMS on 05/03/2010. April 6, 2017

ANY QUESTIONS 88

Performance Management

www.ndtms.net GO THROUGH QUARTERLY PERFORMANCE REPORTS – provide each delegate with their agencies quarterly report.

DAT/AGENCY Quarterly Reports Available through DAMS (NDTMS upload portal) and restricted section of www.NDTMS.net

Data Quality & Data Completeness

Objectives Focus on Data Quality Data Completeness NDTMS Year End Review (2009-10) Regional Data Quality Initiatives How to address monthly data quality reports

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)

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 6, 2017

NTA Data Completeness Drivers NTA National Requirements Percentage completion rate for Parental Status Percentage completion rate for Children Living With Hidden Harm PSA 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 responses Route of Administration Inject versus Injecting Status Health Interventions/BBV PSA 18 – To promote better health and wellbeing of all citizens of society. Completion of Modality Start PSA 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 Status PSA 16 – to increase the proportion of socially of socially excluded adults in settled accommodation, employment education and trainings. 96

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 released end of March / early April. 97

Q2 Data Completeness Analysis Let’s review the Q2 completeness that was released in early February. What action needs to be taken forward? 98

What data quality issues are you facing? April 6, 2017

How can you improve your agency’s overall data quality and data completeness?

Suggestions 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 6, 2017

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/

ANY QUESTIONS Regina.Lally@SPH.nhs.uk Sue.Dales@SPH.nhs.uk Michael.Wallington@SPH.nhs.uk Dami.Omole@SPH.nhs.uk

Dami.Omole@sph.nhs.uk Michael.Wallington@sph.nhs.uk