NTA Patient Placement Criteria (PPC) and Segmentation project David Best

Sub-group: PPC and segmentation Develop, for and with the National Treatment Agency, a model for the segmentation of the treatment population and the at-need group not currently engaged in treatment, in terms of their likely recovery pathways and journeys. This will prepare the way for matching to suitable treatment placement indicators, in the context of the developing recovery framework. Overall, the aims of the group are to agree a process for meaningful segmentation and to utilise this as a way of identifying matching criteria for treatment journeys and ongoing recovery pathways. Dr John Marsden (IoP) – PPC David Best (UWS / Monash) - Segmentation

What is the real purpose? CSAT (2009) say that 58% of people with a substance dependence will eventually recover Is that right? Does it apply to the UK? Who are they? Is there anything you can do to make that figure go up or down?

Hypothesis There are naturally occurring turning points in all life trajectories – birth of a child, getting a job, getting married, moving house etc It is also possible that turning points in trajectories can be induced, and one of those possible transitions is a successful treatment episode It is hypothesised that the reason why some potential turning points are actualised is based on the reserve of recovery capital that the individual possesses

Best and Laudet (2010) Social Recovery Capital Collective Recovery Capital Personal Recovery Capital

How does this link to segmentation? The aim is to use existing resources and materials to identify variables – such as age, gender and drug use profile that may predict recovery outcomes To link this to measures of functioning where available – including but not restricted to TOP data To link this to aspects of community functioning And to link this to locality differences in access to community capital To create a preliminary model that is hypothesis based but data driven to create a segmentation

09/10 data on % in stable housing

09/10 data on % abstinent from opiates and crack

09/10 data on % in education or employment

09/10 data on % meeting all 3 criteria

OVERALL MEASURE OF WELLBEING 3 OBJECTIVE FACTORS – STABLE HOUSING – NO HEROIN OR CRACK USE – MEANINGFUL ACTIVITY 3 SUBJECTIVE FACTORS – PHYSICAL WELLBEING – PSYCHOLOGICAL WELLBEING – QUALITY OF LIFE ALL MADE EQUAL (0-1) TOTAL SCORE OUT OF 6

Composite recovery capital baseline to six months by DAT

Composite recovery capital baseline to six months by gender

Composite recovery capital baseline to six months by age group

SITE VISITS - PURPOSE To map out the recovery communities and systems To assess functioning in those in maintained and abstinent recovery To test measures of collective recovery capital To test the overall model of developmental recovery

WHAT DO WE KNOW ABOUT EACH LOCATION? LIVERPOOLWIRRALCALDERDALE SOCIAL DEPRIVATION INDEX SCORE NATIONAL RANKING (OUT OF 354) OVERALL CRIME PER 1,000 PERSONS % OF WORKING AGE POPULATIONS ON BENEFITS 25.8%21.8%16.1% INFANT MORTALITY PER 1,000 LIVE BIRTHS

Recovery case studies OVERALL ABOUT 180 RECOVERY PROTOCOLS COMPLETED IN THREE LOCATIONS CALDERDALE 52 interviews conducted Mean age = 40.8 years Mean length of recovery time – 39 months 3/52 reported housing problems 22/52 reported some level of education and employment

TOP functioning by group 0-6m in treatment 1-4 years in treatment 4years + in treatment Recovery group Physical health Psychologic al health Quality of life

Correlates of recovery time TIME IN RECOVERY CORRELATED WITH CORRELATION PSYCHOLOGICAL HEALTH0.21 PHYSICAL HEALTH0.15 QUALITY OF LIFE0.23 DAYS OF ACTIVITY0.44

Correlates of activity NUMBER OF DAYS WORKING OR TRAINING CORRELATED WITH CORRELATION PSYCHOLOGICAL HEALTH0.55 PHYSICAL HEALTH0.29 QUALITY OF LIFE0.36 TIME IN RECOVERY0.44

PRELIMINARY COMPARISON WITH THE WIRRAL

ENTRY SOURCES MAINSTREAM TREATMENT COMMUNITY RECOVERY VISIBLE RECOVERY MAINSTREAM MUTUAL AID CSMS CONNECT 3 PROJECT COLT BASEMENT TTP DETOX BASEMENT CRIM JUSTICE OTHERSELF

OVERALL CANDIDATE MODEL BASELINE OF RC ENABLERS – possibly mediated by gender and age PERSONAL RECOVERY CAPITAL SOCIAL RECOVERY CAPITAL This creates an individual model that is then multiplied against: COLLECTIVE RECOVERY CAPITAL IS ASSESSED AS A FRACTION BASED ON: – TREATMENT QUALITY AND ACCESS – RECOVERY CHAMPION VISIBILITY AND ACCESS TO GROUPS – SOCIAL COHESION, DEPRIVATION AND OPPORTUNITY