ndtms~top & yp services ndtms~top young people services april 2009 jill smith nepho – ndtms...

NDTMS~TOP & YP Services

NDTMS~TOPYoung People Services

April 2009

Jill Smith

NEPHO – NDTMS Team

NDTMS – Why Bother?

• Government• Drives PSA 14 and 25 (numbers in treatment include

YP aged 16-18 in specialist drug or alcohol treatment) as part of the delivery for National Drug Strategy 2008-2011

• NTA view– More treatment, better treatment, fairer treatment

• DAT view– Essential to Needs Analysis process– Informs planning & commissioning– Hidden Harm: ineffective if sparse data input

• Treatment Service view– Preserve budgets funding treatment– Evidence for effective/innovative practices

NDTMS – History

Began collecting performance data on treatment of • adult problem drug users, • then YP drug & alcohol misusers,

• 2005 YP dataset made available• 2006 NTA Memorandum of Understanding Defines roles for delivery assurance of YP

Services• adult alcohol April 2008• changes re discharge destination, etc August

2008• CDSF – many changes for YP Services

NDTMS

National Drug (and Alcohol) Treatment Monitoring System

– Client details– Episode details– Treatment modality/intervention details– Treatment outcome Profiles (TOP) details– Local Regional fields

NDTMS – Core Dataset ‘F’

National Drug (and Alcohol) Treatment Monitoring System

• Number of fields has expanded and changed

• Reference options within fields have expanded and changed

• Additional services completing NDTMS

• Additional Government Departments involvement

• Now on Core Dataset F

Where to begin?

NDTMS – Adult/YP/Alcohol??

Adult, Alcohol or YP Datasets?

• Transitional arrangements – special needs• Adult service working with <18s• YP services working with =>18s

It is the service, not the client which determines dataset to selectWHAT CONSTITUTES YP SERVICES?

NDTMS – It is Not……

• The YOT ASSET tool is not detailed enough to inform a specialist SM care plan and cannot be used as a comprehensive SM assessment tool

• YOT targets/performance rules and definitions are different to NDTMS

• Treatments to address SM as it interrelates with offending behaviour are expected to be included within Psychosocial Interventions and YP Criminal Justice Interventions has been removed

• Interventions for children with parents who have SM issues should not be recorded unless they relate to the child’s own SM issue

NDTMS – It is……

“YP’s specialist SM treatment is a care planned medical, psychosocial or specialist harm reduction intervention aimed at alleviating current harm caused by a YP’s SM”.

Foundation for all interventions:• Comprehensive assessment• Care plan• Care Co-ordination by a ‘lead professional’

NDTMS – Confidentiality & Consent

CONFIDENTIALITY AND CONSENT

• Various documents supporting YP services are available

• All services should have clear policiesa)Confidentiality and information sharing

• Agreed by Local Safeguarding Children’s Boards

b)Consent to treatment, and

c) Child protection

NDTMS – Basics

• All fields should be completed • Some fields should be reviewed• Some fields should be completed at discharge• Some fields can be completed after discharge

• Garbage in ~ Garbage out

Analysis and information jeopardisedwhen fields left blank

Basics: Data Completion

NDTMS – Basics

Basics: Understand the Questions

The NTA Business Definition and Reference Data Documentation is important and changes as understanding of usage and meaning develops

NDTMS – Basics

Basics: Get hold of the documentation

NTA WEBSITE FOR DOCUMENTATION:-

http://www.nta.nhs.uk/areas/ndtms/core_data_set_page.aspx

NB: Awaiting revised guidance for young persons' treatment providers

NDTMS – YP Interventions

• 6 YP Interventions• First four describe the delivery:-

• Psychosocial Intervention

• Specialist Harm Reduction (Including injecting behaviour, overdose and accidental injury advice)

• Family Work (Only if YP is in specialist SM treatment)

• Pharmacological Interventions

• Fifth describes setting:• Access to Residential Treatment

• Sixth is for Tier 2 only (optional)• Non structured intervention

Use of combined Tier 2 and Tier 3 interventions can lead to performance measurement errors with serious consequences

NDTMS –YP

YP Dataset

1 Dates - Time is of the essence!: More often than not referral date, triage date, care plan start date and intervention start date should be the same for YP services

2 Accommodation Need: Specific set of 8 YP codes. If NFA then leave postcode blank but complete DAT of residence for treatment provider (if Tier 3) or referring partnership (if Tier 4) and leave PCT of residence blank

NDTMS – YP

3. Parental Status?

Now expanded. Includes biological, step-, foster, adoptive, guardians to include any parenting where a client has full or partial parental responsibilities and is living with that child(ren) for a minimum of one month – see separate Appendix K in business definitions. Children defined as <18.

• All the children live with the client• Some of the children live with client• None of the children live with client• Not a parent• Client declined to answer

NDTMS – YP

4. Children Living with:

Count all children, at all addresses. Include siblings, landlord’s children, etc. Children are defined as <18.

Children’s Home: Only count family/siblings living with client

5.Pregnant: Ask! Record N for males.

6.Problem Substance No. 1: The substance that brought YP into treatment – drugs or alcohol. If more than one, provider to determine which is primary.

NDTMS – YP

7. Referral Source: Raised focus of attention by DCSF. Now 26 different sources, categorised into 5 groups and providing information about integration of treatment/children and family services. See later.

8. Injecting Status & BBV: Endeavour to complete but record in case notes if assumptions around e.g. non-injecting behaviour are made and questions not asked.New: Assessed as not appropriate to offer

9. Employment Status: 8 options available. Only use Unemployed for adults attending YP services

NDTMS – YP

10. Drug treatment health care assessment date: – Young People Treatment providers should only record a date when a young person receives an assessment from a health clinician such as a Nurse, Doctor or Psychiatrist AND when the assessment relates specifically to their substance misuse such as in relation to clinical management, issues arising from injecting behaviour, blood borne viruses or dual diagnosis. Providers should refer to Assessing Y P for substance misuse 2007 for guidance on when it is appropriate for a young person to be assessed by a health clinician.

• Further guidance in relation to health care assessments for young people will be published alongside the forthcoming harm reduction guidance by the end of 2009.

NDTMS – YP

11. TOP: Only complete for YP =>16. NB: use of NA/Zero and collection of crime data.

12. Discharge Date: Date is last face-to-face contact. Discharge c.2 months after DNA and no contact.

Note: If client goes into custody for <21 days, then do not discharge but continue episode and there is no need for TOP Exit~TOP Start.


a) Treatment Start and Treatment End– YP has lead professional?

This refers to the professional who as part of the CAF process has been appointed to act as a single point of contact and coordinate provision for a child and their family when a range of services are involved and an integrated response is required

– YP in contact with mental health services?This refers to a young person who is currently in contact with either inpatient or outpatient Mental Health Services

1. New Fields 1st April 2009


a)Treatment Start and Treatment End– YP in contact with YOT?

This refers to a young person who is currently in contact with the Youth Offending Team as a result of receiving a reprimand or final warning, acceptable behaviour contract (ABC), anti social behaviour order (ASBO) or community sentence

1. New Fields


a) Treatment Start and Treatment End– Involved in Sexual Exploitation? “Children, both male and female, engaging in sexual

activities for money, profit, or any other consideration due to coercion or influence by any adult, syndicate or group. The profit could go either to the child or to any third party involved in the transaction.”

This refers to a young person’s current involvement, or suspected involvement in activities such as prostitution, production of pornography, or age inappropriate relationships with adults

1. New Fields……


a) Treatment Start and Treatment End– Involved in Unsafe drug use?

“Substance use related behaviour that disproportionately increases the magnitude of physical, emotional or social harm to the young person taking the substance” Examples include the use of particularly hazardous routes of administration such as injecting; the use of substances in particularly high quantities and/or in combination or the use of substances alone or with older people.”

This refers to a young person’s current involvement or suspected involvement in unsafe drug and alcohol related activities such as binge drinking, poly drug use, sharing of injecting equipment, being injected by someone else or solvent abuse

1. New Fields……


a) Treatment Start and Treatment End– Involved in Offending?

This refers to a young person’s current involvement or suspected involvement in activities which may or may not have come to the attention of the police, YOT or local authority. Examples include stealing money from parents or friends, shoplifting, drug selling, street drinking (in alcohol restricted zones), graffiti and vandalism

1. New Fields……


a) Treatment Start and Treatment End– YP Self-harming?

“Self - poisoning or self - injury, irrespective of the apparent purpose of the act”

This refers to a young person’s current involvement or suspected involvement in activities such as cutting, burning, banging, hair pulling or poisoning. This includes accidental and non - accidental overdose

1. New Fields……


b)Treatment Start only– YP Education Status (=<16)?

This refers to a young person’s current educational involvement.

1. New Fields…….

Mainstream education includes schools, academies and further education colleges Alternative education includes schooling delivered within a pupil referral unit or home setting

Temporarily excluded refers to young people currently excluded from school on a temporary basis for a fixed term (no more than 45 days a year)

Permanently excluded refers to young people currently excluded from school where alternative schooling arrangements have not yet been made

Persistent absentee


b)Treatment Start only– YP Involved in unsafe Sex?

This refers to a young person’s current or suspected involvement in unsafe sexual activities such as unprotected vaginal, anal or oral sex

– YP Parent in SM Treatment?– YP Parent in MH Treatment?

These refer to a young person who has one or more parent or guardian currently in contact with treatment services to address their drug or alcohol problems or their mental health problems




c) Treatment Exit only

– YP has a CAF?This refers to a young person who has been identified as requiring additional needs and assessed using the Common Assessment Framework at the point of discharge

– YP safer sex?This refers to a young persons current involvement in unsafe sexual activities such as unprotected vaginal, anal or oral sex at the point of discharge




– YP sexual health interventions?

This refers to a young person who has been directly offered, or offered access to a sexual health intervention. These can include STI screening, pre and post test counselling, advice on safer sex, contraception (i.e. condoms), or pregnancy testing




– YP registered with GPThis refers to a young person who has registered with a General Practitioner since the point of treatment entry

– YP met goals on Care Plan

This refers to a young person who has met the main goals of their care plan at treatment exit


2. TOP / Care Coordination flag

Does the treatment provider currently have care coordination responsibility for the client in regards to completing the TOP information when appropriate, during the client’s time in structured treatment?

One service to manage TOP process (agreed at a local Treatment System level)

One set of TOPs for one episode of care

Consent for sharing TOP process data


2. TOP / Care Coordination flag

Recent enquiry received by NDTMS team:

Re top coordination surely ALL providers are required to fill in a care plan for their organization and if they do who decides who is the overall care coordinator?

Care Planning is not the same as Care Coordination

Decisions about Care Coordination have to be made at a local level and even then there must be ongoing communication between services to ensure all the clients’ needs are being met


•COMFORT BREAK?……………


3. Reference data changes

a) Referral Date/Referred to Intervention Date?• Clarification of need for 2-way communication:• Referral date: when the service and YP agreed to referral• Referred to Intervention Date: when keyworker and YP

agreed to treatment

Understanding is important as this information is linked to the performance of services in YP being assessed within 5 days of referral.


3. Reference data changes…..b) Referral SourceChild and Family ServicesCLA - Children Looked AfterChildren and Family ServicesUniversal Education Referrals from main stream or universal educational

services such as schools, colleges and universitiesAlternative Education Referrals from Pupil Referral Units and other alternative

education services for excludees and truants and or any young people who cannot access universal education provision for any reason

Targeted Youth Support Referrals from services providing prevention or early intervention or support services for vulnerable young people.

Outreach Services which provide active outreach to address homelessness, anti-social behaviour, or sex work and other issues

Helpline (NEW) Referrals from help lines apart from FRANK and other local or regional substance misuse initiatives


3. Reference data changes…..b) Referral Source

Health and Mental Health ServicesGP Direct referrals from General Medical Practitioners who

are not formally part of a treatment providerA&E (NEW) Accident and EmergencyHospital (CHANGED) Referrals from Hospitals not including A&E departmentsNon Child Mental Health Services

Mental health services such as adult psychiatric and psychological services; private psychiatric and psychological services and third sector mental health or advocacy services for people with mental health needs

Primary Care (NEW) Referrals from services delivered by health care professionals such as practice nurses, midwives and pharmacists in general medical settings such as walk in centres and pharmacies

Children’s Mental Health Services

Both inpatient and outpatient Child and Adolescent Mental Health Services. This includes referrals from mental health services that work across the age range (i.e.16 - 25) such as early interventions teams

School Nurse (NEW) Referrals from services delivered by registered nurses within the school setting


3. Reference data changes…..b) Referral SourceSubstance Misuse ServicesAdult Treatment Provider Services providing drug or alcohol treatment services

predominantly for those aged 18 years or older. This includes needle exchange programmes and other services to address adult substance misuse.

Young People’s Treatment Provider

Services providing specialist substance misuse treatment services pre-dominantly for those under 18.

Non Treatment substance misuse services

Referrals from young people specific services providing universal, targeted or early interventions to address substance misuse. Young people specific services which provide both treatment and non - treatment interventions should use this code when referring clients to the treatment elements of their programmes.

FRANK (NEW/ CHANGED) Referrals from the Talk to FRANK helpline


3. Reference data changes….. b) Referral Source Arrest Referral/DIP &Community Sentence=Removed

Criminal JusticeCrime Prevention (CHANGED)

Services working with young people identified as at risk of offending and who are not due to attend court and are not currently under sentence such as Youth Inclusion Programmes (YIPs), Youth Inclusion Support Panels (YISPs) or any arrest referral schemes in operation

YOT (NEW) Referrals from Youth Offending Teams for clients who are expecting to receive treatment as part of court ordered sentence arrangements

Custody Service Custodial providers for young people who are currently on a custodial sentence and expect to be receiving substance misuse treatment from a NDTMS registered community provider whilst in custody.

Post Custody Services such as YOTs, RAPs or custodial providers of young people who are currently on a custodial sentence and are about to commence a community sentence.


3. Reference data changes…..b) Referral Source

Family and FriendsSelf Young person with treatment needs has sought

treatment.Relative (NEW) Parents, siblings other relativesConcerned Others (NEW) Carers, friends, boyfriends or girlfriends who are

connected to the young person in a personal rather than a professional capacity have referred the young person to treatment.

Website (NEW)


3. Reference data changes…..

c) Discharge Reason (Separated from Discharge Destination)Please note that different definitions will apply to the above codes depending on the setting of treatment i.e. in YP providers or if the client is being treated primarily for Alcohol.

YP Discharge Reason? – Planned

Treatment Completed - Drug Free

this refers to a young person who no longer requires a structured drug treatment intervention and is not using any substance. This includes alcohol. It is likely that young people successfully leaving treatment will continue to drink alcohol. Even if this is done within recommended alcohol limits the young person should not be recorded in this section. See 2 below.

Treatment Completed Occasional User (not heroin or crack)

this refers to a young person who no longer requires a structured drug treatment intervention There is evidence of occasional drug and/or alcohol use (not heroin or crack) but this is not judged to be problematic


3. Reference data changes…..c) Discharge Reason

YP Discharge Reason? - Neutral

Transferred-Not in Custody

this refers to a young person who has finished at this treatment provider but still has a treatment need so is referred onto another community based treatment provider. This code should only be used if the young person is transferred from one specialist treatment provider to the another in a care planned way

Transferred-In Custody

this refers to a young person who has received a custodial sentence or is on remand and a continuation of structured treatment has been arranged. This will consist of the appropriate onward referral and a two-way communication between the community and secure setting to confirm assessment and that care planned treatment will be provided as appropriate

The distinction between In and Not in Custody may be difficult to determine in some cases – more clarification is being sought.


3. Reference data changesc) Discharge Reason

YP Discharge Reason? - UnplannedIncomplete Treatment Withdrawn by Provider

the treatment provider has withdrawn treatment provision from the client. This item could be used in cases where the client has seriously breached a contract leading to their discharge. It should not be used if the client has simply ‘dropped out’ see below

Incomplete Dropped Out

the treatment provider has lost contact with the client without a planned discharge and activities to re-engage the client back into treatment have not been successful

Incomplete Retained in Custody

the client is no longer with the treatment provider as they are in a secure setting such as a Youth Offending Institution, Secure Training Setting or Secure Children’s Home. While the treatment provider has confirmed this, there has been no formal two-way communication between the treatment provider and the criminal justice care provider leading to continuation of the appropriate assessment and care-planned structured drug treatment

Incomplete Treatment Commencement Declined by the Client

the treatment provider has had face to face contact with the client after which the client has chosen not to commence a recommended structured drug treatment intervention

Incomplete Client died

during their time in contact with structured drug treatment the client died

This option would also have to be used if a client is still known to be using crack/heroin, even occasionally, at the end of care-planned treatment.



c) Discharge Destination? (YP only)

These options refer to a young person, who at the end of the treatment episode is referred:-

Back to Referrer back to the lead agency that originally referred them into specialist treatment

Generic Children’s Services onto Children and Family, Child Looked After or Universal Education services.

Targeted Youth Support

onto services providing prevention, early intervention or support for vulnerable young people. This includes generic youth services providing Information, Advice and Guidance, and targeted services such as Connexions and Positive Activities for Young People

Lead Professional

onto a Lead Professional. As part of the CAF process a lead professional takes the lead to coordinate provision and acts as a single point of contact for a child and their family when a range of services are involved and an integrated response is required

Alternative Educationonto education services for young people who cannot access universal education provision for any reason.

Children’s Mental Health Services

this inpatient or outpatient Child and Adolescent Mental Health Services. This includes referrals from mental health services that work across the age range (i.e.16-25) such as early interventions teams



c) Discharge Destination? (YP only)……

These options refer to a young person, who at the end of the treatment episode is referred:-

Crime preventiononto services working with young people identified as at risk of offending and who are not due to attend court and are not currently under sentence such as YIPs, YISPs or any arrest referral schemes in operation

Accommodation Servicesonto accommodation services specifically commissioned to meet the needs of young people such as supported housing

Adult Treatment Provideronto services providing drug or alcohol treatment services predominantly for those aged 18 or over. This includes needle exchange programmes and other services to address adult substance misuse

Other YP Treatment Service onto another young persons specialist treatment service

No Onward Referral is not referred back or onto other services at the end of the treatment episode.

No Referral Required who at the end of the treatment episode does not require an onward referral.


3. Reference data changes…..d) Employment Status?Removed: Not in Education or Training or employment

Attending PRU/Special Schooling arrangements YP Adults

Regular Employment this refers to employment which is regular and sustained.

Pupil/Student

this refers to education which is regular and sustained and is provided by a school, further education college or university. Young people who receive education from a specialist service in response to specialist needs including problem behaviour or difficulties with standard educational environments should refer to code 8 below.

Economically Inactive

this refers to young people and adults or are not currently in education or employment outside the home either because they have a role within the home as a parent or carer or because they have reached retirement age or because they have health or mental health issues which currently prevent them form working or studying.

Unemployedthis refers to adults who have the capacity to work and who are not currently in regular and sustained employment.

Other this refers to any activity which is not described by other codes

Not Knowntreatment services should endeavour to find out how young people spend their time, if this has not been possible, this code should be used.


4. Fields Removed from YP Dataset

a) Dual Diagnosisb) Sex Workerc) Sexuality

(Picked up through new fields or not appropriate for YP)

NDTMS - YP

Reminder

Do not record parent/carers interventions unless the misuser is a client, has consented to NDTMS and is involved in the intervention.

NDTMS - YP

Reminder

Complete all 3 levels of Substance Misuse which got client into treatment.

NDTMS - YP

Reminder

There will be a revision of the NTA’s recommended Consent and Confidentiality Toolkit. This will be published following final legal advise and consultation – hopefully during April 2009.

• Do you know where to find it?• Do you know what it says now?• Has your service incorporated the advice into your own documentation?

NDTMS - YP

http://www.nepho.org.uk/ndtms

THANK YOU!

ndtms~top & yp services ndtms~top young people services april 2009 jill smith nepho – ndtms...

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