National Drug Treatment Monitoring
System (NDTMS)
Adult drug treatment business definition
NDTMS data set M
Adult drug treatment business definition
v11.06
About Public Health England
Public Health England exists to protect and improve the nation's health and wellbeing,
and reduce health inequalities. It does this through world-class science, knowledge and
intelligence, advocacy, partnerships and the delivery of specialist public health services.
PHE is an operationally autonomous executive agency of the Department of Health.
Public Health England
Wellington House
133-155 Waterloo Road
London SE1 8UG
Tel: 020 7654 8000
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© Crown copyright 2014
You may re-use this information (excluding logos) free of charge in any format or
medium, under the terms of the Open Government Licence v2.0. To view this licence,
visit OGL or email [email protected]. Where we have identified any third
party copyright information you will need to obtain permission from the copyright
holders concerned.
Published November 2015
PHE publications gateway number: 2015474
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Revision history
Version
Author
Reason for change
Date
11.06
N Alhaddad
CDS-M
01/10/2015
All previous revision history archived to appendix L
Introduction of new CDS M fields
-
software system and version used
religion or belief
disability
sexual orientation
patterns of tobacco use (TOP)
smoking cessation (SIR)
Removed items (removed from NDTMS schema):
- drinking days more than binge limit
- AUDIT score
- smoking status
- treatment goal
- sexual orientation (local field)
Recovery Support sub intervention definition for
Adult Smoking cessation
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Contents
About Public Health England
2
1
Introduction
5
2
Requirements
6
3
Data entities
7
4
Data items
8
APPENDIX A – Data items to be updated as episode of treatment progresses
17
APPENDIX B – Scenarios and examples
23
APPENDIX C – Definitions of interventions and sub interventions
30
APPENDIX D – General healthcare assessment
36
APPENDIX E – Accommodation need guidance for adult services
38
APPENDIX F – Adult discharge codes from April 2009
39
APPENDIX G – Parental status from April 2009
42
APPENDIX H – Setting
43
APPENDIX I – Time in treatment
45
APPENDIX J – Outcomes process maps
46
Process map for completing Alcohol and YP Outcomes Records (AOR/YPOR)
Process map for clients transferring between adult services and changing problem
substance: from drug to alcohol
Process map for clients transferring between adult services and changing problem
substance: from alcohol to drug
Process map example for clients being transferred from a YP service to an adult service
APPENDIX K – External references
51
APPENDIX L – Revision history
52
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1 Introduction
This document establishes, at a business level, the set of performance data items
(known as the NDTMS data set) to be collected and utilised by the NDTMS.
In support of evolving business requirements, the data items, which are collected by
the NDTMS programme, are reviewed on an annual basis.
This version (commonly referred to as the NDTMS data set M) will come into
effect for national data collection on 1 April 2016.
This document contains definitions that are primarily applicable to use with clients aged
18 or over. Information and definitions relating to data collection from the young
people’s treatment system can be found at www.nta.nhs.uk/core-data-set.aspx
The NDTMS itself is scoped at capturing performance data on clients who reach the
assessment/triage stage at the agency that generates the report.
This document should not be interpreted as a technical statement – it is intended to
serve the business perspective of what data will be so managed. From this document,
the technical specification will be derived and established as described in Ref [1].
Code sets for the data items listed in this document are provided in Ref [2]. Both
documents are available from the PHE web site see above.
A companion document – ‘An implementation guide to core data set J’ Ref [3]
introduced for CDS-J 2012, remains relevant to CDS-L 2013. It contains various
implementation examples and scenarios.
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2 Requirements
The data items contained in the NDTMS data set are intended to address the following
critical requirements:
• provide measurements to support the upcoming Public Health Outcomes
Framework
• provide measurements that support the outcome and recovery focus of the
government’s drug strategy, such as:
o proportion of clients successfully completing treatment
o proportion of clients that do not return to treatment following a successful
completion
o value for money and where applicable payment by results
o housing and employment
o health and quality of life outcomes
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3 Data entities
The data items (listed later in this document) may be considered as belonging to one of
seven different entities or groups. These are:
•
•
•
•
•
•
•
client details
episode details (including client details which may vary over time)
time in treatment
treatment intervention (modality) details
sub intervention details
reatment Outcomes Profile (TOP) details
local (ie regional) fields whose usage will depend on regional requirements
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4 Data items
Sect
No
1
Sect
No
2
Item
Description
Initial of client’s first
name
The first initial of the client’s first name – for example Max would be ‘M’.
Initial of client’s
surname
The first initial of the client’s surname – for example Smith would be ‘S’, O’Brian would be ‘O’ and McNeil would be
‘M’.
Date of birth of client
The day, month and year that the client was born.
Sex of client
The client gender at registration.
Ethnicity
The ethnicity that the client states as defined in the OPCS census categories. If a client declines to answer then ‘not
stated’ should be used, if a client is not asked then the field should be left blank.
Nationality
Country of nationality at birth.
Item
Description
Referral date
The date that the client was referred to the agency for this episode of treatment – for example it would be the date a
referral letter was received, the date a referral phone call or fax was received or the date the client self-referred.
For scenario examples and how this date is used in waiting times calculations please see appendix B.
Agency code
A unique identifier for the treatment provider (agency) that is defined by the regional NDTMS centres – for example
L0001.
Software system and
version used
A mandatory, system identifier representing the clinical system and version used at the agency, for example
agencies using the data entry tool would have DET V7.0 populated in the field.
Client reference
A unique number or ID allocated by the treatment provider to a client. The client reference should remain the same
within a treatment provider for a client during all treatment episodes. (NB: this must not hold or be composed of
attributers which might identify the individual).
Client ID
A mandatory, technical identifier representing the client, as held on the clinical system used at the agency
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Item
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Description
(treatment provider). NB – this should be a technical item, and must not hold or be composed of attributers, which
might identify the individual. A possible implementation of this might be the row number of the client in the client
table.
Episode ID
A mandatory, technical identifier representing the episode, as held on the clinical system used at the treatment
provider. NB – this should be a technical item, and should not hold or be composed of attributers, which might
identify the individual. A possible implementation of this might be the row number of the episode in the episode
table.
Consent for NDTMS
Whether the client has agreed for their data to be shared with regional NDTMS teams and PHE. Informed consent
must be sought from all clients and this field needs to be completed for all records triaged after 1 April 2006. It does
not need to be completed for clients triaged before this date (it is assumed that all records previously returned have
been consented for).
Previously treated
Has the client ever received structured drug treatment at this or any other treatment provider.
Postcode
The postcode of the client’s place of residence. Depending upon regional preference regarding client confidentiality,
this postcode may or may not be truncated, by removing the final two characters of the postcode (ie ‘NR14 7UJ’
would be truncated to ‘NR14 7’).
If a client states that they are of No Fixed Abode (denoted by having an accommodation need of NFA) the postcode
should be left blank.
Accommodation need
The accommodation need refers to the current situation (28 days prior to treatment start) of the client with respect
to housing need.
The NDTMS data set – reference data [2] contains two sets of reference data for accommodation need, to cater for
those providing services to adults and young persons.
Appendix E and the NDTMS reference data [2] gives some guidance as to the use of this field for adult services.
The religion or belief of the client. If a client is not asked then the field should be left blank.
Religion or belief
Sexual orientation
The sexual orientation that the client states. If a client declines to answer then ‘not stated’ should be used, if a client
is not asked then the field should be left blank. If a client is not asked then the field should be left blank.
Disability 1
Whether the client has a disability.
Disability 2
Whether the client has a secondary disability.
Disability 3
Whether the client has a third disability.
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Item
Description
Parental status
The parental status of the client – whether or not the client has children, whether none of, some of or all of the
children live with the client.
A child is a person who is under 18 years old. See appendix G for revised data items and definitions.
DAT of residence
The Drug Action Team (or partnership area) in which the client normally resides (as defined by their postcode of
their normal residence).
If a client states that they are of No Fixed Abode (denoted by having an accommodation need of NFA) then for Tier
3 agencies the partnership (DAT) of the treatment provider should be used as a proxy; and for Tier 4 treatment
providers the DAT of the referring partnership should be used as a proxy.
Note – although the accommodation need is the status at the start of the episode, the DAT of residence is the
current situation.
PCT of residence
Please note that PCT codes are no longer collected for new clients. These have however been retained as a
placeholder for analysis purposes. All PCT validations have been relaxed.
Local authority
The local authority in which the client currently resides (as defined by their postcode of their normal residence).
If a client states that they are of No Fixed Abode (denoted by having an accommodation need of NFA) then for Tier
3 agencies the local authority of the treatment provider should be used as a proxy; and for Tier 4 treatment
providers the local authority of the referring partnership should be used as a proxy.
Note – although the accommodation need is the status at the start of the episode, the local authority is the current
situation.
GP practice code
This field has been added to the data set in order to support potential future reporting requirements from the
NDTMS. Should this be required, further information regarding the validation and submission of GP practice codes
will be issued.
Problem substance
No 1
The substance that brought the client into treatment at the point of triage/initial assessment, even if they are no
longer actively using this substance. If a client presents with more than one substance the agency is responsible for
clinically deciding which substance is primary.
‘Poly drug’ should no longer be used in this field; instead the specific substances should be recorded in each of the
problem substance fields.
Age of first use of
problem substance
No 1
The age (in years) that the client recalls first using the problem substance No 1.
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Item
Description
Route of
administration of
problem substance
No 1
The route of administration of problem substance No 1 recorded at the point of triage/initial assessment.
Problem substance
No 2
An additional substance that brought the client into treatment at the point of triage/initial assessment, even if they
are no longer actively using this substance. ‘Poly drug’ should no longer be used in this field; instead the specific
substances should be recorded in each of the problem substance fields.
Problem substance
No 3
An additional substance that brought the client into treatment at the point of triage / initial assessment, even if they
are no longer actively using this substance. ‘Poly drug’ should no longer be used in this field; instead the specific
substances should be recorded in each of the problem substance fields.
Referral source
The source or method by which a client was referred for this treatment episode. A valid referral source code should
be used as defined in the NDTMS data set – reference data Ref [2].
Triage date
The date that the client made a first face-to-face presentation to this treatment provider. This could be the date of
triage/initial assessment though this may not always be the case.
Care plan start date
Date that a care plan was created and agreed with the client for this treatment episode.
Injecting status
Is the client currently injecting, have they ever previously injected or never injected.
Children
The number of children under 18 that live in the same household as the client at least one night a week. The client
does not necessarily need to have parental responsibility for the children. Where the client declined to answer, code
‘98’ is used.
Are any of your
children/the children
living with you
This question applies to children of the client in treatment (regardless of whether this child lives with the client or
not) and to children living with the client (regardless of whether this is the child of the client or not).
Pregnant
Is the client pregnant.
Drinking days
Number of days in the 28 days prior to initial assessment that the client consumed alcohol.
Units of alcohol
Typical number of units consumed on a drinking day in the 28 days prior to initial assessment.
Dual diagnosis
Is the client currently receiving care from mental health services for reasons other than substance misuse.
Hep C tested
Has the client been tested for Hep C? This test may be within the current treatment episode or previously to the
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Description
episode. If the response is ‘Yes’ the ‘Hep C – latest test date’ should be completed.
Hep C latest test date
Date that the client was last tested for Hepatitis C. This test may be within the current treatment episode or
previously to the episode. If the exact date is not known then the first of the month should be used if that is known.
If only the year is known then 1 January for that year should be used.
Hep C intervention
status
Within the current treatment episode, whether the client was offered a test for Hepatitis C, and if that offer was
accepted by the client.
Hep B vaccination
count
The number of Hepatitis B vaccinations given to the client within the current treatment episode, or whether the
course of vaccinations was completed. Vaccinations can be provided by the treatment agency or elsewhere, such
as in primary care. Where this, or a partner treatment provider, provides one vaccination to a client but this actually
completes the course, then ‘course completed’ should be recorded rather than ‘one vaccination’.
Hep B intervention
status
Within the current treatment episode, whether the client was offered a vaccination for Hepatitis B, and if that offer
was accepted by the client.
Drug treatment health
care assessment date
The date that the initial health care assessment was completed in accordance to defined local protocols. The full
scope and depth of the assessment will vary according to the presenting needs of the client, but should include an
initial assessment of the client’s physical health and mental health needs. Any arising needs should form part of the
care plan and would be directly responded to by the drugs agency itself or, where health needs are more
specialised (eg dental care, sexual health) a formal referral is made to an appropriately qualified professional and
followed up and reviewed by the drugs worker as part of the on-going delivery of the care plan.
TOP care
coordination
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.
Discharge date
The date that the client was discharged ending the current structured (Tier 3/Tier 4) treatment episode. If a client
has had a planned discharge then the date agreed within this plan should be used. If a client’s discharge was
unplanned then the date of last face-to-face contact with the treatment provider should be used. If a client has had
no contact with the treatment provider for two months then for NDTMS purposes it is assumed that the client has
exited treatment and a discharge date should be returned at this point using the date of the last face-to-face contact
with the client. It should be noted that this is not meant to determine clinical practice and it is understood that further
work beyond this point to re-engage the client with treatment may occur. Note: this process should be used for
clients triaged after 1 April 2006 and records should not be amended retrospectively.
Discharge reason
The reason why the client’s episode of structured treatment (Tier 3/Tier 4) was ended. For discharge codes and
definitions see appendix F.
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3
Sect
No
4
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Item
Description
Time in treatment
assessment date
The date that the time in treatment will commence from. Where this is a first occurrence, the date field should be
populated with the modality start date of the first structured intervention, all subsequent occurrences should capture
the date at which there was a change in the time in treatment threshold.
Time in treatment
The time per week that the client will be spending in episode of structured treatment. This will take into account the
time receiving any combination of pharmacological, psychosocial and recovery support interventions. If a client is
only receiving recovery support then the time in treatment is not expected to be returned. See appendix I for the
definitions of time in treatment.
Time in treatment ID
A mandatory, technical identifier representing the time in treatment, as held on the clinical system used at the
treatment provider. (NB: this should be a technical item, and should not hold or be composed of attributers, which
might identify the individual). This field is mandatory if any items in this section (time in treatment) are not null.
Item
Description
Treatment modality
The treatment modality/intervention a client has been referred for/commenced within this treatment episode as
defined in appendix C of this document, and as explained in more detail in the implementation guide to core data
set J document Ref [3]. A valid treatment modality code should be used as defined in the NDTMS data set –
reference data [2].
The NDTMS data set – reference data [2] contains two sets of reference data for treatment modality, to cater for
those providing services to adults and young persons. A client may have more than one treatment modality running
sequentially or concurrently within an episode and may have more than one of the same type running concurrently
as long as the setting in each are different. Current definitions and name changes for all the structured
modalities/interventions can be found in appendix C.
Date referred to
modality
The date that it was mutually agreed that the client required this modality/intervention of treatment. For the first
modality/intervention in an episode, this should be the date that the client was referred into the treatment system
requiring a structured modality/intervention. For subsequent modalities, it should be the date that both the client and
the keyworker agreed that the client is ready for this modality/intervention. For scenario examples and how this date
is used in waiting times calculations please see appendix B of this document.
Setting
The setting that this intervention is being provided in, if the setting differs from the one that the treatment provider is
registered under in the agency table. This field should be used where a provider has multiple treatment settings or
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Description
where the client is being treated at another setting that would not report to NDTMS. If the setting of the intervention
is the same as that registered then this field must be left blank. See appendix H for a definition of the different
setting types.
Sect
No
5
Modality ID
A mandatory, technical identifier representing the modality, as held on the clinical system used at the agency.
(Note: this should be a technical item, and should not hold or be composed of attributers, which might identify the
individual). A possible implementation of this might be the row number of the modality in the modality table. This
field is mandatory if any items in this section (modality) are not null.
Date of first
appointment offered
for modality
The date of the first appointment offered to commence this modality/intervention. This should be mutually agreed to
be appropriate for the client. The current definition of when a modality commences can be found in appendix C of
this document.
Modality start date
The date that the stated treatment modality/intervention commenced, ie the client attended for the appointment. The
current definition of when a modality commences can be found in appendix C of this document.
Modality end date
The date that the stated treatment modality/intervention ended. If the modality has had a planned end then the date
agreed within the plan should be used. If it was unplanned then the date of last face to face contact date within the
modality should be used.
Modality exit status
Whether the exit from the treatment modality was planned or unplanned.
Item
Description
Sub intervention
assessment date
Sub interventions
received
The date that the sub intervention review was completed.
Sub modality ID
The sub interventions that have been received since the previous review had been completed. If it is the first review
then it will be the sub interventions since the client commenced their latest treatment journey. If it is the first review
for a client already in treatment on 1 November 2012, then it will be the sub interventions that have been received
since then. Sub interventions should be submitted at a minimum of every six months while a client remains in one
or more of the three high-level intervention types. If a client ends any of the three high level interventions before six
months then the sub interventions should be returned at the time of them finishing. See appendix C for the sub
intervention types.
A mandatory, technical identifier representing the sub modality/intervention, as held on the clinical system used at
the treatment provider. NB: this should be a technical item, and should not hold or be composed of attributers,
which might identify the individual. This field is mandatory if any items in this section (sub intervention) are not null.
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Item
Description
Treatment Outcomes
Profile (TOP) date
Date of most recent care plan review. All outcome status submitted in this section of the data set will be associated
and stored as being the status as of this date.
TOP ID
A mandatory, technical identifier representing the TOP, as held on the clinical system used at the treatment
provider. (NB: this should be a technical item, and should not hold or be composed of attributers, which might
identify the individual). A possible implementation of this might be the row number of the TOP in the TOP table.
This field is mandatory if any items in this section (TOP) are not null.
Treatment stage
Stage of treatment that the TOP data relates to.
Alcohol use
Number of days in previous 28 days that client has used.
Consumption
Typical number of units consumed in a drinking day in the last 28 days.
Opiate use
Crack use
Number of days in previous 28 days that client has used opiates.
Number of days in the 28 days prior to treatment that the client smoked tobacco, in whatever form (ready-made
cigarettes, hand-rolled cigarettes, cannabis joints with tobacco, cigars, pipe tobacco, shisha/waterpipes, etc), but
not including nicotine replacement therapy and e-cigarettes.
Number of days in previous 28 days that client has used crack.
Cocaine use
Number of days in previous 28 days that client has used powder cocaine.
Amphetamine use
Number of days in previous 28 days that client has used amphetamines.
Cannabis use
Number of days in previous 28 days that client has used cannabis.
Other drug use
Number of days in previous 28 days that client has used other problem drug.
IV drug use
Number of days in previous 28 days that client has injected non prescribed drugs.
Sharing
Has client shared needles or paraphernalia in last 28 days.
Shop theft
Number of days in previous 28 days that client has been involved in shop theft.
Drug selling
Number of days in previous 28 days that client has been involved in selling drugs.
Other theft
Has client has been involved in theft from or of a vehicle, property or been involved in fraud in last 28 days.
Assault/violence
Has client committed assault/violence in last 28 days.
Tobacco use
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Item
Description
Psychological health
status
Self-reported score of 0-20.
Paid work
Number of days in previous 28 days that client has had paid work.
Education
Number of days in previous 28 days that client has attended college/education system.
Acute housing
problem
Has client had acute housing problem (been homeless) in last 28 days.
Housing risk
Has client been at risk of eviction within past 28 days.
Physical health status
Self-reported score of 0-20.
Quality of life
Self-reported score of 0-20.
Item
Description
Injected in last 28 days
Has the client injected in the last 28 days.
Ever shared
Has the client ever shared injecting paraphernalia.
Previously Hep B
infected
Has the client ever had a previous Hepatitis B infection.
Hep C positive
Is the client Hep C positive.
Referred for
hepatology
Has the client been referred to a hepatology unit.
Employment status
The client’s current employment status.
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APPENDIX A – Data items to be updated as episode of treatment progresses
Sect
No
No
1
2
Field Description
Rules and Guidance
1
Initial of client’s first name
 MUST be completed. If not, record rejected.
Should not change.
2
Initial of client’s surname
 MUST be completed. If not, record rejected.
Should not change
3
Date of birth of client
 MUST be completed. If not, record rejected.
Should not change.
4
Sex of client
 MUST be completed. If not, record rejected.
Should not change.
5
Ethnicity
Should not change.
6
Nationality
Should not change.
7
Referral date
 MUST be completed. If not data may be excluded from performance monitoring reports.
Should not change.
8
Agency code
 MUST be completed. If not, record rejected.
Should not change.
9
Software system used
 MUST be completed. If not, record rejected.
May change (ie current situation).
10
Client reference
Should not change and should be consistent across all episodes at the agency.
11
Client ID
 MUST be completed. If not, record rejected.
Should not change.
12
Episode ID
 MUST be completed. If not, record rejected.
Should not change.
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Rules and Guidance
13
Consent for NDTMS
Client must give consent before their information can be sent to NDTMS.
May change (ie current situation).
14
Previously treated
Not expected to change (ie as at start of episode).
15
Postcode
May change (ie current living situation).
16
Accommodation need
Not expected to change (ie as at start of episode).
17
Parental status
Not expected to change (ie as at start of episode).
18
Religion or belief
Not expected to change (ie as at start of episode).
19
Sexual orientation
Not expected to change (ie as at start of episode).
20
Disability 1
Not expected to change (ie as at start of episode).
21
Disability 2
Not expected to change (ie as at start of episode).
22
Disability 3
Not expected to change (ie as at start of episode).
23
Are any of your
children/the children living
with you
Not expected to change (ie as at start of episode).
24
DAT of residence
 MUST be completed. If not data may be excluded from performance monitoring reports.
May change (ie current living situation).
25
PCT of residence
There is no need to collect PCT data – retained as a data item.
May change (ie current living situation).
26
GP practice code
May change (ie current living situation).
27
Problem substance No 1
 MUST be completed. If not, record rejected.
Not expected to change (ie as at start of episode).
28
Age of first use of problem
substance No 1
Not expected to change (ie as at start of episode).
29
Route of administration of
problem substance No 1
Not expected to change (ie as at start of episode).
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Rules and Guidance
30
Problem substance No 2
Not expected to change (ie as at start of episode).
31
Problem substance No 3
Not expected to change (ie as at start of episode).
32
Referral source
Not expected to change (ie as at start of episode).
33
Triage date
 Trigger to submit record and MUST be completed. If not, record rejected.
Not expected to change (ie as at start of episode).
34
Care plan started date
 MUST be completed when modality start date given.
Not expected to change (ie as at start of episode).
35
Injecting status
Not expected to change (ie as at start of episode).
36
Children
Not expected to change (ie as at start of episode).
37
Pregnant
Not expected to change (ie as at start of episode).
38
Drinking days
Not expected to change (ie as at start of episode).
39
Units of alcohol
Not expected to change (ie as at start of episode).
40
Dual diagnosis
Not expected to change (ie as at start of episode).
41
Hep C tested
May change (ie current situation).
42
Hep C latest test date
May change (ie current situation).
43
Hep C intervention status
May change (ie current situation).
44
Hep B vaccination count
May change (ie current situation).
45
Hep B intervention status
May change (ie current situation).
46
Drug treatment health care Not expected to change (to be completed when initial health care assessment is completed).
assessment date
47
TOP care coordination
May change (ie current situation).
48
Discharge date
 Discharge date required when client is discharged. ALL structured modalities MUST now have end dates.
Discharge reason MUST be given.
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Sect
No
No
Field Description
Rules and Guidance
49
Discharge reason
 Discharge reason required when client is discharged. Discharge date MUST be given
Should only change from ‘null’ to populated as episode progresses.
50
Time in treatment
assessment date
Must be completed for each time in treatment return.
Should not change – otherwise the regional NDTMS team should be advised.
51
Time in treatment
Not expected to change (ie as at time in treatment date).
52
Time in treatment ID
 MUST be completed if any items in this section above are not null. If not, record rejected.
Should not change.
53
Treatment modality
 Required as soon as modality is known.
Should not change.
54
Date referred to modality
 Waiting times calculated from this field. MUST be completed for new presentations/modalities.
Should not change.
55
Modality ID
 MUST be completed if any items in this section above are not null. If not, record rejected.
Should not change.
56
Setting
Not expected to change (ie as at modality start date).
57
Date of first appointment
offered for modality
 Waiting times calculated from this field.
Should not change.
58
Modality start date
 Required when client actually starts modality.
 Trigger for waiting times to be calculated.
Should only change from ‘null’ to populated as episode progresses.
59
Modality end date
 Required when client completes modality or is discharged.
Should only change from ‘null’ to populated as episode progresses.
60
Modality exit status
 Required when client completes modality or is discharged.
Should only change from ‘null’ to populated as episode progresses.
61
Sub intervention
assessment date
Must be completed each time a sub intervention review is completed.
Should not change – otherwise the regional NDTMS team should be advised.
62
Sub interventions received
Not expected to change (ie as at sub intervention review date).
3
4
5
20
Adult drug treatment business definition
Sect
No
No
6
v11.06
Field Description
Rules and Guidance
63
Sub modality ID
 MUST be completed if any items in this section above are not null. If not, record rejected.
Should not change.
64
Treatment Outcomes
Profile (TOP) date
Not expected to change (ie as at TOP date).
65
TOP ID
 MUST be completed if any items in this section above are not null. If not, record rejected.
Should not change.
66
Treatment stage
Not expected to change (ie as at TOP date).
67
Consumption
Not expected to change (ie as at TOP date).
68
Alcohol use
Not expected to change (ie as at TOP date).
69
Opiate use
Not expected to change (ie as at TOP date).
70
Tobacco use
Not expected to change (ie as at TOP date).
71
Crack use
Not expected to change (ie as at TOP date).
72
Cocaine use
Not expected to change (ie as at TOP date).
73
Amphetamine use
Not expected to change (ie as at TOP date).
74
Cannabis use
Not expected to change (ie as at TOP date).
75
Other drug use
Not expected to change (ie as at TOP date).
76
IV drug use
Not expected to change (ie as at TOP date).
77
Sharing
Not expected to change (ie as at TOP date).
78
Shop theft
Not expected to change (ie as at TOP date).
79
Drug selling
Not expected to change (ie as at TOP date).
80
Other theft
Not expected to change (ie as at TOP date).
81
Assault/violence
Not expected to change (ie as at TOP date).
82
Psychological health
status
Not expected to change (ie as at TOP date).
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Adult drug treatment business definition
Sect
No
No
7
v11.06
Field Description
Rules and Guidance
83
Paid work
Not expected to change (ie as at TOP date).
84
Education
Not expected to change (ie as at TOP date).
85
Acute housing problem
Not expected to change (ie as at TOP date).
86
Housing risk
Not expected to change (ie as at TOP date).
87
Physical health status
Not expected to change (ie as at TOP date).
88
Quality of life
Not expected to change (ie as at TOP date).
89
Local agency details
May change (local modality item).
90
Injected in last 28 days
Not expected to change (ie as at start of episode).
91
Ever shared
Not expected to change (ie as at start of episode).
92
Previously Hep B infected
May change (ie current situation).
93
Hep C positive
May change (ie current situation).
94
Referred for hepatology
May change (ie current situation).
95
Local authority
NOW PART OF CORE DATA SET.
 MUST be completed. If not, record rejected.
May change (ie current living situation).
96
Employment status
Not expected to change (ie as at start of episode).
Where items are designated as ‘not expected to change’ this does not include corrections or moving from a null in the field
to it being populated.
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Adult drug treatment business definition
v11.06
APPENDIX B – Scenarios and examples
B.1
Waiting times measurement within NDTMS – key points:
• all waiting times are measured in calendar days.
• the agency ‘referral date’ recorded by a treatment provider may be later than
the ‘date referred to modality’ if the initial contact of a client entering the
treatment system is a third party treatment provider. This is because the wait
for the client is now being measured across the treatment system.
• the date of ‘first appointment offered for modality’ may be a future date, but the
waiting times will only be calculated when a client actually commences a
modality, ie when the modality start date is present in the data.
• waiting times will be reported at both a treatment system and treatment
provider level. For the treatment system, it will be calculated from the ‘date
referred to modality’ to the ‘first appointment offered for modality’ for all
modalities/interventions. For a treatment provider it will be the ‘(agency) referral
date’/‘date referred to modality’ (whichever is later) to the ‘first appointment
offered to modality’ for the earliest modality/intervention in an episode and then
the ‘date referred to modality’ to the ‘first appointment offered for modality’ for
all subsequent modalities/interventions.
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Adult drug treatment business definition
B.2
v11.06
Waiting times scenario 1 – self referral
Key point – the agency ‘referral date’ and the ‘date referred to modality’ are the same.
Client self refers to agency (treatment
provider) A 01/04/06
Client attends GP surgery agreed Tier
3
Specialist
Prescribing itrequired.
After
initial assessment
is agreed
06/04/06
client
requires prescribing
Records returned to NDTMS:
(Agency) referral date – 01/04/06
Date referred to modality – 01/04/06
Modality type – specialist prescribing
Mutually received
Referral
agreed first
by Agency
appointment
A
for
08/04/06 and
client presents for
prescribing
15/04/06
treatment 10/04/06
Record returned to NDTMS:
st
Client DNAs
Mutually
agreed
first 1appointment
Appointment
offered
for
prescribing
and
attends20/04/06
subsequent appointment
22/04/06
Record returned to NDTMS:
Date of 1st Appointment offered for
Modality Start Date – 22/04/06
modality – 20/04/06
Date of first appointment offered for
modality – 15/04/06
Waiting times calculated:
For partnership – 01/04/06 to 15/04/06
= 14 days
For agency A – 01/04/06 to 15/04/06 =
14 days
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Adult drug treatment business definition
B.3
v11.06
Waiting times scenario 2 – referral from a third party treatment provider
Key point – the agency ‘referral date’ is after the ‘date referred to modality’. The ‘date
referred to modality’ that is used reflects the clients experience of when the wait
started.
Client attends triage gateway
service
No data returned to NDTMS by gateway
service, but referral made to treatment
provider A
Agreed tier 3 specialist
prescribing required 06/04/06
Records returned to NDTMS:
(treatment provider) referral date –
08/04/06
Referral received by treatment
provider A 08/04/06
Date referred to modality – 06/04/06
Modality type – specialist prescribing
Client presents for treatment
10/04/06
Note 06/04/06 used as date referred into
the treatment system
Record returned to NDTMS:
Mutually agreed first appointment
for prescribing 20/04/06
Date of first appointment offered for
modality – 20/04/06
Client DNAs first appointment
offered and attends subsequent
appointment 27/04/06
Record returned to NDTMS:
Modality start date – 27/04/06
Waiting times calculated:
For partnership – 06/04/06 to 20/04/06 = 14 days
For agency A – 08/04/06 to 20/04/06 = 12 days
Note the referral date is used to calculate the agency
waiting time
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Adult drug treatment business definition
B.4
v11.06
Waiting times scenario 3 – Tier 4
Key point – the wait for residential rehab begins when it has been agreed that the
client will be referred for funding.
Client attending Tier 3 community
service: treatment provider A
receiving specialist prescribing
Mutually agreed with client and
keyworker that client ready for
residential rehab and that they will
be referred for funding 06/04/06
Record returned to NDTMS by
treatment provider B:
(Agency) referral date – 08/04/06
Referral made to rehab treatment
provider B
Date referred to modality – 06/04/06
Modality type – residential rehab
Received by treatment provider B
08/04/06
Note 06/04/06 used as date agreed
client would be referred for funding
Record returned to NDTMS by
treatment provider B:
Mutually agreed first appointment
for residential rehab 22/04/06
Date of first appointment offered for
modality – 22/04/06
Record returned to NDTMS by
treatment provider B:
Client attends and admitted into
residential rehab at agency B
22/04/06
Modality Start Date – 22/04/06
Waiting times calculated:
For partnership – 06/04/06 to 22/04/06 = 16 days
For treatment provider B – 08/04/06 to 22/04/06 = 14 days
26
Adult drug treatment business definition
B.5
v11.06
Waiting times scenario 4 – prison referrals
Key point – the waiting time begins once the client has been released and is available
for treatment.
Client currently in prison referred to
agency C 01/04/06
Records returned to NDTMS by
treatment provider C:
Agreed client requires structured
day programme at treatment
provider C
Referral date 1/4/06
Prison release date 01/05/06
Referred to modality date 1/5/06
Client offered appointment for
structured day programme for
10/05/06
Records returned to NDTMS by
treatment provider C:
Client exits prison 01/05/2006 and
attends structured day programme
10/05/06
Record returned to NDTMS by
treatment provider C:
Date of first appointment offered for
modality – 10/05/06
Modality start date – 10/05/06
Waiting times calculated:
For partnership – 01/05/06 to 10/05/06 = 9 days
For treatment provider C – 01/05/06 to 10/05/06 = 9
days
Note the date referred to modality is used to calculate
treatment provider waiting time
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Adult drug treatment business definition
B.6
v11.06
Waiting times scenario 5 – subsequent wait within an episode
Key point – the wait for a subsequent intervention within an episode should begin
when both the client and keyworker agree that client is ready.
Client currently in specialist
prescribing at treatment provider D
Mutually agreed 01/05/06 client
requires structured day
programme
Records returned to NDTMS by
treatment provider D – second modality
record:
This intervention also offered by
treatment provider D
Date referred to modality – 01/05/06
Client offered appointment for
structured day programme for
20/05/06
Records returned to NDTMS by
treatment provider D:
Client attends structured day
programme appointment 20/05/06
Record returned to NDTMS by treatment
provider D:
Modality type – structured day
programme
Date of first appointment offered for
modality – 20/05/06
Modality start date – 20/05/06
Waiting times calculated for subsequent intervention:
For partnership – 01/05/06 to 20/05/06 = 19 days
For treatment provider D – 01/05/06 to 20/05/06 = 19 days
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Adult drug treatment business definition
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B.7 Waiting times scenario 6 – measuring inpatient detoxification and residential
rehabilitation as a package
Records returned to NDTMS:
Client agrees with key worker in Tier 3
that package of inpatient detoxification
(IPD) AND residential rehabilitation
(RR) is required
RR agency report date referred to
modality as 01/09/06
Funding for RR is applied for on
01/09/06
Funding application accepted and key
worker notifies the client, IPD and RR
agencies on 12/09/06
Records returned to NDTMS:
Referral letters received by agencies
14/09/06
IPD and RR report (agency) referral
date as 14/09/06
Client commences inpatient
detoxification at on 19/09/06
Records returned to NDTMS:
IPD agency reports date referred to
modality as 12/09/06
IPD agency date of first appointment
offered for modality and modality start
date as 19/09/06
RR agency reports date of first
appointment offered as 19/09/06
Client successfully completes inpatient
detoxification 19/10/06
Records returned to NDTMS:
Client starts RR at Agency C on
23/10/06
RR agency reports modality start date
as 23/10/06
Waiting times calculated:
For partnership IPD = 7 days
For IPD agency = 5 days
For partnership RR = 18 days
For RR agency = 5 days
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Adult drug treatment business definition
v11.06
APPENDIX C – Definitions of interventions and sub interventions
See ‘An implementation guide to core data set J’ Ref [3] for further definitions.
C.1
Pharmacological
The psychosocial interventions that are integral to a service user’s pharmacological
intervention are now reported separately from the pharmacological intervention itself –
as interventions within the psychosocial intervention type. This should not be taken to
suggest that these are not still core elements of the pharmacological interventions. This
change does enable the basis of the pharmacological intervention to be reported for the
pharmacological intervention – as defined below.
It also means that the psychosocial returns will include all psychosocial interventions
provided, whether integral to the pharmacological intervention, additional to the
pharmacological intervention, or provided in the absence of a pharmacological
intervention.
Therefore, in addition to completing interventions concerning pharmacological, all
specific structured psychosocial intervention(s) delivered as integral to or alongside
prescribing should be reported through 'psychosocial’. Recovery support intervention(s)
that are integral to or alongside pharmacological and/or psychosocial interventions
should also be recorded, through ‘recovery support’.
Basis of
pharmacological Definition
intervention
Assessment and
stabilisation
Prescribing of a receptor agonist (such as methadone), or partial agonist (such
as buprenorphine), or other pharmacotherapy specific to substance misuse, to
stabilise use of illicit drug(s), following and alongside continuing appropriate
assessment.
It also includes re-induction onto opioid substitution treatment prior to prison
release, in the limited circumstances where this is appropriate.
Maintenance
Prescribing of substitute medications under a stable dose regimen to medically
manage physiological dependence and minimise illicit drug use.
Maintenance prescribing may be provided to support the individual in achieving
or sustaining medication assisted recovery.
Withdrawal
Prescribing of an agonist or partial agonist or other medication, usually up to12
weeks and 28 days as an inpatient, to facilitate medically supervised assisted
withdrawal and to manage withdrawal symptoms.
Relapse
prevention
Prescribing medication for drug and/or alcohol relapse prevention support
(such as naltrexone as part of opioid relapse prevention therapy).
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Adult drug treatment business definition
C.2
v11.06
Psychosocial
The psychosocial intervention and its sub interventions should be used by both
prescribing and non-prescribing services. They should be used to report structured
psychosocial interventions delivered alone, as well as psychosocial interventions
integrated with or additional to a pharmacological modality/intervention.
Recovery support interventions that are integral to, or provided alongside a
pharmacological intervention, and/or psychosocial interventions should also be
recorded using recovery support intervention codes.
Psychosocial sub
intervention
Definition
Motivational
interventions
Motivational interventions aim to help service users resolve ambivalence for
change, and increase intrinsic motivation for change and self-efficacy through
a semi-directive style and may involve normative feedback on problems and
progress. They may be focused on substance specific changes and/or on
building recovery capital. Motivational interventions can be delivered in
groups or one-to-one and may involve the use of mapping tools.
Motivational interventions require competences over and above those
required for key working, and delivery within a clinical governance framework
that includes appropriate supervision.
Motivational interviewing and motivational enhancement therapy are both
forms of motivational interventions.
Contingency
management
Contingency management (CM) provides a system of reinforcement or
incentives designed to motivate behaviour change and/or facilitate recovery.
CM aims to make target behaviours (such as drug use) less attractive and
alternative behaviours (such as abstinence) more attractive.
CM requires competences over and above those required for key working,
and delivery within a clinical governance framework that includes appropriate
supervision.
Family and social
network
interventions
Family and social network interventions engage one or more of the client’s
social network members who agree to support the client’s treatment and
recovery. The interventions use psychosocial techniques that aim to increase
family and social network support for change, and decrease family and social
support for continuing drug and/or alcohol use. These interventions may
involve the use of mapping tools. They require competences over and above
those required for key working, and delivery within a clinical governance
framework that includes appropriate supervision.
Examples: social behaviour and network therapy (SBNT), community
reinforcement approach (CRA), behavioural couples therapy (BCT) and
formal family therapy.
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Cognitive and
behavioural based
relapse prevention
interventions
(substance misuse
focused)
Cognitive and behavioural based relapse prevention interventions develop
the service user’s abilities to recognise, avoid or cope with thoughts, feelings
and situations that are triggers to substance use. They include a focus on
coping with stress, boredom and relationship issues and the prevention of
relapse through specific skills, eg drug refusal, craving management. They
can be delivered in groups or one-to-one and may involve the use of mapping
tools. They require competences over and above those required for key
working, and delivery within a clinical governance framework that includes
appropriate supervision.
Examples: CBT based relapse prevention (which may include mindfulness
and ‘third wave’ CBT), behavioural self-control (alcohol).
Evidence-based
psychological
interventions for
co-existing mental
health problems
NICE guidelines for mental health problems generally recommend a stepped
care approach. Low intensity psychological intervention for co-existing mental
health problems, include guided self-help or brief interventions for less severe
common mental health problems.
High intensity psychological therapies (such as cognitive behavioural therapy)
are recommended for moderate and severe problems. Typically formulationbased and delivered by clinicians with specialist training who are registered
with a relevant professional/regulatory body. They can be delivered in groups
or one-to-one.
Both low and high intensity interventions require additional competences for
the worker and delivery within a clinical governance framework that includes
appropriate supervision.
A type of psychotherapy that draws on psychoanalytic theory to help people
Psychodynamic
therapy (substance understand the developmental origins of emotional distress and behaviours
such as substance misuse, by exploring unconscious motives, needs, and
use focused)
defences.
Psychodynamic therapy requires additional competences for the worker and
delivery within a clinical governance framework that includes appropriate
supervision. Therapists should be registered with an appropriate
professional/regulatory body.
12-step work
A 12-step intervention for recovery from addiction, compulsion or other
behavioural problems. Interventions are delivered within a clinical governance
framework that includes appropriate supervision.
The aim of 12-step work is to facilitate service users to complete some or all
of the 12 steps.
Counselling –
BACP Accredited
A systematic process that gives individuals an opportunity to explore,
discover and clarify ways of living more resourcefully, with a greater sense of
well-being. This requires additional competences for the worker and delivery
within a clinical governance framework that includes appropriate supervision.
Other
An intervention based on established psychological models/theories that have
an evidence base, and that is undertaken by a worker with the required
competences with adequate supervision and clinical governance
arrangements
This category can only be used where an intervention is not covered by
individual, or a combination of, categories above. It is anticipated that use of
this category would be relatively uncommon.
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Adult drug treatment business definition
C.3
v11.06
Recovery support
During structured treatment, recovery support interventions should be recorded for
interventions delivered alongside and/or integrated with a psychosocial or
pharmacological intervention.
Recovery support interventions can also be delivered and recorded outside of
structured treatment, following the recording of an exit from structured treatment.
Recovery support
sub intervention
Definition
Peer support
involvement
A supportive relationship where an individual who has direct or indirect
experience of drug or alcohol problems may be specifically recruited on a
paid or voluntary basis to provide support and guidance to peers. Peer
support can also include less formal supportive arrangements where shared
experience is the basis but generic support is the outcome (eg as a part of a
social group). This may include mental health focused peer support where a
service user has co-existing mental health problems.
Where peer support programmes are available, staff should provide
information on access to service users, and support access where service
users express an interest in using this type of support.
Facilitated access
to mutual aid
Staff provide a service user with information about self-help groups. If a
service user has expressed an interest in attending a mutual aid group, staff
facilitate the person’s initial contact with the group, for example by making
arrangements for them to meet a group member, arranging transport,
accompanying him or her to the first session and dealing with any concerns.
These groups may be based on 12-step principles (such as Alcoholics
Anonymous, Narcotics Anonymous and Cocaine Anonymous) or another
approach (such as SMART Recovery).
Family support
Staff have assessed the family support needs of the individual/family as part
of a comprehensive assessment, or on-going review of their treatment
package. Agreed actions can include arranging family support for the family in
their own right or family support that includes the individual in treatment.
Parenting support
Staff have assessed the family support needs of the individual as part of a
comprehensive assessment, or on-going review of their treatment package.
Agreed actions can include a referral to an in-house parenting support worker
where available, or to a local service which delivers parenting support.
Housing support
Staff have assessed the housing needs of the individual as part of the
comprehensive assessment, or on-going recovery care planning process, and
has agreed goals that include specific housing support actions by the
treatment service, and/or active referral to a housing agency for specialist
housing support.
Housing support covers a range of activities that either allows the individual to
maintain their accommodation or to address an urgent housing need.
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Adult drug treatment business definition
Recovery support
sub intervention
v11.06
Definition
Employment
support
Staff have assessed the employment needs of the individual as part of the
comprehensive assessment, or on-going recovery care planning process, and
agreed goals that include specific specialised employment support actions by
the treatment service, and/or active referral to an agency for specialist
employment support.
Where the individual is already a claimant with Jobcentre Plus or the Work
Programme, the referral can include a three way meeting with the relevant
advisor to discuss education/employment/training (ETE) needs. The referral
can also be made directly to an ETE provider.
Education and
training support
Staff have assessed the education and training related needs of the individual
as part of the comprehensive assessment, or on-going recovery care
planning process and agreed goals that include specific specialised education
and training support actions by the treatment service, and/or active referral to
an agency for specialist education & training support.
Where the individual is already a claimant with Jobcentre Plus or the Work
Programme, the referral can include a three way meeting with the relevant
advisor to discuss ETE needs. The referral can also be made directly to an
ETE provider.
Supported work
projects
Staff have assessed the employment related needs of the individual as part of
the comprehensive assessment, or on-going recovery care planning process
and agreed goals that include the referral to a service providing paid
employment positions where the employee receives significant on-going
support to attend and perform duties.
Recovery checkups
Following successful completion of formal substance misuse treatment there
is an agreement for periodic contact between a service provider and the
former participant in the structured treatment phase of support.
The periodic contact is initiated by the service, and comprises a structured
check-up on recovery progress and maintenance, checks for signs of lapses,
sign posting to any appropriate further recovery services, and in the case of
relapse (or marked risk of relapse) facilitates a prompt return to treatment
services.
Evidence-based
psychosocial
interventions to
support substance
misuse relapse
prevention
Evidence based psychosocial interventions that support on-going relapse
prevention and recovery, delivered following successful completion of
structured substance misuse treatment.
These are interventions with a specific substance misuse focus and delivered
within substance misuse services.
Evidence-based
mental health
focused
psychosocial
interventions to
support continued
recovery
Evidence-based psychosocial interventions for common mental health
problems that support continued recovery by focusing on improving
psychological well-being that might otherwise increase the likelihood of
relapse to substance use.
These are delivered following successful completion of structured substance
misuse treatment and may be delivered by services outside the substance
misuse treatment system following an identification of need for further
psychological treatment and a referral by substance misuse services.
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Adult drug treatment business definition
Recovery support
sub intervention
v11.06
Definition
Smoking cessation
Specific stop-smoking support has been provided by the treatment service,
and/or the individual has been actively referred to a stop smoking service for
smoking cessation support and take-up of that support is monitored. Suitable
support will vary but should be more than very brief advice to qualify as an
intervention here. It will most commonly include psychosocial support and
nicotine replacement therapy, and will be provided by a trained stop smoking
advisor.
Complementary
therapies
Complementary therapies aimed at promoting and maintaining change to
substance use, for example through the use of therapies such as
acupuncture and reflexology that are provided in the context of substance
misuse specific recovery support.
Other
A recognised recovery activity or support intended to promote and maintain a
service user’s recovery capital, which is not captured by an individual type or
combination of types above.
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Adult drug treatment business definition
v11.06
APPENDIX D – General healthcare assessment
There is now a requirement that all service users within specialist drug treatment
providers receive a general healthcare assessment. This will be monitored within
updated NDTMS reporting mechanisms for Tier 3 and 4 services and will be measured
against local standards.
PHE has defined the healthcare assessment as follows:
‘As part of their assessment and care plan, all drug users require a general
healthcare assessment, which appraises and responds to (by direct intervention
or referral) their risk of, for example, injecting-related wound infection, blood
borne viruses, overdose (accidental or intentional), sexually transmitted disease
or poor dental health, and will also include a basic health screen carried out by a
trained professional.’
Adult Treatment Plan Guidance Notes 2006-07
Purposes/aims:
• to identify unmet health needs and address these through care planning
• to ensure account is taken of health problems which could interact with drug
treatment
• as a means of attracting and retaining patients into drug treatment
• to improve drug treatment outcomes such as abstinence and relapse prevention in
line with current evidence
• to create opportunities for harm minimisation interventions
The intention is first to define a universal healthcare assessment, which should be
carried out by all agencies on all drug users. DANOS competencies required are: AF3
‘Carry out comprehensive substance misuse assessment’).
In the future, PHE intends to issue further guidance on incremental health assessment
according to drug worker competencies, service amenities and drug user needs.
Therefore, as a first stage towards this goal, the minimum definition is as follows:
All drug users presenting to specialist drug agencies will receive as part of their
assessment:
Verbal health assessment
a. General – health questions should address:
•
current illnesses/symptoms particularly epilepsy, asthma, liver disease
•
prescribed/OTC (over the counter) drugs
•
cigarette smoking
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Adult drug treatment business definition
v11.06
•
sexual health (risks and STD history) including smear status in women
aged 25-64
•
current use of/need for contraception
•
dental health
•
diet and weight loss
b. Drug-related – health questions should address:
All patients
•
blood-borne virus testing and results (HIV, HBV, HCV)
•
Hepatitis immunisation status (HBV, HAV) and other immunisations
(Tetanus, TB)
•
history of fits/blackouts
•
history of overdose
Drug smokers
•
smoking methods
•
wheeze/breathlessness/cough/sputum (are you coughing anything up?)/
haemoptysis (are you coughing up any blood?)/chest pain
Past and current injectors
•
injecting status and problems
•
history of skin infection/cellulitis/ulcer/abscess
•
history of septicaemia (blood poisoning)/endocarditis (infection in your
heart valves or the lining of your heart?)
•
history of DVT/PE/other thrombosis (blood clot in your leg/lung/anywhere
else?)
Basic physical health assessment by examination
All patients should be offered examination of:
•
injection sites
•
any current concerns related to wound infections and skin swellings
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Adult drug treatment business definition
v11.06
APPENDIX E – Accommodation need guidance for adult services
The accommodation need for adult services has been defined with high-level reference
data. The following provides guidance as to the sub-categories that make up the highlevel view.
NFA – urgent housing problem:
•
lives on the streets
•
use night hostels (night-by-night basis)
•
sleeps on a different friend’s floor each night
Housing problem:
•
staying with friends/family as a short term guest
•
night winter shelter
•
direct access short stay hostel
•
short term B&B or other hotel
•
squatting
No housing problem:
•
local authority/Registered Social Landlord (RSL) rented
•
private rented
•
approved premises
•
supported housing/hostel
•
traveller
•
own property
•
settled with friends/family
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APPENDIX F – Adult discharge codes from April 2009
When the current NDTMS discharge codes were defined, a scenario that described a
need for treatment for alcohol dependence following the completion of drug treatment
was not included, however the expectation then, as now, is that if a client has
completed drug treatment but still requires a structured alcohol intervention then,
depending where the alcohol treatment is provided, the following processes should be
followed:
Below are the current discharge reasons and their definitions.
Data item name
Definition
Treatment completed –
drug free
The client no longer requires structured drug treatment interventions and
is judged by the clinician not to be using heroin (or any other opioids) or
crack cocaine or any other illicit drug.
Treatment completed –
occasional user (not
heroin and crack)
The client no longer requires structured drug treatment interventions and
is judged by the clinician not to be using heroin (or any other opioids) or
crack cocaine. There is evidence of use of other illicit drug use but this is
not judged to be problematic or to require treatment.
Transferred – not in
custody
The client has finished treatment at this provider but still requires further
structured drug treatment interventions and the individual has been
referred to an alternative non-prison provider for this. This code should
only be used if there is an appropriate referral path and care planned
structured drug treatment pathways are available.
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Data item name
Definition
Transferred – in
custody
The client 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 of care planning information and a twoway communication between the community and prison treatment
provider to confirm assessment and that care planned treatment will be
provided as appropriate.
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 – treatment
withdrawn by provider
The treatment provider has withdrawn treatment provision from the client.
This item could be used, for example, 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’.
Incomplete – retained
in custody
The client is no longer in contact with the treatment provider as they are
in prison or another secure setting. While the treatment provider has
confirmed this, there has been no formal two-way communication
between the treatment provider and the criminal justice system care
provider leading to continuation of the appropriate assessment and careplanned structured drug treatment.
Incomplete – treatment
commencement
declined by the client
The treatment provider has received a referral and has had a 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.
Additional ‘transferred’ discharge codes for use by residential rehabilitation and
inpatient detoxification providers only
Four new ‘transferred’ discharge codes have been added to the data set for use by residential
rehabilitation and inpatient detox providers only in order for NDTMS to more accurately record
the discharge status of clients leaving a residential or inpatient facility.
Residential and inpatient providers should use these codes instead of the ‘transferred’ codes
above. Unlike the existing ‘transferred’ discharge codes that record the status of a client with
the treatment system at the point of discharge from a provider, the residential and inpatient
codes additionally record the outcome of the residential programme and what further
structured interventions are required.
This allows residential and inpatient providers to record where clients have successfully
completed the treatment programme and have been transferred for continued structured
treatment at another provider at either at a second stage residential provider or at a community
provider.
This may be the case for clients at residential and inpatient services that have been
commissioned to provide treatment as a part of a longer treatment journey. The previous data
sets recorded this as a ‘transferred on’, which did not capture information that the client has
successfully completed that part of their treatment journey at the residential or inpatient
provider.
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Data item name
Definition
Transferred – treatment
programme completed at
the residential/inpatient
provider – additional
residential treatment
required
The client has completed the structured treatment programme at the
provider by meeting the goals of their care plan. Although they have
finished treatment at this provider they still require continued
structured treatment interventions and have been transferred to an
alternative residential provider for this. This code should only be used
if there is an appropriate referral path and care planned structured
treatment pathways are available.
Transferred – treatment
programme completed at
the residential/inpatient
provider – additional
community treatment
required
The client has completed the structured treatment programme at the
provider by meeting the goals of their care plan. Although they have
finished treatment at this provider they still require continued
structured treatment interventions and have been transferred to an
alternative community provider for this. This code should only be used
if there is an appropriate referral path and care planned structured
treatment pathways are available.
Transferred – treatment
programme not completed
at the residential/inpatient
provider – additional
residential treatment
required
The client has not completed the structured treatment programme at
the provider because they have not met the goals of their care plan.
They require continued structured treatment interventions and have
been referred to an alternative residential provider for this. This code
should only be used if there is an appropriate referral path and care
planned structured treatment pathways are available.
Transferred – treatment
programme not completed
at the residential/inpatient
provider – additional
community treatment
required
The client has not completed the structured treatment programme at
the provider because they have not met the goals of their care plan.
They require continued structured treatment interventions and have
been referred to an alternative community provider for this. This code
should only be used if there is an appropriate referral path and care
planned structured treatment pathways are available.
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APPENDIX G – Parental status from April 2009
Parental status should include biological parents, step-parents, foster parents, adoptive
parents and guardians. It should also include de facto parents where an adult lives with
the parent of a child or the child alone (for example, clients who care for younger
siblings or grandchildren) and have taken on full or partial parental responsibilities.
The minimum period of cohabitation would be one month.
Data item name
Definition
All the children live
with client
The client is a parent of one or more children under 18 and all the client’s
children (who are under 18) reside with them full time.
Some of the children The client is a parent of children under 18 and some of the client’s children
live with client
(who are under 18) reside with them, others live full time in other locations.
None of the children
live with client
The client is a parent of one or more children under 18 but none of the
client’s children (under 18) reside with them, they all live in other locations
full time.
Not a parent
The client is not a parent of any children under 18.
Client declined to
answer
Only use where client declines to answer.
The second part of the parental status question triggered by a response that the client is living
with one or more of their children or children: Are any of your children/the children living
with you. Note: This question applies to children of the client in treatment (regardless of
whether this child lives with the client or not) and to children living with the client (regardless
whether this is the child of the client or not).
Data item name
Definition
A child looked after or
in foster care
The definition of a looked after child is ‘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’.
Subject to a child
protection plan
These are formal plans developed by the local authority confirming
intentions for a child’s protection. The initial child protection conference is
responsible for agreeing a child protection plan for any child with or
without a care status.
Permissible responses:
• both
• neither
• declined to answer
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APPENDIX H – Setting
The settings below should be recorded in the intervention/modality record where the
intervention being delivered is at a different setting to the one the provider is registered
as on the NDTMS agency database.
Setting
Definition
Community
A structured drug and alcohol treatment setting where residence is not a condition of
engagement with the service. This will include treatment within community drug and
alcohol teams and day programmes (including rehabilitation programmes where
residence in a specified location is not a condition of entry).
Inpatient unit
An inpatient unit provides assessment, stabilisation and/or assisted withdrawal with 24hour cover from a multidisciplinary clinical team who have had specialist training in
managing addictive behaviours 1. In addition, the clinical lead in such a service comes
from a consultant in addiction psychiatry or another substance misuse medical
specialist. The multi-disciplinary team may include psychologists, nurses, occupational
therapists, pharmacists and social workers. Inpatient units are for those alcohol or drug
users whose needs require supervision in a controlled medical environment.
Primary care
Structured substance misuse treatment is provided in a primary care setting with a
General Practitioner, often with a special interest in addiction treatment, having clinical
responsibility.
Prison
Structured drug and alcohol treatment delivered by a locally commissioned substance
misuse team within the prison establishment providing the full range of drug and
alcohol interventions in line with the evidence base articulated in the Patel Report2.
Residential
A structured drug and alcohol treatment setting where residence is a condition of
receiving the interventions. Although such programmes are usually abstinence based,
prescribing for relapse prevention or for medication assisted recovery are also options.
The programmes are often, although not exclusively, aimed at people who have had
difficulty in overcoming their dependence in a community setting.
A residential programme may also deliver an assisted withdrawal programme. This
should be sufficiently specialist to qualify as a ‘medically monitored’ inpatient service –
and it should meet the standards and criteria detailed in guidance from the Specialist
Clinical Addictions Network1. This level of support and monitoring of assisted
withdrawal is most appropriate for individuals with lower levels of dependence and/or
without a range of associated medical and psychiatric problems.
Within the residential setting, people will receive multiple interventions and supports
(some of which are described by the intervention codes) in a coordinated and controlled
environment. The interventions and support provided in this setting will normally
comprise both professionally delivered interventions and peer-based support, as well
as work and leisure activities.
1
SCAN (2006). Inpatient Treatment of Drug and Alcohol Misusers in the National Health Service
Patel K (2010) Reducing Drug-Related Crime and Rehabilitating Offenders – Recovery and rehabilitation for drug users
in prison and on release: recommendations for action. London: House of Lords
2
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Recovery
house
v11.06
A recovery house is a residential living environment, in which integrated peer-support
and/or integrated recovery support interventions are provided for residents who were
previously, or are currently, engaged in treatment to overcome their drug and alcohol
dependence. The residences can also be referred to as dry-houses, third-stage
accommodation or quasi-residential.
Supported housing that does not provide such integrated substance misuse peer or
recovery support as part of the residential placement is not considered a recovery
house for this purpose.
Recovery houses may be completely independent, or associated with a residential
treatment provider or housing association. Some will require ‘total abstinence’ as a
condition of residence whereas others may accept people in medication assisted
recovery who are otherwise abstinent.
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APPENDIX I – Time in treatment
Time in treatment covers the time spent in an average week in structured treatment on
one or more of the interventions defined above. The time will usually be that actually
spent but may include service user absence, within the programme’s stipulated
attendance requirements.
Interventions included in calculating the time should be exclusively made up of the
pharmacological, psychosocial and recovery support interventions defined earlier, but
not only recovery support interventions. A client receiving only recovery support
interventions would not be in structured treatment.
In deciding which threshold to record for a fractional time spent in treatment, the actual
time should be rounded up to the nearest whole hour, eg 14.5 hours rounds up to 15
hours, so would be recorded as ‘high’.
Threshold
Definition
Standard
One or more of the interventions defined above is received by, or made
available to, the service user for 14 hours or less per week. This can
include service user absence, within the programme’s stipulated
attendance requirements.
Interventions should be exclusively made up of a combination of
pharmacological, psychosocial and recovery support interventions, as
defined here, but not only recovery support interventions.
(14 hours or less per
week)
One or more intervention types defined above is received by, or made
available to, the service user for more than 14 and less than 25 hours per
(More than 14 hours
week. This can include service user absence, within the programme’s
and less than 25 hours) stipulated attendance requirements.
This could include non-residential or residential rehabilitation
programmes, including services previously recorded as structured day
programmes.
Interventions should be exclusively made up of a combination of
pharmacological, psychosocial and recovery support interventions, as
defined here, but not only recovery support interventions.
High
Very high
(25 or more hours per
week)
One or more intervention types defined above is received by, or made
available to, the service user for 25 or more hours per week. This can
include service user absence, within the programme’s stipulated
attendance requirements.
This could include non-residential or residential rehabilitation
programmes, including services previously recorded as structured day
programmes.
Interventions should be exclusively made up of a combination of
pharmacological, psychosocial and recovery support interventions, as
defined here, but not only recovery support interventions.
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APPENDIX J – Outcomes process maps
The following process maps outline the steps for recording outcomes information for alcohol clients via the Alcohol
Outcomes Record (AOR) and for young people in treatment via the Young Persons Outcomes Record (YPOR).
They demonstrate how completing AORs and YPORs aligns with the existing processes of completing Treatment Outcomes
Profile (TOPs) for adult drug clients.
Examples are provided for clients who are transferring between alcohol and drug treatment episodes and between adult and
young people’s services.
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Process map for completing Alcohol and YP Outcomes Records (AOR/YPOR)
Client enters treatment
Each YP attending a young person’s provider should complete the YPOR, regardless of that client’s age
Each client attending an adult service with a primary problem substance of alcohol should complete the AOR
(or the TOP if deemed useful at a local level)
Local treatment
Provider:
The provider completes an
outcomes record
The outcomes record
needs to be anchored to
the earliest modality start
date and completed +/- 14
days of this date
Optional: An outcomes
record can also be
completed and submitted at
care plan review if deemed
useful
At exit, a final outcomes record must be completed
+/- 14 days either side of the discharge date
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Process map for clients transferring between adult services and changing problem substance: from drug to alcohol
Primary drug client (problem
substance No 1 is not alcohol)
Local treatment
Provider b: alcohol treatment
Provider a: drug treatment
Provider completes a start TOP that
is anchored to earliest modality start
date
TOP six month reviews should also
be anchored to the earliest modality
start date
Client needs alcohol
treatment and is discharged
from provider (transferred
using code 83) and starts an
intervention at the adult
service within 21 days
If the provider wishes to gain
baseline data for the client’s status
at the start of their service they may
complete an AOR/TOP
AORs can be completed at care
plan reviews if deemed useful at a
local level
At exit, a final outcomes record must be completed +/- 14
days either side of the discharge date
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Process map for clients transferring between adult services and changing problem substance: from alcohol to drug
Primary alcohol client
(problem substance No 1 is
alcohol)
Local treatment
Provider b: drug treatment
Provider a: alcohol treatment
The provider completes a TOP or AOR
The outcomes record needs to be
anchored to the earliest modality start
date and completed +/- 14 days of this
date
AORs can be completed at care plan
reviews if deemed useful at a local level
Client needs further
drug treatment and is
discharged from
provider (transferred
using code 83) and
starts an intervention
at the adult service
within 21 days
Provider completes a start TOP
Six month reviews should then be
completed at regular intervals
At exit, a TOP must be completed +/-14 days
either side of the discharge date
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Process map example for clients being transferred from a YP service to an adult service
Client enters treatment
at a young person’s
provider
Each YP attending a young person’s provider should complete the YPOR, regardless of that client’s age
Local treatment
YP provider:
The provider completes a YPOR
The YPOR needs to be anchored
to the earliest modality start date
and completed +/- 14 days of this
date
YPORs also completed at care
plan reviews if deemed useful at a
local level
Client is discharged from
YP provider, transferred to
adult service (using code
85) and starts an
intervention at the adult
service within 21 days
Adult provider:
Depending on the problem
substance No 1 of the client, the
provider must either:
Complete a start TOP
Complete the AOR
YP provider:
Complete an exit YPOR
to show outcomes at the
end of the YP’s time in YP
service
This and any further review records
should be anchored to the first
modality start date at the adult
service
At exit, a final outcomes record (AOR or TOP) must be
completed +/-14 days either side of the discharge date
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APPENDIX K – External references
Ref No
Title
Version
1
NDTMS data set – technical definition
11.04
2
NDTMS data set – reference data
11.06
3
An implementation guide to core data set J
1.00
This document uses the convention that any external references are indicated by
square brackets, for example [3]
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APPENDIX L – Revision history
Version
Author
Purpose/reason
Date
4.00
M Roxburgh
New items added for 2007/2008 data collection:
04/10/2006
•
•
•
•
•
•
•
•
•
•
•
nationality
accommodation need
frequency of use of problem substance
No 1
children
pregnant
drinking days
units alcohol
dual diagnosis
Hep C – intervention status
modality exit status
sexuality (regional item)
Items removed:
• accommodation status (replaced by
accommodation need)
• postcode in-code (technical change to
existing postcode field will enable this to
be captured by regional NDTMS centres
without requiring a separate data item)
• parental status (replaced with number of
children and pregnancy)
4.10
M Roxburgh
Parental status reinstated, in order to ensure that
existing DH and NTA commitments to hidden harm
data monitoring are not discontinuous. The wider YP
treatment monitoring requirements are currently
being reviewed. This will probably lead to further YP
specific changes being announced as part of NDTMS
data set E (April 07)
Employment status moved from regional data items
to national data items
Description of client reference corrected (field may
contain attributable information)
26/10/2006
4.20
G Scott
4.30
G Scott
Update following review by external parties
Clarification of guidance relating to clients that are
NFA
Clarification of definition of nationality
09/11/2006
4.40
G Scott
Clarify all references to “last month” or “four weeks”
to 30 days
12/02/2007
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Adult drug treatment business definition
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Version
Author
Purpose/reason
Date
5.00
G Scott
Update for CDS-E – inclusion of Treatment
Outcomes Profile (TOP):
29/05/2007
• Treatment Outcomes Profile (TOP) date
• treatment stage
• alcohol use
• opiate use
• crack use
• cocaine use
• amphetamine use
• cannabis use
• other drug use
• IV drug use
• sharing
• shop theft
• drug selling
• other theft
• assault/violence
• psychological health status
• paid work
• education
• acute housing problem
• housing risk
• physical health status
• quality of life
Fields changed:
•
injected in the last 28 days (was injected
in the last 30 days)
Fields removed:
•
•
•
parental status
frequency of use of problem substance
No 1
employment status
5.20
G Scott
Reclassification of parental status as NDTMS data
set
30/08/2007
5.30
M Kozikova
Uplifting external references
02/07/2008
6.00
J Knight
Update for CDS-F:
28/01/2009
•
•
•
•
new discharge coding (see appendix F)
new parental status coding (see appendix
G)
new TOP care coordination field
revised definition of children data item
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Version
Author
Purpose/reason
Date
6.01
R Bull
Discharge date restored
16/02/2009
6.10
R Bull
Consolidation of 6.0.0, 6.0.1 changes
16/02/2009
7.01
J Jaswani
CDS-G modality code definitions
Inpatient treatment
01/03/2010
•
•
•
inpatient treatment assessment only
inpatient treatment stabilisation
inpatient treatment detoxification
(assisted withdrawal)
Psychosocial interventions
•
•
•
•
•
behavioural couples therapy
family therapy
contingency management (drug specific)
psychosocial intervention to address
common mental disorders
other formal psychosocial therapy (eg
community reinforcement approach or
social behaviour network therapy)
7.02
M Hinchcliffe
Appendix A No 29 – ‘pregnant’
Updated to ‘Not expected to change (ie as at start of
episode)’ in line with YP and adult alcohol business
definition
21/04/2010
7.03
M Hinchcliffe
‘Client reference’ definition updated with clarification
“(NB: this must not hold or be composed of attributers
which might identify the individual)”
11/05/2010
Change to ‘PCT of residence’ data item description
7.04
M Hinchcliffe
Appendix A No 22 and 23 – “May be left blank if client
has no second drug” removed for ‘problem substance
No 2’ and ‘problem substance No 3’
03/09/2010
7.05
M Hinchcliffe
Sex worker category data item removed
This item was previously included within the data set
for collection and use at regional level only. Following
consultation, this data item will be removed from the
data set at the next revision in April 2011. In the
interim, the NDTMS systems will be amended to
exclude any data submitted in this field and cease
any entries from being uploaded onto the database
14/10/2010
8.00
M Hinchcliffe
The following fields have been updated to be
mandatory and must be completed in all records:
04/01/2011
•
•
•
•
1
client ID
episode ID
modality ID1
TOP ID1
MUST be completed if any items in this section are
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Author
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Purpose/reason
not null. If not, record rejected
‘Local authority’ field (previously a local field) now
part of the core data set and is mandatory. ‘Local
authority’ must be completed in all records
Date
New field added to core data set for ‘GP practice
code’. This field has been added to the data set in
order to support potential future reporting
requirements from the NDTMS. Should this be
required, further information regarding the validation
and submission of GP practice codes will be issued
New field added to core data set – ‘Hep C tested’.
Permissible values:
•
•
•
no
yes
not asked
8.02
M Hinchcliffe
Updated external references
Section C 5.1 – tier 4b services removed
24/01/2011
8.03
M Hinchcliffe
Definition of ‘local authority’ updated as below:
01/03/2011
The local authority in which the client currently
resides (as defined by their postcode of their normal
residence)
If a client states that they are of No Fixed Abode
(denoted by having an “accommodation need” of
NFA) then for Tier 3 agencies the local authority of
the treatment provider should be used as a proxy;
and for Tier 4 treatment providers the local authority
of the referring partnership should be used as a proxy
10.01
N Ramnarine
Updated external links
06/07/2012
Definitions of interventions and sub interventions
added
Definitions of time in treatment added
10.02
N Ramnarine
Updated following review
10/07/2012
10.03
D Mhambi
CDS-K benchmark update
31/01/2013
Six data items, Sect No 2:
Discharge reason
New discharge codes have been added to core data
set K specifically for residential rehabilitation and
inpatient detox providers. These codes are to be
used on or after 1 April 2013.
Appendix F – additional ‘transferred’ discharge codes
for use by residential rehabilitation and inpatient
detoxification providers only
Four new ‘transferred’ discharge codes have been
added to the data set for use by residential
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Version
Author
v11.06
Purpose/reason
rehabilitation and inpatient detox providers only, in
order for NDTMS to more accurately record the
discharge status of clients leaving a residential or
inpatient facility
Residential and inpatient providers should use these
codes instead of the current ‘transferred’ codes.
Unlike the current ‘transferred’ discharge codes, that
record the status of a client with the treatment system
at the point of discharge from a provider, the
residential and inpatient codes additionally record the
outcome of the residential programme and what
further structured interventions are required. This
allows residential and inpatient providers to record
where clients have successfully completed the
treatment programme and have been transferred for
continued structured treatment at another provider,
either at a second stage residential provider or at a
community provider
This may be the case for clients at residential and
inpatient services that have been commissioned to
provide treatment as part of a longer treatment
journey. The previous data sets recorded this as
‘transferred on’, which did not capture information
that the client has successfully completed that part of
their treatment journey at the residential or inpatient
provider
Data item name: transferred – treatment programme
completed at the residential/inpatient provider –
additional residential treatment required
Data item definition: the client has completed the
structured treatment programme at the provider by
meeting the goals of their care plan. Although they
have finished treatment at this provider, they still
require continued structured treatment interventions
and have been transferred to an alternative
residential provider for this. This code should only be
used if there is an appropriate referral path and care
planned structured treatment pathways are available
Data item name: transferred – treatment programme
completed at the residential/inpatient provider –
additional community treatment required
Data item definition: the client has completed the
structured treatment programme at the provider by
meeting the goals of their care plan. Although they
have finished treatment at this provider, they still
require continued structured treatment interventions
and have been transferred to an alternative
community provider for this. This code should only be
used if there is an appropriate referral path and care
planned structured treatment pathways are available
56
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Author
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Purpose/reason
Date
Data item name: treatment programme not
completed at the residential/inpatient provider –
additional residential treatment required
Data item definition: the client has not completed
the structured treatment programme at the provider
because they have not met the goals of their care
plan. They require continued structured treatment
interventions and have been referred to an alternative
residential provider for this. This code should only be
used if there is an appropriate referral path and care
planned structured treatment pathways are available
Data item name: treatment programme not
completed at the residential/inpatient provider –
additional community treatment required
Data item definition: the client has not completed
the structured treatment programme at the provider
because they have not met the goals of their care
plan. They require continued structured treatment
interventions and have been referred to an alternative
community provider for this. This code should only be
used if there is an appropriate referral path and care
planned structured treatment pathways are available
11.01
D Mhambi
Bringing the document in line with CDS-L
requirements, through the addition of the:
•
•
•
•
11.03
D Mhambi
13/05/2013
consumption field: Typical number of
units consumed in a drinking day in the
last 28 days
are any of your children/the children living
with you
Appendix G: Second parental status
question: Are any of your children/the
children living with you
Appendix J: Outcomes process maps
Uplift 11.03 fixes:
13/08/2013
Updated appendix G relating to the episode level
question: “Are any of your children/the children living
with you?”
Data item description: this question applies to
children of the client in treatment (regardless of
whether this child lives with the client or not) and to
children living with the client (regardless whether this
is the child of the client or not)
Data item name: a child looked after or in foster care
Description: the definition of a “looked after child” is
“Children looked after includes all children being
looked after by a local authority, including those
subject to care orders under Section 31 of the
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Author
v11.06
Purpose/reason
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”
Date
Data item name: subject to a child protection plan
Description: these are formal plans developed by
the local authority confirming intentions for a child’s
protection. The initial child protection conference is
responsible for agreeing a child protection plan for
any child with or without a care status.
Permissible responses:
• both
• neither
Declined to answer
11.04
W Nielsen
Extensive corrections, re-formatting and updating of
NDTMS documentation, bringing in line with PHE
style
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