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NTA Patient Placement Criteria
(PPC) and Segmentation project
David Best
28.3.2011
Sub-group: PPC and segmentation
• Develop, for and with the National Treatment Agency, a
model for the segmentation of the treatment population
and the ‘at-need’ group not currently engaged in
treatment, in terms of their likely recovery pathways and
journeys. This will prepare the way for matching to
suitable treatment placement indicators, in the context of
the developing recovery framework. Overall, the aims of
the group are to agree a process for meaningful
segmentation and to utilise this as a way of identifying
matching criteria for treatment journeys and ongoing
recovery pathways.
• Dr John Marsden (IoP) – PPC
• David Best (UWS / Monash) - Segmentation
What is the real purpose?
• CSAT (2009) say that 58% of people with a
substance dependence will eventually recover
• Is that right?
• Does it apply to the UK?
• Who are they?
• Is there anything you can do to make that
figure go up or down?
Hypothesis
• There are naturally occurring turning points in all
life trajectories – birth of a child, getting a job,
getting married, moving house etc
• It is also possible that turning points in
trajectories can be ‘induced’, and one of those
possible transitions is a successful treatment
episode
• It is hypothesised that the reason why some
potential turning points are actualised is based
on the reserve of recovery capital that the
individual possesses
Best and Laudet (2010)
Personal
Recovery
Capital
Social
Recovery
Capital
Collective
Recovery Capital
How does this link to segmentation?
• The aim is to use existing resources and materials to
identify variables – such as age, gender and drug use
profile that may predict recovery outcomes
• To link this to measures of functioning where available
– including but not restricted to TOP data
• To link this to aspects of community functioning
• And to link this to locality differences in access to
community capital
• To create a preliminary model that is hypothesis based
but data driven to create a segmentation
09/10 data on % in stable housing
100
98
96
94
92
90
Wirral
Liverpool
88
Calderdale
86
84
82
80
78
5-26 week review
27-52 week review
1-3 years
3+ years
09/10 data on % abstinent from
opiates and crack
09/10 data on % in education or
employment
25
20
15
Wirral
Liverpool
Calderdale
10
5
0
5-26 week review
27-52 week review
1-3 years
3+ years
09/10 data on % meeting all 3 criteria
14
12
10
8
Wirral
Liverpool
Calderdale
6
4
2
0
5-26 week review
27-52 week review
1-3 years
3+ years
Differences in reported psychological health as a function of outcomes
achieved
16
14
12
10
8
6
4
2
0
5-26 weeks
27-52 weeks
1-3 years
.00
1.00
2.00
3.00
3+ years
Differences in reported physical health as a function of outcomes achieved
16
14
12
10
8
6
4
2
0
5-26 weeks
27-52 weeks
1-3 years
.00
1.00
2.00
3.00
3+ years
Differences in reported quality of life as a function of outcomes achieved
18
16
14
12
10
8
6
4
2
0
5-26 weeks
27-52 weeks
1-3 years
.00
1.00
2.00
3.00
3+ years
OVERALL MEASURE OF WELLBEING
• 3 ‘OBJECTIVE FACTORS’
– STABLE HOUSING
– NO HEROIN OR CRACK USE
– MEANINGFUL ACTIVITY
• 3 ‘SUBJECTIVE FACTORS’
– PHYSICAL WELLBEING
– PSYCHOLOGICAL WELLBEING
– QUALITY OF LIFE
• ALL MADE EQUAL (0-1)
• TOTAL SCORE OUT OF 6
Composite recovery capital baseline to
six months by DAT
Composite recovery capital baseline to
six months by gender
Composite recovery capital baseline to
six months by age group
SITE VISITS - PURPOSE
• To map out the recovery communities and
systems
• To assess functioning in those in maintained
and abstinent recovery
• To test measures of collective recovery capital
• To test the overall model of developmental
recovery
WHAT DO WE KNOW ABOUT EACH
LOCATION?
LIVERPOOL
WIRRAL
CALDERDALE
SOCIAL
DEPRIVATION
INDEX SCORE
47.0
27.9
23.0
NATIONAL
RANKING (OUT OF
354)
1
60
107
OVERALL CRIME
59.1
PER 1,000 PERSONS
29.7
50.4
% OF WORKING
AGE POPULATIONS
ON BENEFITS
21.8%
16.1%
5.2
6.7
25.8%
INFANT MORTALITY 6.5
PER 1,000 LIVE
BIRTHS
Recovery case studies
OVERALL ABOUT 180 RECOVERY PROTOCOLS
COMPLETED IN THREE LOCATIONS
CALDERDALE
• 52 interviews conducted
• Mean age = 40.8 years
• Mean length of recovery time – 39 months
• 3/52 reported housing problems
• 22/52 reported some level of education and
employment
TOP functioning by group
0-6m in
treatment
1-4 years in 4years + in Recovery
treatment treatment group
12.8
12.6
12.5
14.4
Psychologic 12.6
al health
12.5
11.9
15.2
Quality of
life
13.4
13.4
15.8
Physical
health
13.3
Correlates of recovery time
TIME IN RECOVERY
CORRELATED WITH.......
CORRELATION
PSYCHOLOGICAL HEALTH
0.21
PHYSICAL HEALTH
0.15
QUALITY OF LIFE
0.23
DAYS OF ACTIVITY
0.44
Correlates of activity
NUMBER OF DAYS
WORKING OR TRAINING
CORRELATED WITH .......
PSYCHOLOGICAL HEALTH
CORRELATION
PHYSICAL HEALTH
0.29
QUALITY OF LIFE
0.36
TIME IN RECOVERY
0.44
0.55
PRELIMINARY COMPARISON WITH THE
WIRRAL
MAINSTREAM
COMMUNITY
RECOVERY
VISIBLE
RECOVERY
CONNECT 3
MAINSTREAM
TREATMENT
MUTUAL
AID
PROJECT COLT
TTP DETOX
BASEMENT
CSMS
BASEMENT
ENTRY SOURCES
CRIM
JUSTICE
SELF
OTHER
OVERALL CANDIDATE MODEL
• BASELINE OF RC ENABLERS – possibly mediated by gender and age
• PERSONAL RECOVERY CAPITAL
• SOCIAL RECOVERY CAPITAL
This creates an individual model that is then multiplied against:
• COLLECTIVE RECOVERY CAPITAL IS ASSESSED AS A FRACTION BASED
ON:
– TREATMENT QUALITY AND ACCESS
– RECOVERY CHAMPION VISIBILITY AND ACCESS TO GROUPS
– SOCIAL COHESION, DEPRIVATION AND OPPORTUNITY