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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