FEDERAL PUBLIC SERVICE HEALTH, FOOD CHAIN SECURITY AND ENVIRONMENT
Scientific Institute of Public Health Unit of Epidemiology Drugs Programme
Implementing the “Treatment Demand Indicator” in Belgium: Registration of drug users in treatment
COLPAERT Kathy DE CLERCQ Tinneke
IPH/EPI REPORTS Nr. 2003-018
Epidemiology Unit, Scientific Institute of Public Health, November 2003; Brussels (Belgium) IPH/EPI REPORTS Nr. 2003 - 018 Deposit number: D/2003/2505/38
Implementing the “Treatment Demand Indicator” in Belgium: Registration of drug users in treatment
COLPAERT Kathy DE CLERCQ Tinneke
Scientific Institute of Public Health Unit of Epidemiology Drugs Programme Rue J. Wytsmanstraat 14 B-1050 BRUSSELS Tel. +32 2 642 57 12 Fax +32 2 642 54 10 http://www.iph.fgov.be/epidemio/drugs/
Contents
CONTENTS LIST OF ABBREVIATIONS
3
LIST OF TABLES AND FIGURES
4
INTRODUCTION
5
CHAPTER 1: Assessing drug problems
9
CHAPTER 2: Reporting systems
13
CHAPTER 3: Advantages and limitations of treatment reporting systems
17
CHAPTER 4: The PG/EMCDDA Treatment Demand Indicator Protocol
19
CHAPTER 5: Substance abuse treatment in Belgium
23
CHAPTER 6: Treatment reporting systems in Belgium
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6.1 Primary treatment reporting systems 6.1.1 6.1.2 6.1.3 6.1.4 6.1.5 6.1.6 6.1.7
Primary treatment reporting system - ASL Sentinelle Charleroi Addibru Primary Treatment Reporting System - “De Sleutel” Primary Treatment Reporting System - Eurotox Minimal Psychiatric Data (MPD) Primary Treatment Reporting System “Institut Wallon pour la Santé Mentale (IWSM)” 6.1.8 MEDAR – ARCADE 6.1.9 Minimal Psychiatric Data extra module 6.1.10 Primary Treatment Reporting System - “VLAams STRaathoekwerkOVerleg (VLASTROV)” 6.1.11 Drug Aid RegisTration System (DARTS)
27 29 30 32 33 35 36 38 40 42 43 43
1
Contents 6.2
Umbrella treatment reporting systems 6.2.1 Umbrella treatment reporting system – Eurotox 6.2.2 Vlaamse Registratie Middelenmisbruik (VRM)
CHAPTER 7: Congruence of the reporting systems to the TDI Protocol 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8
National figures Types of Treatment Centres External coverage Selection of cases Internal coverage Unique clients Continuity Variables 7.8.1 7.8.2 7.8.3 7.8.4
Treatment contact details Socio-demographic information Drug-related information Conclusion
45 46 47
49 50 51 58 62 68 68 70 71 71 77 85 94
CONCLUSIONS
97
RECOMMENDATIONS
101
BIBLIOGRAPHY
103
ANNEX
109
2
List of abbreviations
LIST OF ABBREVIATIONS ARCADE: Applicatie voor de Registratie van Cliëntengegevens voor de Administratie Gezondheidszorg en voor Data-Export ASL : Arbeitsgemeinschaft für Suchtvorbeugung und Lebensbewältigung CCAD: Comité de Concertation sur l’Alcool et les autres Drogues CDC: Coordination Drogue Charleroi CGG: Centrum Geestelijke Gezondheidszorg CRC : Cellule Recherche et Concertation CRSSM : Conseil Régional des Services de Santé Mentale CTB : Concertation Toxicomanies Bruxelles DARTS: Drug Aid RegisTration System DGASS : Direction Générale de l’Action Sociale et de la Santé DSM: Diagnostic and Statistical Manual EMCDDA: European Monitoring Centre on Drugs and Drug Addiction EuropASI: European Addiction Severity Index FDGG : Federatie van Diensten voor Geestelijke Gezondheidszorg HP : Hôpital psychiatrique ICD : International Classification of Diseases INAMI : Institut National d’ Assurance Maladie Invalidité IWSM : Institut Wallon pour la Santé Mentale LWSM : Ligue Wallonne pour la Santé Mentale MedAr: Medical Archives MPD: Minimal Psychiatric Data MPG : Minimale Psychiatrische Gegevens ODB : Overleg Druggebruik Brussel PAAZ : Psychiatrische Afdeling van een Algemeen Ziekenhuis PG : Pompidou Group PZ : Psychiatrisch ziekenhuis RIZIV : Rijksdienst voor Invaliditeit en Ziekteverzekering RPM : Résumé Psychiatrique Minimum SSM: Service de Santé Mentale TDI: Treatment Demand Indicator VAD : Vereniging voor Alcohol en andere Drugproblemen VLASTROV : VLAams STRaathoekwerkOVerleg VLIS-DC : Vlaams Informatie Systeem – Drugvrije centra VMSI: Verbond der Medisch-Sociale Instellingen VRM : Vlaams Registratiesysteem Middelenmisbruik VVBV : Vlaamse Vereniging van Behandelingscentra in de Verslavingszorg VVGG : Vlaamse Vereniging voor Geestelijke Gezondheid VVI : Verbond der Verzorgingsinstellingen
3
List of tables and figures
LIST OF TABLES AND FIGURES TABLE 1: Key questions to which epidemiological studies can help find answers
9
TABLE 2: List of twenty core variables in the Joint Pompidou Group – EMCDDA Treatment Demand Indicator Protocol version 2.0
20
TABLE 3: Overview of the primary reporting systems
28
TABLE 4: Main characteristics of the clients registered in 2001 through the ASL reporting system
30
TABLE 5: Main characteristics of the clients registered in 2001 through the Sentinelle reporting system
31
TABLE 6: Main characteristics of the clients registered in 1999 through the Addibru reporting system
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TABLE 7: Main characteristics of the clients registered in 2002 through the De Sleutel reporting system
35
TABLE 8: Main characteristics of the clients registered in 2000 through the MEDAR reporting system
42
TABLE 9: Main characteristics of the clients registered in 1999 through the MPD extra module reporting system
43
TABLE 10: Main characteristics of the clients registered in 2001 through the DARTS reporting system
45
TABLE 11: Main characteristics of the clients registered in 2000 through the CCAD and Sentinelle reporting systems
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TABLE 12: Main characteristics of the clients registered in 1999 through the VRM
48
TABLE 13: Types of existing treatment centres in Belgium in combination with the existing treatment reporting systems
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FIGURE 1: Conceptual framework for different methods to investigate the nature and extent of drug use and drug problems
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4
Introduction
INTRODUCTION Although the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) states in its most recent annual report (EMCDDA, 2002) that the increasing trend regarding problems related to drug use has come to a relatively stable standstill, this does not mean that the problem is solved and no longer requires our attention. Drugs and drug addiction still remain important issues on the political agenda. In Belgium, the recent evolutions regarding legislation, policy statements and initiatives clearly illustrate this observation (Sleiman & Sartor, 2002). In order to be able to organise drug prevention, drug treatment and drug control in an efficient and effective manner, reliable epidemiological information is required about the extent and the specific characteristics of (problematic) drug use in a certain population. Due to the specific nature of drug (ab)use, obtaining this kind of information is not evident and accordingly, adequate methods have to be applied that aim to increase knowledge, sometimes in an indirect manner. The registration of drug users starting treatment can be considered one of those methods. On the European level, the Treatment Demand Indicator (TDI) Protocol (version 2.0) was developed in 2000 in the framework of the EMCDDA. This Protocol provides guidelines to the different member states regarding the registration of drug users in treatment in order to establish and improve the possibility to compare the situation between countries. After all, since the Maastricht treaty in 1993, drug-related matters belong partially to the competences of the European Union and have acquired a prominent place on the European political agenda (Boekhout van Solinge, 2002). The objective of the present report is to provide an overview of the different treatment reporting systems in Belgium and their characteristics. Furthermore the Belgian situation related to drug treatment registration is compared to the guidelines in the European TDI Protocol. Hence, this document should be considered as a basis for discussion with all partners involved, in order to continue the steps that have already been taken towards the search for valid and reliable national figures. This document does not pretend to be exhaustive; it rather aims to be a starting point for discussion and a working tool. In the first five chapters of the report more background information is provided on the assessment of drug problems and the accompanying difficulties, reporting systems, advantages and difficulties of treatment monitoring systems, the European TDI Protocol and finally substance abuse treatment in Belgium. Chapter 6 describes the different treatment monitoring systems in Belgium and their characteristics. A distinction has been made between a primary treatment monitoring system and an umbrella treatment monitoring system. The former is characterised by the fact that a central body receives information from individual treatment centres, using a systematic reporting procedure. Accordingly it is responsible for the
5
Introduction development of registration forms or a computer programme. An umbrella treatment monitoring system on the other hand makes use of existing primary reporting systems to gain insight into the extent and nature of the drug phenomenon on a larger scale. The central body of the umbrella treatment monitoring system receives information of the central body´s of the primary treatment reporting systems. In this way, an umbrella reporting system is dependent on other primary treatment reporting systems and therefore has in general less control on data quality. In chapter 7 the Belgian situation regarding drug treatment registration is compared to the guidelines provided in the European TDI Protocol. The following issues will be addressed: national figures, types of treatment centres, external coverage, selection of cases, internal coverage, unique clients, continuity of the registration and the various variables of the TDI Protocol. In this chapter a number of points are listed that call for in-depth discussion. The reader has to be aware that the situation described in this last chapter has been evaluated as it is today. Treatment reporting systems are all subject to changes over time: changes in the number or nature of the variables, the number of treatment centres or with regard to the registration guidelines. This implies that congruence to the TDI Protocol also varies over time, although one should expect congruence improval through the years since most of the reporting systems have already made, and are still making, efforts to adjust their system to the needs of the Protocol. In annex the registration forms have been included of all primary treatment reporting systems described in chapter 6. Before proceeding to the first chapter of this report a number of comments have to be made regarding the focus of this report and the terminology that was used. As described above, the subject of this report is the registration of people with drug problems starting treatment. However, in some of the consulted literature the terminology that is being used is ‘treatment demand registration’. Also the European Protocol itself is called the ‘Treatment Demand Indicator Protocol’. Nevertheless, in this report the choice has been made to speak of ‘treatment registration’ because of the fact that in reality no persons are registered who do not start treatment. Furthermore, also during the European expert meetings on TDI at the EMCDDA headquarters in Lisbon, experts agreed that the term ‘treatment demand’ does no longer cover what is really registered in practice. The TDI Protocol has been drawn up within the framework of the EMCDDA, an agency that has been established to provide objective, reliable and comparable information at European level concerning drugs and drug addiction and their consequences (EMCDDA, 2002). Its main concern goes out to illegal drugs. The guidelines in the TDI Protocol state that clients with alcohol as a primary drug should not be taken up in this type of registration activities and that only data on clients with illegal drug problems should be submitted to the EMCDDA by the member states. Clients with illegal drug problems are therefore also the main focus of this report.
6
Introduction Nevertheless, in reality this rather artificial boundary is not always easy to retain: treatment centres often treat clients with alcohol and illegal drug problems, the coordinating organisations of the reporting systems have missions related to illegal drugs but also to alcohol, etc ... Therefore the main focus of this report are persons with illegal drug problems but has been sometimes interpreted in a flexible way. In Belgium, substance abuse treatment is characterised by a large diversity of treatment possibilities in different types of treatment facilities. Dependent on the prevailing views and guiding principles, people with drug problems being treated in a treatment centre are nominated differently. In psychiatric hospitals people will rather be regarded as ‘patients’ while for example in low threshold services the term ‘guests’ or ‘clients’ is more common. Also language differences have to be taken into account. In the French-speaking part of Belgium for example, the French equivalent for ‘client’ has a totally different meaning and will never be used in this context and preference is being given to the term ‘patients’. In this report however the choice has been made to systematically use the term ‘clients’ when talking about persons with drug problems starting treatment, since it is most commonly used as a global term in the English scientific literature too. For the same reason the term ‘treatment’ has been retained in this report. In some types of treatment facilities, sometimes also related to the different parts of the country, the term ‘treatment’ is not used due to fundamental objections to the underlying assumptions related to the discussion on the nature of addiction (Schaler, 2000). Preference is being given to other expressions, such as ‘guidance’. These arguments are acknowledged by the authors but for an easy reading of the report only the term ‘treatment’ has been withheld. When the term ‘practitioners’ is used in the context of the registration activities, all professionals are meant that work directly with clients to deal with drug problems and that are in general also the persons that are responsible for registering the information of clients starting treatment. In this report, the term practitioners is for example used for experts through experience as well as for psychiatrists. The term is mainly used to describe the group of people that is actually taking care of the registration. This report has been drawn up on the basis of existing written documents and has been sent to the persons responsible for the various treatment reporting systems in Belgium for verification and comments, and to a number of other experts active in the field of substance abuse or mental health research: -
Virginie Bellefroid: Institut Wallon pour la Santé Mentale (IWSM) ; Willy Brunson: Belgian representative at the Management Board of the European Monitoring Centre for Drugs and Dug Addiction (EMCDDA); Joris Casselman: Belgian representative at the Management Board of the European Monitoring Centre for Drugs and Dug Addiction (EMCDDA); Luc Claeys: Vlaamse Vereniging voor Geestelijke Gezondheid (VVGG);
7
Introduction -
Philippe Depaepe: Cellule Recherche et Concertation (CRC), Coordination Drogue Charleroi (CDC) ; Herwin De Kind: Ministry of the Flemish Community; Ilse De Maeseneire: Vereniging voor Alcohol en andere Drugproblemen (VAD); Marijs Geirnaert: Vereniging voor Alcohol en andere Drugproblemen (VAD) Pol Gerits: Federal Public Service ‘Public Health, Security of the Food Chain and Environment’; Jean-Pierre Gorissen: Federal Public Service Public Health, Security of the Food Chain and Environment; Fabienne Hariga: Eurotox Sofie Köttgen: Arbeitsgemeinschaft für Suchtvorbeugung und Lebensbewältigung (ASL) ; Margarète Molnar: Eurotox; Veerle Raes: Dienst Wetenschappelijk Onderzoek en Kwaliteitszorg De Sleutel; Jo Thienpont en Paul Van Deun: Vlaamse Vereniging van Behandelingscentra in de Verslavingszorg (VVBV); Mark Vanderveken: Concertation Toxicomanies Bruxelles / Overleg Druggebruik Brussel (CTB/ODB); Wim Verhelst : VLAams STRaathoekwerkOVerleg (VLASTROV); Geert Verschuren: Rijksdienst voor Invaliditeit en Ziekteverzekering (RIZIV) / Institut National d´Assurance Maladie Invalidité (INAMI).
Furthermore, a meeting was held on the 29th September. During this meeting, the findings of the experts present were discussed.
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Chapter 1: Assessing drug problems
CHAPTER 1: ASSESSING DRUG PROBLEMS One cannot ignore the fact that drug use and drug abuse have gradually taken their places in our present society. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) reports in its latest annual report that the overall trend in the European countries seems to incline towards a stabilisation of the problem. In the 1980s and the first half of the 1990s, extreme increases were still part of the daily reality (EMCDDA, 2002). This does not imply however that the situation is under control. After all, drug (ab)use can bring about serious consequences, not only for the individual but also for his or her environment and the society at large. Therefore adequate responses have to be sought after in order to prevent the situation or get it under control. In order to be able to organise drug prevention, drug treatment and drug control in an efficient and effective manner, reliable epidemiological information is required about the extent and the specific characteristics of (problematic) drug use in a certain population, preferably obtained through a low cost manner (Hartnoll et al., 1998; Saxena & Donoghoe, 2000). Governments or other relevant actors need information on when, where and why people use illicit drugs (UN, 2003) in order to understand the situation, monitor trends, identify priorities and engage in appropriate responses. Therefore, they are particularly interested in the evolution of these patterns over time (Hartnoll et al., 1998). In the WHO publication “Guide to Drug Abuse Epidemiology”, Saxena and Donoghoe (2000) summed up a number of key questions to which epidemiological studies can help to find answers (Table 1). Table 1: Key questions to which epidemiological studies can help find answers (Saxena & Donoghoe, 2000)
1. What is the extent of drug abusing behaviours? 2. What are the nature and pattern of the drug abusing behaviours? 3. What are the characteristics of persons abusing drugs? 4. How do drug abusing trends look over time and what impact do the characteristics of drug abusers and drug abuse patterns at any point in time have on these trends? 5. What factors are associated with abuse of drugs and influence the onset of drug abusing behaviours and continued abuse of drugs? 6. What protective factors are associated with not using drugs? 7. What are the social, behavioural, biomedical, psychological, psychiatric, and economic impacts of drug abusing behaviours on individuals, families, communities, and society?
Unfortunately, due to several reasons, monitoring the situation of drug use is not an easy task since drug use is generally an illegal and socially stigmatised behaviour (Simon et al., 1999; Stimpson & Judd, 1997; Saxena & Donoghoe, 2000). After all,
9
Chapter 1: Assessing drug problems drug use tends to be related to other illegal or deviant behaviour (Hartnoll et al., 1998). Prevalence and incidence of drug use are difficult to determine due to the hidden nature of the phenomenon (Wiessing et al., 2001). Furthermore, individuals do not like to report about their drug use and if they do, questions can be raised about the accuracy of their statements (Saxena & Donoghoe, 2000). Also the nature of drug use itself, with rapid variation in the types of drugs being used, has consequences for the ways that are to be followed for assessment and research (UN, 2003). Different information collection methods and indicators have been developed to address the methodological problems that go along with the specific nature of drug use and drug problems. Each of them has its own limitations and reflects only one aspect of drug using behaviour or its consequences (UN, 2003). Various ways exist to classify these different epidemiological methods. In 1980 the WHO distinguished the following methods: collation and analysis of existing data, surveys, intensive casefinding, observations and reporting systems (Rootman & Hughes, 1980). Later on in 2000, Smart and Sloboda (2000) drafted another classification, based on the research question postulated, also in the framework of a WHO publication. The UN on the other hand makes a distinction between “active” sources, such as population surveys, and “passive” sources, such as existing reports (UN, 2003). In the WHO publication “The assessment of drug problems” (Hartnoll et al., 1998), a more extensive overview was given of these different methods, sources of information and indicators (fig. 1).
Fig. 1: Conceptual framework for different methods to investigate the nature and extent of drug use and drug problems (Hartnoll et al., 1998).
10
Chapter 1: Assessing drug problems The choice between the different data collection methods depends clearly a lot on the type of information that is needed (linked to the (policy) level requiring the data, e.g. international, national or local), the research questions that are postulated and the purposes for which the information obtained will be used, e.g. planning of prevention activities, organisation of the treatment offer, etc. Each of these epidemiological methods also concentrates on a certain segment of the population concerned (Hartnoll et al., 1998). Nevertheless most reports argue for a combination of methods in case one really wants to obtain a comprehensive picture of drug use and drug problems in a community (Saxena & Donoghoe, 2000; UN, 2003).
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Chapter 2: Reporting systems
CHAPTER 2: REPORTING SYSTEMS Reporting systems are among the data collection methods that can be used to obtain information on drug (ab)use in a population. In order to define such a reporting system in the context of substance abuse, Rootman & Hughes (1980, p.9) have set out a few characteristics: -
reports are sent to a central body (university, research team, government agency, etc.) for data collection, analysis and presentation; reporting procedures have to be systematic, meaning that procedures have to be explicit regarding data transmission, data checking, data analysis and data presentation.
As a consequence they define a reporting system as: “an information system based on reports submitted to a central body using systematic reporting procedures.” (Rootman & Hughes, 1980). Reporting systems have the advantage that information on drug users can be collected, which is often not covered by other data collection methods. Second, reporting systems can be set up on the basis of existing data. Furthermore, they are particularly useful to (Rootman & Hughes, 1980, p.7): -
determine the incidence, prevalence and characteristics of drug users in contact with reporting institutions; continuously measure the trends and consequences of drug use; identify and describe groups at risk; determine how and to what extent community agencies are used to deal with drug abuse; assess existing efforts to treat and prevent drug abuse.
Different types of reporting systems exist. In the WHO publication on drug abuse reporting systems (Rootman & Hughes, 1980), a number of elements can be found that can be used to distinguish and describe different types of reporting systems: -
Event-reporting systems, case-reporting systems and case registers; Specialised versus non–specialised reporting systems; The types of participating reporting institutions.
In order to be able to describe in chapter 6 the existing reporting systems, in the Belgian substance abuse treatment centres, the authors feel that two extra classification elements should be added: -
Primary versus umbrella reporting system; Type-based and geographically-based reporting systems.
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Chapter 2: Reporting systems à 1. Event-reporting systems, case-reporting systems & case registers The distinction between event-reporting systems, case-reporting systems and case registers, made by Rootman & Hughes (1980), is a classification based on the degree to which systems can link different events for the same person. Event-reporting systems imply that for an individual different events can be reported. These systems cannot link events belonging to the same person and cannot extract the number of individuals from the total number of events registered. Nevertheless these systems can be important since they can alert people to emerging drug abuse phenomena. Furthermore direct costs are mostly lower than for the other two systems, confidentiality problems are less acute and fewer maintenance problems arise. On the other hand event-reporting systems also have disadvantages or limitations: first the fact that they cannot determine how many individuals are involved in the total number of events. Second the system cannot provide in follow-up information. Third, such systems cannot link information coming from different types of institutions (e.g. hospitals and police statistics). Next, validity and reliability of data in event-reporting systems is generally less certain than the data obtained through the other systems since the data managers cannot check the consistency and the accuracy of the data. Finally event-reporting systems may be less accessible for scientific research (Rootman & Hughes, 1980). Case-reporting systems on the other hand are capable of linking different events for the same person in the same institution, but they can also present the data in the way that event-reporting systems do. As a consequence case-reporting systems have the possibility to describe the characteristics of people who have particular types of drug problems and can accordingly identify high-risk groups. It can also provide a better overview at outcomes for individuals, it has a better validity and reliability and finally, due to the fact that case-reporting systems usually collect more information, they are better qualified for interpreting changes that have possibly been observed in the event-reporting systems. On the other hand these systems also have an important limitation, they cannot link events for the same person across institutions, preferably between different types of institutions (Rootman & Hughes, 1980). Finally, case registers have the possibility to link events for the same person across institutions, preferably between different types of institutions (e.g. treatment centre, police, …) but can also present the data in the way that event-reporting systems and case-reporting systems do. Characteristic for case registers is that their analytic capability and flexibility is much higher, meaning that they can present the data in the format they wish: events, cases or individuals. Furthermore case registers enable to follow people´s route from one institution to another. Due to the fact that data managers can perform a larger number of checks on their data, the validity and reliability is logically higher than for the other two types of systems. Therefore case registers can more easily be used for scientific research. Possible difficulties also exist however: problems with confidentiality, the need for qualified and trained staff and higher direct costs (Rootman & Hughes, 1980).
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Chapter 2: Reporting systems These types of reporting systems can be considered ranked since the type that is higher in rank can always perform all operations the one that is situated lower can do and is as a consequence more flexible and has more analytical capabilities. This classification is perhaps not ideal and should therefore not be interpreted as a rigid structure. Some reporting systems can for example combine elements of all three types or can be considered a limited version of one of them. à 2. Specialised versus non–specialised systems A distinction between systems that have been developed for the monitoring of drug abuse solely and systems that are monitoring a wider range of phenomena (including drug abuse) : specialised versus non-specialised systems. Specialised systems are generally more expensive but on the other hand it is possible to totally adjust them to meet the needs of the substance abuse field (planners or policy-makers). Non– specialised systems are in general cheaper but the problem is that it is not always easy to ensure comparability with the specialised systems. Furthermore, such systems can only incorporate a limited number of substance-related issues, since also other problems or phenomena have to be questioned (Rootman & Hughes, 1980). à 3. Types of participating reporting institutions In the report of Rootman & Hughes (1980) this topic was not addressed as such to make a classification or description of reporting systems. Nevertheless different possible participants were mentioned: emergency rooms in general hospitals, drug treatment programmes, police, medical examiners or coroners, mental health care services, general practitioners, prison medical officers, psychiatric institutions, etc … à
4. Primary versus umbrella reporting systems
Primary reporting systems can be characterised by the fact that a central body receives information from individual treatment centres, using a systematic reporting procedure. Accordingly they are responsible for the development of registration forms or of a computer programme. Umbrella reporting systems on the other hand make use of existing primary reporting systems to gain insight into the extent and nature of a phenomenon on a larger scale. The central body of the umbrella reporting system receives information of the central body´s of the primary reporting systems. In this way, an umbrella reporting system is dependent on other primary reporting systems and therefore has in general less control on data quality. One has to be aware however that certain organisations can manage a primary treatment monitoring system, as well as an umbrella treatment monitoring system. This is the case when they partly rely on other organisations and partly organise their own data collection.
15
Chapter 2: Reporting systems à 5. Type-based and region-based reporting systems Some treatment monitoring systems are oriented towards a certain city or geographical area and generally try to extend their scope beyond one type of treatment centre. Therefore they can be called “geographically-based” monitoring systems. Others are oriented towards all treatment centres of a certain type and can thus be called “type-based” monitoring systems. Type-based monitoring systems can however contain also a certain limitative element. One can for example look at a certain type of treatment centres but only for a certain region or belonging to a certain non-profit organization.
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Chapter 3: Advantages and limitations of treatment reporting systems
CHAPTER 3: ADVANTAGES AND TREATMENT REPORTING SYSTEMS
LIMITATIONS
OF
Treatment demand data can be considered a direct measure of the demand for treatment by people and an indirect indicator of more general trends in problematic substance abuse (Hartnoll et al., 1998). When drug users seek guidance or treatment for the social, psychological or physical consequences of their drug use, they become ‘more visible’ and are for a certain time no longer ‘hidden’ (Simon, 1997). Reporting systems on the basis of treatment (demand) data have several advantages: In first instance, the data can be used for several purposes, and this by managers as well as by epidemiologists (Tomas & Kozel, 1991). Treatment data are generally collected by practitioners (as defined in the introduction of this report). This has the advantage that they are in direct contact with drug users for clinical purposes and therefore have access to relevant information of good quality. They are specialists in the domain of substance abuse treatment and are able to follow standards and consequently deliver data with a high degree of validity and reliability (Simon et al., 1999; EMCDDA, 2000). Treatment data can be provided at low cost since mostly these data are already collected for clinical purposes (EMCDDA, 2000; Simon, 1997). That makes it possible to organise continuous data collection, instead of e.g. periodical large-scale survey research, and consequently increases the validity of the data and makes trend analysis possible (Simon et al., 1999). Treatment reporting systems however have certain limitations as well: Only a proportion of all people using drugs is actually seeking help in a treatment centre. The population covered will always be smaller than the total population of drug users (Simon et al., 1999). One can assume that especially persons with heavier patterns of drug use and experiencing more serious problems are addressing themselves to the treatment centres (Hartnoll et al., 1998; Tomas et al., 1991). The major limitation of such a client monitoring system is therefore logically that only ‘clients’ are monitored and that many others who for some reason do not find the way to or do not enter in treatment are not monitored but can have a very different clinical and demographical profile (DeVillaer, 1996). The hidden population is not reached (Stauffacher, 1998; Stauffacher et al., 1999). Furthermore, not always all clients that are being treated, are not always included in the registration. Certain facilities have been deliberately excluded or do not want to participate (Simon et al. 1999). Second, one has to be aware that when using treatment data, a time lag has to be taken into account. Several years can have gone by between the first drug use and the first treatment (demand) (Stauffacher, 1997).
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Chapter 3: Advantages and limitations of treatment reporting systems The extent to which treatment data reflect patterns of drug use, depends very much on the availability of services, their priorities and policies (Hartnoll et al., 1998). The availability and accessibility of treatment and also changes in the orientation of facilities can have important consequences for the size and characteristics of the treated population (Hartnoll, 1994). Furthermore, the fact that these elements can have such an influence raises some questions regarding the possibility to use treatment data for comparative objectives (Simon, 1997). An element that also has to be mentioned here is the problem of multiple countings. As long as no unique identifier is being used by reporting systems, the number of treated drug users is systematically being overestimated (Hartnoll, 1994). When reporting systems are not solely oriented towards drug users in treatment, the selection of these cases in a larger database can cause difficulties (Simon, 1997). Other sources of concern are the validity and the reliability of the data (DeVillaer, 1996; Soldz et al., 2002). The data originate from the clients themselves who could be rather reticent regarding information on their use of illegal substances. Also their mental and cognitive abilities could be disturbed at the time of registration (Soldz et al., 2002). Not only the clients, but also the role of the practitioners has to be critically examined. Although the participation of practitioners in this type of research brings along positive aspects, the other side has to be discussed as well. A first issue is the fact that in this type of registration activities, a large number of practitioners is involved (Soldz et al., 2002; Vanderplasschen et al., 2001a). This can be a source of error because the whole becomes more difficult to manage and new practitioners, entering the field, have not always received an adequate training or firsthand guidelines. Second, registration can be considered an additional assignment or even a real burden and can possibly give rise to incomplete or less careful registration (Soldz et al., 2002; Vanderplasschen et al., 2001a). Third, a certain “registration fatigue” can occur when practitioners have to register during too long a period (Vanderplasschen et al., 2001a), when too much information is asked, when too many registration forms have to be filled in containing the same information, when information is being asked but no feedback is given, etc. Despite the limitations of these treatment-based epidemiological data, treatment monitoring systems are generally accepted among the most valuable information sources available (Simon, 1999).
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Chapter 4: The PG/EMCDDA Treatment Demand Indicator Protocol
CHAPTER 4: THE PG/EMCDDA TREATMENT DEMAND INDICATOR PROTOCOL On different levels treatment reporting systems were being developed, introduced and improved but only during the eighties a start was made within the framework of the Pompidou Group (PG) of the Council of Europe to combine efforts and to come to a comparable international instrument (Stauffacher & Kokkevi, 1999). Based on the multi-city project of the Pompidou Group (since 1982) and on city-based pilot and other complementary studies (from 1989 onwards), the definitive protocol was finalised in 1994. This protocol is a standard framework for collecting data on clients who contact treatment centers that contains a number of core variables, methodological guidelines with regard to definitions, classification of treatment centres and data collection (Hartnoll, 1994). During the nineties the efforts and competencies of the European Union with regard to drug issues have expanded. First, in 1992 the Amsterdam Treaty laid the foundations for a general European approach of drug problems across the individual policy domains. Subsequently in 1997, within the Maastricht Treaty these decisions were further elaborated. One of the new explicit objectives of the European Union is explained in article 152. As opposed to the Rome Treaty of 1957 and the Amsterdam Treaty of 1992, the European Union now possesses the legal grounds to initiate actions to ‘improve’ public health whereas before only legal grounds were present to ‘protect’ public health (Europese Commissie, 2002). As a consequence of these evolutions, in 1989 the European Information Network on Drugs and Drug Addiction (REITOX) and in 1993 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) were founded. The main objective of the EMCDDA is to provide the Member States of the EU, the European Commission and the European Parliament with reliable and comparable information on drugs and related subjects. One of the indicators used by the EMCDDA is the Treatment Demand Indicator (TDI). Based on the existing Pompidou Group Protocol and several EMCDDA studies and projects the EMCDDA and the different partners of the REITOX network have elaborated the Joint Pompidou Group – EMCDDA Treatment Demand Indicator Protocol version 2.0. (EMCDDA, 2000) that has been set up for treatment demand monitoring at a national level, whereas the Pompidou Group Protocol was rather city-based. The value of this Pompidou Group Protocol should nevertheless not be underestimated. The European Councils of Helsinki (December 1999) and Feira (June 2000) have further taken on the challenge and have respectively approved the “European Union Drugs Strategy 2000–2004” and the “EU Action Plan on Drugs 2000–2004” (Europese Commissie, 2002). Besides the explicit mention in this Action Plan, the Treatment Demand Indicator was also subject of the Council Resolution on the implementation of the five key epidemiological indicators on drugs of November 2001.
19
Chapter 4: The PG/EMCDDA Treatment Demand Indicator Protocol The Standard TDI Protocol itself and its Technical Annex provide a classification of treatment centers, definitions of concepts and guidelines on methods of collection, analysis and reporting. It also comprehends a list of 20 core variables which have to be collected for each client starting treatment and which can be classified into three categories: treatment contact details, socio-demographic information and drug-related information (Table 2). Countries are free to collect more data or to use other methods or categories but ultimately countries should be able to draw the variables that are described in the Protocol out of their data sources (EMCDDA, 2000). All member states are expected to collect the treatment demand data according to this protocol and to provide those figures on a regular basis to the EMCDDA through the national REITOX Focal Points. For Belgium the national Focal Point is situated in the Epidemiology Unit of the Scientific Institute for Public Health. Due to the specific Belgian situation four Sub-Focal Points have been designated: the VAD for the Flemish Community, Eurotox for the French Community, CTB/ODB for Brussels Capital Region and ASL for the German-speaking Community. The Sub-Focal Points are expected to group the data for their respective Community or Region together. Table 2: List of twenty core variables in the Joint Pompidou Group – EMCDDA Treatment Demand Indicator Protocol version 2.0.
Treatment contact details
Socio-demographic information
Drug–related information
1. Treatment centre type
6. Gender
14. Primary drug
2. Date of treatment:
7. Age
15. Already receiving
month 3. Date of treatment: year
substitution treatment 8. Year of birth
16. Usual route of administration
4. Ever previously treated
9. Living status
17. Frequency of use
(with whom) 5. Source of referral
10. Living status (where)
18. Age at first use
11. Nationality
19. Other (secondary)
12. Labour status
20. Ever injected /
drugs currently used currently injecting 13. Highest educational level completed
The Protocol has a long history and can therefore be seen as the final result of a long period of discussions and negotiations. On the other hand, this Protocol should be considered as a ‘starting’ point and not as the ‘final result’, as has been stated in the Protocol (EMCDDA, 2000, page 7):
20
Chapter 4: The PG/EMCDDA Treatment Demand Indicator Protocol “ This paper is the first version of this Treatment Demand Indicator (TDI) Protocol … The data-collection process and the new experiences associated with the TDI will be comprehensively evaluated and – if necessary – changes and additions will be made to the protocol. Because drug use and users – as well as drug treatment itself – are constantly changing, this evaluation phase will not be the final one. If required, the protocol will be reconsidered and revised every five years ”
21
Chapter 5: Substance abuse treatment in Belgium
CHAPTER 5: SUBSTANCE ABUSE TREATMENT IN BELGIUM In Belgium a large diversity of treatment possibilities exist for people with drug problems. Not only with regard to the types of treatment centres, but also regarding the specific methods of treatment that are used. Furthermore, due to the organisation of the Belgian state structure with its different policy levels (the federal level, the communities and regions), not all types of treatment centres fall under the same legislation or the same financial regulations. Treatment centres might fall under different policy levels, but also under different policy domains (e.g. public health, internal affairs). Moreover, often several authorities are involved at the same time and consequently the division of competencies between them is not always clear. Because of the fact that for the further course of this report the competent and subsidising policy level is important, the different types of treatment centres will be presented according to this criterion. In first instance a number of treatment centres specialised in (illegal) substance abuse treatment have gradually entered into a so-called ‘revalidation agreement’ with the National Institute for Invalidity and Health Insurance and consequently fall under the authority of the federal policy level. These centres are often referred to as the ‘specialised substance abuse treatment centres with RIZIV/INAMI1 convention’. Most of these centres are exclusively oriented towards people with illegal drug problems. Some of them have added a clause in their agreement that allows them to take up a limited number of people with primary alcohol problems. By the end of the year 2000, 28 centres (possibly with different units or treatment modules) were working within the framework of such a financial agreement with the RIZIV/INAMI. Within this group of treatment centres a distinction has to be made between four different types of treatment centres: long-term residential programmes (the therapeutic communities); the residential crisis intervention centres; the ambulatory centres and the medical– social reception centres (MSOC/MASS2). In 2000, 14 long-term residential treatment centres, 8 crisis intervention centres, 7 ambulatory centres and 8 medical–social reception centres had entered in an agreement with the RIZIV/INAMI (INAMI, 2001). This number of centres stayed stable until 1 April 2003, when a new medicalsocial reception centre entered in an agreement with the RIZIV/INAMI. A second group of services where people with drug problems can turn to are the psychiatric hospitals (PZ/HP3) and the psychiatric wards in general hospitals (PAAZ/ SPHG4). These treatment centres are as such not exclusively oriented towards people 1
The “Rijksdienst voor Invaliditeit en Ziekteverzekering” (RIZIV) and “Institut National d’ Assurance Médicale et Invalidité” (INAMI) are the respective Dutch and French terms for the National Institute for Invalidity and Health Insurance in Belgium. 2 “Medisch-Sociaal Opvang Centrum” (MSOC) and “Maison d’Acceuil Socio-Sanitaire” (MASS) are the respective Dutch and French terms for ‘Medical – social reception centre’. 3 “Psychiatrisch Ziekenhuis” (PZ) and “Hôpital psychiatrique” (HP) are the respective Dutch and French terms for ‘psychiatric hospital’. 4 “Psychiatrische Afdeling van een Algemeen Ziekenhuis” (PAAZ) and “Service Psychiatrique des Hôpital Général (SPHG)” are the respective Dutch and French terms for ‘psychiatric ward in a general hospital’.
23
Chapter 5: Substance abuse treatment in Belgium with illegal drug problems; on the contrary, a variety of psychiatric problems are treated. On the other hand, due to the specific characteristics of their client population, it is possible that certain PZ/HP or PAAZ/SPHG have decided to create a specialized substance abuse unit. Naturally, all of these treatment centres follow the same general regulations as other hospitals and are therefore mostly subject to federal legislation. The policy level of the communities has however certain competencies on the matter (e.g. quality assurance). A third group of treatment centres that plays a significant role in the treatment of substance abuse problems are the Centres for Mental Health Care. As well as the PZ/HP and the PAAZ/SPHG, these centres treat a large number of psychological or psychiatric problems. Certain CGG/SSM5 have however developed a certain specialisation in the treatment of drug problems. According to the principles of the Belgian state structure, where the communities are responsible for certain attributed person–related matters, the CGG/SSM can be situated exclusively under the competences of this policy level. Due to historical and pragmatic reasons however, the responsibility for the SSM in the French-speaking part of Belgium has been transferred to the Walloon Region instead of the French Community. Although these three groups of treatment centres can be considered to take up a large part of drug users starting treatment in Belgium, the group of other treatment facilities for persons with drug problems should not be ignored or underestimated. Other types of treatment or guidance than the ones mentioned above are: general practitioners, self-employed psychologists or psychiatrists, emergency wards in general hospitals, initiatives in the general health or social welfare sector, street corner work, nonsubsidized initiatives, half way houses, sheltered living, temporary projects, self-help groups, etc (BIRN, 2002). Certain types of treatment centres run parallel in the different parts of Belgium since they are subsidized at the federal level. Other services are organised or represented in a different manner. General practitioners for example tend to play a larger role in substitution treatment in Brussels and the French Community than in the Flemish part of Belgium (EMCDDA, 2002). When describing the diversity of treatment possibilities, the focus was on the different treatment centres, but one should be aware of the recent evolutions concerning care circuits and the used concepts. When looking at different treatment possibilities in the context of a care circuit, one no longer makes the distinction between treatment centres, but the focus is on different the modules that can be offered. A care circuit forms the complete offer of care of a network, for a certain target group in a certain region. Such a circuit consists of units of care that offer certain modules. These modules represent the necessary care routes for that specific target group and
5
“Centrum Geestelijke Gezondheidszorg” (CGG) and “Service de Santé Mentale” (SSM) are the respective Dutch and French terms for ‘Centre for Mental Health Care’.
24
Chapter 5: Substance abuse treatment in Belgium offer the guarantee of continuity in care and care adapted to the specific needs of the client (Nassen et al., 1999). In mental health care and youth assistance, as in the assistance for drug users, the organization of care by networks in the form of care circuits, becomes more and more of a common thought. Care adapted to the client, continuity of care, collaboration and more effective and efficient care are central concepts (Vanderplasschen et.al., 2001b).
25
Chapter 6: Treatment reporting systems in Belgium
CHAPTER BELGIUM
6:
TREATMENT
REPORTING
SYSTEMS
IN
In Belgium different treatment monitoring systems exist, each with its own characteristics, strengths and limitations. In this chapter the existing reporting systems in Belgium will be described, that have the possibility to provide data on drug users in treatment. First the primary treatment reporting systems will be presented, followed by the umbrella treatment reporting systems. The second classification element that has been used to present the systems is the difference between type-based and geographically-based reporting systems. All systems will also be situated in the light of the other 3 classification elements mentioned in chapter 2: event-reporting systems, case-reporting systems & case registers; specialised versus non–specialised reporting systems and types of participating reporting institutions.
6.1. Primary treatment reporting systems In order to be acknowledged as a “primary treatment monitoring system” in this report, an established organisation (a central body) had develop a reporting system in which more than one treatment centre is involved and which was established with a long-term perspective. The central body is responsible for the development of registration forms or of a computer programme for the treatment centres, that use a systematic reporting procedure. The system has the collection of raw data on drug users in treatment as a first objective or it has the possibility to select those cases out of a larger database. The existing primary treatment monitoring systems in Belgium have been set up out of different concerns and interests. Some are oriented towards a certain city or geographical area (e.g. ‘Sentinelle Charleroi’) and try to go beyond one type of treatment centre. Therefore they can be called “geographically-based” monitoring systems. Others are oriented towards all treatment centres of a certain type (e.g. the reporting system of the ‘Institut Wallon pour la Santé Mentale (IWSM)’) and can therefore be called “type-based” monitoring systems. Type-based monitoring systems can however also contain a certain limitative element. One can for example look at a certain type of treatment centres but only for a certain region (e.g. the treatment reporting system of the IWSM only covers the Centres for Mental Health Care in the French-speaking part of Belgium) or belonging to a certain non-profit organization (e.g. the treatment reporting system of De Sleutel). According to the above-mentioned criteria table 3 summarizes the different primary treatment monitoring systems in Belgium and their coordinating organisations. In case the monitoring system has been given a name, this is mentioned in the table. Next a description is made of the different primary treatment reporting systems, ordered alphabetic according to the central body´s.
27
Chapter 6: Treatment reporting systems in Belgium To most of the descriptions of the primary treatment reporting systems, illustrative tables that have been added containing data regarding the total amount of registrations, covered by that system. No selection has been made regarding “illegal drugs”. The tables are intended to provide a first insight into the extent and the nature of the systems. Table 3 :Overview of the primary reporting systems Event reporting Data Specializedsystem -case collecnon specialised reporting system tion - case register starts in
Central body
Name
Geographically based – type based
ASL
/
geographically based: German-speaking community
specialised
case-reporting system
2000
CRC
Sentinelle
geographically based: Charlerloi
specialised
case register
1995
CTB/ODB
Addibru
geographically based: Brussels
specialised
case-reporting system
1996
De Sleutel*
/
type based: RIZIV Convention (Flanders) De Sleutel
specialised
case register
1998
geographically based: French community
specialised
case-reporting system
2000
MPD
type based: PZ/HP & PAAZ/SPHG
non-specialised
event-reporting system
1996
IWSM
/
type based: SSM (Wallonia)
non-specialised
case-reporting system
2002
Ministry of the FlemishCommunity
ARCADE
type based: CGG (Flanders)
non-specialised
case-reporting system
2003
Overlegplatform FDGG/VVI
MEDAR
type based: CGG (Flanders)
non-specialised
case-reporting system
1976
VAD
MPD extra module
type based: PZ & PAAZ (Flanders)
specialised
case-reporting system
1996
VLASTROV
/
type based: Outreach work (Flanders)
specialised
case-reporting system
1999
VVBV
DARTS
type based: RIZIV Convention (Flanders)
specialised
case-reporting system
1988
EUROTOX
FPS Public Health
* Dienst wetenschappelijk onderzoek en kwaliteitszorg
28
Chapter 6: Treatment reporting systems in Belgium 6.1.1 Primary treatment reporting system ASL For the German-speaking Community in Belgium, the “Arbeitsgemeinschaft für Suchtvorbeugung und Lebensbewältigung (ASL)” has set up in the year 2000 a reporting system specifically for the registration of drug users in treatment. Therefore it has to be considered as a specialised reporting system. As opposed to the other communities and regions in Belgium, the German-speaking community does not have specialised drug treatment centres at its disposal. As a consequence no specialised treatment centres participate in the reporting system of ASL. The treatment centres that do participate are: the social psychological centre, the psychiatric hospital and a few more welfare oriented services (Köttgen, 2002). Objectives are to ensure that data on drug users in treatment in the German-speaking Community are incorporated in national and international statistics and to explore trends and centres of gravity within the own community through the redaction of an own regional drugs report. For each drug user who comes into contact with one of the participating centres, a paper-based registration form is filled in. Through the ASL reporting system only users of illicit drugs are recorded. No unique identifier is used, but in the accompanying letter, practitioners are asked to check, before filling in the form, whether the client had not started treatment that year in another centre. Therefore the ASL reporting system can be considered almost a case register. The concrete organisation of the reporting system, including data management, analysis and reporting, is in the hands of the “Arbeitsgemeinschaft für Suchtvorbeugung und Lebensbewältigung (ASL)”. Annually, ASL publishes a report on the overall results of the registration. The results are also transferred to the National REITOX Focal Point. In table 4 the main characteristics of the 71 registrations that were recorded in 2001 (most recent data) through the ASL reporting system can be found. The information is presented for the total number of registrations. (Köttgen, 2002).
29
Chapter 6: Treatment reporting systems in Belgium Table 4: Main characteristics of the clients registered in 2001 through the ASL reporting system (Köttgen, 2002)
Total number of registrations in 2001 Sex Male Female Age < 19 years 20 - 24 25 - 29 30 - 34 > 35 Primary Drug Heroin Stimulants Hypno-sedatives Cannabis Injecting behaviour Currently injecting 6.1.2
Number 71
Percentage
47 24
66,2 33,8
33 26 4 5 3
46,5 36,6 5,6 7,0 4,2
9 8 2 48
12,7 11,3 2,8 67,6
1
1,4
Sentinelle Charleroi “Cellule Recherche et Concertation (CRC)”
The reporting system “Sentinelle” has been operative in Charleroi since 1995. At the moment about ten treatment centres participate in the reporting system, made up of the following types of treatment centres: medical social reception centre, crisis intervention centre, long term residential treatment, psychiatric hospital, ambulatory services. Some of these are specialised treatment centres with a RIZIV/INAMI convention, others are financed through other means. The objective is to monitor the drug users’ population that is in contact with one of the services in the area of Charleroi, providing social, medical or psychological help. Since the monitoring system has been established especially for this purpose, Sentinelle Charleroi can be considered a specialised system. For each drug user who comes into contact with one of the participating centres, a registration form is filled in. Through the Sentinelle reporting system only users of illicit drugs are recorded. The whole registration procedure is paper-based. Next, a specific procedure is started up in order to attribute an anonymous code to the client. This takes place under the responsibility of the Vincent Van Gogh hospital, where a unique 10-digit number is drawn up on the basis of the client´s initials and date of birth. This enables Sentinelle to filter out multiple occurrences and provide information on the amount of unique clients, and not only on the amount of registrations. Therefore Sentinelle Charleroi can be considered a case register. The concrete organisation of the reporting system, including data management, analysis and reporting, is in the hands of the “Cellule Recherche et Concertation
30
Chapter 6: Treatment reporting systems in Belgium (CRC)”. CRC is the research team of the prevention unit within the framework of the Prevention and Security contract of the city of Charleroi. However, the meeting where decisions regarding Sentinelle are taken is called the “comité scientifique”. In this meeting the representatives of all participating centres come together and discuss definitions, anonymity, development of the questionnaire, etc. Annually, CRC publishes a report on the overall results of the registration. The results are also transferred in the framework of the Multivilles research partnership of the Council of Europe. The data themselves are sent anonymously (without the identification information on individuals and institutions) to Eurotox, that is, in its role as umbrella treatment reporting system, responsible for providing figures on drug users in treatment in the French Community. In table 5 the main characteristics of the 536 registrations that were recorded in 2001 (most recent data) through the “Sentinelle” reporting system can be found. The information is presented for the total number of registrations. Multiple countings have not been excluded (Depaepe, 2002). Table 5: Main characteristics of the clients registered in 2001 through the Sentinelle reporting system (Depaepe, 2002)
Total number of registrations in 2001 Sex Male Female Age < 18 years 18 - 20 years 21 - 25 years 26 - 30 years > 30 years Current substance use Cannabis Methadone Heroin Cocaine Alcohol Injecting behavior of current heroin users Ever injected but not in the last month Currently injecting
Number 536
Percentage
423 113
78,8 21,2
29 38 102 198 169
5,3 7,1 19,0 37,0 31,6
313 305 303 195 150
58,4 56,9 56,5 36,3 27,9
239 187
44,5 34,9
31
Chapter 6: Treatment reporting systems in Belgium 6.1.3
Addibru “Concertation Toxicomanies Bruxelles/Overleg Druggebruik Brussel (CTB/ODB)”
The registration of drug users in treatment in Brussels has started off in 1996 with the reporting system Addibru. At the moment between 10 and 15 treatment centres participate in the reporting system. The majority of the participating services are specialised treatment centers (CTB/ODB, 1998). The Addibru reporting system has been set up with the objective of obtaining an overview of health problems related to drug use (CTB/ODB, 2000). Therefore, the Addibru reporting system can be considered a specialised reporting system. For each drug user who comes into contact with one of the participating facilities, a number of variables are registered by means of computer software, especially developed for this purpose. From 1997 onwards Addibru now has the possibility to exclude records from clients who have already been treated in the same facility that year, through the use of an intra-institutional code. Since 1998 the intra-institutional codes are automatically and periodically checked, compared and records deleted when necessary (always keeping the last treatment episode). An inter-institutional code exists but has not yet become fully operative (CTB/ODB, 2000). Therefore, Addibru can be described as a case-reporting system. The organisation of the Addibru reporting system is managed by “Concertation Toxicomanies Bruxelles (CTB)/Overleg Druggebruik Brussel (ODB))”, i.e. responsibility for data collection (content and practical aspects of the software), data analysis and data reporting. CTB/ODB was established in 1993 as a bicommunitary organisation active in Brussels Capital Region regarding: data collection, consultation between treatment centres, coordination of prevention and treatment regarding drug use and finally: advice and support for demand reduction activities (CTB/ODB, 2001). Up to now, the registration results have lead to the publishing of two epidemiological reports: one in 1998 (CTB/ODB, 1998) and another in 2000 (CTB/ODB, 2000). The data regarding the treatment centres of the French Community in Brussels are transferred to Eurotox, who is, in its role as umbrella treatment reporting system, responsible for providing figures on drug users in treatment for the French Community, and therefore also needs data on drug users in the French Community in Brussels (Molnar et al., 2002). The data are also used in the framework of the “Multivilles” research partnership of the Council of Europe and are also sent by CTB/ODB to the REITOX National Focal Point. In table 6 the main characteristics of the 1.217 registrations (alcohol as a primary drug included) that were recorded in 1999 through the Addibru reporting system can be found (CTB/ODB, 2000).
32
Chapter 6: Treatment reporting systems in Belgium Table 6 : Main characteristics of the clients registered in 1999 through the Addibru reporting system (CTB/ODB, 2000)
Total number of registrations in 1999 Sex Male Female Age < 19 years 20 – 24 years 25 – 29 years 30 – 34 years 35 – 39 years > 40 years Primary drug Opiates Alcohol Stimulants Cannabis Hypno-sedatives 6.1.4
Number 1.217
Percentage
1.027 190
84,4 15,6
24 178 292 361 219 143
2,0 14,6 24,0 29,6 18,0 11,7
749 155 141 84 76
61,5 12,7 11,6 6,9 6,2
Primary Treatment Reporting System “De Sleutel”
De Sleutel is a network of 10 centres and associated units for specialised substance abuse treatment, all embedded in the same non profit organization: the Provincialate of Brothers of Charity. The network consists of the following types of treatment centres: long-term residential treatment (therapeutic community), crisis intervention centres, ambulatory centre and residential centre for youngsters6. Except the last mentioned, all of the treatment centres have a RIZIV/INAMI convention. They are spread over Flanders: Oost-Vlaanderen, West-Vlaanderen, Antwerpen en Brussel. For treatment monitoring purposes, all of the De Sleutel centres participated in the VLIS-DC registration up to 1998. Due to the size of their network and to their explicit choice to provide data solely on the basis of the EuropASI7, which has been fully introduced in De Sleutel in 1998. De Sleutel does not use the DARTS-program, but developed an own information system for data collection and processing. This reporting system can be considered a specialized treatment reporting system since it has been developed solely to register aspects related to drug problems. The VVBV decided to no further integrate the data of the De Sleutel data because of different inclusion criteria.
6
De Sleutel also consists of social working places but these are not taken into consideration for this report. 7 The “European Addiction Severity Index (EuropASI)” is a standardised and validated, semi-structured interview aimed at gaining insight into different aspects of a persons’ life that have possibly contributed to the genesis of alcohol and/or illegal drug problems. The questionnaire can be used for clinical purposes as well as for research or policy purposes (De Sleutel, 1999).
33
Chapter 6: Treatment reporting systems in Belgium The objectives of the registration activities within De Sleutel are formulated as different interests (Raes &Lombaert, 2003b): - clinical interest: to improve the tuning of the treatment offer to the needs and demands of the clients, to foresee a structure for the treatment planning, treatment programs and client files,… - minimal basic data interest: uniformity in and standardization of data gathering, lay the foundation for an addiction care and cure supporting information system,… - research interest: increase the insight in the addiction problem itself, specificity of problem profiles in clients applying for counseling and/or treatment,… - management interest: being able to give hard data for internal management Within the reporting system of De Sleutel, different registration moments and/or forms have to be distinguished: -
-
-
Form for apply for help and first contact: a standard form in all centres of De Sleutel which is filled in the first time a client addresses himself to one of the centres. Through the use of an inter-institutional unique client code, clients are recognised by the system when they apply for help several times during the same reference year. Medical registration form: a form that is filled in for all clients having a treatment demand related to substitution substances or medication, the first time in the reference year they formulate a treatment demand in one of the centres. EuropASI: this interview is carried out in the first phase of a clients’ treatment in one of the centres, except for the Crisis Intervention Centre. Limited client registration form: this form is based on the same rules as the EuropASI but is shorter, due to the specific nature of the centre where it is not always feasible to take off the whole EuropASI.
The whole reporting system of De Sleutel is computerized. The Dux – system of De Sleutel is a registration programme in which the two first forms haven been taken up. The EuropASI forms on the other hand can be optically read and can be integrated in the DUX system. As already mentioned, the reporting system works with unique client codes to link the different forms and to trace multiple countings. Therefore the system can be considered a case register. The concrete organisation of the reporting system, including data management, analysis and reporting, is in the hands of two departments within De Sleutel: the department of research and quality assurance on the one hand and the automation department on the other hand. The department for research and quality assurance is responsible for: the contents of the client registration and –databases related to the clients’ pathway, (optical) reading of the different forms, control of the database and the linkage of the Dux system with the EuropASI data. The automation department is
34
Chapter 6: Treatment reporting systems in Belgium involved in the processes of data sharing, system analysis and management of the Dux system. Data are analysed and presented in the annual reports of De Sleutel (Dienst wetenschappelijk onderzoek De Sleutel, 1999; Raes & Lombaert, 2000; Raes & Lombaert, 2001; Raes & Lombaert, 2002; Raes & Lombaert, 2003a) and were also transferred to the VAD, the umbrella treatment reporting system for Flanders. Furthermore the data are also used by the department of research and quality to actively participate in international networking. In table 7 the main characteristics can be found of the registrations that were recorded in 2002 (most recent data) through the reporting system of De Sleutel. The information is presented for the total number of new clients “applying for help”, so also clients who don’t start treatment are included in the figures below (Raes & Lombaert, 2003a). Table 7: Main characteristics of the clients registered in 2002 through the De Sleutel reporting system (Raes & Lombaert, 2003a)
Total number of new clients applying for help in 2002 Sex Male Female Age Mean Primary Drug Opiates Methadone Stimulants Cocaine Hypno-sedatives Cannabis Alcohol 6.1.5
Number 2769
Percentage
2290 479
82,7 17,3
24,7 928 75 313 393 83 706 72
33,5 2,7 11,3 14,2 3,0 25,5 2,6
Primary Treatment Reporting System Eurotox
By the end of 2000 Eurotox was given the assignment to coordinate the data collection regarding drug use for the French Community. At that time, they took over the task that the « Comité de Concertation sur l’Alcool et les autres Drogues (CCAD). » had been carrying out since 1992. For the data on drug users in treatment, Eurotox makes use of other existing reporting systems and function therefore as an umbrella treatment reporting system. Besides, they also collect part of the treatment data themselves, with an own registration form and act therefore also as a primary treatment reporting system (Molnar et al., 2000).
35
Chapter 6: Treatment reporting systems in Belgium CCAD started the registration of drug users in treatment in the framework of the activities of the Pompidou Group of the Council of Europe. In 1999, 34 treatment centres, spread over the French Community (Brussels included), participated in the registration, made up of the following types : specialised substance abuse treatment centres with RIZIV/INAMI convention (long term residential treatment, crisis intervention centres, ambulatory centres), psychiatric hospitals, centres for mental health care, other. CCAD has also drafted a short registration form which could be filled in by street workers and general practitioners. CCAD regularly published reports on the results of the registration activities and also published articles that were written on the basis of those treatment data (Bils & Preumont, 2000). When Eurotox took over the activities from CCAD, the different registration forms were reduced to one single registration form. For the time being the reporting system is still paper-based, but concrete plans exist to use the Addibru software, subject to a number of changes, as required by the specific objectives of Eurotox and the French Community (Molnar et al., 2002). The data coming from the Eurotox primary treatment reporting system will be brought together with the data from other primary treatment reporting systems in the French Community, in the Eurotox umbrella treatment reporting system and sent in this format to the Belgian National REITOX Focal Point. For the primary treatment reporting system of Eurotox no figures yet exist since the system has recently been installed. In its most recent report, Eurotox has analysed the figures that have been collected through the registration forms of CCAD together with the figures of Sentinelle Charleroi. A summary of the most recent and main characteristics can be found in table 11, in the part about Eurotox as an umbrella treatment monitoring system. 6.1.6
Minimal Psychiatric Data (MPD) Federal Public Service Public Health, Security of the Food Chain and Environment
The “Minimale Psychiatrische Gegevens (MPG)” or the “Résumé Psychiatrique Minimum (RPM)” are data that are being registered through a reporting system that is being applied in psychiatric hospitals, psychiatric wards of general hospitals, psychiatric nursing homes and initiatives for sheltered living (Wherten et al., 1999). The registration of the MPD is compulsory for all of the above mentioned services through the Royal Decree of the 1st October 2002 (KB 1 oktober 2002), in which the procedures and variables to be collected are legally laid down. However, the history of the MPD goes back to 1996 when a first Royal Decree had been drafted. Due to a judgement by the Supreme Administrative Court of Belgium, this Decree was abrogated. As a consequence registration in psychiatric hospitals and psychiatric wards of general hospitals was no longer mandatory. The abrogation of the Decree was due to the presence of articles that were in conflict with existing legislation, more specific regarding the required degree of anonymity of the data. Meanwhile a solution
36
Chapter 6: Treatment reporting systems in Belgium has been sought after for these conflicting interests and a new Decree has been drafted which has gone through all of the required procedures (e.g. advice of the Committee for the Protection of Private Life; advice of the Supreme Administrative Court of Belgium) and which has been formally approved on October 1st, 2002. The services themselves have however continued the registration of MPD despite the legal vagueness and therefore it will be possible in the near future to ask the services for their data and conduct the analyses on the data from 1996 onwards. The registration of MPD serves 4 objectives (KB 1 oktober 2002): -
Assessing the need for psychiatric services; Describing the qualitative and quantitative recognition standards for the psychiatric hospitals and services; Organising the financing of psychiatric hospitals and services including controlling good use of public resources; Developing policy on the basis of epidemiological data.
The Royal Decree on MPD is part of federal legislation; consequently MPD are to be registered in all parts of the country. The federal Minister of Public Health assumes the responsibility for the system. The director-general of the directorate-general Health Services of the Federal Public Service ‘Public Health, Security of the Food Chain and Environment’ is responsible for the analysis of the data (KB 1 oktober 2002). Until now no results have been published, except for an article on drug-related hospitalisations (Ministerie van Sociale Zaken, Volksgezondheid en Leefmilieu, 1998). With the registration of MPD, information is being collected on all people starting treatment, or more specific on all people for whom a financial budget is being set, in one of the above mentioned services. Consequently information is being collected on the whole spectrum of mental disorders, of which the substance-related disorders make up only one subgroup. Registration of MPD can therefore be considered a nonspecialised reporting system. MPD consist of two types of data. On the one hand some data are collected on a continuous basis; on the other hand some data are collected within a limited period of time (sample data). The continuously collected data consist of the intake and discharge data (per living unit and per service) and the social indicators. The unit of observation consists of a medical psychiatric stay. The sample data are being collected during maximum 2 registration weeks a year. The moment of those registration weeks is by decree limited to certain periods a year and is being determined by the head of the directorate-general Health Services of the Federal Public Service ‘Public Health, Security of the Food Chain and Environment’. The unit of observation here consists of care in a living unit. Sample data contain besides some general data on the client, information on basic functioning, social functioning, behaviour control, relational functioning, care and treatment actions provided. These two types of data are called the Minimal Psychiatric Data.
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Chapter 6: Treatment reporting systems in Belgium Simultaneously with the MPD also other information is being requested from the services; information that is not related to individual clients but to the hospital or service as an organizational unit, being: information on the institution, the living units and the length of stay (KB 1 October 2002). The data are anonymised in that manner that stays related to the same person cannot be matched to one another, even if the person stayed more than once in the same institution. Therefore the MPD reporting system has to be regarded an event-reporting system. Since the MPD reporting system has been set up as a non-specialised system, no drugspecific information is requested such as frequency of use, types of drugs consumed, etc. Only product-information can be partly deducted from the Diagnostic and Statistical Manual (DSM) IV diagnosis. Secondly, due to its non-specialised nature, the way the other variables are presented has not taken into account the guidelines in the TDI Protocol, since this is established specific for drug-related treatments. On the basis of the available MPD of the second semester of 1996 and the first of 1997 a small-scale study has been carried out regarding drug-related hospitalisations in the Belgian hospitals. For this period 7.252 stays were reported in psychiatric hospitals or in psychiatric wards of general hospitals where the client had received a primary or secondary diagnosis related to drug addiction: excessive use, addiction or a psychiatric disorder induced by drug use. A number of corrections have however been applied in order to counter biases due to difficulties with the attribution of DSM IV and ICD 9 codes. As a result the number of stays related to drug problems was estimated between 5.816 and 6.562 (Ministerie van Sociale Zaken, Volksgezondheid en Leefmilieu, 1998). 6.1.7
Primary Treatment Reporting System “Institut Wallon pour la Santé Mentale (IWSM)”
By means of the Decree of 4 April 1996 for the Walloon Region, all centres of mental health care in the Walloon Region, have the obligation to deliver a clearly marked off set of anonymous epidemiological data and a uniform activity report to the subsidising authorities (i.e. the Walloon Region). A working group has been set up in 1996, to reflect upon these issues and to develop an instrument that could meet these requirements. In 1999 the “Ligue Wallonne pour la Santé Mentale (LWSM)” was given the mandate to further develop such an instrument, in collaboration with the “Conseil Régional des Services de Santé Mentale (CRSSM)” and the “Direction Générale de l’Action Sociale et de la Santé (DGASS)” (IWSM, s.d.). The collected data have to be submitted to the subsidising authorities but also serve other objectives. Each centre can use the information on its clients and therapeutic activities for permanent evaluation since it will be possible to follow evolutions through these data. A global view can be developed on the work of the centres for mental health care and the data can make up the basis for valorisation or adjusting of their activities. Furthermore the data also serve a more collective objective, since they
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Chapter 6: Treatment reporting systems in Belgium also allow for emphasizing the specific place of centres for mental health care in the global care and treatment network and affirm their own identity (LWSM, 2000). In 2000 the work of the LWSM resulted in a number of guidelines for the elaboration of the activity reports, which had to be followed from 2000 onwards. In 2002 an epidemiological data collection instrument for adult clients was developed, which has been tested during 6 months in 10 centres for mental health care. Simultaneously reflection took place regarding a specific instrument for children (IWSM, s.d.). The epidemiological instrument consists of two types of variables: data of sociodemographic nature on the one hand and diagnostic data on the other hand. With regard to the first type of data, the test phase has been concluded. Socio-demographic data are therefore being collected from January 2003 onwards (IWSM, s.d.). For the diagnostic part of the registration however, no consensus has been reached yet. A new instrument has been tested by the same 10 centres, whereby the International Classification of Diseases (ICD) 10 was used instead of the DSM IV. Recently the decision has been taken to employ a combination of both classification systems. At present this system is being introduced in all centres through training sessions in order to be applied from January 2004 onwards (IWSM, 2003). Part of the epidemiological information is not requested on the epidemiological form itself but on the ‘Consultations – form’, one of the three forms developed for the elaboration of the activity report (Consultations, Activities and Training of personnel) (LWSM, 2000). Following the reorganisation in the sector of mental health care in the Walloon Region, registration activities are now coordinated by the DGASS in cooperation with “Institut wallon pour la Santé Mentale (IWSM)”. With the reporting system of the IWSM, information is being collected on all people starting treatment in one of the centres for mental health care in the Walloon Region. Consequently information is being collected on the whole spectrum of mental disorders, of which the substance-related disorders make up only one subgroup. This reporting system can therefore be considered a non-specialised reporting system. Clients who start treatment in the same centre several times during the reference year keep the same dossier number and are not considered new cases. Avoiding multiple countings between centres is however not possible (IWSM, s.d.). Therefore the reporting system of the IWSM can be considered a case-reporting system. A number of centres for mental health care have however been legally assigned a specific task regarding the care and treatment of drug users. Within this respect they are obliged to keep extra data on these clients. In collaboration with Eurotox, an addendum to the above mentioned epidemiological form has been worked out, containing more specific variables on drug abuse that only has to be filled in by this subgroup of centres. These data are also being collected from 2003 onwards (Molnar et al., 2002). At the moment the IWSM and Eurotox are negotiating an agreement concerning the management of these data.
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Chapter 6: Treatment reporting systems in Belgium
The IWSM has not published any epidemiological reports yet. Only data collected during the experimentally phases are available which are not to be published. 6.1.8
MEDAR - ARCADE “Samenwerkingsplatform “Federatie van Diensten voor Geestelijke Gezondheidszorg (FDGG)” en Verbond der Verzorgingsinstellingen (VVI)” - “Ministerie van de Vlaamse Gemeenschap”
A number of centres for mental health care in the Flemish Community started registering on a voluntary basis in 1976. Gradually nearly all recognized and subsidized centres for mental health care in Flanders started participating in the common registration project (Samenwerkingsplatform FDGG/VMSI, 1995). From 2000 onwards registration has become compulsory by law (Braeckevelt et al., 2003). From the beginning, registration served a double purpose (Werthen et al., 1999): To offer centres the possibility, through an automated analysis of their data, to gain insight into their client population and the services provided and if desired, to be able to compare themselves to other centres; To generate research material on national and/or regional level that can make epidemiological and statistical studies possible. The concrete organisation of the reporting system, including data management, analysis and reporting, is being carried out by the “Vlaamse Vereniging voor Geestelijke Gezondheid (VVGG)”. The VVGG is responsible for the logistical side of the registration project. The global management of the system is in the hands of a collaboration platform between the “Federatie van Diensten voor Geestelijke Gezondheidszorg (FDGG)” and the “Verbond der Medisch-Sociale Instellingen (VMSI)”. The forum where decisions with regard to content-related aspects of the reporting system are being taken is called the “Commissie Registratie” in which both organisations are represented (Samenwerkingsplatform FDGG/VMSI, 1995). As a result of a reorganisation of Caritas, the part of the VMSI concerning mental health care, was on 01/09/1999 merged into the "Verbond der Verzorgingsinstellingen" (VVI). From then on is spoken of the collaboration platform FDGG/VVI. In the beginning the registration was paper-based. In 1989 however, software was introduced. This software was partly derived from existing software for general practitioners, called “Medical Archives (MedAr)”. Although the reporting system for the centres for mental health care has not been given a name, it is often referred to as the MEDAR registration programme. The system has been developed in that way that it is so flexible that centres can add their own variables and can generate own tables (Samenwerkingsplatform FDGG/VVI, 2000). With the reporting system of the FDGG/VVI, information is being collected on all people starting treatment in one of the centres for mental health care in Flanders
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Chapter 6: Treatment reporting systems in Belgium (including the Dutch-speaking centres in Brussels). Consequently information is being collected on the whole spectrum of mental problems, of which the substance-related disorders make up only one subgroup. The reporting system of the FDGG/VVI can therefore be considered a non-specialised reporting system. In collaboration with the VAD, an addendum (“Luik D”) has been developed in 1996 which contains a number of substance-specific variables, not present in the general framework of the registration instrument (Vandenbussche, 2000). Clients who start treatment in the same centre several times during the reference year keep the same dossier number and are not considered new cases. Avoiding multiple countings between centres is however not possible (Samenwerkingsplatform FDGG/VMSI, 1999). Therefore the reporting system of the FDGG/VVI can be regarded a case-reporting system. Data are analysed and presented in annual reports (Samenwerkingsplatform FDGG/VVI, 2001). After data cleaning and a number of recodings, the data were sent to the VAD, who was until recently, in its role as umbrella treatment reporting system, responsible for providing figures on drug users in treatment in the Flemish Community. On written, motivated request, data can also be put at the disposal of other organisations for research purposes if the necessary guarantees are provided (Samenwerkingsplatform FDGG/VMSI, 1999). Earlier this year, the collaboration platform FDGG/VVI has been releaved from its responsibilities regarding the registration project. From 2003 onwards, the Ministry of the Flemish Community is now the primary responsible for the registration in the Flemish centres for mental health care and developed a new software package, called “Applicatie voor de Registratie van Cliëntengegevens voor de Administratie Gezondheidszorg en voor Data-Export (ARCADE)” (Braeckevelt et al., 2003). Centres were asked to appoint one or more establishments who would start register through the new program from January 2003 on. In the meanwhile the program exists in a, still incomplete, version 3.0 and all the establishments of the centers of mental health care are obliged to enter their data of the first half-year by the end of September 2003. The ambition to make of ARCADE a genuine client follow-up system was left. In the meanwhile a centre of mental health care developed a program called Idefix, with more elements of a client follow-up system. At this moment 20% of the centers of mental health care uses this program. Idefix will deliver the same data-elements to the government than ARCADE, but these concrete elements are still being discussed. In table 8 a few characteristics can be found of the 49.845 registrations that were globally (all clients registered, not only clients who start treatment for drug use) recorded in 1999 (most recent data) through the “MEDAR” reporting system. (Samenwerkingsplatform FDGG/VVI, 2001).
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Chapter 6: Treatment reporting systems in Belgium Table 8: Main characteristics of the clients registered in 1999 through the MEDAR reporting system (Samenwerkingsplatform FDGG/VVI, 2001).
Total number of registrations in 1999 Sex Male Female Age < 19 years 20 – 24 years 25 – 29 years 30 – 34 years 35 – 39 years > 40 years Reasons for consultation according to the client Dependency of substances DSM-IV Axis 1. Psychiatric disorders D. Drug-related disorders 6.1.9
Number 49.845
Percentage
23.377 26.468
46,9 53,1
17.151 4.348 3.873 4.502 5.126 14.751
34,7 8,7 7,8 9,0 10,3 29,6
6.530
13,1
7.776
15,6
Minimal Psychiatric Data extra module “Vereniging voor Alcohol en andere Drugproblemen (VAD)”
In the framework of her role as coordinating organisation of the “Vlaams Registratiesysteem Middelenmisbruik (VRM)”, the umbrella treatment reporting system for the Flemish Community, the “Vereniging voor Alcohol and andere Drugproblemen (VAD)” has developed an extra module with substance-related variables to be added to the MPD (Vandenbussche, 2000). The VAD has engaged in individual agreements with 21 psychiatric hospitals and 12 psychiatric wards in general hospitals spread over Flanders in order to collect extra information on drug users in treatment in those facilities. Therefore the regular pathway of the MPD is not followed; data are directly transferred from the participating treatment facilities to the VAD. The software has been developed in that way that it not only attaches the extra module to the MPD, but that it can also extract a number of variables of a more general nature (e.g. sex, age, …), already being collected in the MPD themselves (Vandenbussche, 2000). Data collection, analysis and reporting was carried out by the VAD and results were presented in its reports. Due to the fact that the VAD has been relieved from its assignment to coordinate the umbrella treatment reporting system for Flanders, data analysis and reporting regarding the MPD extra module reporting system are at the moment on hold. The facilities however are still registering and the VAD is technically assisting where necessary in expectation of concrete decisions. In table 9 the main characteristics can be found of the registrations that were recorded in 1999 (most recent data) through the MPD extra module reporting system. Since the
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Chapter 6: Treatment reporting systems in Belgium VAD has missions in the field of illegal drugs as well as alcohol, the reporting system is oriented towards clients in PZ or PAAZ with alcohol and/or illegal drug problems. Consequently, in the report and in the data below, data on clients with alcohol as main problem are included as well (Vandenbussche, 2000). Table 9: Main characteristics of the clients registered in 1999 through the MPD extra module reporting system (Vandenbussche, 2000)
Total number of registrations in 1999 Sex Male Female Age Mean Primary Drug Opiates Stimulants Cocaine Hypno-sedatives Cannabis Alcohol Injecting behavior of current heroin users Currently injecting heroin
Number 7.086
Percentage
4.694 2.392
66,2 33,8
40,78 425 320 167 784 353 4.775
6,0 4,5 2,4 11,1 5,0 67,4
191
49,5
6.1.10 Primary Treatment Reporting System “VLAams STRaathoekwerkOVerleg (VLASTROV)” In Flanders, street corner work projects exist that are specifically targeted towards drug users. Due to the specific nature of this kind of low threshold “treatment”, registration remains limited to a number of variables that are collected by the street workers. Coordination is being carried out by the “VLAams STRaathoekwerkOVerleg (VLASTROV)”, the Flemish umbrella organisation for street corner work (Vandenbussche, 2000). This reporting system can be considered a specialised, casereporting system. Data were also transferred to the VAD, in its role as coordinator of the Flemish umbrella treatment reporting system. But since the VAD is no longer responsible for the collection of data regarding drug users in treatment, the data are transferred to the Ministry of the Flemish Community. 6.1.11 Drug Aid RegisTration System (DARTS) “Vlaamse Vereniging van Behandelingscentra in de Verslavingszorg (VVBV)” The Drug Aid RegisTration System (DARTS) is a reporting system that is being used in a number of specialised substance abuse treatment centres with RIZIV/INAMI convention in the Flemish part of Belgium, more specific: medical social reception centres, day centres, crisis intervention centres and long-term residential treatment
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Chapter 6: Treatment reporting systems in Belgium centres. DARTS can therefore be considered a specialised reporting system (Thienpont, 2003a). Registration with DARTS is not compulsory and takes place on a voluntary basis. Coordination of the registration activities and the analysis of data is being carried out by the “Vlaamse Vereniging van Behandelingscentra in de Verslavingszorg” (VVBV) (Thienpont, 2003b). Data are systematically collected from 1988 onwards when a few of the centres, associated with the VVBV took the initiative to develop a common reporting system, at the time called “Vlaams Informatie Systeem – Drugvrije centra (VLIS-DC)” (Kerremans et al., 1995a, Kerremans et al., 1995b). Gradually all new centres with a RIZIV/INAMI convention joined in and started registering as well. At present 10 partners are participating in the DARTS. Since those partners often consist of different types of treatment centres (e.g. day centre and long-term residential treatment), there are actually 30 treatment centres participating in the registration project. Treatment centres of partners that don’t have a RIZIV/INAMI convention do not participate in the registration. However since 2000 the treatment centres of De Sleutel and the Medical Social Reception Centre for the province of Limburg are no longer participating in the DARTS registration, since they have a reporting system of their own which is too different of the DARTS to be included or converted (Thienpont, 2003b). Originally the registration activities in VLIS-DC were carried out through pen and paper. In 1998 computer software, written in Microsoft Access 97 was developed with the financial support of the Flemish Community via the VAD (Vandenbussche, 2000). The programme is flexible in the way that users can add more variables if requested and that several adjustments can be made to better serve the user. Treatment centres can also use the programme to generate tables for their own reports. From that moment onwards the system was assigned the name DARTS. Unit of reference in DARTS is a person starting treatment for problems related to drug use. The system has the possibility to find clients that have started treatment more than once in the same centre and to retain one of those treatment episodes. It is not possible to indicate clients across treatment centres (Thienpont, 2003a). Therefore DARTS can be considered a case-reporting system. DARTS registers every first registration, intake and departure of each client. Within DARTS six different forms are taken up and linked: the first registration form; the intake form; the RIZIV/INAMI form, the EuropASI form, the medical form and the observation form. Together 73 variables need to be scored (Thienpont, 2003a). In table 10 the main characteristics can be found of the registrations that were recorded in 2001 (most recent data) through the “DARTS” reporting system. The
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Chapter 6: Treatment reporting systems in Belgium information is presented for the total number of registrations (Thienpont, in preparation). Table 10: Main characteristics of the clients registered in 2001 through the DARTS reporting system (Thienpont, in preparation)
Total number of registrations in 2001 Sex Male Female Age Mean Primary Drug Opiates Methadone Stimulants Cocaine Hypno-sedatives Cannabis Alcohol Injecting behavior Ever injected
Number 1.483
Percentage
1.181 302
79,6 20,4
25,9 720 84 182 172 29 224 64
48,5 5,7 12,3 11,6 1,9 15,1 4,3
634
48,1
6.2 Umbrella treatment monitoring systems As mentioned in chapter 2, umbrella reporting systems can be described as reporting systems that make use of existing primary reporting systems to gain insight into the extent and nature of a phenomenon on a larger scale. Umbrella reporting systems are dependent on other systems and have therefore less control on data quality. Within the field of drug treatment reporting systems in Belgium, two umbrella treatment monitoring systems can be identified: the “Vlaamse Registratie Middelenmisbruik (VRM)” in the Flemish Community, coordinated by the VAD on the one hand and the umbrella treatment monitoring system in the French Community, managed by Eurotox. Both of these organisations are also responsible for an own primary treatment reporting system as well (see above), that is being integrated together with other systems. They partly rely on other organisations and partly organise their own data collection.
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Chapter 6: Treatment reporting systems in Belgium 6.2.1
Umbrella treatment reporting system Eurotox
In 2000 Eurotox has been given the task of monitoring the different aspects related to drug use (including the collection of epidemiological data) for the French Community (Molnar et al., 2002). With regard to the registration of drug users in treatment, Eurotox has first carried out an inquiry in all the drug treatment centres in the French Community regarding the types of data that were already being collected and regarding their needs. Subsequently a meeting has been organised to reflect on the results of the inquiry. Next, a working group has been set up with representatives of all reporting systems in the French Community. As a results of these activities, in 2002 the umbrella treatment reporting system of Eurotox has gradually began to take shape. This system will consist in first instance of the data collected by Eurotox itself through its primary treatment reporting system where Eurotox assumes the first responsibility in all aspects of data collection. Furthermore data will also originate from the primary treatment reporting systems “Sentinelle Charleroi”, Addibru and the system developed by the IWSM (Molnar et al, 2002). In its most recent report, Eurotox has analysed the figures that have been collected through the registration forms of CCAD together with the data from Sentinelle Charleroi. A summary of the most recent and main characteristics of the 1,752 registrations that were recorded in 2000 can be found in table 11. CCAD (and Eurotox) and Sentinelle Charleroi are responsible for data collection regarding illegal drugs and alcohol, therefore in the report the data include also the clients with alcohol as their main problem (Molnar et al., 2002). Table 11: Main characteristics of the clients registered in 2000 through the CCAD and Sentinelle Charleroi reporting system (Molnar et al., 2002)
Total number of registrations in 2000 Sex Male Female Age Mean Primary drug Opiates Alcohol Cannabis Cocaine Injecting behavior of primary heroin users Currently injecting
Number 1,752
Percentage
1296 456
74 26
30 563 299 156 60
47 25 13 5
391
32,7
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Chapter 6: Treatment reporting systems in Belgium 6.2.2
Vlaamse Registratie Middelenmisbruik (VRM) Vereniging voor Alcohol en andere Drugproblemen (VAD)
In the framework of the Drug Note of W. De Meester, former Minister of Health Care in the Flemish Community, the VAD was given the assignment to elaborate action point 4.1.: Uniform Registration (Van Baelen & Wydoodt, 1998). A reporting system had to be developed that would: - provide insight into the number and characteristics of persons who address to treatment because of alcohol, medication or illegal drug use; - make up a source of information for the health policy in the Flemish Community regarding problem drug use; - allow to situate Flanders within a Belgian and European context; - be able to provide a systematic data collection for the participating services in function of an internal evaluation of own results and processes. Since 1996, VAD has therefore been working to establish a coordinating system that could provide data for the entire Flemish Community on drug users, treated in one of the different types of treatment facilities. Furthermore this system had to be congruent to the European TDI Protocol in order to realise the third objective mentioned above. After a period of study and research, the umbrella treatment reporting system “Vlaamse Registratie Middelenmisbruik (VRM)” has been achieved. The VAD has chosen not to develop a completely new system but to build on the already existing reporting systems and enlarge them where necessary (Vandenbussche, 2000). All methodological aspects related to the different existing systems have been closely examined and compared to one another before establishing the umbrella system (Vandenbussche & Wydoodt, 2000b). VRM is made up of the primary treatment reporting systems: DARTS (formerly known as the VLIS-DC registration), MEDAR and the system coordinated by VLASTROV. Next to it, the VAD also acts as a primary treatment reporting system itself since it has developed an extra module to be linked to the MPD, and is therefore responsible for the contacts with the psychiatric hospitals and psychiatric wards in general hospitals, data collection, data analysis and reporting (Vandenbussche & Wydoodt, 2000a). The results of this entire process have been published in several reports (Van Baelen & Wydoodt, 1998; Vandenbussche & Wydoodt, 2000a; Vandenbussche, 2000). A summary of the most recent and main characteristics of the 15,436 registrations that were recorded in 1999 through the VRM can be found in table 12. One has to be aware that the data also contain information on clients with alcohol as their main problem (Vandenbussche, 2000).
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Chapter 6: Treatment reporting systems in Belgium Table 12: Main characteristics of the clients registered in 1999 through the VRM (Vandenbussche, 2000)
Total number of registrations in 1999 Sex Male Female Age Mean Median Modus Primary drug Alcohol Stimulants Cannabis Opiates Hypno-sedatives Injecting behavior of heroin users Currently injecting
Number 15,436
Percentage
11,059 4,377
71,6 28,4
34,21 33 19 6,673 2,486 2,426 2,359 1,012
43,2 16,1 15,7 15,3 6,6
983
43,8
Since De Sleutel is no longer participating in the DARTS reporting system and has further elaborated its own reporting system, De Sleutel now also transfers its data directly to the VAD, and no longer through the VVBV. However, from 2002 onwards, the VAD is no longer responsible for the collection of data regarding drug users in treatment. Instead, the Ministry of the Flemish Community would take over the coordination, but at present little is known about the future of the VRM and of the data collection through the extra module linked to the MPD, where the VAD assumed the primary responsibility. At present the Ministry of the Flemish Community is keeping information rounds with the different coordinating organisations involved in order to study the situation.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol
CHAPTER 7: CONGRUENCE OF THE REPORTING SYSTEMS TO THE TDI PROTOCOL As described above, the joint PG/EMCDDA Treatment Demand Indicator Standard Protocol (EMCDDA, 2000) provides a number of basic guidelines that have to be followed in order to be able to reach a minimal comparison of the situation across member states with regard to the number and characteristics of drug users in treatment. The Protocol does not require that all data are collected in a standardised way, but demands that the Member States are capable of deriving the minimal information that is being requested in the TDI Protocol from their own data. The Protocol can accordingly be considered as a minimal data set. Member States are free to collect more information if desired. The draft of the current TDI Protocol is characterised by a long consultation process with international experts from whole Europe. Unconsciously this process already started with the launch of the multi-city project of the Pompidou Group (PG) in the beginning of the eighties, since the definitive Protocol of the PG laid to a large extent the foundations for the joint PG/EMCDDA TDI Protocol. The fact that this Protocol has been built on the ideas of so many field experts and that, despite of all contextual differences between countries a consensus has been found, can be considered the strength but also the weakness of this document. Since, in order to be applicable in all European countries, the Protocol had to confine itself to general guidelines and variables that were as context-independent as possibly could. By doing so, it still leaves a number of methodological questions unanswered. The space in which individual countries could maneuver while following the Protocol remained high, countries make own interpretations through which the possibility of comparing information is undermined. Furthermore some of the guidelines in the Protocol are perhaps aiming too high and are not yet feasible for all countries. One can even state that probably none of the member states can say that the Protocol is being followed 100%. As a consequence it should be noticed that in reality different pieces of the puzzle called “drug phenomenon” and in this case “number and characteristics of drug users in treatment” are being collected and compared. During the European TDI expert meetings at the EMCDDA headquarters these issues are addressed and discussed in order to improve the reliability and the comparability of the data that are being collected through the treatment monitoring systems. In this chapter a number of specific issues regarding the TDI Protocol and the Belgian situation will be discussed: national figures, types of treatment centres, external coverage, selection of cases, internal coverage, unique clients, continuity and variables. Since the TDI Protocol is an instrument that has been developed for the improvement of comparison between countries, these issues will be dealt with from a national, consequently, Belgian perspective. As however, Belgium does not dispose of one single treatment reporting system, the various primary and umbrella treatment reporting systems will be scrutinized.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol 7.1 National figures In contrast to other member states or candidate countries of the European Union, Belgium already has a long tradition in the registration of the number and characteristics of persons with drug problems in treatment. When all European countries agreed on the objective to gather data on drug users in treatment in a uniform way, namely as been set out in the TDI Protocol, Belgium didn’t had to install a completely new reporting system. After all, several organisations had already started registration activities in the sector of drug treatment or mental health care (as a broader framework) years before. This early start contains advantages as well as disadvantages. Advantages because the sector was already familiar with the idea of registration. Gradually, as in other sectors (e.g. hospital settings), the drug treatment sector could get used to the idea that registration makes up one aspect of their activities. Furthermore not only the treatment centres themselves but also quite a few representative organisations are involved in the registration activities which results in a broad public support and acceptance. Disadvantages because each treatment monitoring system has been developed in a particular context to meet its own objectives, as shown in the previous chapter. As a consequence, reporting systems should not automatically be considered comparable, only because of the fact that the same target group is envisaged: drug users in treatment. A simple addition of percentages is therefore out of the question. Although in research it is not infrequently proclaimed that before considering new initiatives, existing sources should be explored, it is often not the easiest way. In the past few years, already a lot of effort has been made to increase comparability between reporting systems in Belgium and conformity to the TDI Protocol, but one cannot ignore the fact that figures regarding the situation at the country’s level are not yet readily available and that the advantages and head start that Belgium had, have gradually turned in arrears. A complete analysis of possible causes would lead us too far, but besides the confusion regarding competencies going hand in hand with the complex Belgian state structure and the questions “Who is competent / responsible?” and “Who is authorised to ask what to who?”, another important issue in this framework cannot be left undiscussed. The process whereby the data registered by the practitioners are being analysed and manipulated by the respective organisations in order to be presented as ‘congruent with the TDI Protocol’ is characterised by a limited degree of transparency. An essential characteristic of undertaking research of high quality is that another researcher should be, theoretically, able to reconstruct the same results from the raw data. With regard to the data coming from treatment monitoring systems in Belgium reconstructing the results would be at the moment practically impossible. Within this context, the fact that the coordination of these treatment monitoring systems is only one of the many tasks wherefore the respective organisations are
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Chapter 7: Congruence of the reporting systems to the TDI Protocol responsible, cannot be disregarded. Priorities have to be set and the limited staff often has to engage oneself in a wide range of activities through which a detailed methodological description of methods of research and analysis often have to be strongly limited in favour of the presentation of results. Nevertheless if data on a Belgian level are requested on the basis of existing treatment monitoring systems, transparency with regard to methods of data collection, manipulation, analysis and reporting is crucial for the reliability and the validity of these data. The TDI Protocol is an instrument that has been developed for implementation on the level of the European member states and one should always keep in mind that this Protocol has a nation-based character, in contrast with the first protocol on treatment demand registration of the Pompidou Group which had a city-based character. When discussing issues related to this TDI Protocol it is therefore crucial to distance oneself at that time from the specific, complex Belgian state structure and to take the perspective of Belgium as one of the member states of the European Union as a common point of departure and point of view. On the other hand, the fact that the TDI Protocol has been developed within a European context doesn’t imply that data on a Belgian level are only required and useful for European purposes. Treatment monitoring systems remain one of the major information sources for demand reduction activities, comprising prevention as well as treatment activities. In Belgium some of those activities belong to the competencies of the Communities and Regions (such as all prevention activities or the treatment activities of the Centres for mental health care) but others are still organised on the federal level (such as the activities in the specialised drug treatment centres that have a convention with the INAMI/RIZIV or in the more locally oriented projects on drug treatment that are being carried out under the auspices of the Ministry of Internal Affairs). Therefore also on a federal level reliable nationwide information is crucial for the orientation of policy choices regarding the programming and financing of an adequate treatment offer for persons with drug problems.
7.2 Types of Treatment Centres When developing a drug treatment monitoring system for a certain geographical area, it should be constructed in a way that it is theoretically capable to register every person that meets the inclusion criteria. In Belgium people with drug problems can call upon a wide range of treatment facilities. The type of treatment centre people address themselves to, is however not only dependent from the mission and objectives of the centres, the specific problems and profile of the clients, etc … but also from factors such as availability of certain types of treatment centres in the environment, previous contacts between client and centre, referral patterns between treatment centres, etc … Although the different types of treatment centres will have surely formulated their objectives and target group, it is not unthinkable that some of these
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Chapter 7: Congruence of the reporting systems to the TDI Protocol centres attract other persons than they have postulated at the beginning. Furthermore, it is also perfectly possible that in time changes occur. With regard to ‘treatment’ and ‘treatment centre’ the TDI Protocol provides the following definitions in order to make decisions regarding the types of treatment centres that have to be included in the registration activities: “ Treatment is any activity that directly targets people who have problems with their drug use and which aims to ameliorate the psychological, medical or social state of individuals who seek help for their drug problems. This activity often takes place at specialised facilities for drug users, but may also take place in general services offering medical/psychological help to people with drug problems (EMCDDA, 2000, p. 10). ” “ A treatment centre is any agency that provides treatment as defined above to people with drug problems. Treatment centres can be based within structures that are medical or non-medical, governmental or non-governmental, public or private, specialised or non-specialised. They include inpatient detoxification units, outpatient clinics, drug substitution programmes (maintenance or shorter-term), long-term residential treatment centres, counselling and advice centres, street agencies, crisis centres, drug treatment programmes in prisons and special services for drug users provided within general health or social care facilities (EMCDDA, 2000, p.11). ”
These definitions are accompanied by more concrete examples of types of treatment or treatment centres that should or should not be included in the Treatment Demand registration. Although the TDI Protocol provides guidelines, variables and corresponding categories, it should not be considered a questionnaire that is ready to use, and it doesn’t claim to be so either (Simon et al., 1999). This is not only the case for the categories of the different items but also for the underlying basic assumptions and definitions in the Protocol. The definitions that are being provided have been gradually developed during consultation sessions and are formulated in that manner that they can apply for numerous countries, each with their own contextual specificity with regard to the organisation of substance abuse treatment. Therefore it is crucial that when implementing the TDI Protocol discussions are held on a national level in order to apply and translate the definitions in the Protocol to the specific national situation and to explicit the choices that have been made in a written document. This is in particular the case when deciding which Treatment Centres should be invited to participate in the registration, because with this kind of monitoring activity the number and the type of treatment centres that participate determine to a large extent the results that will be obtained. The under or overrepresentation of certain types of centres causes a bias (Simon e.a., 1999). The data provided by the Vereniging voor Alcohol en andere Drugproblemen (VAD), managing organisation of the umbrella treatment reporting system for the Flemish
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Chapter 7: Congruence of the reporting systems to the TDI Protocol Community can be considered an illustration of this observation. In the report presenting the registration data for 1999 (Vandenbussche, 2000) the results are presented by type of treatment centre: psychiatric hospitals, psychiatric units in general hospitals, long-term residential treatment centres, crisis intervention centres, day centres, medical social reception centres, centres for mental health care and street work. In the Centres for Mental Health Care the percentage of clients that starts treatment with opiates as a primary drug (within the total number of clients with primary illegal drug problems) is 10%, whereas the percentage in the long-term residential treatment centers is much higher, respectively 44%. Within the total number of registered clients with primary illegal drug problems, the Centres for Mental Health Care are responsible for the delivery of 31% of the data, whereas the long-term residential treatment centres are only responsible for 2.5% of the total number of clients. Whether or not certain types of treatment centres participate in the registration activities determines to a large extent the results that will be obtained. As such this doesn’t has to be exaggerated since it is one of the characteristics of this type of monitoring activity. But on the other hand one has to be extremely cautious when interpreting the data and be well aware of the limited status and extrapolation value of the findings. As mentioned before, Belgium has a very differentiated care and treatment offer towards persons with illegal drug problems. It is not easy to provide a classification of these treatment facilities, since several possibilities exist to make a distinction between them: inpatient versus outpatient, drug free versus substitution, specialised versus general, main source of funding etc … In this chapter, a combination will be used of the classification that has recently been elaborated by the EMCDDA for all EU Member States and Norway (EMCDDA, 2002) and the global division that has been used in the TDI Protocol (EMCDDA, 2000). The first provides a limited inventory of all existing treatment facilities in Belgium, but a few corrections have to be made here since in this report another definition of drug addiction treatment is being used as a leading principle than in the TDI Protocol. The definition that is being used here reads as follows: “Formalised treatment in a physical setting in the community with specific medical and/or psychosocial techniques aiming at reducing or abstaining from illegal drug use thereby improving the general health of the client.” (EMCDDA, 2002, p.2). As a consequence of this definition drug-free wings and substitution treatment in prisons and outreach work are not taken into consideration. Within the context of the TDI Protocol these types of treatment centres are however to be taken into account, as well as in this report. Furthermore the most recent reports on treatment demand data of VAD (Vandenbussche, 2000), Eurotox (2002), CTB/ODB (1998) and ASL (Köttgen, 2002) have been used. In Table 13 a quick overview can be found of the different types of treatment centres in Belgium combined with the primary treatment monitoring systems that are
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Chapter 7: Congruence of the reporting systems to the TDI Protocol responsible for the data collection for those specific types of treatment centres in that specific part of the country. This table only gives an indication of the different types of treatment centres covered by the various monitoring systems, not of the external coverage of these systems.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol
Table 13: Types of existing treatment centres in Belgium in combination with the existing treatment monitoring system Brussels Capital Region Flemish Community
French Community
D D & DS
German – speaking Community
Dutch speaking
French speaking
E&S
-
-
E&S
A
A
OUTPATIENT SERVICES Medical and Social Reception Centres (MSOC/MASS) Specialised Outpatient treatment facilities Mental Health Care Centres
M/A
Other outpatient services
I
ASL
E&S
M/A
-
A
A
INPATIENT / RESIDENTIAL SERVICES D & DS
E&S
Psychiatric Hospitals
M/E
E&S
Psychiatric wards of General Hospitals
M/E
E&S
D & DS
E&S
V
E
ASL
-
-
GENERAL PRACTITIONERS General Practitioners
-
E
-
A
A
TREATMENT UNITS IN PRISON Treatment units in prison
-
E
-
-
Crisis intervention centres and Short
A
Therapeutic programmes
Long-term Residential Treatment centres (Therapeutic
ASL
-
A
-
A
Communities)
LOW THRESHOLD SERVICES Outreach work
Notes. A: ADDIBRU; ASL: ASL; D : DARTS; DS : DE SLEUTEL; E : EUROTOX; I : IWSM; M/A : MEDAR/ARCADE; M/E : MPD (extra module); S : Sentinelle Charleroi; V : VLASTROV. Grey: not relevant; - : not registered
Chapter 7: Congruence of the reporting systems to the TDI Protocol Next to the data collection by the primary treatment monitoring systems, the coordinating bodies for each Community or Region (the 4 Sub-Focal Points: VAD, Eurotox, CTB/ODB and ASL) have been given the responsibility to take the necessary steps in order to obtain figures for their respective Community or Region that take into account the diversity of the treatment offer. In consultation with the sector of drug treatment in Flanders, the “Vereniging voor Alcohol en andere Drugproblemen (VAD)” has decided in 1996 when setting up the umbrella treatment reporting system “Vlaamse Registratie Middelengebruik (VRM)”, to gather the data on the basis of or through extension of existing primary reporting systems, particularly Darts, Vlastrov, Medar and MPD, and not through the development of a completely new system. Thanks to the VRM, information in Flanders is assembled of clients that were treated in psychiatric hospitals, psychiatric units in general hospitals, long-term residential treatment centres, crisis intervention centres, day centres, medical social reception centres, centres for mental health care and street work. In the different reports describing the results of the registration project, the registration data have been presented in each case per participating type of reporting system (Van Baelen & Wydoodt, 1998; Vandenbussche & Wydoodt, 2000a; Vandenbussche, 2000). The names of the participating treatment centres are not listed in the reports. The association Coordination Toxicomanie Bruxelles (CTB) / Overleg Druggebruik Brussel (ODB) is responsible for the data collection in the Brussels Capital Region. CTB/ODB is managing a primary reporting system, called ADDIBRU. In the epidemiological reports of CTB/ODB no distinction is made between the different types of treatment centres and the results are accordingly not presented by type of treatment centre. In the most recent report of CTB/ODB (2000), a separate chapter presents data of clients that are being treated for their drug problems in the Dutch speaking centres for mental health care in Brussels. Accordingly, the Sub-Focal Point has not yet taken sufficient steps to present figures for Brussels Capital Region that take into account the diversity of existing treatment centres (e.g. psychiatric hospitals, street work) nor has it undertaken steps to integrate other reporting systems in its own system or create an umbrella treatment reporting system. In the epidemiological report of the 1997 data, all participating centres were explicitly mentioned. In the report with the 1998 and 1999 data, this was no longer the case (CTB/ODB, 2000). For the French speaking part of Belgium, Eurotox is responsible for the coordination of the collection of treatment demand data. Eurotox has taken over this task from the CCAD in 2000. In order to carry out this assignment, the organisation is managing a primary treatment monitoring system of its own but is on the other hand also working together with the organisations Coordination Drogue Charleroi (CDC) in Charleroi, the Institut Wallon pour la Santé Mentale (IWSM) and CTB-ODB in Brussels. The umbrella reporting system of Eurotox is accordingly built up on the basis of different reporting systems. In its most recent report Eurotox doesn’t provide information on the types of treatment centres that are participating (only the distinction inpatient / outpatient has been made), nor is information given about the identity of the
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Chapter 7: Congruence of the reporting systems to the TDI Protocol participating treatment centres (Eurotox, 2002), this in contrast to the reports of the former CCAD (Bils & Preumont, 2000). Regarding the treatment monitoring systems that provide information to Eurotox, one can say that the IWSM provides information on drug users that are being treated in the seven Centres for Mental Health Care of the French Community, that have a specific mission related to drug problems. The CRC on the other hand provides information on drug users that are being treated in a large number of treatment centres in Charleroi. In the most recent report of CRC, all treatment centres are being presented briefly. The types of treatment centres that participate in the registration activities are the following: a psychiatric crisis unit in a general hospital, a long-term residential programme (therapeutic community), a short residential therapeutic programme, several specialised ambulatory centres, the medical social reception centre and a few general practitioners (CRC, 2002). For the German-speaking Community in Belgium, the “Arbeitsgemeinschaft für Suchtvorbeugung und Lebensbewältigung (ASL)” is responsible for the coordination of the data collection on drug users in treatment. As opposed to the other Communities and Regions in Belgium, the German-speaking community doesn’t have specialised drug treatment centres at its disposal. As a consequence no specialised treatment centres are participating in the primary treatment reporting system of ASL. The treatment centres that do participate are: the social psychological centre, the psychiatric hospital and a few more welfare oriented services. The services are enumerated in the most recent report of ASL (Köttgen, 2002). One can immediately observe that in general more or less the same types of treatment centres participate in registration activities in the different Communities and Regions, but that a few differences however exist. A first explanation is simply the fact that the treatment offer in the different parts of Belgium is not the same all over. This is in particular the case for the Germanspeaking Community where for example no specialised drug treatment centres are established. Logically, if certain types of treatment centres don’t exist, no registration activities can take place. On the other hand, the C.A.T.D., the “Centre d'Accueil le Trait D'union” in Charleroi, an ambulatory assistance service for the reception of persons with drug problems that have been questioned by the police, is probably a type of service that is not established in the other parts of the country. This service has been established within the framework of the ‘contracts of security and prevention’, agreements between Belgian cities and the Minister of internal affairs, represented in this matter by a permanent structure: “Het Vast Secretariaat voor het Preventiebeleid” / “Le Secrétariat permanent à la Politique de Prévention” (VSP, 2003). A second reason for these differences could possibly be found in a different reading and interpretation of the TDI Protocol. For example the inclusion or exclusion of outreach work could be one of possible differences in opinion
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Chapter 7: Congruence of the reporting systems to the TDI Protocol A final reason could be that in certain parts of the country, due to different reasons (communication problems, practical barriers, existence of networks, etc …) it is easier or more difficult for the coordinating organisations to collaborate with the representatives of certain types of centres or primary treatment reporting systems. One always has to keep in mind that the registration of drug users in treatment is still voluntary work. In most cases, there are no legal obligations and in most cases no financial compensation is foreseen. A possible stimulating factor for collaboration with general practitioners could be for example the presence of local networks of general practitioners specialised in the treatment of people with drug problems in the French Community, the so-called ‘réseau ALTO’, a network that doesn’t exist for example in the Flemish Community. The fact that not exactly the same types of treatment centres register in the different Communities and Regions is partly a logical result of the way that the treatment offer is organised and distributed in Belgium. But on the other hand efforts should be made to further elaborate a common classification structure for drug treatment in Belgium, accepted by all parties involved. Suggestion here is to always include the names of the different types of treatment centres in their original language since this increases recognisability. This structure could then serve as a starting point to establish a detailed inventory, accompanied by information on the ‘registration status’ of the respective treatment centres. However, a discussion regarding the types of treatment centres to be included in the TDI registration can take place at the same time and should not be postponed. Especially the situation of psychiatric hospitals and psychiatric wards in general hospitals should be looked in to. The data of the Flemish Community (where data are being provided by centre type) illustrate that data of clients being treated in these types of centres for illegal drug problems easily make out 26% of the total number of registrations and should therefore not be neglected (Vandenbussche, 2000). Finally also a decision regarding the inclusion or exclusion of outreach work has to be taken jointly.
7.3 External coverage As mentioned before a national drug treatment monitoring system should in fact endeavor to include every single drug user that meets the inclusion criteria, into the reporting system. This means that in an ideal situation every treatment centre where a drug user could possibly address oneself to, should register treatment demand data. In reality, this is nearly impossible to achieve. The fact that in Belgium registration is a voluntary, unpaid for activity; the lack of suitable personnel; a certain skepticism towards registration as such; the possible lack of feedback; etc … could all be reasons why certain centres prefer not to participate. In the TDI Protocol the difficulty of attaining full coverage, meaning that all treatment centres that according to the inclusion criteria should participate, is for that matter being acknowledged. Nevertheless it is important that as many treatment centres as possible are stimulated and urged to participate (Simon e.a., 2000).
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Chapter 7: Congruence of the reporting systems to the TDI Protocol As long as full coverage has not been reached, it is important that we can form ourselves an idea on the percentage of drug users in treatment that can possibly be identified with the different existing systems. A direct measure to find out this amount doesn’t exist. The number of illegal drug users that is being treated in a certain centre is not a fixed number; this number can vary over time. A measure that can be used as an estimation is the percentage of treatment centres that is participating in a registration system in proportion to the total number of treatment centres that according to the inclusion criteria should be participating. This can be called the external coverage. In the following chapter the difference with internal coverage will be discussed. If we want to use this so-called external coverage as an indicator for the percentage of treated drug users, the global coverage percentage of a country or region is not sufficient. As has been expounded above, the types of treatment centres determine to a large extent the results that will be obtained. The inclusion or exclusion of for example psychiatric hospitals in the reporting system of a certain region has important consequences for the results that will be obtained. Therefore not only general information on the types of treatment centres that participate and a general coverage percentage for that region or country are important, also detailed information about the coverage of the different types of treatment centres is crucial. In the report of Eurotox for example the figures on primary drug show that the percentage of drug users with cannabis as a primary drug is six times higher in outpatient facilities than in residential facilities (13% compared to 2%)8. Eurotox estimates however that the coverage regarding the ambulatory sector is somewhat higher than in the residential sector. This could signify that the global percentage of drug users that are being treated in the French Community for primary cannabis problems (now being 13% in the report) in reality (if all treatment centres would participate in the registration activities) would be lower. Calculating coverages is not an easy task. Furthermore, when doing so one also has to bear in mind the fact that these coverage percentages are actually meant to be an indirect measure for the percentage of registered drug users in treatment in proportion to the total number of drug users in treatment. Especially for the types of treatment facilities where also other problems are being treated this indirect measure is often not the most adequate one. For example when it is stated that 52.5% of the psychiatric hospitals in the Flemish Community are registering data on drug users in treatment (Vandenbussche, 2000), it is not unthinkable that the percentage of drug users registered in this type of centres is in reality much higher because for example the centres that are counting a large share of drug users among their population in treatment are more tending to participate in the registration than the ones that only 8
In the Eurotox report the drug users with alcohol as a primary drug have been maintained (25%). If those clients would be excluded or if the primary and secondary drugs (if another illegal drug is present) would be recoded, the share of clients with Cannabis as a primary drug would be much higher (a detailed discussion of the subject “alcohol as a primary drug” follows later).
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Chapter 7: Congruence of the reporting systems to the TDI Protocol rarely treat a person with drug problems. Coverage on “centre – level” is therefore not always a good indicator for the coverage on “client – level”. In general the calculation of coverage per type of treatment centre should not be considered an easy assignment. Before such a calculation can be started, it is necessary to: 1. Agree on the ‘unit of analysis’: a treatment centre often comprise different treatment units. Sometimes these treatment units can clearly be distinguished from one another (e.g. an ambulatory versus a residential section), but in other cases this is not so clear. 2. Compose an inventory of all existing facilities in Belgium that can possibly treat persons with drug problems (specialised and general, subsidised and non – subsidised, medical or social, member and non – members of certain umbrella organisations etc …). Hereby the work done by for example the regional platforms should definitely be taken into account. 3. Classify and arrange this list into different types of treatment centres, taking into account classifications already made on other levels (e.g. European level). 4. Formally appoint responsible organisations or persons in order to make sure that this list can serve as point of reference for Belgium and is up to date at any time. 5. Clearly agree with all partners involved which types of treatment centres should participate when applying the inclusion criteria of the TDI Protocol to the Belgian situation regarding treatment availability. 6. Coverage percentages should be calculated per type of treatment centre. 7. If possible provide more qualitative information on differences between “centre-level” coverage and “client-level” coverage. At this moment some of the coordinating organisations have already progressed on this matter and pronounced sentences or calculated the coverage percentage of their respective reporting systems. The way that this has been executed, the underlying assumptions and limitations that have been taken and the area of reference are however not always the same.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol When for example CTB/ODB makes mention in its report of “an almost complete coverage” (CTB/ODB, 2000) one has to be careful when interpreting this information. Although CTB/ODB is one of the four Sub-Focal Points and has consequently been assigned to coordinate the treatment demand data for the area of Brussels Capital Region, CTB/ODB has made a choice to limit the data collection to the specialised drug treatment centres in Brussels (the centres with a RIZIV/INAMI convention) since CTB/ODB feels that at this moment only this way guarantees the collection of reliable data. When interpreting the “almost complete coverage”, one has to be therefore conscious of the fact that the coverage is only almost complete on the level of the specialised drug treatment centres. This information on coverage hasn’t started off from a description of all centres providing treatment to drug users in a given area, here Brussels. It is merely an indication of the percentage of participating centres in proportion to the total number of centres that were aimed at (the specialised drug treatment centres in Brussels). Although the report clearly explains this, one has to be aware of “Babel – like” confusions when this information is placed next to information of other Sub-Focal Points. The coverage figures of Eurotox (the Sub-Focal Point for the French Community) have been drawn with the aim of calculating the number of participating treatment centres in proportion to the total number of existing centres that treat drug users and that are situated in the French-speaking part of the country, excluding Brussels. In their most recent report Eurotox provides a first estimation of the coverage. The results are presented separately for each province and a distinction has been made between ambulatory and residential services. For ambulatory services the global coverage percentage is 48%, for residential services this is 42%. Eurotox indicates that this exercise is a first estimation and that a better evaluation of the treatment offer in the future will result in a better estimation of the coverage of the reporting systems (Eurotox, 2002). A first remark is that although a more detailed distinction between centres has been made in annex, the figures on coverage have only been calculated separately for ambulatory and residential services. A more detailed approach would have been more informative. Secondly, although the list of treatment centres in annex clearly shows that also other than centres with an RIZIV/INAMI convention have been included, Eurotox has drawn up certain inclusion criteria of their own before taking up certain centres in the list, for example the centre has to receive a specific public financing with regard to illegal drugs. These choices can contribute to the exclusion of for instance centres for mental health care that don’t have an explicit assignment towards the treatment of substance abuse problems or psychiatric hospitals which are treating a broad spectrum of mental disorders and perhaps don’t receive specific funding for the treatment of drug problems. In the report drawn up by the VAD, the Sub-Focal Point for the Flemish Community, (Vandenbussche, 2000) the results of the merging process where several separate reporting systems have been combined, are presented. The coverage figures have been presented per type: psychiatric hospitals (52.5%), psychiatric wards in general hospitals (35%), centres for mental health care (99%), long-term residential treatment
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Chapter 7: Congruence of the reporting systems to the TDI Protocol centres & short term therapeutic programmes (100%), crisis intervention centres (100%), day centres (100%), medical social reception centres (100%), outreach work drug users (60%). A general figure is not being provided. Also here the question is whether these calculations have been made on the total number of treatment facilities in Flanders. It is possible that initiatives that are difficult to be categorised in this classification, that are not a member of the VAD or that are not financed by the regular sources have not been taken into consideration. In its report ASL, the Sub-Focal Point for the German-speaking Community, provides an overview of the 8 treatment centres that are participating in the registration project (Köttgen, 2002). No information is given about the possible presence of other services in the German-speaking Community that are treating drug users but are not participating. ASL only makes mention of the fact that the data collection is taking place within a not representative sample. The discussion above shows that information on coverage or coverage percentages can be calculated in different ways on the basis of different assumptions and decisions, which finally leads to information that has to be interpreted in such a specific context that comparison is not possible but is all the same being done anyway. Before a uniform way of calculating coverage in the different parts of the countries can take place the different steps mentioned above have to be taken, in order to definitively cut certain knots.
7.4 Selection of cases The TDI Protocol provides a number of guidelines with regard to the selection of cases. Once a country has determined, for its specific context, the types of treatment centres that are supposed to register according to the definitions of treatment and treatment centre (see above) not all clients that are being treated in these centres can be registered for TDI purposes just like that. The TDI Protocol (Simon e.a., 2000, p. 14) provides the following case definition: “ A case is a person who starts treatment for their drug use at a treatment centre during the calendar year 1 January to 31 December. ” Furthermore the following guidelines are being provided when to include or not include a client starting treatment for TDI purposes: -
The most important inclusion criteria is the client using illegal drugs and starting treatment for it, because it caused him problems. In some centres explicit diagnoses are being made when a client enters treatment for his drug use. This is however not a necessity for being included in TDI registration.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol -
TDI data have to be collected when a client starts treatment, in concreto meaning after the second face to face contact. ‘Treatment requests only’, requests by family members and telephone enquiries should not be taken into account.
-
TDI registration concerns the persons who are using illegal drugs and are starting treatment. All persons who are related to the client and come into contact with the treatment centre should not be registered if they are not drug users themselves. This could for example be a possible point of discussion when centres work in a contextual therapeutic manner.
-
For TDI purposes clients with alcohol and tobacco as a primary drug should be excluded. Clients that use drugs that are taken up in the list but are being used for medical reasons, should not be registered.
-
If a person starts treatment more than once in the same calendar year in the same centre or in another centre, only the last treatment episode should be kept for TDI purposes since this episode contains the most recent data on the person.
-
If a person started treatment last year and is still being treated in that centre, he should not be registered again for TDI purposes.
These two last guidelines require detailed rules on what consists ‘the end of treatment’. Here fore the TDI Protocol doesn’t provide a standard guideline. When a treatment should be considered finished, should be decided by the countries themselves. Various possibilities exist: administrative rules; no more contact with the client; treatment is an ongoing process and takes years anyhow, etc … It is however very important to nationally define when a treatment is considered completed, since a lack of common definition can, according to the TDI Protocol, heavily influence the results. All of the above can be classified under the heading ‘case selection’. Of course the individual registrars and the treatment centres play an important role in the correct application of the above, but for a correct case selection especially the coordinators of the primary monitoring systems are responsible. After all, the TDI Protocol doesn’t require that all information is collected in a rigid, fixed way but rather asks the countries that the way that they are collecting the information makes it possible to extract the information required in the Protocol out of the total amount of information. Therefore the recoding activities done by reporting system coordinators are extremely important. The operations whereby cases are being selected or excluded make up a very important phase in the whole TDI registration, but is perhaps also the least documented one. These actions take place at different levels:
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Chapter 7: Congruence of the reporting systems to the TDI Protocol -
-
the level of the primary treatment monitoring systems: DARTS, VLASTROV, De Sleutel, MEDAR/ARCADE, MPD, MPD extra module (developed by the VAD), ADDIBRU, Sentinelles Charleroi, EUROTOX, IWSM and ASL; and the level of the umbrella treatment monitoring systems where information coming from different data sources are combined for a certain Community or Region: more specific by the VAD for the Flemish Community and by Eurotox for the French Community
At each of these levels certain transformations take place to adapt the collected data to the format requested by the TDI Protocol. These actions are rarely described in a written document and the knowledge regarding these issues is mostly situated in the heads of the persons responsible for the data management and analysis. à Case selection at the level of the primary treatment monitoring systems With this level the instructions are meant that primary treatment monitoring systems give to the treatment centres with regard to the question: “When does a registration form has to be filled in?”. In the DARTS reporting system a client is a person that starts treatment for his drug use in a treatment centre. In certain facilities a threshold of 3 contacts is taken into account before can be spoken about real treatment. Clients are being registered from the moment they can be ‘billed’ to the RIZIV/INAMI. In long-term residential treatment (therapeutic communities) and crisis intervention centres this is already the case from one stay onwards, in the day centres this is dependent on what has been agreed in the convention (this can be after 3 contacts) (Vandenbussche & Wydoodt, 2000b). In the Vlastrov reporting system a client is registered from the first contact on, meaning after the first conversation between the streetworker and the client, when the base for the working relationship is made. In the centres of De Sleutel, a registration form ‘apply for help and first contact’ is filled in for every unique client applying for help in a certain reference year. This form is filled in at the first informative consult. This doesn’t have to necessarily mean that the client also starts treatment. When he yet decides to follow the proposal that has been suggested for him and he starts orientation, the EuropASI interview is carried out. For MEDAR, in general each person that is being examined, counselled or treated by (a member of) the team is subject of registration. Per client only one registration form can be filled (per centre) in each working year (1 January till 31 December). Clients are registered when they are subscribed in the centre and have minimal had one face to face contact in the framework of counselling/treatment. If there is a question of a ‘client system’ (when for example several members of the same family are repeatedly being counselled regarding one specific problem), they can all be registered and receive a registration code starting with the same file number. In order to be able to
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Chapter 7: Congruence of the reporting systems to the TDI Protocol distinguish between the different ‘types’ of clients that are being registered a variable “client type” has been introduced with the main categories: the reference person, a member of the nuclear family of the reference person, a non resident family member or an acquaintance or relative. In the centres for mental health care of the Flemish Community a file is being closed if the treatment or the counselling of the client has been ended. On the registration form, the date of the last face to face contact is being mentioned as closing date. If at the end of the year the person is still in treatment the code 8888 has to be filled in: “verder in begeleiding/behandeling” or further in counselling or treatment. The specific appendix on drug use has to be filled in if on the core registration form a DSM score on the first axis has been mentioned that starts with F1 (substance-related disorder) or if on one of the answers on “aanmeldingsproblematiek” or problems at application a code has been mentioned starting with 8, being “afhankelijkheidsproblematiek” or problems of dependency except for codes 85 (nicotine), 86 (food) or 87 (gambling) (Samenwerkingsplatform FDGG-VMSI, 1999). Within the ARCADE reporting system different phases can be distinguished in which information has to be collected. Dependent on the phase, the software indicates which fields have to be filled in. “Hoofdcliënten” are distinguished from “nevencliënten”. Furthermore a distinction is being made between information that is related to the client himself and information that is related to a certain “zorgperiode”. The same client can have multiple “zorgperiodes”: at the same time (for another problem), consecutive or as “hoofdcliënt” and “nevencliënt”. Already when a client applies for help, some basic information is registered. When the decision has been taken to start treatment extra information has to be registered. For the MPD extended version developed by the VAD, patients are persons that remain for a certain period in a facility (Vandenbussche & Wydoodt, 2000b). For the reporting system in Charleroi the population of illicit drug users that come into contact with a service or care provider who helps these people on a social, medical or psychological level is being registered. For being registered at least one contact has to had taken place (exclusion of telephone contacts). This contact had to be caused by illicit drug use or by problems related to this illicit drug use. In the beginning of each period (January – December) the registration starts from zero. For the centres that work directly with the reporting system developed by Eurotox the following guidelines are being provided on the registration form (Eurotox, 2003): - A registration form has to be filled in each time a client starts treatment for a problem related to his drug use; - This has to be done for each client: clients who start treatment for the first time in their life as well as those who don’t; - If it isn’t the first time a client starts treatment, a period of 6 months has to be taken into account before a new treatment episode can be registered. - Some of the treatment centres have expressed the will to have the possibility to register clients who appeal to the centre but will not be treated there. Therefore
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Chapter 7: Congruence of the reporting systems to the TDI Protocol a variable has been included called “suite prévue” or foreseen consequence with the answer categories: no – information, in the centre, external referral, other or unknown; Within the reporting system of the IWSM at least one face to face contact has to have taken place where the client at least had one counseling session at the centre, before a registration form is to be filled in. In case of a ‘client system’ (when for example several members of the same family are repeatedly being counselled regarding one specific problem) one reference person has to be chosen, according to the rules described in the manual. According to the guidelines of the IWSM the epidemiological fiche has to be interpreted as a ‘picture’ of the client when entering treatment. The centres can decide for themselves if they need several sessions (maximum 3) to complete the form. The registration of the required information has to be connected to the clinical activities and should not be seen as a separate activity. For ASL the instruction is being given that the questionnaire can only be filled in if has been stated that the questionnaire hasn’t been filled in somewhere else during that same year (ASL, 2002). à Case selection at the level of the umbrella treatment monitoring systems In the key documents regarding the different reporting systems sometimes elements are being discussed regarding the selection of cases at the transfer from primary towards umbrella treatment reporting system. For the DARTS reporting system for example clients that have been treated more than once in the same treatment centre are only counted once. This can be done on the basis of the number of treated persons per centre and the number of treatments, by comparing several person – specific variables (Vandenbussche & Wydoodt, 2000b). For MEDAR records are being selected that have a DSM score on the first axis that starts with F1 (substance-related disorder) or if for one of the answers on “aanmeldingsproblematiek” or problems at application a code has been mentioned starting with 8, being “afhankelijkheidsproblematiek” or problems of dependency except for codes 85 (nicotine), 86 (food) or 87 (gambling) (Samenwerkingsplatform FDGG-VVI). For the MPD data, the VRM has the possibility to exclude persons that have been taken up in the same hospital more than once in the same year. This can be done on the basis of a combination of the information on the number of treated persons per hospital and the number of treatments that they have received (Vandenbussche & Wydoodt, 2000b). An important aspect regarding the case selection at second level (the manipulations and recodings that are being done by the responsibles of the primary and umbrella treatment monitoring systems) is without doubt the whole subject matter on alcohol as a primary drug.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol Partly due to the specific competences of the European Union, and as a consequence of the EMCDDA, the TDI Protocol does not allow drug users with alcohol as a primary drug to be included in the registration activities on treatment demand. For the Belgian situation this brings along a few problems. In most cases the treatment centres that assure the treatment of and the support to users of illegal drugs also tend to do this for persons with alcohol as a primary problem. Secondly the organisations that are responsible for the data collection and coordination with regard to illegal drugs have also been indicated by their financing authorities to do so for alcohol. In the list of substances that can be indicated as a primary drug of the TDI Protocol alcohol has not been taken up. On the other hand all registration forms that are being used by the different responsible parties in Belgium do maintain alcohol in their lists of substances. This means that practitioners responsible for the registration of treatment demand data can choose on their own judgement which substance is to be indicated as primary drug. The requirements of the TDI Protocol do not play a single role in this choice. One element that could play a (limited) role in their choice is the fact that the specialised drug treatment centres that have signed a convention with the RIZIV/INAMI often have been specifically commissioned for the treatment of users of illegal drugs and only in exceptional cases for the treatment of persons with alcohol as primary problem (INAMI, 2001). In general the specific requirement in the TDI Protocol to exclude persons with alcohol as a primary drug of the data collection, only turns up after the data have been collected. When manipulating the data in order to be in accordance with the requirements of the TDI Protocol certain choices have to be made when clients appear in the statistics with alcohol as a primary drug and one or more illegal drugs as secondary substances. At that moment the different organisations that are responsible for coordinating the registration of treatment demand data have to decide whether or not these clients will be taken up in the data that will be transferred to the European level (case selection). On the one hand one can decide not to take those clients into account since alcohol is their most important problem. But on the other hand one can also decide to take up those clients since they are a part of the group of people that has a problem with illegal drugs and that require treatment for those problems (although these substances do not make up their primary problem), since this population forms the target group of treatment demand registration. When after consideration the second possibility is retained, the data for these clients are being recoded in order that alcohol is no longer the primary substance but one of the secondary substances and that secondly one of the illegal substances is now the primary drug of that client. This should not be considered an easy decision. The organisations in question are after all also in charge of the data collection on persons with alcohol problems. Of course, recodings can often be considered a necessary evil but on the other hand one cannot afford to present and deliver figures on different levels (local, regional, Belgian or European) that reveal totally different situations regarding the number and characteristics of persons with drug and/or alcohol
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Chapter 7: Congruence of the reporting systems to the TDI Protocol problems. Furthermore it is not clear when recodings take place which illegal substance is being selected as primary drug. This issue has not yet been formally discussed and a uniform decision on the matter has not yet been taken. Both possibilities have pros and cons. Therefore it is advisable to discuss this matter in depth and to adopt a general guideline with regard to the selection of cases for the registration of clients in the framework of treatment demand registration.
7.5 Internal coverage For ‘internal coverage’, the individual registrars and treatment centres play a more important role than for case selection. Internal coverage deals with the question: is every client, that meets the inclusion criteria above and that is being treated in one of the treatment centres that is expected to participate, registered? The internal coverage should be calculated on the level of the centre and has to be calculated with the total number of “eligible” clients as denominator (and not the total number of clients in the treatment centre). Reasons for not reaching a 100% can be: shortage of staff, low priority to registration activities, weekend service with limited staff, wrong interpretation of certain guidelines, arrangements made within the centre that are not conform to the guidelines but do facilitate easier registration circumstances, etc … The percentage of internal coverage for a centre can only be estimated through a specific research design whereby client files are being matched to the presence or absence of data on the client in the database used for TDI purposes. The reporting system in Charleroi is the only one who takes up the challenge to provide a figure regarding the internal coverage, here the relationship between the number of registration forms filled in and the number of registrations that should have been done. The mean coverage is said to be around 60%. In the report it is being stated that coverage figures can be very different from one centre to another and that these figures can improve or deteriorate. Influencing factors are being provided: the feeling of incompatibility of registration with the clinical work, agreement versus obligation by management of the centre and finally the daily reality in the centre. The report concludes by saying that the internal coverage is surely incomplete (Coordination Drogue Charleroi (CRC), 2002).
7.6 Unique clients As been mentioned before the TDI Protocol requests that clients, that have been treated several times in the same or another treatment centre in the same reference year, are only registered once for TDI purposes (more specific the last treatment episode should be retained). This has everything to do with the fact that the treatment demand registration has been developed not only to provide information on the characteristics, but also on the number of drug users in treatment. With regard to
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Chapter 7: Congruence of the reporting systems to the TDI Protocol number as well as characteristics, it is crucial that this information is being collected on the basis of so-called ‘unique clients’. For the study of (evolution of) the number of drug users in treatment, argumentation is trivial. With regard to characteristics this issue can be discussed. A small-scale study mentioned in the report of the reporting system in Charleroi (Coordination Drogue Charleroi (CRC), 2002) states that no significant differences have been found between the population of drug users that has been treated more than once in the same year and the population that was only registered once. A registration project in the province of Oost-Vlaanderen on the other hand, established within the framework of the regional platform mental health care, reaches rather other conclusions. The methodological choice to not take the number of persons starting treatment as a point of reference, but the number persons attending intake consultations, has to be taken into account. In Charleroi the point of reference was the number of persons being in treatment in a certain year. The data of the registration project in Oost-Vlaanderen show that 27% of all intakes concerns clients that have been registered more than once. After the data had been reduced to data on unique clients (from 1.647 registrations to 1.202 unique clients) the report puts that around 20% of those unique clients are clients that were registered more than once. In the report significant differences are demonstrated between the group of drug users that have been registered more than 3 times, the socalled “revolving door clients” (a sub-group of the persons that have been registered more than once) and the other clients on certain variables, being injecting behaviour, opiates dependency and type of client (Vanderplasschen e.a., 2001). Therefore it remains absolutely necessary to aspire ways to exclude the redundant data of clients that have been treated and registered more than once in the same year within the same or another centre. Of course the information that has been collected on those other treatment episodes has not been registered futile. This information can for example be of utmost importance for clinical purposes. It can for example be extremely useful to have an idea on the number and the characteristics of the “revolving door clients” (Vanderplasschen e.a., 2001) in order to improve the treatment offer for this specific group. In Belgium, at the level of the individual centres, registrations of clients that have been treated more than once in the same year can generally be traced and can be for TDI purposes only counted once. At this moment the written reports of the different organisations managing the reporting systems don’t provide information on which of the treatment episodes is being kept. The TDI Protocol requests that the last, most recent treatment episode would be retained. Besides the elimination of multiple countings at centre-level, some of the primary treatment monitoring systems have the possibility to exclude multiple countings across centres on a local level. Only that information is then transferred to the organisation that is responsible for the merging of data at Community or Regional level. The reporting system in Charleroi for example is using a unique code based on an algorithmic transformation of initials and birth date.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol At present no method exist to exclude multiple countings on a national level. Also the Sub-Focal Points that are responsible for merging the treatment demand data for their respective Communities and Regions haven’t introduced this possibility yet. The epidemiological report of CTB/ODB stipulates that for the ADDIBRU reporting systems the possibility to use an inter-institutional code has been introduced but that this code is not being used yet by all centres. One could say that at present Belgium is situated in a transitory phase where experiments with unique codes are taking place on different levels. This state has certain consequences. Because eliminations are already taking place at centre-level and also at the level of some primary treatment monitoring systems, the data that are being presented by the Sub-Focal Points are difficult to interpret. These data cannot be regarded as treatment registrations (since a large number has already been excluded, especially on centre-level) nor as unique clients (multiple countings between centres have not yet been eliminated, apart from some exceptions). This creates the difficulty that actually no substantives can be placed next to the figures. At present it is no longer possible to interpret the data presented. Furthermore each year further steps are being taken regarding this matter and gradually we are moving on a string from number of registrations at one end to number of unique clients at the other end. The position we are taking at a certain moment will definitively have its influence on the data results obtained. In order to create clarity with regard to the status of one single record in the databases and to follow the guidelines of the TDI Protocol on this matter, a common unique identifier for Belgium would be a solution. In order to establish such an identifier, the Belgian law on the protection of private life has to be respected and a detailed dossier should be submitted. Furthermore the introduction of a common unique identifier is pointless if all reporting systems in Belgium cannot be joined together in order to trace the multiple countings and eliminate them. With regard to the technical aspects of this matter already a few organisations exist in Belgium who have experimented with such a code. Furthermore under the authority of the EMCDDA, Alain Origer (1996) has made an analysis of procedures to avoid double countings in drug treatment monitoring systems.
7.7 Continuity Treatment demand data make up an important source of information to find out trends with regard to the number and characteristics of drug users in treatment over time. In turn this provide us with an indication on trends with regard to drug use in society. At present such possibilities are still in the future for Belgium. The number and types of participating treatment centres are subject to regular changes and important discussions as mentioned above (types of treatment centres expected to register) have not yet taken place. As a consequence the participating force of treatment centres cannot yet be called stable. Increases and drops with regard to the number of
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Chapter 7: Congruence of the reporting systems to the TDI Protocol registrations / unique clients or with regard to certain variables related to client characteristics are therefore mostly logical consequences of increases and drops in the number of treatment centres and of changes in the distribution patterns of types of treatment centres. Treatment monitoring systems mostly mention changes of this sort in their reports but when tables and figures are presented, they are often introduced for several years. At that time no longer reference is made to the changes that have occurred in the number of registering treatment centres. Also changes in definitions and changes in the number or nature of answer categories can be the cause of apparent changes. The year that the changes have taken place or introduced, these changes are generally comprehensively explained. After several years this information is considered known and tables are presented for several years without a detailed explanation of possible causes. Therefore it is important that efforts are being made to keep the number of participating treatment centres, the proportion distribution between types of centres and the definition and answer categories of variables as stable as possible. When changes are required, preference should be given to one well-considered systematic global revision as opposed to regular smaller changes or additions.
7.8 Variables 7.8.1. Treatment contact details
1. Treatment-centre type
1. Outpatient treatment centres 2. In-patient treatment centres 3. Low threshold / drop-in / street agencies 4. General practitioners 5. Treatment units in prison
Each primary treatment monitoring system is collecting data on drug users in treatment, but each has a different focus (on certain specific types of treatment centres or certain geographical areas) and specific objectives. Each system collects data on the name of the treatment centre (and sometimes type of unit). Consequently it is theoretically possible to provide a distinction between the different types of treatment centres mentioned above, up to the level of the unit. On the level of the umbrella treatment monitoring systems on the other hand, data that could make it possible to identify the centre or the client, are not always provided by the primary treatment monitoring system. Furthermore, if identification information
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Chapter 7: Congruence of the reporting systems to the TDI Protocol on the treatment centre is sent along, the division above is not always made (f.e. a treatment centre that has outpatient as well as inpatient units). Next, the distinction between the first and the third category is not always clear. Eurotox for example is surely collecting data on medical social reception centres but doesn’t transfer these data to the REITOX National Focal Point under the third category, but under the first category. Only ASL transfers separate data on low threshold services to the Belgian/European level. Therefore arrangements have to be made on country level under which category certain centres have to be taken up. In general these decisions should be rather easy to take. With regard to those 5 categories, one can say that efforts regarding the data collection should especially be focused on inpatient and outpatient treatment services. Regarding the 3 last ones, the other European countries provide little information as well. In the future probably additional, more detailed information will be requested on the type of treatment. A first proposal has already been made in an EMCDDA working group, but the contextual comparative basis has not yet been assessed. Perhaps proactive work should take place whereby all partners involved could already do a smallscale exercise in order to see which types of treatment exist and how these could be summarised in a few general categories.
2. Date of treatment – month
If the date of treatment is known, all kinds of important calculations can be made. This date is for example crucial in order to know which treatment episode is the most recent one when multiple countings are being eliminated through the use of a unique identifier (the process from number of registrations à number of unique clients). In the case of Sentinelles Charleroi this date is very important since this reporting system registers all clients being treated in a certain year (and not starting treatment). Furthermore, the date of treatment is in the case of Sentinelles Charleroi the day of the first contact with the client in the year of reference. This is a different point of departure than the other systems. Therefore extra attention should be paid to the selection of cases for TDI purposes. ASL doesn’t seem to have information on this variable. For all other primary monitoring systems this variable is provided.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol
3. Date of treatment – year
See: variable “2. Date of treatment – month”
4. Ever previously treated
1. Never 2. Previously treated 3. Not known
The TDI Protocol is interested to obtain information on clients who start treatment for drug misuse for the first time in their life at any centre anywhere. The so-called variable on ‘first treatment’ is a very important variable because it allows to calculate the incidence or ‘treated incidence’, meaning the number of persons that start treatment for the first time within a certain period of time. Several possibilities exist to gain information on this subject: - by using a central register of treated clients, as has been done in the RIZIV/INAMI study (INAMI, 2001); - by performing internal checks on centre-level to see if previous treatments have occurred; - by asking the drug user if he or she has been in treatment before. According to the Protocol the latter seems to be the most popular method of data collection on this subject (Simon e.a., 2000). From an epidemiological point of view it is not only important to identify the total number of cases (prevalence), but also to identify the number of ‘new cases’ (incidence). Furthermore for almost all standard tables on TDI that have to be sent periodically to the EMCDDA, the division is being made between “all treatments”, comprising all unique clients, and “first treatments”, comprising those unique clients that are starting treatment for the first time. In the past, this variable posed considerable difficulties for almost all primary treatment monitoring systems in Belgium. Recently it has been adjusted in a few systems, but still no general congruence with the Protocol or overall comparability has been reached. The Vlastrov system doesn’t provide any information on the subject. DARTS and MPD (extra module) have included the variable, but only ask if the client has been ever treated before in his life in the same centre for the same substance problems. The presentation of this question in the reporting systems of the centres for mental health care of the Flemish Community (MEDAR/ARCADE) is insufficiently clear. The question is being asked if the person has had contacts within (MEDAR and ARCADE) and out (only ARCADE) the sector of mental health care before. The question is being
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Chapter 7: Congruence of the reporting systems to the TDI Protocol followed by an extensive list of possible services. ARCADE has added the idea “for mental health problems” as opposed to MEDAR where no information was given whatsoever. This addition gives the impression (and probably is indeed the case) that the question is not specifically asked with regard to drug-related problems. Therefore it is not in accordance with the TDI Protocol. However for the question on previous contacts with services outside the mental health care sector, the sector of drug treatment is being mentioned (one out of 9 answer possibilities). On the basis of this information however, no sound information can be deducted to respond to the TDI Protocol requests. The question that has been taken up in the questionnaire of ASL (“Erstanfrage einer Therapie/Unterbringung/Betreuung in Bezug zur Lebensspanne” with answer categories “Ja” or “Nein”) has more or less the same shortcoming. It is not formulated clearly enough that the question relates to the persons’ drug problems. Although the question in the questionnaire seems to take the clients’ whole life as a period of reference, the most recent ASL report (Köttgen, 2002) provides conclusions on first treatments “bei der betreffenden Institution”. Questionnaire and report are therefore contradictory. Furthermore, the answer categories don’t take into account the possibility “unknown”. Addibru and Eurotox both have the same variable name and answer categories, responding to the requests of the TDI Protocol. Moreover, the variable “traitement antérieur” can be answered by chosing between: “Oui, dans l’institution”, “Oui, ailleurs”, “Non, aucun” or “Inconnu”. To make sure that the question is absolutely clear, Eurotox has added an extra phrase “concernant les démarches relatives à l’usage de produits”. The fact that Addibru didn’t, is not a problem since the way the question has been drawn up already implicitly gives this connotation to this question. The reporting system Sentinelles Charleroi asks several questions regarding previous treatments: “Age de la première démarche auprès d’un service ou d’un intervenant (y compris un médecin généraliste)”, “A déjà eu un contact avec notre service” and “A déjà contacté un autre service ou un autre intervenant (y compris un médecin généraliste)”. The registration form explicitly mentions: “Cela correspond aux démarches relatives à l’usage de produits”. At first sight the way the third question has been formulated, takes into account too little the “during the whole life of the client” aspect and could lead to answers that are based only on the present situation. Due to the first question which has been formulated markedly different, comparisons can and should be made between the answers on both questions to make sure that registrars have correctly interpreted this third question. The reporting system of De Sleutel provides adequate information on this TDI item and even collects information on the number of treatments and on the types of treatment centres in which the client has already been treated. The reporting system IWSM contains the variable “Prises en charges antérieures”. The manual clarifies that here the types of treatment facilities have to be indicated that
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Chapter 7: Congruence of the reporting systems to the TDI Protocol the client has consulted before he came with his problem to the centre for mental health care.
5. Source of referral
1. Self-referred 2. Family / friends 3. Other drug-treatment centre 4. General practitioner 5. Hospital / other medical source 6. Social services 7. Court / probation / police 8. Other 9. Not known
According to the TDI Protocol the most important source of referral should be indicated. In the form for apply for help and first contact of de Sleutel three broad categories are presented: no source of referral, another unit of De Sleutel or an external source of referral. The reporting system do contains the possibility for the clinician to register extra information on the source of referral. In the EuropASI no information on this variable has been found. For the centres for mental health care of the Flemish Community a large number of answer categories is being provided (86 possible answers in MEDAR and 121 in ARCADE). For ARCADE the source of referral is the last person by whom the client came into contact with the care sector. This large number of categories has however been grouped in a smaller number of main categories: 4 main categories for MEDAR and 11 for ARCADE. For both systems the division of the TDI Protocol cannot be retrieved immediately in the main categories of this item, certain answers are situated on the lower level of sub-categories (e.g. general practitioner and other drug treatment centre in ARCADE). This creates a problem since registrars have the choice to register only by using the main categories or by also using the sub-categories. The reporting system of IWSM uses a similar hierarchical system with main and subcategories. In total 111 answer possibilities exist. Within the IWSM system the source of referral is the person or the service that has influenced, oriented or forced the person into treatment. If the search for treatment has not been influenced at all, code 0000 “sans objet” has to be indicated. Including this last category, 15 main categories exist in the IWSM system, which don’t correspond very well to the 9 categories of the TDI Protocol. The same problem as in MEDAR/ARCADE exist here since registrars have the choice to register only by using the main categories or by also using the sub-categories.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol Eurotox and CTB/ODB are using the same division for this variable and can therefore be discussed together. In those systems the number of categories corresponds relatively well to the TDI Protocol, as well as the content. Certain elements are somewhat different of the categories in the TDI Protocol: “Family / friends” in TDI is described as “entourage” in Eurotox and CTB/ODB; “General Practitioners” in TDI cannot be found in the list of the two systems; for “Hospital / medical source” in the TDI, no explicit mention is made of hospitals in the Eurotox and CTB/ODB registration forms and these ‘medical’ sources of referral are divided in “secteur santé mentale” and “secteur santé non spécialisé’. “Court/Probation/Police” is being summarized in the two databases as “secteur justice”. Eurotox mentions that the source of referral is the person or organisation that has sent the person to the consultation. With regard to the number of possible answers, the question on source of referral in the Sentinelles Charleroi is quite comparable to the one in the Protocol, but regarding content again certain differences exist: “General Practitioners” and “Other drug treatment centres” have not been taken up as a category. The category “Family / Friends” has been reduced to “Un membre de la famille”. The category “Court/Probation/Police” has been divided into two categories: “une instance judiciaire” and “une instance policière”. The two remaining categories are not really comparable to the two remaining categories in the Protocol: “Un service d’aide” and “Un professionel de la santé” as opposed to “Hospital/other medical source” and “Social services”. Furthermore, as opposed to the guidelines in the Protocol, the registrars in Charleroi can indicate 2 sources of referral. In the Vlastrov system the majority of the answer categories concerning this variable are the same as those mentioned in the TDI protocol. There are three categories missing in the Vlastrov system: general practitioner, hospital/other medical sources and court/probation/police. Another difference is that the distinction has been made between the category family and the category friends/companions in misfortune. No mention is made of a question regarding the source of referral in the ASL questionnaire. In the DARTS reporting system the last source of referral in the chain has to be indicated. 7 answer possibilities exist. However, each treatment centre using the DARTS reporting system has the liberty to add names of centres or organisations within these 7 main categories according to their own needs. Half of the categories correspond well to the TDI Protocol but the other ones (4,5 and 6 of the Protocol) are difficult to convert. Furthermore the answer possibilities “Other” and “Not known” are not available in DARTS. Within the MPD, 3 persons can be registered in chronological order who intervened in order for the client to be admitted to the hospital. 25 answer possibilities exist. Due to the non-specialised nature of the MPD system, the third TDI category is not an option. The other categories can be composed on the basis of those 25 possibilities. For the
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Chapter 7: Congruence of the reporting systems to the TDI Protocol category “Court, probation, police” however, another variable from the MPD will be necessary as well: “Wijze van opname” which gives information on possible legal arrangements that are inherent in the admission. 7.8.2. Socio-demographic information
6. Gender
1. Male 2. Female 3. Not known
This variable can be considered the same for all treatment monitoring centres. Still, two small differences exist: ARCADE explicitly makes mention of the fact that gender should be registered as is being mentioned on the persons’ identity card or similar document. In case of doubt, the registrar should indicate the gender that at the moment of registration is being mentioned on the identity card. The TDI Protocol foresees a answer category “not known”, the monitoring systems of Darts, De Sleutel, MPD extra module, ARCADE, MEDAR, IWSM, Sentinelles Charleroi and ASL do not.
7. Age
For De Sleutel, Eurotox and IWSM the age is not separately being registered or immediatly calculated on the basis of date of birth and date of treatment. For ADDIBRU, DARTS, MEDAR, ARCADE, MPD extra module, Sentinelles Charleroi and Vlastrov the age is automatically being calculated. For ASL only the age is available (not the year of birth).
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Chapter 7: Congruence of the reporting systems to the TDI Protocol
8. Year of birth
In principle the TDI Protocol only requests that the year of birth would be registered. If however multiple countings are expected to be eliminated, it is crucial to have the full date of birth in order to be able to compose a unique identifier for each client. Most of the primary treatment monitoring systems dispose of the complete date of birth (DARTS, De Sleutel, MPD extra module, ARCADE, ADDIBRU, EUROTOX and Sentinelles Charleroi). For ARCADE the date of birth has to be noted that is mentioned on the identity card of the person or a similar document. When these data are being exported to a treatment monitoring system at a higher level, it is possible that only the year of birth is being transferred (as is the case for example for the VRM). Vlastrov, MEDAR and IWSM only register the birth year and not the entire birth date. If the year of birth is not known for a client being registered in the system of Vlastrov, it is being estimated by the street worker. The registration form of ASL only questions the age of the person, not the year or the date of birth.
9. Living status (with whom)
1. Alone 2. With parents 3. Alone with child 4. With partner (alone) 5. With partner and child(ren) 6. With friends 7. Other 8. Not known
According to the TDI Protocol this variable has to provide us with information on the living status of the drug user, 30 days prior to the start of treatment. If the situation should have changed during these 30 days, then the living status immediately prior to treatment contact should be registered. In the systems of DARTS and De Sleutel the most current living situation has to be registered in which the client has lived for the past 3 years. All categories that are being provided in the TDI Protocol can be found in the categories of DARTS and De Sleutel. These two systems even provide more answer possibilities; as a consequence “met familie”, “in een gecontroleerde omgeving” and “wisselende leefsituaties (niet
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Chapter 7: Congruence of the reporting systems to the TDI Protocol stabiel in de afgelopen drie jaar)” have to be taken up under the TDI category “other”. For Vlastrov the present living situation at the moment of registration is being noted. Regarding categories it should be said that the TDI category “with friends” is not present in the Vlastrov categories. On the other hand the Vlastrov categories “Met partner bij ouders”, “Met partner/kinderen bij ouders” are being taken up in “with parents” and “Gevangenis” and “Residentieel” are being taken up into the VRM category “Instelling, gezinsvervangende leefsituatie”, which has no equivalent in TDI. “Zwerven” and “Verschillende woonplaatsen” will have to be recoded into the TDI category “other”. For what is concerned ARCADE again the same problem turns up as was the case for the variable “source of referral”. Again a lot of possible answer categories exist (26 in total) and certain categories of the TDI Protocol are hidden as a sub-category behind the main categories. This is in particular the case for answer possibilities 3, 4 and 5 in the Protocol. These are situated in ARCADE behind the main category “Eigen gezin”. So again the same problems could arise as could be the case for the variable on “source of referral”. Furthermore the category “with friends” doesn’t exist in ARCADE. When this is the case it should be mentioned by indicating “Ander”. No clear reference period in time is mentioned. According to the ARCADE manual, information on the living status should be registered for the period prior to the first face to face contact. In case of doubt, the place where most household activities take place should be registered. For the MPD extra module, the same remark can be formulated as for ARCADE. Also here a lot of answer possibilities exist (27 in total) which are divided into main categories and sub-categories. The main categories almost don’t correspond to the TDI categories. Only the first TDI category can be found in the main categories, the other ones are present in sub-categories (“with parents”), or are not present at all (“with friends” is not present, the distinction between the TDI categories “alone with child”, “with partner (alone)” and “with partner and child(ren)” cannot be made on the basis of the information in the MPD extra module). With regard to the MPD extra module, the living environment is registered where the client has mainly stayed the last three months preceding the present medical admission. For MEDAR, the real living situation with permanent character is being registered. The same remark can be made as for ARCADE and MPD extra module: the TDI categories 3, 4 and 5 are hidden behind the main category “eigen gezin”. The TDI option “with friends” is not present and the other options that have been described in the MEDAR system don’t have an equivalent in the TDI categories and will have to be recoded into “other”. For all treatment systems that are being merged together in the VRM system (Darts, MPD extra module, De Sleutel, MEDAR and Vlastrov), an extra condition has been formulated before registrars have the freedom to indicate “cliënt leeft alleen”, “cliënt
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Chapter 7: Congruence of the reporting systems to the TDI Protocol leeft bij ouders of (andere) familie”, “cliënt heeft een eigen gezin” or “cliënt woont bij zijn kinderen in”. They have to make sure that this situation is “stable”. It is doubtful if all registrars take this condition into account. The reporting system of IWSM deals with the same problems as the systems mentioned above. 4 out of 8 answer possibilities in the TDI Protocol are hidden in the IWSM system behind the main category “familial”. Furthermore the TDI category “with friends” does not exist in the IWSM system and a number of categories exist in IWSM that haven not been taken up in the TDI Protocol. As a period of reference, the clinician has to keep in mind the everyday situation during which the client has made his treatment demand. For ASL the “aktuelle Wohnsituation des Klienten” is being registered. Almost all categories are perfectly comparable to the TDI categories except for “with friends” which is not present in ASL and “Wohngemeinschaft” which is not present in TDI. Furthermore ASL doesn’t provide the possibility for the categories “other” and “not known”. Eurotox doesn’t want to take in account the possible presence of children when registering “cohabitation”. Eurotox does however include two other questions on the subject of children (“Nombre d’enfants” and “Vit avec des enfants”), but these questions do not provide conclusive information on the question whether or not the person has been living together with his or her own children during the past 3 months (the children could be someone else’s). An extra category “Vit en institution” has been added to the TDI categories. Eurotox also has the category “avec amis” but adds ‘relatives’ to it. No specific reference period is being mentioned. For Addibru the same categories have been used, meaning that also no information on the possible presence of own children is being taken into account. For Brussels neither questions on children are taken up. The extra category “Vit en institution” has also been added and the change to the category “avec amis” has also been made. No specific reference period is being mentioned. Sentinelles Charleroi has also chosen not to include the possible presence of children into the question on “mode de vie”. However Sentinelles Charleroi do provides an extra question “Si a des enfants, dont il est géniteur, vit avex eux?” which can provide information on whether or not the person has been living together with his children before he or she started treatment. Still, the fact that the information is spread over two questions makes it difficult to reconstruct the information requested by the TDI Protocol. Furthermore Sentinelles Charleroi allows categories to be combined if these have occurred simultaneously.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol
10. Living status (where)
1. Stable accommodation 2. Unstable accommodation 3. Institutions (prison, clinic) 4. Not known
The living status of the client with regard to his accommodation should be determined for the reference period being 30 days before the start of treatment. This variable is a very difficult one. The EMCDDA has kept the categories so general as possible but has requested the different countries to operationalise this variable. In Belgium this hasn’t yet happened. Most of the reporting systems (DARTS, De Sleutel, Vlastrov, MPD extra module, ARCADE, MEDAR, IWSM, Sentinelles Charleroi and ASL) are therefore not collecting data on this variable. Only Addibru and Eurotox have tried to operationalise this variable. The following categories have been chosen: 1. “Sans (instable)”; 2. “Logement propre (stable)”; 3. “Logement famille (stable)”; 4. “Logement amis (stable)”; 5. “Institution (stable)”; 6. “Prison (instable)”; 8. “Autre (instable)”; 9. “Inconnu”. This variable concerns the stability of the place where the person is living at this moment (so not like the Protocol, 30 days before the start of treatment). The category “sans” can mean: persons living with friends, in the streets, etc … but in an unstable way.
11. Nationality
1. National of this country 2. EU national 3. National of another country 4. Not known
All reporting systems have information on nationality. Most of the systems collect the data on the same manner that the TDI Protocol requests. Only De Sleutel, Vlastrov and ASL have taken up an open question in their registration forms where the nationality of the clients can be written down and later on classified. Most of the systems don’t foresee the possibility “not known”: DARTS, De Sleutel, Vlastrov, MPD extra module, MEDAR, Sentinelles Charleroi and ASL. ARCADE has however some problems. Only a limited number of countries is being listed: 5 European countries, supplemented by Turkey and Maroc. If the client has
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Chapter 7: Congruence of the reporting systems to the TDI Protocol another nationality the option “andere” has to be indicated. Consequently also clients with a European nationality will find themselves among “andere”.
12. Labour status
1. Regular employment 2. Pupil / student 3.
Economically
inactive
(pensioners,
housewives/-men, invalids) 4. Unemployed 5. Other 6. Not known
The TDI Protocol has provided global categories since the various forms of employment in the different countries are difficult to make uniform. Persons in irregular, illegal or other forms of employment should not be considered as people in regular employment but as “unemployed” or as having an “other” labour status. In Belgium information on main profession is not always collected. The variable “sources of income” is used more often. Although this source often provides useful information, it cannot be directly used for TDI purposes. If a person states that his parents are his primary source of income, this person can be student as well as unemployed as invalid. It is not because someone theoretically could benefit from social provisions (unemployment, invalidity, disability, etc …) that this person also has applied for these grants and undertook the necessary administrative steps. Consequently the source of income can only inform us about a part of that group. In the DARTS reporting system the current profession is being registered. If the person has a changing professional status, the most long-lasting status has to be mentioned that has been effectuated the past 6 months. If the different status have the same duration, then the status with the highest income has to be indicated. Out of the information collected, all TDI categories can be deduced, except for the third and the fourth, which cannot be separated from one another. Within DARTS they belong to the same category “niet actief”. It has however to be said that the categories “niet actief” and “student” are subcategories of the main category “andere”. It is therefore possible that only the main categories are indicated. In the reporting system of De Sleutel the habitual working situation has to be mentioned for the past 3 years. Again TDI category three and four are difficult to put next to these categories in the system of De Sleutel. In that system the category “werkloos/brugpensioen/bijstand/huisvrouw” (comparable to the fourth category) contains a number of situations that would belong to the third TDI category. Also the reference period can be considered long. In the IWSM reporting system, the variable “catégorie professionelle” contains most of the answer categories described in the TDI Protocol. Except for the categories three and four which are combined in IWSM as “sans profession”. Within the IWSM
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Chapter 7: Congruence of the reporting systems to the TDI Protocol system also the variable “source principale de revenus” exist. Possibly this variable could be used in combination with the former to improve congruence with the TDI Protocol categories. In the system of MPD extra module the current or last main profession has to be registered. This means that in cases of pensioning unemployment, invalidity, etc … the last profession in the persons life will be registered. This is not compatible with the guidelines of the TDI Protocol, even if the possibility would exist to combine the information with for example sources of income, the congruence with the Protocol could be questioned. In the reporting system of MEDAR the most important activity in the daily life of the client (resulting in income or not) has to be indicated. No reference period is mentioned. The categories “werkloos”, “pensioen”, “gepensioneerd”, “gehandicapt/invalide” and “student/leerling” exist but are subcategories behind “niet beroepsactief”. It is therefore possible that only the main categories are indicated. In ARCADE, the current or last main profession has to be registered. This means that in cases of pensioning unemployment, invalidity, etc … the last profession that resulted in a taxable income will be registered. Therefore under the main category “niet beroepsactief” only the subcategories “huishouden” and “leerling, student” can be found. Illegal work is not being taken into account. If the person has a changing professional status, the most long-lasting status has to be mentioned that has been effectuated the past 6 months. If the different status are still the same then the status with the highest income has to be indicated. It is difficult to use the information. In Addibru only the distinction between regular, episodical and no professional activities is being made. This provides too little information for TDI purposes. For ASL the question is being asked “Aktuell ist der Klient:”. As possible answers all categories are being given required by the Protocol. The third category has been split up in two. For Vlastrov, Eurotox and Sentinelles Charleroi no information on profession, only on sources of income is available.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol
13. Highest educational level completed
1. Never went to school / never completed primary school 2. Primary level of education 3. Secondary level of education 4. Higher level of education 5. Not known
This information is being collected by all treatment monitoring systems. In most cases much more detailed than the categories in the TDI Protocol. The Protocol clearly asks about the highest level that has been completed. If the client is still studying, the level under the level in which he is situated now should be recorded. The reporting system of De Sleutel indicates for minors (-18y) the level that was being followed at the moment of the interview. When transferring data in the framework of TDI, one has to make sure that these responses are converted to a lower level since those clients are still studying and haven’t yet finished the level they are in. One has to see if other variables can help to do this in a well-considered way. The reporting system of Sentinelles Charleroi has chosen to include a category “enseignement spécial”. Although can be understood that this information can be of use, it is impossible to convert this category in function of the information asked for TDI purposes since no distinction is made between primary and secondary special education. The reporting system of IWSM consists, besides of the 4 TDI categories, of a number of other answer possibilities: “promotion sociale” and “contrat d’apprentissage”. These have to be converted to the 4 categories according to the International Standard Classification of Education (ISCED) rules. “Promotion sociale” however can be secondary as well as higher level. De Sleutel, Sentinelles Charleroi and ASL don’t have a category ”not known”. It is so that a large number of reporting systems (DARTS, Vlastrov, MPD extra module, ARCADE, Eurotox, IWSM) have included a category ‘autre’ or “andere”. This was not foreseen in the Protocol. In se each form of education should be possible to assign to one of those 4 categories (ISCED rules). In a number of reporting systems the division has been made between lower secondary and higher secondary education (the previous secondary education structure in Belgium). One has to be aware that according to the TDI Protocol the highest level has to be indicated that has been completed. For those clients for whom lower secondary education has been indicated, it is not secondary education that
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Chapter 7: Congruence of the reporting systems to the TDI Protocol should be transferred for TDI purposes but primary education since secondary education hasn’t been finished (yet). The reporting systems of MEDAR and ARCADE make use of two variables to gather this information. The variable “opleiding”, comprising the education that the person is following or that he has completed. In case he is still following this level of education the system of ARCADE asks that a second variable “studiejaar”, the year, should be indicated as well. In MEDAR a second variable “onderwijsfase” or status has to be filled in at all times. This variable indicates if the education level mentioned is still being followed, has been interrupted, ended after several failures or ended. As for De Sleutel, when converting data in the framework of TDI, one has to make sure that the responses on the first variables are corrected by combining them with the second variable in order to transfer the correct information. 7.8.3.
14. Primary drug
Drug-related information
1. Opiates (total)
11. Heroin 12. Methadone 13. Other opiates
2. Cocaine (total)
21. Cocaine 22. Crack
3. Stimulants (total)
31. Amphetamines 32. MDMA and other derivates 33. Other stimulants
4. Hypnotics and sedatives (total)
41. Barbiturates 42. Benzodiazepines 43. Others
5. Hallucinogens (total)
51. LSD 52. Others
6. Volatile inhalants 7. Cannabis (total) 8. Other substances (total)
According to the TDI Protocol the main drug (the drug that causes the client the most problems) has to be indicated here. How this is being assessed can differ from one system to another. It can be based on a choice made by the client or it can also be based on short diagnoses (e.g. ICD 10). The Protocol acknowledges that it is at present unclear in what way these differences influence issues regarding the comparability. At present a study is being undertaken by the Drugs programme of the
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Chapter 7: Congruence of the reporting systems to the TDI Protocol Scientific Institute on Public Health, in collaboration with the reporting systems of De Sleutel and Sentinelles Charleroi, called the PRIMO project, in order to gain more insight into the way that the primary drug is being chosen and if those differences create problems for what is concerned comparability issues. Furthermore the TDI Protocol also stipulates that alcohol cannot be recorded as a primary drug and that therefore clients whose primary drug is alcohol should be excluded. For users of “speedball”, heroin should be registered as the primary drug and cocaine as a secondary drug. The answer categories in the Protocol have been set up in this way that if the exact substance is not known, the registrar should indicate simply the main category. If a prescribed substance has been chosen it is important that the problems are directly caused by this substance. For this item no reference period has been reported in the Protocol. All reporting systems collect information on the types of substances that are being taken by the client. The methods by which this is being done are varied. Some reporting systems (Eurotox and IWSM), apply the logic that is being presented in the Protocol. An item on primary drug has been taken up in the registration form including a list of substances out of which one substance has to be chosen. Another item on secondary or other substances puts on again the same list out of which a certain number of drugs can be chosen, For Eurotox and IWSM, 3 substances maximum. For Addibru the item on secondary drugs has been split up in 3 items: “produit secondaire 1”, “produit secondaire 2” and “produit secondaire 3” where the same list of substances has been presented. Each time only one substance has to be marked. Other reporting systems (ARCADE, MEDAR, ASL, Vlastrov, DARTS and MPD extra module) have chosen to combine these two items and provide one list with substances. Substances have to be marked and set in order of importance. The first one is logically the primary drug. For MEDAR, ARCADE, Vlastrov, DARTS and MPD extra module three products maximum can be marked (one primary drug + two secondary substances). For ASL the instructions on the registration form are not totally clear: (1 + 3) or (1 + 2). The registration forms of the De Sleutel and Sentinelles Charleroi on the other hand contain a large table in which all the substances have to be indicated that the client has ever taken and is taking at the moment (the last 30 days). Only after the table has been completely filled in a decision will be taken regarding the primary drug. For De Sleutel this is however not always the case since also “poly drug” can be indicated as primary drug. Furthermore for all reporting systems combined in the VRM, it is the registrar who decides which product is the most important one. If two products are equally important, the most recent substance should be noted. For the system of De Sleutel, according the EuropASI, it is also the registrar who decides the primary drug. In case of doubt however the question can be asked to the client.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol For Eurotox the primary product is the substance that causes the client the most problems and lies at the origin of his treatment demand. This drug hasn’t to be consumed necessarily in the past month. For all systems in VRM, “methadone on prescription” should be marked if the person is addicted in the framework of a detoxification programme while “methadone not on prescription” should be marked if it concerns an addiction that is unrelated to this. Also for Eurotox the category “opiacès substitutifs” should only be indicated if the client experiences problems with his substitution treatment. Regarding the substances themselves some systems have chosen to take up a large number of substances and divide them into categories (DARTS, MPD extra module, ARCADE, MEDAR and Addibru), others have chosen to list all the substances without assigning them to main categories (De Sleutel, Vlastrov, Eurotox, Sentinelles Charleroi, IWSM and ASL). The total number of answer possibilities varies from 11 for Sentinelles Charleroi to around 40 for DARTS. Mostly if a system has been organised on the basis of main and subcategories the registrars can chose whether or not to indicate only the main categories or to indicate also the subcategories. A problem could arise if not all of the TDI main categories are presented as main categories in the different systems. As a result information could get lost if these categories are “hidden” behind another main category.. Cocaine for example is a substance that is in the TDI Protocol being considered a main category (next to opiates, stimulants, hypnotics & sedatives, hallucinogens, volatile inhalants, cannabis and other substances). In a number of other reporting systems however (DARTS, MPD extra module, ARCADE, MEDAR and Addibru) cocaine has been included as a subcategory of stimulants. In most reporting systems more substances have been taken up in the lists than in the TDI Protocol. This means that when data are converted to the TDI format recodings will have to be carried out to “other opiates” or “other stimulants” or … Besides the substances that are being summed up in the Protocol all reporting systems also have taken up alcohol in the list of substances. Some systems (Addibru, Eurotox and IWSM) also included “jeux, paris” in the list. Furthermore several systems (De Sleutel, ARCADE, Addibru, Eurotox and IWSM) included the answer category “aucun”, or “geen produkt” in the list. The answer categories “other substances” has been included by all reporting systems. One has to be careful with the categories “onbepaalde drugs of substanties” or “Inconnu” that have been taken up in the lists of most reporting systems (DARTS, Vlastrov, MPD extra module, ARCADE, MEDAR, Addibru, Eurotox and IWSM). Similar categories were not foreseen in the TDI Protocol. One has to be careful when
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Chapter 7: Congruence of the reporting systems to the TDI Protocol interpreting these categories since it is not always clear what is being meant with this categories: a substance that is new and that hasn’t been given a name yet or the primary drug that is considered unknown because the registrar can’t or doesn’t want to make a choice.
15.
Already
receiving
substitution treatment a. Heroin
1. Yes
b. Methadone
2. No
c. Other opiates
3. Not known
d. Other substances
There is no reporting system that collects information on this variable the way that it has been suggested in the TDI Protocol. However a number of systems could succeed in providing limited information on the subject on the basis of other variables. For the reporting systems of MEDAR, ARCADE, MPD extra module and Vlastrov a distinction can be made within the variable “product” between prescribed and non prescribed methadone. This is also the case for the variables “Voornaamste product”, “Tweede product” and “Derde product” in the DARTS reporting system. In the system of Sentinelles Charleroi a separate column has been added to the consumption table to indicate whether or not the heroin, methadone, psychotropic drugs, speed or other substances have been prescribed. ASL has included an item “Teilnahme an Methadon programm” with “ja” and “nein” as answer categories. For De Sleutel, Addibru, Eurotox and IWSM no information is available on this variable.
16. Usual route of administration (primary drug)
1. Inject 2. Smoke / inhale 3. Eat / drink 4. Sniff 5. Others 6. Not known
ASL is presenting the same categories as the TDI Protocol. Only “inhalieren” and “rauchen” are mentioned separately and no categories “others” and “not known” have been included for the item “Art der einnahme der Hauptdroge”. 88
Chapter 7: Congruence of the reporting systems to the TDI Protocol For MEDAR, ARCADE, DARTS, De Sleutel, IWSM and the MPD extra module all the same categories have been taken up as in the TDI Protocol. Except for the IWSM an extra distinction has been made between injecting and IV injecting. Although in the TDI Protocol only one route can be indicated (the usual route) MEDAR and ARCADE admit that more than one route to be indicated. If two routes of administration are very different from one another, they have to be mentioned both by indicating first the route of administration that is mentioned the highest in the list. The order in which the different routes have been presented reflects that degree of risk. For MEDAR and ARCADE another extra category called “geen tweede wijze” has been added. If within the DARTS and the MPD extra module reporting systems two routes of administration of the same product are very different from one another, the route of administration should be indicated that is mentioned highest in the list. The order in which the different routes have been presented reflects that degree of risk. For the reporting systems of De Sleutel and Sentinelles Charleroi information on route of administration has to be registered for all substances. Since afterwards the primary drug is being selected it is not difficult to extract the data needed for TDI purposes. In Charleroi however only information is available on: IV, Non IV and Mixte. No more detailed information is available. Addibru and Eurotox don’t provide information on this variable.
17. Frequency of use (primary drug)
1. Not used in past month / used occasionally 2. Used once per week or less 3. Used 2 – 6 days per week 4. Used daily 5. Not known
In the TDI Protocol this information refers to the frequency of use regarding the primary drug during the 30 days prior to the start of treatment. If the client is drug free or has not used in the past 30 days, the first category should be indicated. For ASL an item “Häufigkeit der Einnahme der Hauptdroge” has been included. The categories correspond to those in the TDI Protocol. The VRM, the system that merges data together for the Flemish Community, has provided some guidelines regarding the registration of substances. According to these guidelines one should only register a substance the moment the client uses it at least 3 times a week (irrespective of the dosage) or during a certain period for at least two
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Chapter 7: Congruence of the reporting systems to the TDI Protocol successive days a week up to the point where it hinders regular activities like work, school, family, … It is not clear if all primary treatment monitoring systems in the Flemish Community apply these rules. This is especially strange since for certain of them the category “once a week or less” exists. Furthermore the way the questions have been drawn up for the different systems (DARTS, Vlastrov, MEDAR, ARCADE and MPD extra module), could do expect that not the frequency of use of the primary drug but of drug use in general is being registered. For the DARTS system the categories “niets in het laatste jaar” and “minder dan eens per maand” have to be joined in one category “not used in past month / used occasionally”. A category “niet van toepassing” has been added, but it is not yet clear why. The categories of Vlastrov correspond to a large extent to those in the TDI Protocol, taking into account that “meermaals daags” and “dagelijks” will have to be joined in one category “daily” and the Vlastrov categories “Geen gebruik vorige maand” and “onregelmatig” have to be joined in one category “not used in past month / used occasionally”. For the reporting systems MEDAR and ARCADE all categories are the same as the ones in the TDI Protocol, except for the first category which has not been taken up in those systems. The reference period of 30 days is explicitly mentioned. The reporting system of Sentinelles Charleroi only provides for 3 categories: “quotidien”, “régulier” and “irrégulier”. With the explanation between brackets one can conclude that the 1st TDI category can be considered “irrégulier”, the 2nd and the 3rd one as “régulier” and the 4th one as “quotidien”. The reporting system of Sentinelles Charleroi can therefore not provide separate figures for TDI categories 2 and 3. The frequency has to be filled in for each substance (taken in the past or at present) but since the primary drug has to be indicated, it is not difficult to extract the data required for TDI purposes. For De Sleutel for each substance the number of days in the past 30 days has to be written down that the client used this substance. Since the primary drug has to be indicated the information can easily be deduced. Eurotox, IWSM and Addibru don’t provide information on this variable.
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18. Age at first use of primary drug
This information is correctly being collected by the reporting systems of DARTS, Vlastrov, MPD extra module, ARCADE, MEDAR, Eurotox and IWSM. Furthermore for the MPD extra module system it is indicated that if the primary drug is alcohol the age at first use should not be registered. In the systems of De Sleutel and Sentinelles Charleroi the age at first use has to be indicated for all substances that have been used in the past or that are being used at present. Since the primary drug has to be indicated the information can easily be deduced. Addibru doesn’t provide information on this variable. ASL has included an item called “Alter der Ersteinnahme”. The name of this item and also the results described in the ASL report do not give the impression that this is asked for the primary drug. When this question is meant to question the age of first use of any illegal drug, the results do not provide the information that is requested by the TDI Protocol.
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19. Other (=secondary) drugs currently used
1. Opiates (total)
11. Heroin 12. Methadone 13. Other opiates
2. Cocaine (total)
21. Cocaine 22. Crack
3. Stimulants (total)
31. Amphetamines 32. MDMA and other derivates 33. Other stimulants
4. Hypnotics and sedatives (total)
41. Barbiturates 42. Benzodiazepines 43. Others
5. Hallucinogens (total)
51. LSD 52. Others
6. Volatile inhalants 7. Cannabis (total) 8. Alcohol as a secondary drug (total) 9. Other substances (total)
For this item all elements have been described under the heading “primary drug” since primary and secondary drugs have been discussed there together.
20. Ever injected / currently (last 30 days) injecting
1. Ever injected, but not currently 2. Currently injecting 3. Never injected 4. Not known
As has been mentioned in the TDI Protocol, this question accounts for the injection of all drugs and not only of the primary drug. The period of reference for currently injecting is the last 30 days. Injection for medical purposes (e.g. diabetes) should not be included. The reporting systems of Addibru, Eurotox and IWSM collect this information in almost the exact way that the TDI Protocol is requesting. Eurotox further explains on its registration form that this question deals with at least one consumption through 92
Chapter 7: Congruence of the reporting systems to the TDI Protocol injection for non medical reasons, no matter which substance, with or without sharing and carried out under optimal or non optimal circumstances. Addibru has included an extra category “sans objet”. It is not clear why this category has been added. Although this question has been presented in the TDI Protocol as one item with 4 answer categories, the reporting systems DARTS, Vlastrov, MPD extra module and MEDAR have chosen to divide this item into two questions: one on “ever injected” and one on “currently injecting”. For all those systems it is stated that this question does not apply for alcohol, that injection for medical purposes should be excluded and that for currently injecting a reference period of 30 days has to be taken into account. In the system of De Sleutel the question is also divided into two separate questions. For the second question on the past 30 days the registrar has to fill in the number of days that the client has been injecting and not merely ‘yes’ or ‘no’. This can however easily be converted. The reporting systems of De Sleutel and ASL don’t have the possibility “not known”. In the reporting system of Sentinelles Charleroi the route of administration has to be indicated for all substances that the client has ever taken in his life or is taking at the moment. For the substances alcohol, Hasj, LSD, XTC and volatile inhalants this is not necessary. For each drug that has been indicated (a drug that has been taken in the past or that is being taken at the moment) it should be registered if this drug has ever been administered by IV injection. Secondly for each drug it has to be indicated how this drug is being used: IV injection, Non IV or mixte. This approach is somewhat different from the other reporting systems. Based on the global drug consumption table the same information can be obtained on “ever injected” and “actually injecting”. However the TDI Protocol demands information on injecting behaviour while the Sentinelles Charleroi reporting system provides solely information on IV injecting behaviour. The question on injecting behaviour in the reporting system of ASL cannot be converted to the information requested by the TDI Protocol. In the registration form, the question “Hat der Klient jemals gespritzt?” with answer categories “Gelegentlich”, “Häufig” and “Nie”. This question can only provide information if the client has ever injected in his life but not on the situation of the past 30 days. The reporting system of ARCADE has included a very vague question, being: “Is er sprake van risico-gedrag?” with answer categories “ja” and “neen”. It is not really clear if this question merely refers to injecting behaviour or for example rather to needle sharing.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol 7.8.4
Conclusion
In the TDI Protocol a list of variables and corresponding answer categories have been taken up. These variables and categories should be considered as minimal requirements. Countries are free to add as many variables or categories as desired for own national purposes but should be capable to present data to the EMCDDA in the format that can be found in the TDI Protocol. Regarding the congruence of the variables present in the various reporting systems to each other and to the TDI Protocol the following conclusions can be made: Some variables are not collected at all by certain registration systems, in particular “Date of treatment” by ASL, “Previously treated” by Vlastrov, “Source of referral” by ASL; “Living status” by DARTS, De Sleutel (EuropASI), Vlastrov, MPD extra module, ARCADE, MEDAR, Sentinelles Charleroi & ASL; “Labour status” by Vlastrov, Eurotox & Sentinelles Charleroi; “Substitution treatment” by De Sleutel (EuropASI), Addibru, LWSM & Eurotox; “Route of administration” by Addibru, LWSM & Eurotox; “Frequency of use” by Addibru, LWSM & Eurotox; “Age at first use” by Addibru. Other variables in the TDI Protocol are being collected by the different systems but have another connotation or perspective. Within this respect the most striking is the variable ‘previously treated’. Although the TDI Protocol clearly is interested to know how many clients are being treated for the first time in their life for drug problems, a number of registration systems (DARTS, MPD extra module) provides information on the fact if the client has been ever treated in the same centre where they are being treated now (and not across all centres). For ASL the question has been correctly formulated but the report is contradictive on this matter. For the systems of MEDAR and ARCADE the scope of this question is extended to mental health problems, and is not restricted to drug problems. For Sentinelles Charleroi one could call in question if the lifetime perspective is sufficiently emphasized. For some questions it is sometimes unclear if the way they have been formulated really collect the information that is expected according to the TDI Protocol. In some cases the exact variable as requested by the TDI Protocol is not present but a similar variable has been included (for example not “labour status” is being collected but “sources of income”). It is not clear if this information is used for TDI purposes and if the information resulting from these variables is comparable to the variable that should have been collected. In some cases the structure on which the information is being collected is not the same as the one proposed in the TDI Protocol. For example with regard to the variable “nationality” several systems have included an open question instead of a question with categories. In general this has limited consequences.
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Chapter 7: Congruence of the reporting systems to the TDI Protocol Some registration systems are using a registration form where several variables have been developed with a huge number of answer possibilities (sometimes over hundred possibilities). In most cases these answer categories have been classified according to a hierarchical structure with 2 or more levels. Practitioners have the freedom to indicate one of the main categories or to indicate the appropriate subcategory. This is in accordance with the spirit of the TDI Protocol if this information can be correctly transferred to the categories of the TDI Protocol variables. Sometimes this can be seriously doubted since in some registration systems, some of the answer categories in the Protocol are hidden behind another main category. If registrars decide (or guidelines per individual treatment centre) to register only on the level of the main categories important information can get lost. It is a pity that at least the main categories for some variables are not the same as in the Protocol. One example in this regard is the variable “primary drug” where several registration systems (DARTS, MPD extra module, ARCADE, MEDAR and Addibru) have chosen to take up cocaine as a subcategory of stimulants Another conclusion is the fact that the categories provided by the different registration systems not always correspond completely to the answer categories suggested by the TDI Protocol. In some cases the registration systems only foresee one answer category where the TDI Protocol foresees two categories for the same answer possibilities. Consequently the information cannot be transformed into the way requested by the Protocol. In other cases some TDI answer categories have not been taken up with the answer categories in the registration systems and are accordingly often hidden behind the category “other”, if existing or in another category that has been formulated in a broader way than the TDI Protocol. Besides the different variables and the corresponding answer categories, the TDI Protocol also sometimes provides extra guidelines for correct registration of certain variables. One of those guidelines is the inclusion of a certain period of reference. For some variables the TDI Protocol requests that the information would be collected for the situation 30 days before the start of treatment. This period of reference is not systematically mentioned in all registration systems. Sometimes no period of reference is mentioned at all, sometimes a much longer period is taken into account (for example the last three years). Another example is that for the variable “frequency of use” only the primary drug has to be taken into account, for “ever injecting/currently injecting” however all substances have to be taken into account. The different registration systems don’t apply uniform rules regarding the presence of the answer categories “unknown” and “other”. Sometimes these categories are present, sometimes they are not. This also could have consequences for the way certain variables are registered. For certain variables different methods exist to collect the information requested. Often the TDI Protocol doesn’t provide guidelines about the way this information should be collected, but on the other hand the method has consequences for the results obtained. For the determination of the “primary drug” for example registrars can
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Chapter 7: Congruence of the reporting systems to the TDI Protocol chose the primary drug themselves, they can appeal to a certain diagnostic instrument or they can ask the client. No arrangements or uniformity exist between the procedures of individual registrars and registration systems.
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Conclusions
CONCLUSIONS In 2000 the European “Joint PG – EMCDDA Treatment Demand Indicator (TDI) Protocol version 2.0.” has been developed in the framework of the EMCDDA. This protocol provides guidelines and a minimum set of variables to the various member states regarding the registration of drug users in treatment in order to establish and improve the possibility to compare the situation between countries. The TDI Protocol is based on the protocol on treatment demand registration that has been developed in 1994 within the Pompidou Group of the Council of Europe. As opposed to this protocol, the “Joint PG – EMCDDA TDI Protocol” has been developed for treatment demand registration at national level, while the former protocol was rather city-based. All member states are expected to collect the treatment demand data according to this protocol and to provide those figures on a regular basis to the EMCDDA through the national REITOX Focal Points. For Belgium the national Focal Point is situated in the Epidemiology Unit of the Scientific Institute of Public Health. Due to the specific Belgian situation four Sub-Focal Points have been designated: the VAD for the Flemish Community, Eurotox for the French Community, CTB/ODB for Brussels Capital Region and ASL for the German-speaking Community. The Sub-Focal Points are expected to group together the data for their respective Community or Region. In Belgium no national treatment reporting system exists. However, a number of smaller treatment reporting systems exist, often with already a long history. 11 primary treatment monitoring systems can be distinguished: Sentinelle Charleroi, ADDIBRU, MEDAR/ARCADE, DARTS, MPD, MPD extra module and the reporting systems of Eurotox, IWSM, VLASTROV, De Sleutel and ASL. To be complete we would also like to mention the Minimal Clinical Data (MCD); the “Minimale Klinische Gegevens (MKG)”/ “Résumé Clinique Minimum (RCM)”. The MCD are data that are registered through a reporting system that is applied in general hospitals. The registration of the MCD is compulsory for all general hospitals through the Royal Decree of 6 December 1994. The MCD consists of a set of data that is registered among all patients who stay in a general hospital. In that way the MCD can be considered as a non-specialized monitoring system. We want to mention these data since on the basis of the ICD-9-CM diagnosis code, drug problems can be detected. The MCD were not discussed earlier, since the persons registered through this system, in first instance, not really seek help for their drug problems, but are rather treated for the consequences of their drug problems. In addition the MCD and drug problems are often mentioned as secondary diagnosis. If one wishes to examine whether or not this specific Belgian situation regarding the registration of drug users with its different reporting systems, meets the criteria and guidelines of the European TDI Protocol, the tendency exists to only look into the various variables. However, the TDI Protocol is much more than these twenty variables. The guidelines and rules regarding case selection are just as important, if not more important and this is often not sufficiently acknowledged.
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Conclusions A first important issue regards the types of treatment centres participating in the registration activities. Especially since with this kind of monitoring activity the number and the type of treatment centres that participate determine to a large extent the results that will be obtained. The presence, absence, under or overrepresentation of certain types of centres causes a bias. Since no national reporting system exists in Belgium, people who need figures on drug users in treatment make use of the figures provided by the four Sub-Focal Points, that are theoretically representative of the different geographical parts of Belgium. Prudence is however called for since these four data providers consist of two primary and two umbrella treatment reporting systems. The types of treatment centres participating in those reporting systems are not the same. While Addibru focuses on the specialised substance abuse treatment centres with RIZIV/INAMI convention, the umbrella systems of VAD and Eurotox also include treatment centres in the field of the more general mental health care. ASL finally completely takes up data from general services as no specialised services exist in the German-speaking Community. Second, the coverage of the reporting systems has to be looked into more closely, since not only the type of treatment centres determines to a large extent the results that will be obtained, also the number and the proportion of centres belonging to a certain type of treatment facility. With regard to the number (the real coverage figures) of participating centres related to the total number of treatment centres present in a certain geographical area, the different reporting systems do not always use the same denominator. Psychiatric hospitals for example are taken up in both of the umbrella systems of the VAD and Eurotox but the coverage is higher in that of the VAD. Not only the external coverage but also the internal coverage is an important issue: is every client, who meets the inclusion criteria above and who is treated in one of the treatment centres that is expected to participate, registered? Until now, however, no such figures have been calculated for any of the reporting systems in Belgium. Related to this issue, the difficulties regarding case selection have to be mentioned. Especially due to the fact that a number of the reporting systems in Belgium where drug users in treatment are registered, are non-specialised systems, a correct selection of the cases in the database is crucial. Of particular interest here is without doubt the whole subject matter on alcohol as a primary drug. For Belgium as a whole no common decisions have been taken on this matter. Treatment demand data are a useful source of information to determine trends over time. Precondition is however that all aspects of the registration procedure remain stable, such as the number and types of participating centres, the definition of variables, the training of the professionals regarding the registration, etc. In a large number of the reporting systems a lot of changes occurred over the years: the participating centres change, the number and definitions of variables have changed, the co-ordinating organisation changes, etc. This is a rather contradictory situation since although these changes occur to improve the reporting system and its congruence to the TDI Protocol, it also implies that the reporting system loses its
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Conclusions capacity to track changes. Most of the reporting systems mention these changes but present the data for the different years anyhow. TDI Protocol requires that data are collected on individual clients and that registrations belonging to the same client can be retrieved and that only the last treatment episode is retained. In Belgium it is not possible to provide a figure related to the number of clients in treatment since no unique identifier exists for the whole country. There is a large diversity across the various reporting systems regarding this issue. Some treatment centres already perform this exercise within their centre before sending the data to the co-ordinating organisation; some reporting systems have a unique code while others have not; etc. Besides the fact that the figures provided do not reflect the number of unique clients, due to this first operation taking place in the centres, the figures that are provided do not reflect the total number of registrations either since a number of them are already filtered out. Finally with regard to the variables and the corresponding categories the Protocol is partly followed but still differences of all kinds can be observed: -
-
-
-
-
Some variables are not collected at all by certain systems; Other variables in the TDI Protocol are collected by the different systems but have another connotation or perspective; For some questions it is unclear if the way they have been formulated really collects the information that is expected to be collected according to the TDI Protocol; If the exact variable as requested by the TDI Protocol is not present but a similar variable is included, it is not clear whether this information is used for TDI purposes and whether the information resulting from these variables is comparable to the variable that should have been collected; In some cases the presentation mode is not the same as the one proposed in the TDI Protocol; Some systems use answer categories that have been classified according to a hierarchical structure with 2 or more levels; Another conclusion is that the categories provided by the different reporting systems not always correspond completely to the answer categories suggested by the TDI Protocol; Besides the different variables and the corresponding answer categories, the TDI Protocol also sometimes provides extra guidelines for correct registration of certain variables. These are not always followed. The different reporting systems do not apply uniform rules regarding the presence of the answer categories “unknown” and “other”; For certain variables different methods exist to collect the information requested; no uniform method has been chosen by the different reporting systems.
Despite the presence of these different reporting systems, at present no national figures on the number and characteristics of people treated for drug problems in Belgium exist. The methodological differences between them make it impossible and
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Conclusions irresponsible to pool the data together into national figures since the validity and the reliability of the data cannot be checked. Although most of the reporting systems have already made many efforts to increase their congruence to the TDI Protocol and to each other, these efforts often stay limited to the twenty variables and accompanying answer categories mentioned in the Protocol and forget the more fundamental decisions on which agreement has to be reached in order to establish congruence with the Protocol.
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Recommendations
RECOMMENDATIONS Below a number of suggestions and recommendations for further action are proposed in order to stimulate the discussion and to gradually move forward in the direction of valid and reliable national figures on drug users in treatment, that are in congruence with the TDI Protocol. With regard to the discussion on the types of treatment centres that, according to the guidelines in the TDI Protocol, should participate in the registration activities, it would be particularly useful to elaborate a common classification structure for drug treatment in Belgium, accepted by all parties concerned. This common classification structure could then serve as a starting point to establish a detailed inventory, accompanied by information on the ‘registration status’ of the respective treatment centres. At the same time it is important that a discussion takes place on a national level regarding the types of treatment centres to be included in the TDI registration. Only when such an analysis has been made, conclusions can be drawn regarding the external coverage of the registration activities on drug users in treatment in Belgium. This is crucial since the participating types of treatment centres and their proportion within the total number of participating centres determine to a large extent the results that will be obtained. The different steps in this process could be: 1. Agree on the ‘unit of analysis’, 2. Compose an inventory of all existing facilities in Belgium that can possibly treat persons with drug problems; 3. Classify and arrange this list into different types of treatment centres; 4. Formally appoint responsible organisations or persons in order to make sure that this list can be a point of reference for Belgium and is up to date at any time; 5. Clearly agree with all partners involved what types of treatment centres should participate; 6. Coverage percentages should be calculated per type of treatment centre; 7. If possible provide more qualitative information on differences between “centre-level” coverage and “client-level” coverage. In order to limit the extent to which changes regarding coverage are the direct cause for increases and drops with regard to the number of registrations / unique clients or with regard to certain variables related to client characteristics, efforts should be made to keep the number of participating treatment centres, the proportion distribution between types of centres and the definition and answer categories of variables as stable as possible. When changes are required, preference should be given to one well-considered systematic global revision as opposed to regular smaller changes or additions.
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Recommendations Furthermore, a detailed description of all inclusion criteria and recoding or selection activities applied with regard to case selection is required at all levels. Answers on all guidelines in the TDI Protocol mentioned above should be examined. An important aspect regarding case selection is without doubt the whole subject matter of alcohol as a primary drug. After discussion, joint decisions need to be taken regarding this matter. Also the ‘internal coverage’ needs to be addressed: is every client, who meets the inclusion criteria above and who is treated in one of the treatment centres that is expected to participate, registered? The internal coverage should be calculated at the level of the centre and has to be calculated with the total number of “eligible” clients as denominator (and not the total number of clients in the treatment centre). In order to create clarity with regard to the status of one single record in the databases and to follow the guidelines of the TDI Protocol on this matter, efforts should be increased to develop a common unique identifier for Belgium. In order to establish such an identifier, the Belgian law on the protection of private life has to be respected and a detailed dossier should be submitted. Furthermore the introduction of a common unique identifier is pointless if all reporting systems in Belgium cannot be merged together in order to trace the multiple countings and eliminate them. With regard to the variables and the corresponding categories included, the general observations, described in this report, should be further examined in order to take clear decisions on certain matters.
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Bibliography Vandenbussche, E. & Wydoodt, J.-P. (2000b). Vlaamse Registratie Middelengebruik. Registratiegegevens 1998. Bijlagen. Brussel: VAD. Vandenbussche, E. (2000). VRM. Vlaamse Registratie Middelengebruik. Registratiegegevens 1999. Brussel: VAD. Vanderplasschen, W., Lievens, K. & Broekaert, E. (2001). De instroom in de Oost-Vlaamse drughulpverlening: Registratie van aanmeldingen en intakes tussen februari 1999 en mei 2000. Orthopedagogische Reeks Gent, Nr. 13, Gent: VZW OOBC. Vanderplasschen, W., Mostiens, B., Claeys, P., Raes, V. & van Bouchaute, J. (2001). Conceptnota organisatiemodel zorgcircuit middelenmisbruik. Orthopedagogische Reeks Gent, Nr. 12, Gent: VZW OOBC. Vanderveken, M., Meremans, Ph. & Candeur, M. (2003). Programme Addibru (version 2002.04). Manuel d’utilisation. Bruxelles: CTB/ODB. Vast Secretariaat voor het Preventiebeleid (VSP). (2003). De veiligheidspreventiecontracten. Brussel: VSP. Available on: http://vspp.fgov.be/n/cpsn.htm
en
Werthen, S. & van Heeringen, K. (1999). Geestelijke Gezondheid in Vlaanderen: onderzoek naar de verzameling van informatie. Universiteit Gent: Eenheid voor Zelfmoordonderzoek. Wiessing, L., Hartnoll, R. & Rossi, C. (2001). Epidemiology of drug use at macro level: indicators, models and policy-making. In: EMCDDA (2001). Modelling drug use: methods to quantify and understand hidden processes. Lisbon: EMCDDA.
107
Annex
ANNEX 1.
Registration forms used in primary treatment reporting systems 1) Arbeitsgemeinschaft für Suchtvorbeugung und Lebensbewältigung (ASL) 111 2) Sentinelle Charleroi, Cellule Recherche et Concertation
113
3) Eurotox
118
4) Institut Wallon pour la Santé Mentale
122
5) Minimal Psychiatric Data (extra module)
129
109
110
1) Arbeitsgemeinschaft für Suchtvorbeugung und Lebensbewältigung (ASL) Fragebogen zur Datenerfassung für BIRN (Belgian Information Reitox Network) Fragebogen nur ausfüllen wenn sichergestellt ist, dass nirgendwo anders im gleichen Jahr gleicher Fragebogen ausgefüllt wurde!
Laufende Nummer des Klienten und Institution 2001 Institution Wer füllt den Fragebogen aus 1a Klient 6 Sozialarbeiter/Betreuer 1b Sozialarbeiter + Klient
Häufigkeit der Einnahme der Hauptdroge: 1 gelegentlich 2 1x pro Woche oder weniger 3 2 –6 x pro Woche 4 täglich Art der Einnahme der Hauptdroge: 3 schlucken 2 rauchen 4 schnupfen 1 spritzen 5 inhalieren
Geschlecht des Klienten: F weiblich M männlich Alter des Klienten: Nationalität des Klienten:
1 2
Aktuelle Wohnsituation des Klienten 1 allein lebend 2 mit den Eltern/Stiefeltern 3 allein mit Kind 4 mit Partner/in 5 mit Partner/in + Kindern 6 Wohngemeinschaft
Schulische Ausbildung (jeweils beendet) 2 Primarschule 3a Mittelschule 3b Sekundarstufe 4 Universität/Hochschul e
Aktuell ist der Klient: 1 berufstätig 4a arbeitslos 3 krankgeschrieben/invalide 4b pensioniert 2 beschult Erstanfrage Therapie/Unterbringung/Betreuung in Bezug zur Lebensspanne: 1 Ja 2 Nein
Beschaffung: Inland Ausland
Hat der Klient jemals gespritzt 1 gelegentlich 2 häufig 3 nie einer
Drogenbedingte Infektionskrankheiten: 1 Hepatitis C 2 Hepatitis B 3 HIV
Alter der Ersteinnahme Benennung der Hauptdroge(n) maximal 3! Die Zahl 1 neben die Hauptdroge setzen, 2 Teilnahme an Methadonprogramm neben die zweithäufigste, 3 neben die 1 Ja dritthäufigste Droge und 4 neben die 2 nein vierthäufigste Droge ! 7 6 11 12
Cannabis Lösungsmittel Heroin Methadon
111
21 22 31 32 41 42 51 52 9 10
Kokain Crack Amphetamine (Aufputschmittel) Extasy (MDA,MDMA,MDEA) Barbiturate (Schlafmittel) Benzodiazepine (Beruhigungsmittel) LSD Pilze Andere Alkohol
112
2) Sentinelle Charleroi, Cellule Recherche et Concertation Talon à renvoyer à la C.D.9 avec le formulaire pour l’encodage Sentinelle
………………………………….………..
Code CED
|__|__|__|__|__|__|__|__|__|__|
Date de premier contact ___/___/_____
Premier contact avec l’individu dans l’année de l’enregistrement
Théoriquement, le délai de clôture de l’enquête est de 3 mois. Indiquez ici le moment réel où l’enquête a été terminée.
Date de clôture de l’enquête ___/___/_____
Formulaire incomplet ou non rempli en raison de ¨ Distraction de l’intervenant ¨ Refus de l’individu ¨ Circonstances de l’entretien ¨ Autre : ………………………. Réservé à l’encodeur : Date de réception du formulaire ___/___/_____ Numéros d’enregistrement |__|__|__|__|__|
"-------------------------------------------------------------------------------------------Talon à conserver par la sentinelle
Prénom No m
|__|……………………
Code CED
|__|__|__|__|__|__|__|__|__|__|
|__|……………………
Date de naissance ___/___/_____ Numéros de dossier |__|__|__|__|__|__|
"-------------------------------------------------------------------------------------------Talon à renvoyer au Comité d’Ethique et de Déontologie10 pour la codification Sentinelle
………………………………….………..
Prénom No m
|__| |__|
Date de naissance ___/___/_____ Numéros de dossier |__|__|__| Réservé à la personne chargée de codifier : Code CED |__|__|__|__|__|__|__|__|__|__|
9
COORDINATION DROGUE, I.GOELENS, 80 rue Tumelaire, 6000 CHARLEROI HOPITAL VINCENT VAN GOGH, R.GUILLAUME, 53, rue de l’Hôpital, 6030 MARCHIENNE-AU-PONT
10
113
Pour tous les items :
Age
-
Ne cochez aucune case, correspond à une donnée inconnue Cochez « autre » et ne rien spécifier équivaut à une donnée inconnue
|___|___|
Se x e ¨ Féminin ¨ Masculin
Nationalité ¨ Belge ¨ CEE : ………………………………. ¨ Hors CEE : …………………………
Pays d’origine
Si les parents sont d’origines différentes, prendre en compte l’origine paternelle
¨ Belgique ¨ CEE : ………………………………. ¨ Hors CEE : …………………………
á Si d’origine non belge, né en Belgique ¨ Non ¨ Oui
Lieu d’habitation : Commune : ………………………………… Il s’agit du lieu où vit l’individu, où il dort la nuit. Dans les cas où la personne vit en institution de type thérapeutique ou en prison, indiquez le lieu de vie précédant l’entrée en institution ou en prison
Niveau de scolarité
s Cochez le cycle scolaire achevé ¨ Aucun diplôme s notez en toute lettre la dernière année ¨ Enseignement primaire d’enseignement terminée ¨ Enseignement secondaire professionnel ¨ Enseignement secondaire technique ¨ Enseignement secondaire général ¨ Supérieur non universitaire ¨ Universitaire ¨ Enseignement spécial ¨ Autre : ………………………………………………………. Dernière année réussie : …………………………………….
Enfant(s) A des enfants (dont il est géniteur) ? ¨ Non ¨ Oui á Si oui (si a des enfants), vit avec eux ? ¨ Non ¨ Oui á Si non (si la personne ne vit pas avec ses enfants), a-t-elle des contacts avec eux ? ¨ Non ¨ Oui, occasionnellement (moins d’une fois par mois) ¨ Oui, régulièrement (plus d’une fois par mois)
114
s
Mode de vie
Les propositions peuvent être cumulées, si elles sont simultanées (ne pas répondre de manière historique).
¨ Vit seul s Ne pas inclure la situation des enfants qui fait partie ¨ Vit avec son (sa) conjoint(e) de l’item précédent. ¨ Vit avec son père ¨ Vit avec sa mère ¨ Vit avec les deux parents (famille d’origine) ¨ Vit avec les deux parents (famille reconstituée) ¨ Vit avec les beaux-parents (famille du conjoint) ¨ Vit avec un autre membre de la famille, à savoir : ……………………………… ¨ Vit en institution, maison d’accueil, etc.… ¨ Vit en prison ¨ Vit chez les copains ¨ Vit sans domicile fixe ¨ Autre :…………………………………………
Ressources financières officielles, légales
• La personne bénéficie-t-elle de ressources financières légales ? ¨ Non ¨ Oui
• Si oui, quelles sont-elles ?
2 propositions peuvent être cumulées.
¨ Activité professionnelle ¨ Incapacité de travail temporaire ¨ Allocations de chômage ¨ Allocations du CPAS (Minimex) ¨ Allocations d’invalidité (sous la Mutuelle depuis au moins un an) ¨ Allocations d’handicapé (par ex. Vierge Noire) ¨ Autre : …………………………..
Situation judiciaire : • Affaires judiciaires pénales en cours ¨ Non ¨ Oui
Il s’agit des éléments de toute la chaîne judiciaire : en partant du parquet jusque la « probation »
• Incarcération ¨ Non ¨ Oui
á Si oui, s Combien de fois la personne a-t-elle été incarcérée : |___|___| fois s A-t-elle été incarcérée dans les 6 derniers mois : ¨ Non ¨ Oui
Antécédents thérapeutiques : Cela correspond aux démarches relatives à l’usage de produits • Age de la première démarche auprès d’un service ou d’un intervenant (y compris un médecin généraliste) : |___|___| ans Démarche antérieure DISTINCTE et • A déjà eu un contact avec notre service : NON démarche passée qui continue ¨ Non ¨ Oui
• A déjà contacté un autre service ou un autre intervenant (y compris un médecin généraliste) : ¨ Non ¨ Oui
115
s s
Expression de la demande ¨ Sevrage
Il est possible de cocher au maximum 3 demandes. Situation actuelle et non historique.
Demande d’arrêt de toute substance , de sevrage physique
¨ Méthadone ¨ Arrêt de la méthadone ¨ Prise en charge résidentielle ¨ Logement ¨ Aide socio-administrative
Demande de méthadone, quels que soient les objectifs d’arrêter à plus ou moins long terme l’héroïne
Prise en charge hospitalière, Séjour en centre d’hébergement pour usagers de drogues, Postcure,…
Demande d’écoute, de guidance, , de psychothérapie,…
¨ Soutien psychologique ¨ Soins médicaux ¨ Pas de demande spécifique
Soins relatifs aux pathologies somatiques annexes à la toxicomanie Aucune demande clairement exprimée mais l’individu se présente ou fréquente le service.
¨ Autre demande : ……………………………………………………………………………………
Demande subordonnée à une injonction : ¨ Non ¨ Oui
á Si oui, ¨ de type judiciaire ou policier ¨ de type familial ¨ autre :…………………………
Pourvoyeur
Au maximum 2 pourvoyeurs peuvent être mentionnés
¨ Venu de soi-même ¨ Un membre de la famille : …………………………………… ¨ Un service d’aide : …………………………………………… ¨ Une instance judiciaire : …………………………………….. ¨ Une instance policière : ……………………………………… ¨ Un professionnel de la santé : ………………………………. ¨ Autre :……………………………………………………………
Proposition formulée ¨ Initiation d’une prise en charge ¨ Initiation d’une prise en charge et référence ¨ Continuation d’une prise en charge ¨ Continuation d’une prise en charge et référence ¨ Référence ¨ Sans suite
Suite à l’analyse de la demande par l’intervenant, une proposition peut être formulée. C’est cette proposition qui est enregistrée. Cette proposition pourra être effective ou pas : cela n’est pas l’objet de l’enquête.
Dans les cas de référence (avec ou sans prise en charge), quel est le référent ? ¨ Hôpital : ………………………………………… ¨ Médecin généraliste ¨ Service d’aide ambulatoire : …………………. ¨ Service d’aide résidentiel : ……………………
2 référents peuvent être mentionnés.
¨ Autre : …………………………………… 116
produit Princi pal
Consommation
Rythme de
Age
Mode de consommation
Prescrip
consommation
de la 1ère consomm ation
A dé jà e u recours à l’injection pa r le PASSÉ ?
A recours à l’injection
tion
IV
IV
Tableau des consommations de produits Actu Pas elle sée
Réguli Irré er gu lier
Auc une
Non IV
¨
Alcool (« cuite », défonce)
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
Hasch
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
Héroïne
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
¨
¨
¨
¨
¨
¨
¨
Méthadone
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
¨
¨
¨
¨
¨
¨
¨
Cocaïne
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
¨
¨
¨
¨
¨
Médicaments psychotropes 1…………………
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
¨
¨
¨
¨
¨
¨
2…………………
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
¨
¨
¨
¨
¨
¨
3…………………
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
¨
¨
¨
¨
¨
¨
¨
LSD (acide, buvard)
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
XTC
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
Speed
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
¨
¨
¨
¨
¨
¨
¨
Solvants (colle, éther, rush)
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
Autre :…………………
¨
¨
¨
|__|__|__|
¨
¨
¨
|__|__| ans
¨
¨
¨
¨
¨
¨
¨
Régulier = cycle répété : 1 ou 2 fois par semaine, par mois,…
(shoo t, fix)
Non IV
?
Mixt e
Passée signifie que l ‘usager a stoppé la consommation depuis au moins un mois.
Arrêt depuis (en mois)
Quoti dien
psychotropes
ACTUELLEMENT
Oui
Non
Irrégulier = Occasionnel, expérimental Si consommation passée, considérez le rythme ou la prescription passée. Si plusieurs périodes de consommations passées, considérez la période la plus récente. Si consommation actuelle, considérez le rythme ou la prescription actuelle.
117
3) Eurotox
118
3.
DATE D’ADMISSION ACTUELLE:
4.
DATE DE NAISSANCE :
5.
- - / - - / - - - - (jj / mm/ aaaa)
1 2 9
- - / - - / - - - - (jj/mm/aaaa)
SEXE masculin féminin inconnu
1.
INSTITUTION :
2.
6.
NATIONALITE
7.
1 3
belge hors UE
2 9
UE non belge inconnu
UNITE : RESIDENCE
(inconnu = 9999)
Pour la Belgique, indiquer le code postal. Pour les pays hors Belgique, inscrire l’indicatif téléphonique. (Ex.: France=33,Luxembourg=352,Pays-Bas=31, etc.)
8.
9.
COHABITATION
LOGEMENT
10.
NIVEAU DE SCOLARITE
11.
(diplôme obtenu) 1 3 4 6 7 8 9
1 2 3 4 5 6 8 9
vit seul vit avec parents vit en couple vit avec relations ou amis vit en institution autre (incl. prison) inconnu
(concernant
les
démarches
à l'usage de produits) 1 2 3 9
non, aucun oui, dans l'institution oui, ailleurs inconnu
15. ADRESSE PAR 1 2 3 4 5 6 7 8 9
propre initiative secteur santé non spécialisé secteur santé mentale secteur santé toxicomanie secteur social secteur justice entourage autre inconnu
20. NOMBRE D’ENFANT(S)
16. PRODUIT PRINCIPAL
1 2 3 4 5 6 9
néant primaire secondaire inférieur secondaire supérieur supérieur non universitaire supérieur universitaire inconnu
17. PRODUIT(S) SECONDAIRE(S)
Héroïne Opiacés substitutifs Autres opiacés Cocaïne (incl., crack) Amphétamines MDMA (XTC) et dérivés Benzodiazépines ‘Rohypnol’ Autres hypnotiques/sédatifs Hallucinogènes Inhalants volatiles Cannabis Alcool Autres substances psychotropes Jeux, pari Aucun ou sans objet inconnu
22.
AGE DU 1ER USAGE DU PRODUIT PRINCIPAL
enfant(s)
11 16 18 21 22 24 32 33 38 40 50 60 70 80 85 95 99
Héroïne Opiacés substitutifs Autres opiacés Cocaïne (incl., crack) Amphétamines MDMA (XTC) et dérivés Benzodiazépines ‘Rohypnol’ Autres hypnotiques/sédatifs Hallucinogènes Inhalants volatiles Cannabis Alcool Autres substances psychotropes Jeux, pari Aucun ou sans objet inconnu
24. STATUT SEROLOGIQUE HIV · Statut sérologique
ans
rapporté par le patient
21. VIT AVEC DES ENFANTS 1 2 9
oui non inconnu
23.
1 2 3
MODE DE CONSOMMATION DU PRODUIT PRINCIPAL injecte fume/ inhale boit/ mange
4 5 9
sniffe autre inconnu
sans 6 travail régulier 7 travail occasionnel 8 conjoint, partenaire 88 famille, parents 9 chômage
CPAS mutuelle handicap autre inconnu
13. EXPERIENCE
JUGE OU PARQUET
DE PRISON
1 2 9
1 2 9
oui non inconnu
18. COMPORTEMENT D'INJECTION
19. SUITE PREVUE
1 2 3 4
sans objet jamais oui, mais plus actuellement oui, encore actuellement
1 2 3 8 9
9
inconnu
oui non inconnu
(max. 3)
relatives 11 16 18 21 22 24 32 33 38 40 50 60 70 80 85 95 99
1 21 22 3 4 5
12. ENTENDU PAR
PRENOM : oooooooooooooooooooo
14. TRAITEMENT ANTERIEUR
sans (instable) logement propre (stable) logement famille (stable) logement amis (stable) institution (stable) prison (instable) autre (instable) inconnu
SOURCE PRINCIPALE DE REVENUS (ressources légales)
basé sur un test de laboratoire
Date du dernier test : _ _ / _ _ / _ _ _ 24.a) testé : oui ( Si oui, indiquer le résultat :) résultat positif résultat négatif résultat inconnu non
non – information dans l’institution orientation extérieure autre inconnu
(= au cours des 30 derniers jours)
25.
STATUT SEROLOGIQUE HBV
· Statut sérologique rapporté par le patient basé sur un test de laboratoire
Date du dernier test : _ _ / _ _ / _ _ _ _ 25.a) vacciné oui Ø passer à la question 26 non 25.b) testé : oui ( Si oui, indiquer le résultat :) résultat positif résultat négatif résultat inconnu non
26.
STATUT SEROLOGIQUE HCV
· Statut sérologique rapporté par le patien
basé sur un test de
laboratoire · Date du dernier test : _ _ / _ _ / _ _ _ _ 26.a) testé : oui ( Si oui, indiquer le résultat :) résultat positif résultat négatif résultat inconnu non 26.b) stade actuel de la maladie : aigu chronique guéri
NOM :oooooooooooooooooooo
Avis important! Pour chaque question, des instructions sont disponibles au verso de cette fiche. Veuillez les consulter s.v.p.
inconnu
119
Instructions d’encodage de la fiche Eurotox Quand utiliser un formulaire ? Cette fiche sera complétée chaque fois qu'une personne débute un traitement auprès d’un dispositif de traitement pour un problème lié à son usage de drogue. Par personne qui débute un traitement, on entend toute personne qui le fait pour la première fois dans sa vie ou non. Dans ce dernier cas, la période d’interruption entre le dernier épisode et le nouvel épisode de traitement est de 6 mois.
NB : Certaines institutions souhaitent aussi enregistrer les demandes de prise en charge non suivie par un traitement : dans ce cas, la variable ’19. Suite prévue’ permettra de faire la distinction entre une prise en charge effective (modalités 2 ou 3) et une demande sans suite ( 1).
Comment répondre aux questions ? Il vous est demandé de cocher une seule réponse par variable, excepté pour la variable 17 ‘produits secondaires’ où trois réponses maximum sont possibles ainsi que pour la variable 23 ‘mode de consommation’ où plusieurs réponses sont possibles. À défaut de pouvoir répondre, cochez la case correspondant au code 9 ou 99 ( ‘inconnu’).
Sur quelle période portent les questions ? La grande majorité des questions se rapportent à la démarche actuelle ou à la situation qui prévaut au moment de l'entretien (par exemple ‘âge’, ‘résidence’, ‘logement’) ou dans une période de 30 jours antérieure à l'entretien (‘comportement d'injection’). Certaines questions portent sur l'entièreté du passé du patient : par exemple ‘traitement antérieur’,’entendu par un juge ou un parquet’, ‘incarcération’.
Quand renvoyer les formulaires ? Les intervenants utilisant la fiche papier Eurotox renverront leurs données à Eurotox au fur et à mesure (1fois par mois) de la période d’enregistrement et au plus tard 1 mois après la fin de la période d’enregistrement, soit pour le 31 janvier de l’année suivant l’année d’enregistrement. Les intervenants utilisant le logiciel ADDIBRU renverront leurs données encodées à Eurotox (par mail ou sur disquette) au plus tard 3 mois après la fin de la période d’enregistrement, soit pour le 31 mars de l’année suivant l’année d’enregistrement.
VARIABLES Remarque préliminaire : les champs des Nom et Prénom sont principalement destinés à l’encodage au niveau de l’institution elle-même pour les intervenants utilisant le logiciel informatique Addibru. Ces données n’apparaissent que sur la fiche destinée à être conservée par l’institution et ne figurent pas sur le second feuillet de la fiche. Ces données sont privées et ne peuvent donc en aucun cas être transmises à l’Unité d’Observation.
1. Institution : inscrire le nom de l’institution. 2. Unité : inscrire le type de l’unité qui enregistre les cas. Choisissez parmi les types suivants : [Résidentiel:] communauté thérapeutique/centre de post-cure - centre de crise - hôpital général ; hôpital psychiatrique [Ambulatoire:] hôpital de jour/ centre de réadaptation fonctionnelle de jour- centre de santé mentale - autre centre ambulatoire [Bas-Seuil :] MASS ou antenne - Comptoir d’échange [Médecin généraliste] [Service en milieu carcéral ] [Autre] ( SPECIFIER le type s.v.p.)
3. Date d’admission actuelle : il s’agit de la date du premier entretien : jour (jj), mois (mm) et année (aaaa). 4.
Date de naissance : indiquer le jour (jj), le mois (mm) et l’année de naissance (aaaa).
5.
Sexe : cocher 1 pour masculin et 2 pour féminin.
6.
Nationalité : il s’agit de la nationalité et non de l’origine ethnique du patient. En cas de double nationalité, cocher belge si la nationalité est belge et autre UE/ hors UE. (UE = Union européenne)
7. Résidence : inscrire le code postal de la commune où le patient ‘vit’, même s'il squatte un logement ou séjourne sans-abri. Cela n'est pas nécessairement le domicile légal (qui est inscrit sur la carte identité). Pour les pays en dehors de la Belgique, inscrire l’indicatif téléphonique du pays (ex.:France=33, Luxembourg=352).
120
8. Cohabitation : répond à la question «avec qui vit le patient ? ». Les enfants n’entrent pas en ligne de compte pour cette question. 9. Logement : se rapporte au caractère stable du lieu de vie ou du logement où vit actuellement le patient. Le caractère stable est indiqué entre parenthèses en regard de la modalité. La modalité « sans » comprend les cas suivants : la personne vit chez des amis, dans la rue, en abri de nuit, etc., mais de manière instable. 10. Niveau de scolarité : correspond au diplôme le plus élevé obtenu quelles que soient les études en cours actuellement. 11. Source principale de revenus : la question concerne les revenus ‘légaux’. Les revenus ‘illégaux’ (ex. : travail au noir, deal) ne sont pas considérés ici. Rappel : une seule réponse possible ! 12. Entendu par un juge ou un parquet : s'applique à toute présentation devant un juge d'instruction ou un substitut pour une affaire de drogue au moins une fois dans le passé. On inclura les situations dans lesquelles, bien que l’audition n’ait pas encore eu lieu, la date d'audition a été effectivement fixée. 13. Expérience de prison : se rapporte à toute incarcération dans un établissement pénitentiaire quel qu'en ait été la durée ou le type (préventive ou pénale). 14. Traitement antérieur : correspond à tout traitement pour usage de drogue antérieur à la demande actuelle de prise en charge, que ce soit dans la même institution ou dans une autre institution. 15. Adressé par : correspond à la personne ou à l'instance qui a envoyé le patient à la consultation. 16. Produit principal : le produit principal est celui cité par le patient comme lui posant actuellement le plus de problème et ‘à l’origine’ de la consultation. Il ne s'agit pas nécessairement d'une consommation au cours du dernier mois. Remarque sur les ‘Opiacés substitutifs’ : Cette catégorie correspond au patient qui a un problème avec le traitement de substitution (par exemple qui voudrait arrêter la substitution) ou celui qui utilise ces produits en dehors d’une prescription médicale. Pour le patient sous substitution sans problème lié à ce traitement de substitution mais qui néanmoins entame une prise en charge (par exemple psychothérapeutique), le produit initial sera mentionné (par exemple ‘héroïne’). 17. Produits secondaires: permet le cas échéant d'enregistrer au maximum trois autres produits utilisés au cours du dernier mois. Il ne s'agit pas d'enregistrer toutes les drogues consommées mais seulement celle(s) que le patient ou la personne chargée de l'entretien considère comme jouant un rôle important dans la toxicomanie du patient. 18. Comportement d'injection : correspond à au moins une administration par injection pratiquée à des fins non médicales, peu importe la drogue injectée, avec ou sans partage, effectuée dans des conditions optimales ou non. Si le patient ne s'est pas injecté au cours des 30 derniers jours, mais s'est déjà injecté au moins une fois avant cela, choisissez la réponse ‘oui, mais plus actuellement’. 19. Suite prévue : concerne la conclusion donnée à l'issue du premier (ou deuxième, c’est selon) entretien. ‘Non-information’ signifie que rien n'est prévu pour la suite quelle qu'en soit la raison ou que seulement de l'information a été transmise. 20. Nombre d'enfants : inscrire le nombre d'enfants (y compris les enfants légalement adoptés). 21. Vit avec enfants : répond la question « le patient vit-il avec des enfants ? », que ce soient ses propres enfants ou les enfants de son conjoint. 22. Âge du premier usage du produit principal : inscrire l'âge auquel le patient a consommé pour la première fois le produit enregistré comme produit principal. 23. Mode de consommation du produit principal : il s’agit de la voie d’administration la plus habituelle en lien avec le produit principal. Si cela s’avère nécessaire, plusieurs réponses sont possibles.
24-26. Statuts sérologiques HIV, HBV, HCV La collecte de cette information est optionnelle. Néanmoins, chaque centre doit décider au départ si cette information sera collectée systématiquement ou pas. L’information rapportée par le patient est considérée comme valable pour toutes ces variables. La date du dernier test doit toujours être indiquée. Concernant l’hépatite B, si le patient a été vacciné (25.a = oui), ignorer les sous-questions suivantes et passer directement à la question 26. Concernant l’hépatite B et l’hépatite C, si on se base sur un test de laboratoire pour répondre aux questions 25.c) et 26.b), le stade actuel de la maladie correspond à la présence d’antigènes (Ag) et/ ou d’anticorps (Ac) suivants : aigu = Ag HBs ; chronique = Ag HBs + Ac HBc ; guéri = Ac HBs + Ac HBc.
N’oubliez pas s.v.p. de nous renvoyer la copie anonyme de cette fiche et d’en conserver l’original dans le dossier du patient. Merci.
121
4) Institut Wallon pour la Santé Mentale (IWSM) Fiche d’enregistrement de données à caractère épidémiologique pour la population consultant les services de santé mentale en Wallonie FICHE « ADULTES » (18 ANS ET +) (une fiche par dossier concernant toute nouvelle demande)
1. SSM n°
££££ + £
4. Dossier n° ££££££££
+ £ (mission spéc.)
Les données épidémiologiques suivantes seront transférées à partir du « rapport d’activités ». 2. Equipe 3. Année d’enregistrement 5. Réactivé 6. Type de dossier 7. Né(e) en 8. Sexe 9. Domicile 17. Nature de la démarche 18. Origine de la démarche. 10. Etat civil £ 1 célibataire 5 divorcé 2 marié 6 veuf 3 séparé 8 inconnu 4 contrat de vie commune 11. Nationalité
£
1 belge 3
12. Langue maternelle
2
hors UE
autre UE 8 inconnu
£
1 français 2 néerlandais 3 allemand
5 italien 6 arabe 7 turc
4
8
anglais
inconnu 9 autre :………………….
13. Mode de vie ££ 14. Niveau de scolarité 10 seul A. Atteint ££ B.Dernière année réussie££ 20 familial 10 pas suivi d’enseignement 21 en couple 20 maternel 21-22-23 selon l’année réussie 22 partenaire + enfant(s) 30 primaire 31-32-33-34-35-36 selon l’année 23 avec les enfants 31 normal réussie 24 chez les enfants 32 spécial 25 chez les parents 40 secondaire 41-42-43-44-45-46-47 selon l’année 26 famille recomposée 41 général réussie 27 avec 1 autre membre de la famille 42 technique 29 autre :…………………… 43 professionnel 30 communautaire 44 spécial 49 certificat de qual. de l’ens. spécial 40 institution d’aide ou de soins 50 supérieur non universitaire 51-52-53-54 selon l’année réussie 50 sans domicile fixe 60 universitaire 61-62-63-64-65-+66 selon l’année 60 prison/défense sociale 70 promotion sociale réussie 80 inconnu 75 contrat d’apprentissage 71-72-73-74 selon l’année réussie 90 autre :……………………. 80 inconnu 90 autre :……………………… 15. Catégorie professionnelle 1 ouvrier 2 employé 3 cadre/directeur 4 profession libérale 5 indépendant 6 étudiant 7 sans profession 8 inconnu 9 autre :………………
£
19. Prises en charge antérieures
16. Source principale de revenus £ 1 propre activité professionnelle 2 allocations de chômage 3 (pré-)pension 4 allocations de handicap 5 allocations de maladie/invalidité 6 allocations du CPAS 7 sans revenu 8 inconnu 9 autre :…………………………
££££
+
££££
+
££££11
11
Sélectionner les codes parmi ceux du tableau général des types de professionnels et de services (cf. annexe du manuel d’utilisation ou la fiche jaune).
122
20. Demande du consultant
££
££ (+££)
21. Motifs présentés lors de la 1ère consultation
10
suivi 11 thérapie 12 rééducation 13 soutien 14 accompagnement social 19 autre :…………………. 20 bilan / expertise 30 inscription / réévaluation AWIPH 40 autres demandes 41 information 42 conseil / avis 43 orientation 44 attestation 45 prescription médicale 50 pas de demande précise 80 inconnu 90 autre :…………………………….. 22. Codes ICD 10: _ _ _ . _ _ intitulé __________________________ _ _ _ . _ _ intitulé __________________________ _ _ _ . __ intitulé __________________________ 23. Proposition(s) de prise en charge ££ 10 information/clarification + ££ 20 thérapie + ££ 21 individuelle 22 familiale 23 de couple 24 de groupe 30 accompagnement et soutien 31 individuel 32 familial 33 de couple 34 de groupe 40 accompagnement social 41 individuel 42 familial 43 de couple 44 de groupe 50 rééducation 60 bilan / expertise 70 traitement médicamenteux 80 pas de prise en charge immédiate 1
orientation vers££££ 82 liste d’attente 83 aucune proposition 89 autre :…………………………. 90 autre :…………………………… 81
1
10
problématique personnelle 11 plaintes et symptômes physiques 12 plaintes et symptômes psychiques 13 mal-être 14 acte(s) délictueux 19 autre :………………………………… 20 problématique relationnelle 21 difficultés ppales dans le couple 22 difficultés ppales dans le milieu familial 23 difficultés ppales dans le milieu social 24 difficultés ppales dans le milieu professionnel 25 difficultés ppales dans le milieu scolaire 29 autre :…………………………………. 30 sans motif 80 inconnu 90 autre :……………………………………
_ _ _ . _ _ intitulé _____________________________ _ _ _ . _ _ intitulé _____________________________ _ _ _ . _ _ intitulé _____________________________ 24. Réseau professionnel 1
££££ ££££ ££££ ££££ 25. Ressources ££ + ££ + ££ 10 personnelles 20 familiales 30 amis 40 entourage social 50 entourage professionnel 80 inconnu 90 autre :………………………….. 26. Variables à usage interne
£ £ £ £ ££ ££ A
B
C
D
E
F
££ ££ ££££ ££££ G
H
I
J
££££ ££££ K
L
voir note page précédente.
123
Fiche d’enregistrement de données à caractère épidémiologique pour la population consultant les services de santé mentale en Wallonie Fiche « enfants » (moins de 18 ans) (une fiche par dossier concernant toute nouvelle demande)
1. SSM n° ££££ + £
4. Dossier n° ££££££££ + £ (mission
spéc.)
Les données épidémiologiques suivantes seront transférées du « rapport d’activités ». 2. Equipe 3. Année d’enregistrement 5. Réactivé 6. Type de dossier 7. Né(e) en 8. Sexe 9. Domicile 17. Nature de la démarche 18. Origine de la démarche. 10.Nbre d’enfants dans le milieu familial 1 11. Nationalité
£
1 belge 3
13. Mode de vie
££
2 autre UE hors UE 8 inconnu
££+££
7 turc 8
inconnu :………...…………….
9 autre
14. Niveau de scolarité A. Atteint££ B. Dernière année réussie ££ 10 pas suivi d’enseignement 20 maternel 21-22-23 selon l’année réussie 30 primaire 31-32-33-34-35-36 selon l’année 31 normal réussie 32 spécial 40 secondaire 41-42-43-44-45-46-47 selon l’année 41 général réussie 42 technique 43 professionnel 44 spécial 49 certificat de qual. de l’ens.spécial 50 supérieur non universitaire 51-52-53-54 selon l’année réussie 60 universitaire 61-62-63-64-65-+66 selon l’année 70 enseig. et formation réussie en alternance (CEFA) 71-72-73-74 selon l’année réussie 75 contrat d’apprentissage 80 inconnu 90 autre :………………………
10
seul 20 familial 21 en couple 22 avec ses 2 parents 23 avec sa mère seule 24 avec son père seul 25 avec des parents adoptifs 26 famille recomposée 27 avec 1 autre membre de la famille 28 famille élargie 29 famille d’accueil 30 autre :…………………… 40 institution d’aide ou de soins 50 en internat scolaire 80 inconnu 90 autre :…………………….
15. A. Catég. professionnelle des parents
12. Langue maternelle £ 1 français 5 italien 2 néerlandais 6 arabe 3 allemand 4 anglais
12
££ 16.A. Source principale de revenus des parents 1 ££
H F OU 15.B. du jeune £
H F OU 16.B. du jeune £
1 ouvrier 2 employé 3 cadre/directeur 4 profession libérale 5 indépendant 6 étudiant 7 sans profession 8 inconnu 9 autre :………………
19. Prises en charge antérieures 13
1 propre activité professionnelle 2 allocations de chômage 3 (pré-)pension 4 allocations de handicap 5 allocations de maladie/invalidité 6 allocations du CPAS 7 sans revenu 8 inconnu 9 autre :…………………………
££££
+
££££
+
££££
12
Répondre en fonction du milieu de vie familial principal. Si « sans objet », coder « 0 ». Sélectionner les codes parmi ceux du tableau général des types de professionnels et de services (cf. annexe du manuel d’utilisation ou fiche jaune). 13
124
20. A. Demande ££ B. formulée par
£
1. consultant 2. adulte responsable 10
suivi 11 thérapie 12 rééducation 13 soutien 14 accompagnement social 19 autre :…………………. 20 bilan / expertise 30 inscription / réévaluation AWIPH 40 autres demandes 41 information 42 conseil / avis 43 orientation 44 attestation 45 prescription médicale 50 pas de demande précise 80 inconnu 90 autre :……………………………..
££ (+££)
21. Motifs présentés lors de la 1ère consultation 10
problématique personnelle 11 plaintes et symptômes physiques 12 plaintes et symptômes psychiques 13 mal-être 14 acte(s) délictueux 15 difficultés d’apprentissage 16 prob. de développement psychomoteur 17 prob. de langage 19 autre :………………………………… 20 problématique relationnelle 21 difficultés ppales dans le couple 22 difficultés ppales dans le milieu familial 23 difficultés ppales dans le milieu social 24 difficultés ppales dans le milieu professionnel 25 difficultés ppales dans le milieu scolaire 29 Autres :…………………………….. 30 sans motif 80 inconnu 90 autre :……………………………………
22. Evaluation diagnostique :
23. Proposition(s) de prise en charge 10 information/clarification + 20 thérapie + 21 individuelle 22 familiale 23 de couple 24 de groupe 30 accompagnement et soutien 31 individuel 32 familial 33 de couple 34 de groupe 40 accompagnement social 41 individuel 42 familial 43 de couple 44 de groupe 50 rééducation 51 logopédie 52 psychomotricité 60 bilan / expertise 70 traitement médicamenteux 80 pas de prise en charge immédiate 1
££ ££ ££
orientation vers££££ 82 aucune proposition 89 autre :…………………………. 90 autre :…………………………… 81
1
24. Réseau professionnel1
££££ ££££ ££££ ££££ 25. Ressources ££ + ££ + ££ 10 personnelles 20 familiales 30 amis et autres jeunes 40 autres adultes 80 inconnu 90 autre :………………………….. 26. Variables à usage interne
£ £ £ £ ££ ££ A
B
C
D
E
F
££ ££ ££££ ££££ G
H
I
J
££££ ££££ L
K
voir note 2 page précédente
125
ENREGISTREMENT DE DONNEES EPIDEMIOLOGIQUES SUR LES PRISES EN CHARGE D’USAGERS DE DROGUE EN COMMUNAUTE FRANCAISE EUROTOX Unité permanente d’observation sanitaire et sociale Alcool-Drogues de la Communauté française ADDENDUM A LA FICHE EPIDEMIOLOGIQUE DE L’IWSM (Instructions au verso) 27. Nombre d’enfants : ££ 28. Produit/Problème principal : ££ ££ ££ (max 3) 11. Héroïne 16. Opiacés substitutifs 18. Autres opiacés 21. Cocaïne (incl., crack) 22. Amphétamines 24. MDMA (XTC) et dérivés 32. Benzodiazépines 33. ‘Rohypnol’ 38. Autres hypnotiques/sédatifs 40. Hallucinogènes 50. Inhalants volatiles 60. Cannabis 70. Alcool 80. Autres substances psychotropes 85. Jeux, pari 95. Aucun ou sans objet 99. ?
29. Autres produits problématiques : ££ 11. Héroïne 16. Opiacés substitutifs 18. Autres opiacés 21. Cocaïne (incl., crack) 22. Amphétamines 24. MDMA (XTC) et dérivés 32. Benzodiazépines 33. ‘Rohypnol’ 38. Autres hypnotiques/sédatifs 40. Hallucinogènes 50. Inhalants volatiles 60. Cannabis 70. Alcool 80. Autres substances psychotropes 85. Jeux, pari 95. Aucun ou sans objet 99. ?
30. Age 1er usage du produit principal : ££ ans 31. Mode d’administration du produit principal : £££ 1. injecte 2. fume/ inhale 3. voie orale 4. sniffe 5. autre 9. ?
32. Comportement d’injection dans la vie : £ 1. sans objet 2. jamais 3. oui, mais plus actuellement 4. oui, encore actuellement (= au cours des 30 derniers jours) 9. ?
33. Statut sérologique HIV (optionnel) : • •
Statut sérologique £ rapporté par le patient £ basé sur un test de laboratoire Date du dernier test :_ _ / _ _ /_ _ _ _
£ résultat positif £ résultat négatif £ résultat inconnu £ non
33.a) testé : £ oui (si oui, indiquer le résultat :) 126
34. Satut sérologique HBV (optionnel) : (optionnel) : • Statut sérologique £ rapporté par le patient rapporté sur le patient £ basé sur un test de laboratoire sur un test de laboratoire • Date du dernier test : _ _ / _ _ / _ _ test : _ _ / _ _ / _ _ _ _
35. •
Statut
sérologique
HCV
Statut sérologique £ £ •
basé
Date du dernier
34.a) vacciné £ oui 4passer à la question 35 £ non 34.b) testé :
35.a) testé :
£ oui ( Si oui, indiquer le résultat :) le résultat :)
£ oui ( Si oui, indiquer
£ résultat positif £ résultat négatif £ résultat inconnu
£ résultat positif £ résultat négatif £ résultat
inconnu £ non 34.c) stade actuel de la maladie : £ aigu £ chronique £ guéri £ guéri £ inconnu 35. Entendu par juge ou parquet : £ 1. oui 2. non 9. ?
£ non
£ inconnu
35.b) stade actuel de la maladie : £ aigu £ chronique
36. Incarcération : £ 1. oui 2. non 9. ?
Instructions :
27. Nombre d'enfants : inscrire le nombre d'enfants (y compris les enfants légalement adoptés). 28. Produit/ Problème principal : le produit principal est celui cité par le patient comme lui posant actuellement le plus de problème et ‘à l’origine’ de la consultation. Il ne s'agit pas nécessairement d'une consommation au cours du dernier mois. Remarque sur les ‘Opiacés substitutifs’ :
127
Cette catégorie correspond au patient qui a un problème avec le traitement de substitution (par exemple qui voudrait arrêter la substitution) ou celui qui utilise ces produits en dehors d’une prescription médicale. Pour le patient sous substitution sans problème lié à ce traitement de substitution mais qui néanmoins entame une prise en charge (par exemple psychothérapeutique), le produit initial sera mentionné (par exemple ‘héroïne’). 29. Autres produits problématiques: permet le cas échéant d'enregistrer au maximum trois autres produits utilisés au cours du dernier mois. Il ne s'agit pas d'enregistrer toutes les drogues consommées mais seulement celle(s) que le patient ou la personne chargée de l'entretien considère comme jouant un rôle important dans la toxicomanie du patient. 30. Âge du premier usage du produit principal : inscrire l'âge auquel le patient a consommé pour la première fois le produit enregistré comme produit principal. 31. Mode d’administration du produit principal : il s’agit de la voie d’administration la plus habituelle en lien avec le produit principal. Si cela s’avère nécessaire, plusieurs réponses sont possibles. 32. Comportement d'injection dans la vie : correspond à au moins une administration par injection pratiquée à des fins non médicales, peu importe la drogue injectée, avec ou sans partage, effectuée dans des conditions optimales ou non. Si le patient ne s'est pas injecté au cours des 30 derniers jours, mais s'est déjà injecté au moins une fois avant cela, choisissez la réponse ‘oui, mais plus actuellement’. 33-35. Statuts sérologiques HIV, HBV, HCV La collecte de cette information est optionnelle. Néanmoins, chaque centre doit décider au départ si cette information sera collectée systématiquement ou pas. L’information rapportée par le patient est considérée comme valable pour toutes ces variables. La date du dernier test doit toujours être indiquée. Concernant l’hépatite B, si le patient a été vacciné (34.a = oui), ignorer les sous-questions suivantes et passer directement à la question 35. Concernant l’hépatite B et l’hépatite C, si on se base sur un test de laboratoire pour répondre aux questions 34.c) et 35.b), le stade actuel de la maladie correspond à la présence d’antigènes (Ag) et/ ou d’anticorps (Ac) suivants : aigu = Ag HBs ; chronique = Ag HBs + Ac HBc ; guéri = Ac HBs + Ac HBc. 36. Entendu par un juge ou un parquet : s'applique à toute présentation devant un juge d'instruction ou un substitut pour une affaire de drogue au moins une fois dans le passé. On inclura les situations dans lesquelles, bien que l’audition n’ait pas encore eu lieu, la date d'audition a été effectivement fixée. 37. Incarcération : se rapporte à toute incarcération dans un établissement pénitentiaire quel qu'en ait été la durée ou le type (préventive ou pénale).
128
5) Minimal Psychiatric Data (extra module) Identificatiegegevens instelling 1. Naam instelling :……………… 2. Instellingscode:... 3. Stad : .............................................
Identificatiegegevens cliënt Naam cliënt: ............................................... Postcode : ............... Gemeente : ……………. 4. Codenummer cliënt ………….
Sociodemografische gegevens 5. Nationaliteit: ……………… 1. Belg 2. niet-Belg, Europese Gemeenschap 3. niet-Belg, niet-Europese Gemeenschap 9.onbekend
6. Bron van inkomsten : …………… 1. eigen beroepsaktiviteiten 2. partner, ex-partner 3. andere familieleden 4. RVA 5. OCMW
6. ziekte/ invaliditeit 7. pensioen 8. andere 9.onbekend
7. Actuele justitiële situatie: ……………….. staat:………. 0. vrij 1. definitief vrij na periode van vrijheidsberoving 2. vrij (in afwachting van behandeling strafzaak) 3. rnaatregel jeugdrechter 4. praetoriaanse probatie 5. bemiddeling in strafzaken 6. probatie (opschorting - uitstel 7. vrij onder voorwaarden / voorlopig vrij 8. voorlopige hechtenis
8. Burgerlijke 9. vrij (in afwachting van uitvoering gevangenisstraf) 10. gedetineerd (als veroordeelde) 11. gedetineerd (als geïnterneerde) 12. gedwongen verblijf - collocatie 13. opname ter observatie 14. voorwaardelijk vrij - vrij op proef 98. andere 99.onbekend
1.gehuwd 2.ongehuwd 3. wettelijk gescheiden 4. feitefijk gescheiden 5. weduwe/weduwnaar 9.onbekend
9. Feitelijke verblijfplaats: ……….. Behandelingsgegevens 10. Soort cliënt :……….. 1. nieuwe cliënt 2. reeds in behandeling geweest in dit centrum 9.onbekend
11. Soort behandeling opgestart 1. detox - cold turkey 2. detox - substitute 3. detox - afbouw 4. onderhoudsbehandeling
5. medicamenteuze behandeling 6. psychosociale begeleiding 7. (psycho-)therapie 8. geen behandeling opgestart / doorverwijzing
129
II Bepalen van producten gekoppeld aan frequentie en toedieningswijze (tijdens de laatste 30 dagen). Product voornaamste product tweede product derde product
12
Toedienings wijze 13
Frequentie gebruik laatste maand 14
Leeftijd bij eerste gebruik 15
16
17
18
19
20
21
22
23
12,16,20. Product 1. OPIATEN
2. STIMULANTIA
3. SLAAP- EN KALMEERMIDDELEN
4. HALLUCINOGENEN
5. VLUCHTIGE SNUIFMIDDELEN
11. heroïne
21. cocaïne
31. barbituraten en andere slaapmiddelen
41. LSD
12. opium-morfine
22. amfetamine
32. benzodiazepines
42. paddestoelen en
62.marihuana
andere plantenafleidingen 48. andere hallucinogene producten
68. andere cannabisderivaten
13. codeïne 23. MDMA (xtc) 38. andere slaap- en kalmeermiddelen 14. voorgeschreven methadon 28. andere stimulantia 15. niet-voorgeschreven methadon 18. andere opiaten
7. ALCOHOL
51. Vluchtige snuifmiddellen
6.CANNABIS
8. ANDERE PSYCHOACTIEVE DRUGS
71. bier
74. aperitieven
81. onbepaalde drugs of substanties
72. wijn
78. andere alcohol
82. niet-gespecifieerde geneesmiddelen 85. anti-depressiva
73. sterke drank
13,17, 21 Toedieningswijze 1. slikken, drinken
4. spuiten (niet IV)
2. snuiven
5. intraveneus
3. inhaleren of roken
8. andere
9. GEEN TWEEDE /DERDE PRODUCT
84. anti-parkinson
83.speedball
61. hasj
99. geen product
88. andere specifieke drugs
14,18,22. Frequentie
15,19,23. leeftijd bij eerste gebruilk
1. éénmaal per week of minder 2. twee tot zes dagen per week
3. dagelijks
...........
9.onbekend
9.onbekend
24. leeftijd bij eerste gebruik van illegale drugs (niet van toepassing voor alcohol) :
25. probleemniveau van middelenmisbruik 1. hoofdprobleem 2. nevenprobleem
3. geen onderscheid
130
Risicogedrag (niet van toepassing bij alcohol) 26. ooit geïnjecteerd : ....... 1.ja
2.neen
9.onbekend
Indien vraag 26 : "ja" 27. momenteel injecterend (tijdens vorige 30 dagen): ....... 1. ja
2. neen
9.onbekend
28. ooit gemeenschappelijk gebruik injectiemateriaal : ........ 1. ja
2.neen
9.onbekend
29. gemeenschappelijk gebruik injectiemateriaal laatste maand : ..... ..............................................
1. ja
2.neen
9.onbekend
30. leeftijd eerste injectie : Middelengerelateerde ziektes 31. HIV-status: ......... 1. getest – positief Wanneer werd dit voor het eerst gezegd: ...../ 2. getest – negatief Wanneer was de laatste test: ..../..../.... 3. getest - onbekend Wanneer was de laatste test: ..../..../....
32. Heeft de cliënt ooit hepatitis gehad ? /....
1. ja 2.neen 9.onbekend
4. nooit getest 9.onbekend
Indien vraag 32. "Ja" 33. Zo ja, welke hepatitis ? Wanneer?..../..../.... 1. hepatitis A
.3.hepatitis C
2. hepatitis B
9.onbekend
131
132
2.
Variable lists of primary treatment reporting systems using software for registration 1) Addibru – CTB/ODB
134
2) De Sleutel
140
3) Minimal Psychiatric Data
147
4) MEDAR-ARCADE
159
5) Vlastrov
164
6) DrugAid Registration System (DARTS)
172
133
1) Addibru–CTB/ODB A. REPERTOIRE Code : PATIENT (par défaut) Assistant(e) social(e) Juge/Substitut Médecin Policier/Gendarme Psychologue Divers Titre : NOM : Prénom : Institution : Service : Adresse : Localité : Tél privé Tél bureau Fax GSM Email Remarque
134
B. ADDIBRU N° institution : Unité : Consultation : 1 Hospitalisation 2 Urgence 3 Liaison 4 Prison 6 Autre 8 Sexe : Homme 1 Femme 2 ? Inconnu 9 Nationalité : Belge Union européenne Hors UE ? Inconnu Résidence (code) Etat civil Célibataire Marié(e) Séparé(e) Divorcé(e) Veuf(ve) Autre ? Inconnu Traitement antérieur Oui, dans l'institution Oui, ailleurs Non, aucun Inconnu Adressé par propre initiative secteur santé non spécialisé secteur santé mentale secteur santé toxico secteur social secteur justice entourage autre ?? Inconnu Démarche personnelle orientée obligée ?? Inconnu
1 2 3 9
1 2 3 4 5 8 9 1 2 3 9 1 2 3 4 5 6 7 8 9 1 2 3 9
135
Type consultant usager ou ex-usager partenaire parent enfant autre ?? Inconnu Problème dominant Aucun Santé Social Justice Autre ?? Inconnu Problème secondaire 1 Problème secondaire 2 Problème secondaire 3 Produit principal Aucun ou sans objet Héroïnes et opiacés héroïne opiacés substitutifs autres opiacés précisés Stimulants du SNC cocaïne amphétamines MDMA (ecstasy) et dérivés Hypnotiques et sédatifs benzodiazépines "Rohypnol" autres hypnotiques et sédatifs Hallucinogènes Inhalants volatils Cannabis Alcool Autres substances psychotropes Jeux, paris ?? Inconnu
1 3 4 5 8 9 1 2 5 6 8 9
95 11 16 18 21 22 24 32 33 38 40 50 60 70 80 85 99
Produit secondaire 1 Aucun ou sans objet Héroïnes et opiacés héroïne opiacés substitutifs autres opiacés précisés Stimulants du SNC cocaïne amphétamines MDMA (ecstasy) et dérivés Hypnotiques et sédatifs benzodiazépines "Rohypnol" autres hypnotiques et sédatifs Hallucinogènes Inhalants volatils Cannabis Alcool Autres substances psychotropes Jeux, paris ?? Inconnu
95 11 16 18 21 22 24 32 33 38 40 50 60 70 80 85 99
136
Produit secondaire 2 Aucun ou sans objet Héroïnes et opiacés héroïne opiacés substitutifs autres opiacés précisés Stimulants du SNC cocaïne amphétamines MDMA (ecstasy) et dérivés Hypnotiques et sédatifs benzodiazépines "Rohypnol" autres hypnotiques et sédatifs Hallucinogènes Inhalants volatils Cannabis Alcool Autres substances psychotropes Jeux, paris ?? Inconnu Produit secondaire 3 Aucun ou sans objet Héroïnes et opiacés héroïne opiacés substitutifs autres opiacés précisés Stimulants du SNC cocaïne amphétamines MDMA (ecstasy) et dérivés Hypnotiques et sédatifs benzodiazépines "Rohypnol" autres hypnotiques et sédatifs Hallucinogènes Inhalants volatils Cannabis Alcool Autres substances psychotropes Jeux, paris ?? Inconnu
95 11 16 18 21 22 24 32 33 38 40 50 60 70 80 85 99
95 11 16 18 21 22 24 32 33 38 40 50 60 70 80 85 99
137
Durée dépendance : de 00 à 99 ans Injection Sans objet Jamais Oui, mais plus actuellement Oui, encore actuellement ?? Inconnu Cohabitation Seul Parent(s) Couple Relations ou amis En institution Autre (incl. Prison) ?? Inconnu Logement sans logement propre logement famille logement amis institut prisons autre ?? Inconnu
1 2 3 4 9 1 3 4 6 7 8 9 1 2 3 4 5 6 8 9
138
Niveau instruction Néant Primaire Secondaire inférieur Secondaire supérieur Supérieur non universitaire Supérieur universitaire ?? Inconnu Activité professionnelle Aucune Episodique Régulière ?? Inconnu Source revenus Sans Travail régulier Travail occasionnel Conjoint, partenaire Famille, parents Chômage CPAS Handicap/Mutuelle Pension Autre ?? Inconnu Couverture soins Oui, en ordre Oui, mais pas en ordre, avec couverture CPAS Oui, mais pas en ordre, pas de couverture CPAS Non, mais couverture CPAS Non, mais couverture possible Non, et couverture impossible (illégal) ?? Inconnu Entendu Juge/Parquet Oui Non ?? Inconnu Expérience de prison Oui Non ?? Inconnu Suite prévue Aucune Dans institution Orientation extérieure Autre ?? Inconnu
1 2 3 4 5 6 9 1 2 3 9 1 21 22 3 4 5 6 7 8 88 9 1 2 3 4 5 6 9 1 2 9 1 2 9 1 2 3 8 9
139
2) De Sleutel Form for apply for help and first contact All treatment demands pass through the first module “Apply for help and first contact”, which automatically means that for every unique client that applies for help in a particular centre a basic registration form is completed. This form is a standard in all the centres of the Sleutel. The content of the paper form is identical with the content op the input-screen. One form is completed for every unique client that applies for help in the reference year per centre. A client applying for help in more than one centre of the network can be traced, because of the unique client code.
140
141
At the effective face-to-face contact relevant missing or unclear information on the registration form is added. We call this the minimal basic (treatment demand) data. They cover of about 75% of the original treatment demands. Ten from the twenty European Treatment Demand Indicators are included in this first registration form. 142
Treatment contact details § treatment centre type § date of demand (month) § date of demand (year) § source of referral Socio-demographic information § gender § age § year of birth § nationality Drug-related information § primary drug § Other (secondary) drugs currently used (çè part of treatment demand) Medical registration form In all cases of treatment demand with substitution or medication, a physician is involved. The general practitioners of the centre complete a medical registration from the first time in the reference year a client is consulting him concerning drug use, substitution and/ or drug related health problems.
143
144
Limited client registration (crisis centre only) In the crisis centre where it seems not to be feasible to take off a full EuropASI-interview for all clients, a more limited client file is used including the minimal clinical data asked for TDI. However the instructions on how to gather this information follow the rules from the EuropASI-interview.
145
EuropASI form The Addiction Severity Index goes into seven possible problem areas: Medical, Education/Employment/Income or Support, Alcohol & Drugs, Legal, Family/Social and Psychiatric. There are four several scores resulting from the interview for every problem area: § the viewpoint of the client: the bother score and the need for help score § the viewpoint of the clinician: the severity index based on the information of the critical items and on both client scores § the computed composite score, based only on objective critical information and from the last 30 days. The information from EuropASI that is used for the TDI is limited to the parallel TDI Protocol items. For some of them the codes are to be regrouped according to the protocol.
146
3) Minimal Psychiatric Data A. ITEMLIJST STRUCTURELE GEGEVENS SI ALGEMENE KENMERKEN VAN DE INSTELLING Instelling-ID: CIV - nummer SI01 Naam van de MPG-verantwoordelijke SI02 Erkenningsnummer partner 1 in het samenwerkingsverband SI03 voor BeWo Erkenningsnummer partner 2 in het samenwerkingsverband SI04 voor BeWo Erkenningsnummer partner 3 in het samenwerkingsverband SI05 voor Bewo Erkenningsnummer partner 4 in het samenwerkingsverband SI06 voor BeWo Erkenningsnummer partner 5 in het samenwerkingsverband SI07 voor BeWo Erkenningsnummer partner 6 in het samenwerkingsverband SI08 voor BeWo NIS-code van de gemeente van de zetel van het regionale SI09 overlegplatform Aantal erkende bedden/plaatsen onder kenletter A SI10 Aantal erkende bedden/plaatsen onder kenletter A1 SI11 Aantal erkende bedden/plaatsen onder kenletter A2 SI12 Aantal erkende bedden/plaatsen onder kenletter K SI13 Aantal erkende bedden/plaatsen onder kenletter K1 SI14 Aantal erkende bedden/plaatsen onder kenletter K2 SI15 Aantal erkende bedden/plaatsen onder kenletter T SI16 Aantal erkende bedden/plaatsen onder kenletter T1 SI17 Aantal erkende bedden/plaatsen onder kenletter T2 SI18 Aantal erkende bedden/plaatsen onder kenletter TFB SI19 Aantal erkende bedden/plaatsen onder kenletter TFP SI20 Aantal erkende bedden/plaatsen onder kenletter VP SI21 SU SU01 SU02 SU03 SU04 SU05 SU06
FUNCTIONELE ORGANISATIE LEEFEENHEDEN ID-Nummer van de leefeenheid Aantal plaatsen in 1-persoonskamers Aantal plaatsen in 2-persoonskamers Aantal plaatsen in meer-persoonskamers Datum opening leefeenheid Datum sluiting leefeenheid
147
B. IP IP01 IP02 IP03 IP04
ITEMLIJST CONTINUE MINIMALE PSYCHIATRISCHE GEGEVENS IDENTIFICATIE PATIENT ID-nummer patiënt Naam en voornaam Geboortedatum Geslacht
MA MA01 MA02 MA03 MA04 MA05 MA06 MA07 MA08 MA09 14 MA10.01 MA10.02 MA10.03 MA11 MA12 MA13 MA14 MA15
MA16.01 MA16.02 MA16.03
MA16.04 MA16.05
MA16.06 MA16.07 MA16.08
14
MEDISCHE OPNAME ID-nummer patiënt Volgnummer medisch -psychiatrisch verblijf Datum medische opname ( dag van de week / export ) Kenletter van de behandeldienst ID-Nummer van de leefeenheid Gemeente woonplaats Type opname Wijze van opname Tussenkomende persoon L Tussenkomende persoon VL Tussenkomende persoon DL Sociodemografische gegevens Leefmilieu voor opname Type laatst beëindigd onderwijs Niveau laatst beëindigd onderwijs Beroepsstatus bij opname Huidig of laatste hoofdberoep Voorlopige DSM IV Diagnose bij medische opname Klinische stoornissen As1 / 1 Primaire diagnose volgens as 1 van de DSM-IV As1 / 2 Secundaire diagnose volgens as 1 van de DSM-IV As1 / 3 Tertiaire diagnose volgens as 1 van de DSM-IV Persoonlijkheidsstoornissen, Zwakzinnigheid As2 / 1 Primaire diagnose volgens as 2 van de DSM-IV As2 / 2 Secundaire diagnose volgens as 2 van de DSM-IV ICD9CM Somatische aandoeningen As3 / 1 Primaire diagnose volgens as 3 van de DSM-IV As3 / 2 Secundaire diagnose volgens as 3 van de DSM-IV As3 / 3 Tertiarie diagnose volgens as 3 van de DSM-IV
PVT en BW kunnen dit item niet invullen omwille van wettelijke bepalingen.
148
MA16.09 MA16.10 MA16.11 MA16.12 MA16.13 MA16.14 MA16.15 MA16.16 MA16.17 MA16.18 MA16.19 MA16.20
MT MT01 MT02 MT03 MT04 MT05 MT06 MT07 MT08 MT09
MT10.01 MT10.02 MT10.03 MT10.04 MT10.05 MT10.06 MT10.07 MT10.08 MT10.09 MT10.10 MT10.11 MT10.12 MT10.13 MT10.14 MT10.15 MT10.16 MT10.17 MT10.18 MT10.19 MT10.20 MT10.21
Hoofddiagnose op As: As4 Psychosociale en omgevingsproblemen Geen problemen aangeduid Binnen de primaire steungroep Gebonden aan de sociale omgeving Opvoedingsproblemen Werkproblemen Woonproblemen Financiële problemen Met toegankelijkheid v.d. gezondheidsdiensten Met justitie/politie of misdaad Andere psychosociale en omgevingsproblemen As5 GAF-schaal: Algehele beoordeling van het functioneren MEDISCHE BEHANDELING ID-nummer patiënt Volgnummer medisch-psychiatrisch verblijf Type beweging Volgnummer beweging Datum begin behandeling Kenletter van de behandeldienst ID-Nummer van de leefeenheid Datum einde behandeling Aantal gefactureerde verpleeg/verblijfsdagen BEGIN BEHANDELING Problemen bij begin van behandelings/verblijfsperiode Psychische tekens & symptomen Zelfmoordgedachten Auto-agressie dreiging Auto-agressie daden Vijandig, gespannen, negativistisch Agressiviteit t.o.v. objecten Agressiviteit t.o.v. personen Depressieve stemming, minderwaardigheid Vertraging, verminderd gevoelsleven Onaangepaste gevoelens Agitatie, verbale agressie Angst, vrees, fobie Obsessies, compulsies Sociaal teruggetrokken Euforie Hallucinaties Wanen Wantrouwen, - achterdocht Grootheidsgedachten, (megalomanie) Overdreven afhankelijkheid t.o.v. personen Problemen i.v.m. alcohol Problemen i.v.m. medicatie 149
MT10.22 MT10.23 MT10.24 MT10.25 MT10.26 MT10.27 MT10.28 MT10.29 MT10.29A MT10.30 MT10.31 MT10.32 MT10.33 MT10.34 MT10.34A MT10.35 MT10.36 MT10.37 MT10.38 MT10.39 MT10.39A MT10.40 MT10.41 MT10.42 MT10.43 MT10.44 MT10.44A MT10.45 MT10.46 MT10.47 MT10.48 MT10.49 MT10.50 MT10.51 MT10.52 MT10.53 MT10.53A MT11. 01 MT11. 02 MT11. 03
MT12.01 MT12.02
Problemen i.v.m. intraveneus druggebruik Problemen i.v.m. ander druggebruik Anti-sociale houding Somatische overbezorgdheid Desoriëntatie Problemen i.v.m. geheugen Problemen i.v.m. taal Ander psychisch probleem Omschrijving Relatieproblemen Met de kinderen Met de partner Met de ouderfiguren Met andere familieleden Ander relatieprobleem Omschrijving Problemen i.v.m. sociaal functioneren Studies Werk Huishouden Vrije tijd Ander probleem in het sociaal functioneren Omschrijving Ontwikkelingsproblemen Intellectueel Motorisch Taal Affectief Andere ontwikkelingsprobleem Omschrijving Problemen i.v.m. lichamelijk functioneren Vermoeidheid Slaapproblemen Eetproblemen Algemeen lichamelijke achteruitgang Sexuele problemen Enuresis / encopresis Epileptische toeval, convulsies Spraakproblemen Ander lichamelijk probleem Omschrijving Therapeutische doelstellingen Symptoom Psychosociale aanpassing Oppuntstelling EINDE BEHANDELING Overzicht van de verstrekte zorgen Basiszorgen Hygiëne aansporen Hygiëne handelen
150
MT12.03 MT12.04 MT12.05 MT12.06 MT12.07 MT12.08 MT12.09 MT12.10 MT12.11 MT12.12 MT12.13 MT12.14 MT12.15 MT12.16 MT12.17 MT12.17A MT13.01 MT13.02 MT13.03 MT13.04 MT13.05 MT13.06 MT13.07 MT13.08 MT13.09 MT13.10 MT14.01 MT14.02 MT14.03 MT14.04 MT14.05 MT14.06 MT14.07 MT14.08 MT14.09 MT14.10 MT14.11 MT14.12 MT14.13
MT15.01 MT15.02 MT15.03 MT15.04 MT15.05
Fecale continentie aansporen Fecale incontinentie handelen Mobiliteit aansporen Mobiliteit handelen Opstaan / liggen aansporen Opstaan / liggen handelen Voeding aansporen Voeding handelen Aan- en uitkleden aansporen Aan- en uitkleden handelen Toedienen van een behandeling IV, perfusie I.M., S.C., I.D. Per os Zorgen bij shocktherapie Andere specifieke zorg Omschrijving Overzicht van het verstrekte toezicht Op levens- en / of zelfmoordgevaar Op vitale parameters (BD, T°, ...) Op het onder invloed zijn (alcohol, drugs, medicatie,...) Via monitoring Op beschermingsmiddelen Op afzondering in een isoleerkamer Op separatie Op uitgangscontrole Op uitgangsverbod Andere specifieke toezichtsmaatregel Overzicht van de uitgevoerde evaluaties Lichamelijk onderzoek Mentaal onderzoek Sociale evaluatie Psychologisch testonderzoek Verpleegkundige evaluatie Logopedisch testonderzoek Neurofysiologisch bilan Biologisch bilan Stafvergadering behandelingsteam Overleg met het netwerk Medisch-juridisch overleg Specifiek protocol Andere specifieke evaluatie Overzicht van de psychotrope en medicamenteuze behandelingen Anxiolytica Antidepressiva Neuroleptica Langwerkende neuroleptica Slaapmiddelen
151
MT15.06 MT15.07 MT15.08 MT15.09 MT15.09A MT16.01 MT16.02 MT16.03 MT16.04 MT16.05 MT16.06 MT16.07 MT16.08 MT16.09 MT16.10 MT16.11 MT16.12 MT16.13 MT16.14 MT16.14A
MT17.01 MT17.02 MT17.03
MT17.04 MT17.05
MT17.06 MT17.07 MT17.08 MT17.09 MT17.10 MT17.11 MT17.12 MT17.13
Thymostabilisatoren Noöptropica Somatische medicatie (niet psychotropisch) Andere psychotrope of psychofysiologische behandeling Omschrijving Overzicht van de relationele behandelingen Gespreksbegeleiding Relatie-, gezinstherapie Psychotherapie individueel Psychotherapie in groep Kinesitherapie, Psychomotorische therapie Logopedie Ergotherapie: economisch productief Ergotherapie: economisch niet productieve activiteiten ADL training van de basisfuncties Socioculturele en vrijetijdsbegeleiding Cognitief intellectuele training Psychopedagogische interventie Sociaal maatschappelijke begeleiding Andere relationele behandeling Omschrijving Diagnose DSM IV bij einde behandeling/verblijfsperiode Klinische stoornissen As1 / 1 Primaire diagnose volgens as 1 van de DSM-IV As1 / 2 Secundaire diagnose volgens as 1 van de DSM-IV As1 / 3 Tertiaire diagnose volgens as 1 van de DSM-IV Persoonlijkheidsstoornissen, Zwakzinnigheid As2 / 1 Primaire diagnose volgens as 2 van de DSM-IV As2 / 2 Secundaire diagnose volgens as 2 van de DSMIV ICD9CM Somatische aandoeningen As3 / 1 Primaire diagnose volgens as 3 van de DSM-IV As3 / 2 Secundaire diagnose volgens as 3 van de DSM-IV As3 / 3 Tertiarie diagnose volgens as 3 van de DSM-IV Hoofddiagnose op As: As4 Psychosociale en omgevingsproblemen Geen problemen aangeduid Binnen de primaire steungroep Gebonden aan de sociale omgeving Opvoedingsproblemen
152
MT17.14 MT17.15 MT17.16 MT17.17 MT17.18 MT17.19 MT17.20
Werkproblemen Woonproblemen Financiële problemen Met toegankelijkheid v.d. gezondheidsdiensten Met justitie/politie of misdaad Andere psychosociale en omgevingsproblemen As5 GAF-schaal: Algehele beoordeling van het functioneren
MT18.01 tot 10 Vrije variabelen ID ID01 ID02 ID03 ID04 ID05 ID06 ID07 ID08 ID09 ID10 MD MD01 MD02 MD03 MD04 MD05 MD06 MD07
MD08.01 MD08.02 MD08.03 MD08.04 MD08.05 MD08.06 MD08.07 MD08.08 MD08.09 MD08.10 MD08.11 MD08.12 MD08.13
INTERMEDIAIR ONTSLAG ID-nummer patiënt Volgnummer medisch-psychiatrisch verblijf Volgnummer beweging Datum intermediair ontslag Kenletter van de behandeldienst ID-Nummer van de leefeenheid Verwacht aantal dagen Bestemming Reden Datum intermediaire heropname MEDISCH ONTSLAG ID-nummer patiënt Volgnummer medisch-psychiatrisch verblijf Volgnummer beweging Datum medisch ontslag Kenletter van de behandeldienst ID-Nummer van de leefeenheid Wijze van ontslag Overblijvende problemen bij medisch ontslag Psychische tekens & symptomen Zelfmoordgedachten Auto-agressie dreiging Auto-agressie daden Vijandig, gespannen, negativistisch Agressiviteit t.o.v. objecten Agressiviteit t.o.v. personen Depressieve stemming, minderwaardigheid Vertraging, verminderd gevoelsleven Onaangepaste gevoelens Agitatie, verbale agressie Angst, vrees, fobie Obsessies, compulsies Sociaal teruggetrokken 153
MD08.14 MD08.15 MD08.16 MD08.17 MD08.18 MD08.19 MD08.20 MD08.21 MD08.22 MD08.23 MD08.24 MD08.25 MD08.26 MD08.27 MD08.28 MD08.29 MD08.29A MD08.30 MD08.31 MD08.32 MD08.33 MD08.34 MD08.34A MD08.35 MD08.36 MD08.37 MD08.38 MD08.39 MD08.39A MD08.40 MD08.41 MD08.42 MD08.43 MD08.44 MD08.44A
MD08.45 MD08.46 MD08.47 MD08.48 MD08.49 MD08.50 MD08.51 MD08.52
Euforie Hallucinaties Wanen Wantrouwen, - achterdocht Grootheidsgedachten (megalomanie) Overdreven afhankelijkheid t.o.v. personen Problemen i.v.m. alcohol Problemen i.v.m. medicatie Problemen i.v.m. intraveneus druggebruik Problemen i.v.m. ander druggebruik Anti-sociale houding Somatische overbezorgdheid Desoriëntatie Problemen i.v.m. geheugen Problemen i.v.m. taal Ander psychisch probleem Omschrijving Relatieproblemen Met de kinderen Met de partner Met de ouderfiguren Met andere familieleden Ander relatieprobleem Omschrijving Problemen i.v.m. sociaal functioneren Studies Werk Huishouden Vrije tijd Ander probleem in het sociaal functioneren Omschrijving Ontwikkelingsproblemen Intellectueel Motorisch Taal Affectief Andere ontwikkelingsprobleem Omschrijving Problemen i.v.m. lichamelijk functioneren Vermoeidheid Slaapproblemen Eetproblemen Algemene lichamelijke achteruitgang Sexuele problemen Enuresis / encopresis Epileptische toeval, convulsies Spraakproblemen
154
MD08.53 MD08.53A
MD09.01 MD09.02 MD09.03 MD10.01 MD10.02
MD10.03 MD10.04 MD10.05 MD10.06 MD10.07 MD10.08 MD10.09 MD10.09A MD11 C. SP PI01 PI02 PI03 PI04 PI05 PI06 PI07 PI08 PI09 PI10 PI11 PI12 PI13
PF01 PF02
Ander lichamelijk probleem Omschrijving Therapeutische doelstellingen voor de voorgestelde nazorg Symptoom Psychosociale aanpassing Oppuntstelling Voorgestelde nazorg en nabehandeling Basiszorgen Toedienen van medicamenteuze behandeling en/of verpleegtechnische zorgen door een derde Toezicht Evaluatie Somatische behandeling Psychotrope behandeling Relationele behandeling Sociaal maatschappelijke begeleiding Andere te specifiëren nazorg Omschrijving Bestemming
ITEMLIJST STEEKPROEF MINIMALE PSYCHIATRISCHE GEGEVENS STEEKPROEF-GEGEVENS PATIENT ALGEMENE GEGEVENS ID-nummer patiënt Datum registratiedag Kenletter van de behandeldienst ID Nummer van de leefeenheid Nummer behandelingsgroep 1 Nummer behandelingsgroep 2 Aanwezigheid van de patiënt tijdens de eerste dag van de registratieweek Aanwezigheid van de patiënt tijdens de tweede dag van de registratieweek Aanwezigheid van de patiënt tijdens de derde dag van de registratieweek Aanwezigheid van de patiënt tijdens de vierde dag van de registratieweek Aanwezigheid van de patiënt tijdens de vijfde dag van de registratieweek Aanwezigheid van de patiënt tijdens de zesde dag van de registratieweek Aanwezigheid van de patiënt tijdens de zevende dag van de registratieweek FUNCTIONEREN Basisfunctioneren Voeding Wassen
155
PF03 PF04 PF05 PF06 PF07 PF08 PF09 PF10 PF11 PF12 PF13 PF14 PF15 PF16 PF17 PF18 PF19 PF20 PF21 PF22 PF23 PA01 PA02 PA03 PA04 PA05 PA06 PA07 PA08 PA09 PA10 PA11 PA12 PA13 PA14 PA15 PA16 PA17 PA18 PA19 PA20 PA21 PA22 PA23 PA24
Mobiliteit Transfer toilet Incontinentie Oriëntatie in personen Oriëntatie in tijd Maatschappelijk functioneren Openbaar vervoer Boodschappen Omgaan met geld Administratieve zelfstandigheid Gedragsbeheer Mate van initiatief Vrije tijd Sociaal aanvaardbaar gedrag Communicatie naar anderen Terugkoppeling op zelfpresentatie Bijdrage aan en het in stand houden van de sfeer Belangen van anderen in de maatschappij Daadwerkelijke band met vrienden en kennissen Relationeel functioneren Relationeel functioneren t.a.v. medebewoners Relationeel functioneren t.a.v. vrienden Relationeel functioneren t.a.v. broers/zussen Relationeel functioneren t.a.v. ouderfiguren ZORGACTIVITEITEN Psychiatrische urgentie Anamnese Gestructureerde observatie Diagnostische activiteiten Dieet Arbeidsgerichte activiteiten Training socio-economische vaardigheden Begeleiden van huishoudelijke activiteiten Begeleiden van socio-culturele, maatschappelijke en vrijetijdsbestedingsactiviteiten Begeleiding van sociale of juridische problemen Gespreksbegeleiding: relatie patiënt - milieu Psychotherapie Toediening psychofarmacologische medicatie Toediening somatische medicatie Toediening medicatie I.M./S.C./I.D. Registratie van biologische parameters Afnemen van bloedstaal Wondverzorging Bewegingsvrijheid Begeleiden van de patient naar en van een andere dienst of instelling Beschermingsmiddelen Afzondering in isoleerkamer Separatie (niet in isoleerkamer) Vaste uurroosteractiviteiten: individueel
156
PA25 PA26
Vaste uurroosteractiviteiten: in groep Niet-geplande, niet-gestructureerde, begeleidende activiteiten
ST PT01 PT02 PT03 PT04 PT05 PT06 PT07 PT08 PT09 PT10 PT11
STEEKPROEF-GEGEVENS BEHANDELINGSTEAM Datum registratiedag ID-Nummer van de leefeenheid Aantal F.T.E. psychiatrisch verpleegkundigen Aantal uren psychiatrisch verpleegkundigen Aantal F.T.E. sociaal verpleegkundigen Aantal uren sociaal verpleegkundigen Aantal F.T.E. algemene en andere verpleegkundigen Aantal uren algemene en andere verpleegkundigen Aantal F.T.E. ander verzorgend personeel Aantal uren verzorgend personeel Aantal F.T.E. stagiaires verpleegkundig en verzorgend personeel Aantal uren stagiaires verpleegkundig en verzorgend personeel Aantal F.T.E. medische staf Aantal uren medische staf Aantal F.T.E. psychologisch en pedagogisch personeel Aantal uren psychologisch en pedagogisch personeel Aantal F.T.E. personeel maatschappelijk werk Aantal uren personeel maatschappelijk werk Aantal F.T.E. resocialiserend personeel Aantal uren resocialiserend personeel Aantal F.T.E. andere leden behandelingsteam Aantal uren andere leden behandelingsteam Aantal F.T.E. stagiaires exclusief verpleegkundig, verzorgend personeel Aantal uren stagiaires exclusief verpleegkundig, verzorgend personeel
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D.
RR01 RR02 RR03 RR04 RR05 RR06 RR07 RR08 RR09
ITEMLIJST GEREALISEERDE VERPLEEG-VERBLIJFSDAGEN PER KENLETTER DIENST GEREALISEERDE VERPLEEG/VERBLIJFSDAGEN Kwartaal van het jaar Kenletter van de dienst Gemiddeld aantal bedden/plaatsen voor volledige hospitalisatie Gemiddeld aantal bedden/plaatsen voor partiële hospitalisatie Maand 1 Aantal gerealiseerde volledige verpleegdagen 1 Aantal gerealiseerde partiële verpleegdagen 1 Aantal gerealiseerde gepondereerde partiële verpleegdagen 1 Maand 2
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RR10 RR11 RR12 RR13 RR14 RR15 RR16
Aantal gerealiseerde volledige verpleegdagen 2 Aantal gerealiseerde partiële verpleegdagen 2 Aantal gerealiseerde gepondereerde partiële verpleegdagen 2 Maand 3 Aantal gerealiseerde volledige verpleegdagen 3 Aantal gerealiseerde partiële verpleegdagen 3 Aantal gerealiseerde gepondereerde partiële verpleegdagen 3
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4) MEDAR – ARCADE For the primary treatment reporting system MEDAR-ARCADE it was decided to just add the addendum, which contains a number of substance-specific variables. A complete overview of the used forms would leed us to far. One gets a warning to fill in data on this subgroup when: As 1 Aanmeldingsproblematiek
Code D (80-223) Code 11 (Verslavingsproblemen)
Leeftijd eerste druggebruik Formulier: Veldnaam: Veldtype: Formaat: Parameter: Verplicht: MVG: Standaard:
Drugs EersteGebruik Numeriek Byte P_Drug_leeftijd Ja Ja 0 (-kies leeftijd eerste druggebruik-)
Definitie van de variabele: De leeftijd bij het eerste gebruik van de drug vraagt naar de leeftijd waarop de persoon voor het eerst gebruik maakte van de probleemdrug. Werkwijze: Keuzelijst met invoervak: De lijst verschijnt automatisch bij een muisklik op de pijl, de selectie gebeurt door een klik van de muis op de keuze in de lijst. Antwoordcategorieën: DrugLft_ID 0 1 2 3 4 5 6 7 8 9 10 99
Leeftijd - kies leeftijd eerste druggebruikJonger dan 6jr Tussen 6-12 jr 13-14 jr 15-16 jr 17-18 jr 19-20 jr 20-25 jr 25-30 jr 30-40 jr Ouder dan 40 jr Onbekend
Product Formulier: Veldnaam:
Veldtype: Formaat: Parameter: Verplicht:
Drugs Produkt_1a Produkt_1b Produkt_2a Produkt_2b Produkt_3a Produkt_3b Numeriek Byte P_Drug_Produkt Ja
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MVG: Standaard:
Ja 0 (geen product)
Definitie van de variabele: Product slaat op de namen van het belangrijkste product, het tweede product en het derde product. Hierbij wordt als uitgangspunt genomen dat de persoon die registreert bepaalt welk product het belangrijkst is. Als twee middelen belangrijk zijn, noteer dan het recent belangrijkste middel. Werkwijze: Keuzelijst met invoervak: De lijst verschijnt automatisch bij een muisklik op de pijl, de selectie gebeurt door een klik van de muis op de keuze in de lijst. Antwoordcategorieën: De hoofdcategorie kan men selecteren door het aanklikken van één van de categorieën die in hoofdletters staan: Volg_Sub DrugMiddel 0 1 101 102 103 104 105 108 2 201 202 203 208 3 301 302 308 4 401 402 403 5 501 502 6 601 602 608 7 701 702 703 704 708 8 801 802 803 804 805 808 99
Geen product OPIATEN Heroïne Opium-morfine Codeïne Voorgeschreven methadon Niet-voorgeschreven methadon Andere opiaten STIMULANTIA Cocaïne Amfetamine Xtc (mdma) Andere stimulantia SLAAP- EN KALMEERMIDDELEN Barbituraten en andere slaapmiddelen Benzodiazepine Pijnstillers Andere slaap- kalmeermiddelen HALLUCINOGENEN Lsd Paddestoelen en andere plantafleidingen Andere hallucinogene producten VLUCHTIGE SNUIFMIDDELEN Bepaalde vluchtige snuifmiddelen Onbepaalde vluchtige snuifmiddelen CANNABISDERIVATEN Hasj Marihuana Andere cannabisderivaten ALCOHOL Bier Wijn Sterke drank Aperitieven Andere alcohol ANDERE PSYCHOACTIEVE DRUGS Onbepaalde drugs of substanties Niet-gespecifieerde geneesmiddelen Speedball Anti-parkinson Anti-depressiva Andere specifieke drugs GEEN TWEEDE/DERDE PRODUKT
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Toedieningswijze Formulier: Veldnaam:
Drugs Toediening1 Toediening2 Toediening3 Numeriek Byte P_Drug_Toediening Ja Ja 0 (-kies een toedieningswijze-)
Veldtype: Formaat: Parameter: Verplicht: MVG: Standaard:
Definitie van de variabele: Toedieningswijze van de probleemdrug slaat op de manier waarop de drug wordt gebruikt. Men kan dit invullen voor “Produkt 1”, “Produkt 2” en “Produkt 3”. Werkwijze: Keuzelijst met invoervak: De lijst verschijnt automatisch bij een muisklik op de pijl, de selectie gebeurt door een klik van de muis op de keuze in de lijst. Antwoordcategorieën: Toediening_ID 0 1 2 3 4 5 8 9 99
Toediening - kies een toedieningswijze slikken,drinken snuiven roken,inhaleren spuiten niet-intraveneus spuiten intraveneus andere wijze geen tweede wijze onbekend
Frequentie Formulier: Veldnaam:
Veldtype: Formaat: Parameter: Verplicht: MVG: Standaard:
Drugs Frequentie1 Frequentie2 Frequentie3 Numeriek Byte P_Drug_Frequentie Ja Ja 0 (-kies frequentie-)
Definitie van de variabele: Frequentie van het druggebruik gedurende de laatste maand. Men kan dit invullen voor “Produkt 1”, “Produkt 2” en “Produkt 3”. Werkwijze: Keuzelijst met invoervak: De lijst verschijnt automatisch bij een muisklik op de pijl, de selectie gebeurt door een klik van de muis op de keuze in de lijst.
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Antwoordcategorieën: DrugFrequentie_ID 0 1 2 3 9 99
DrugFrequentie - kies een frequentie max 1 x/week twee tot 6 maal per week dagelijks onbekend niet aanwezig
Risicogedrag Formulier: Veldnaam: Veldtype: Formaat: Parameter: Verplicht: MVG: Standaard:
Drugs Risicogedrag? Numeriek Ja/nee / Ja Ja Niet aangevinkt
Definitie van de variabele: Is er sprake van risicogedrag? Antwoordcategorieën: Aanvinkmogelijkheid of er al dan niet sprake is van risicogedrag: vinkje aan = positief vinkje uit = negatief HIV Formulier: Veldnaam: Veldtype: Formaat: Parameter: Verplicht: MVG: Standaard:
Drugs HIV Numeriek Byte P_Drug_HIV Ja Ja 0 (-kies HIV-status-)
Definitie van de variabele: HIV-status wil nagaan of de cliënt ooit werd getest op HIV. Werkwijze: Keuzelijst met invoervak: De lijst verschijnt automatisch bij een muisklik op de pijl, de selectie gebeurt door een klik van de muis op de keuze in de lijst. Antwoordcategorieën: HIV_ID 0 1 2 3 4 9
HIV - kies HIV-status getest positief getest negatief getest onbekend nooit getest onbekend
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Hepatitis Formulier: Veldnaam: Veldtype: Formaat: Parameter: Verplicht: MVG: Standaard:
Drugs Hepatitis Numeriek Byte P_Drug_Hepatitis Ja Ja 0 (-kies Hepatitis-status)
Definitie van de variabele: Hepatitis-status bevraagt of de persoon ooit hepatitis gehad heeft en zo ja welke vorm. Werkwijze: Keuzelijst met invoervak: De lijst verschijnt automatisch bij een muisklik op de pijl, de selectie gebeurt door een klik van de muis op de keuze in de lijst. Antwoordcategorieën: Hepatitis_ID 0 1 2 3 4 5 6 7 9
Hepatitis - kies hepatitis-status Hepatitis A (1A) Hepatitis B (1B) Hepatitis C (1C) geen Hepatitis (2) Hepatitis A+B (3) Hepatitis A+C (4) Hepatitis B+C (5) onbekend
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5) Vlastrov 1. Algemeen Variabele Persoonscode (sleutel) Datum creatie record Datum wijziging record
Mogelijke waarde xxx-xx-xxxx-xxx (centrum-werker-jaar-gast) dd-mm-jjjj dd-mm-jjjj
2. Persoonsgegevens Variabele geslacht
leeftijd
geboortejaar nationaliteit
afkomst
onderwijs
opleiding dit jaar
diploma
Mogelijke waarde man vrouw onbekend bekend schatting onbekend jjjj belg europees niet-europees onbekend België Turkije Marokko Oost-Europa onbekend andere onbekend andere niet schoolgaand dagonderwijs avondonderwijs leercontract deeltijds onderwijs ja neen onbekend geen LO BLO lager algemeen middelbaar lager technisch middelbaar lager beroeps middelbaar lager kunst middelbaar buitengewoon secundair hoger algemeen middelbaar
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diploma (vervolg)
inkomen (met bijkomend: tweede inkomen)
woon- en leefsituatie
justitie
gevangenis
hoger technisch middelbaar hoger beroeps middelbaar hoger kunst middelbaar hoger niet-gespecifieerd hoger niet-universitair universitair ander onbekend onbekend loon-arbeider loon-bediende zelfstandige OCMW-uitkering werklozenvergoeding invaliditeit ziektevergoeding jobstudent partner/ex-partner familie geen officieel inkomen ander onbekend bij ouders woont alleen bij partner bij partner en kind(eren) met partner bij ouders met partner/kind. bij ouders gevangenis residentieel zwerven (geen woonplaats) verschillende woonplaatsen andere alleen met kinderen onbekend nooit lopende zaak maatregel van toepassing ooit veroordeeld onbekend ooit nooit
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3. Contacten Variabele datum eerste contact eerste contactpunt
doorverwijzing naar straathoekwerk via
periode van periode tot aantal contacten voornaamste contactpunt soort contact
vertrouwensrelatie vertrouwelijk gesprek probleem begeleiding
Mogelijke waarde dd/mm/jjjj straat cafébezoek openbare plaats bar (prostitutie) gevangenis residentieel bureel thuis jeugdhuis prostitutie-raam prostitutie-hotel park andere park eigen initiatief huisbezoek (bij anderen) sociaal restaurant voetbalstadion onbekend geen doorverwijzing categoriale behandelingscentra andere welzijnsdiensten familie vrienden-lotgenoten andere dd/mm/jjjj dd/mm/jjjj xx (N, max. 99) zelfde als bij eerste contactpunt in observatie kennismaking opbouw vertrouwen relatie andere ja of nee ja of nee ja of nee
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4. Leefdomeinen (problematieken) Variabele problematiek/leefdomein
sinds maand tot maand aangegeven door organisatie samenwerking met organisatie doorverwezen naar organisatie begeleiding door straathoekwerk hulpvraag voorgelegd ingegaan op hulpvraag
gast tevreden
straathoekwerk tevreden
Mogelijke waarde drugs prostitutie wonen tijdsbesteding werk juridisch school-vorming medisch psychisch financieel samenleving administratie familie-relaties andere minderjarigen (pos-mof) voetbal socio-emotioneel (vanaf 2003) mm/jjjj mm/jjjj gast: ja of neen straathoekwerk: ja of neen verschillende, telkens afhankelijk van geregistreerde problematiek of leefdomein ja of neen ja of neen ja of neen ja of neen ja neen gedeeltelijk ja neen gedeeltelijk ja neen gedeeltelijk
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5. Drugproblematiek Variabele contacten met drughulpverlening ooit gespoten
(gespoten) vanaf leeftijd momenteel injecterend injectiemateriaal gemeenschappelijk injectiemateriaal gemeensch. laatste mnd hygiëne
voeding
lichamelijke klachten
HIV test-datum HIV teststatus
Hepatitis test-datum Hepatitis teststatus
Mogelijke waarde vroeger of nu: ja of neen ja neen onbekend jj ja of neen ja of neen ja of neen goed minder goed slecht onbekend goed minder goed slecht onbekend onbekend tandpijn schurft luizen tuberculose andere geen dd/mm/jjjj getest-positief getest-negatief getest-onbekend nooit getest onbekend dd/mm/jjjj positief a positief b positief c positief andere positief onbekend getest negatief getest onbekend nooit getest onbekend positief b en c vaccin b, positief c vaccin b, negatief c
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6. Drugs, middelen Variabele gebruikt middel
hoofdmiddel probleem ervaren door gast probleem ervaren door straathoekwerk aard van gebruik
toedieningswijze
gebruiksfrequentie
Mogelijke waarde heroïne opium – morfine codeïne voorgeschreven methadone niet-voorgeschreven methadone andere opiaten cocaïne amfetamine xtc andere stimulantia barbituraten – andere slaapmiddelen benzodiazepines andere slaap-kalmeermiddelen lsd paddestoelen-plantenafleidingen andere hallucinogenen vluchtige snuifmiddelen onbepaalde drugs – substantia niet gespecifieerde geneesmiddelen speedball anti-parkinson anti-depressiva andere specifieke drugs cannabis alcohol gokken snowball speed ketamine (vanaf 2003) anabole steroïden (vanaf 2003) ja of neen ja of neen ja of neen gebruik misbruik afhankelijkheid onbekend spuiten intraveneus chinezen roken snuiven drinken slikken onbekend spuiten freebase meermaal daags 169
gebruiksfrequentie (vervolg)
leeftijd eerste gebruik
(leeftijd eerste gebruik)
dagelijks 2-6 keer per week wekelijks onregelmatig geen gebruik vorige maand onbekend raming bekend onbekend jj
7. Straathoekwerkers variabelen Variabele project code straathoekwerker naam straathoekwerker
Mogelijke waarde configuratievariabele (wordt geïnstalleerd met programma per registrerend project) 1 tot en met 99 vrij in te vullen veld
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8. Activiteiten Variabele
Mogelijke waarde
datum
dd/mm/jjjj
activiteit
voetbal competitie voetbal recreatief basket competitie basket recreatief deelname grabbelpas deelname speelpleinwerking deelname sporttornooi deelname jeugdbeweging tocht (dropping-kaart-kompas) meerdaagse activiteit kickactiviteit kleinschalige activiteit zuiver recreatieve activiteit vormingsactiviteit andere xx xx xx jj jj organisator deelnemer medewerker
aantal deelnemers duur uren duur dagen leeftijd van leeftijd tot rol straathoekwerk
9. Activiteiten (gasten) Variabele persoonscode rol gast
Mogelijke waarde zie sleutel deelnemer organisator medewerker
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6) DrugAid Registration System (DARTS) 1. Identiteitsscherm
Het identiteitsscherm is gelinkt met alle formulieren en staat bovenaan elk formulier. 1.1.ID ID: wordt automatisch door DARTS gemaakt 1.2. Pincode Herkomst: DARTS Definitie: PIN-code: wordt automatisch door DARTS gemaakt indien alle elementen bekend zijn: eerste letter voornaam, eerste letter(s) familienaam, geboortedatum, en geslacht 1.3. Naam Herkomst:DARTS Definitie:Vrij veld voor de familienaam van uw cliënt in te geven Opmerkingen: Onderdeel van de PIN-code Let op de juiste schrijfwijze van de naam. Dit is belangrijk omdat dit zijn invloed heeft op de Pincode !! 1.4. Voornaam Herkomst: DARTS Definitie: Vrij veld voor de voornaam van uw cliënt in te geven Opmerkingen: Onderdeel van de PIN-code 1.5. Dossiernummer Herkomst: DARTS Definitie: Vrij veld voor het dossiernummer van uw cliënt in te geven Opmerkingen: Elk centrum kan zijn eigen systeem gebruiken 1.6. Geboortedatum Gemeenschappelijke variabele !!! Herkomst: DARTS Definitie: De geboortedatum van uw cliënt Codetabel: Datumveld Opmerkingen: Onderdeel van de PIN-code
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1.7. Geboorteplaats Herkomst: DARTS Definitie: Postnummer van de geboorteplaats van de cliënt. Hiervoor kan je de lijst gebruiken. Indien de cliënt geboren is in het buitenland, geef dan de telefooncode van het land in. Codetabel : Lijst met steden en gemeenten 1.8. Geslacht Gemeenschappelijke variabele !!!! Herkomst: VAD5 Definitie: Zoals vermeld op de identiteitskaart Codetabel: Geslacht Man Vrouw
Code 1 2
Opmerkingen: Onderdeel van de PIN-code 2. Aanmeldingsscherm In dit formulier worden alle aanmeldingen geregistreerd. Dit formulier bevat slechts een beperkt aantal variabelen. 2.1. Registratieplaats Gemeenschappelijk variabele !!! Herkomst: DARTS Definitie: Vrij veld om de afdeling van uw centrum in te geven Codetabel: Vrij Opmerking: Voor de gemeenschappelijke verwerking is het belangrijk dat de naam van desbetreffende registratieplaats steeds op een herkenbare wijze wordt weergegeven en dat dit consequent wordt toegepast. 2.2. Interviewer Herkomst: DARTS Definitie: Vrij veld om de naam van de interviewer van de cliënt in te geven Codetabel: vrij 2.3. Wijze van contact Herkomst: DARTS Definitie: Op welke wijze meldde de cliënt zich aan. Telefonisch, per brief of andere enkel scoren indien de cliënt zich nooit persoonlijk heeft aangemeld. Codetabel: Wijze van contact In persoon Telefonisch Per brief Andere Onbekend
Code 1 2 3 4 9
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Opmerkingen : Indien iemand eerst per brief zich aanmeldt en later persoonlijk naar het centrum komt duidt men ‘in persoon ‘ aan. Men kijkt dus naar hoe “ver” iemand geraakt is. 2.4. Aanmeldingsdatum Herkomst: VLIS-DC Definitie: De datum waarop de cliënt werd aangemeld in het centrum Codetabel: Datumveld Opmerkingen: Gelinkt met intakescherm 2.5. Aanmeldingsnummer Herkomst: DARTS Definitie: De hoeveelste aanmelding van de betrokken persoon in het centrum Codetabel: Vrij 2.6. Soort Cliënt Herkomst: VAD16 Definitie: Soort cliënt stelt vast in welke mate de persoon reeds in contact kwam met het betrokken centrum voor dezelfde middelenproblematiek. De termijn wordt niet beperkt tot het afgelopen jaar, maar tot het volledige leven van de persoon. Codetabel: soort cliënt Nieuwe cliënt Reeds in behandeling geweest in dit centrum Onbekend
Code 1 2 9
Opmerkingen: Gelinkt met intakescherm 2.7. Leeftijdschatting Herkomst: DARTS Definitie: Indien de geboortedatum van de cliënt niet bekend is, kan hier een schatting van de leeftijd worden ingegeven. 2.8. Voornaamste product Opmerkingen: Gelinkt met intakescherm; zie 3.27 2.9. Toedieningswijze Opmerkingen: Gelinkt met intakescherm; zie 3.28
2.10. Frequentie Gebruik Opmerkingen: Gelinkt met intakescherm; zie 3.29 2.11. Hoeveelheid per dag Herkomst: DARTS Definitie: Vrij veld om de hoeveelheid van de door de cliënt gebruikte drug(s) in te geven Codetabel: Vrij 2.12. Gebruikte dosis VM Naam Variabele: Gebruikte dosis van vervangmedicatie
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Herkomst: DARTS Definitie: Vrij veld voor de gebruikte dosis van vervangmedicatie in te geven Codetabel: Vrij Opmerkingen: Gelinkt met intakescherm 2.13. Probleemniveau gebruik Opmerkingen: Gelinkt met intakescherm 2.14. Justitiële situatie Opmerkingen: Gelinkt met intakescherm; zie 3.52 2.15. Justitiële situatie 2 Opmerkingen: Gelinkt met intakescherm; zie 3.52 2.16. Verwijzer Gemeenschappelijke variabele !!! Herkomst: Vlis-DC Definitie: De laatste verwijzer in de keten wordt gedefinieerd. Codetabel: Beschrijving code Gebruiker Omgeving Welzijn en ggz Gespecialiseerde centra Medische psychiatrisch ambulant Medische psychiatrisch residentieel Juridisch
Code 100 200 300 400 500 550 600
Opmerkingen !! : Elk centrum krijgt hier de mogelijkheid om organisaties aan de lijst toe te voegen binnen de bestaande hoofdcategorieën. Een eigen codetabel kan men maken door in het formulier ‘voorblad’ op de knop ‘versie’ te drukken. In de tabel kan men nu per centrum eigen codes ingeven. Eenmaal ingegeven verschijnt in het programma een afrolmenu met de eigen keuzes. Gelinkt met intakescherm 2.17. Postcode verblijfplaats Gemeenschappelijke variabele !!! Herkomst: DARTS Definitie: De postcode van de gemeente waar de cliënt verbleef, juist voor de start van de behandeling in het betrokken centrum. Hiervoor kan je de lijst gebruiken. Indien de cliënt in het buitenland verbleef, geef dan de telefooncode van het land in. Codetabel: Lijst met steden en gemeenten en postnummers 2.18. Afloop aanmelding Herkomst: DARTS Definitie: Beschrijving van wat er met de aanmelding is gebeurd - Opgenomen: Cliënt werd “onmiddellijk” (binnen een maand) opgenomen, er werd “onmiddellijk” een behandeling gestart. - Doorverwezen: Cliënt kwam niet in aanmerking voor behandeling of opname in betrokken centrum, en werd doorverwezen. 175
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Geen behandeling opgestart: Cliënt haakte zelf af, kwam niet meer opdagen, liet niets meer van zich horen,… - Cliënt verhinderd: Cliënt komt in aanmerking voor opname in betrokken centrum, maar werd bijvoorbeeld door justitie niet vrijgelaten, er waren medische redenen,… - Nog niet beëindigd: De aanmelding loopt nog - Onbekend: We weten het niet, maar de cliënt startte geen behandeling. Codetabel: Afloop aanmelding Opgenomen Doorverwezen Geen behandeling opgestart Cliënt verhinderd Nog niet beëindigd. Onbekend
code 1 2 3 4 8 9
2.19. Afloop aanmelding: vertrokken naar Herkomst: DARTS Definitie: Naar waar is de cliënt naartoe gegaan ( al dan niet verwezen) na de afronding van de aanmelding. Codetabel: Beschrijving code Gebruiker Omgeving Welzijn en ggz Gespecialiseerde centra Medische psychiatrisch ambulant Medische psychiatrisch residentieel Juridisch
Code 100 200 300 400 500 550 600
Opmerkingen: Elk centrum krijgt hier de mogelijkheid om organisaties aan de lijst toe te voegen binnen de bestaande hoofdcategorieën. Een eigen codetabel kan men maken door in het formulier ‘voorblad’ op de knop ‘versie’ te drukken. In de tabel kan men nu per centrum eigen codes ingeven. Eenmaal ingegeven verschijnt in het programma een afrolmenu met de eigen keuzes. 2.20. Commentaar bij ontslag Herkomst: DARTS Definitie: Gelinkt-vrij tekstveld. Hier wordt de eventuele commentaar van het laatste ontslag weergegeven Codetabel: Vrij Opmerkingen: Gelinkt met intakescherm 2.21. Commentaar bij aanmelding Herkomst: DARTS Definitie: Vrij tekstveld. Hier kan je eventuele commentaar bij deze aanmelding weergeven. Codetabel: ‘memoveld’
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3. Intakescherm Alle variabelen die gemeenschappelijk verwerkt worden staan vermeld in dit formulier. Dit formulier wordt ingevuld van zodra de cliënt een behandeling start, het betreft dus behandelingsgegevens. 3.1. Registratieplaats Opmerkingen: Gelinkt met aanmeldingscherm 3.2. Wijze van contact Opmerkingen:Gelinkt met aanmeldingscherm 3.3. Betrouwbaarheidscode Herkomst: DARTS Definitie: Beoordeling van de betrouwbaarheid van de gegevens van het intakescherm. Codetabel: Beschrijving code Onbetrouwbaar Summier Betrouwbaar Onbekend
Code 1 2 3 9
3.4. Interviewer Opmerkingen: Gelinkt met aanmeldingscherm 3.5. Aanmeldingsdatum Opmerkingen: Gelinkt met aanmeldingscherm 3.6. Aanmeldingsnummer Opmerkingen: Gelinkt met aanmeldingscherm; zie 2.5 3.7. Start/Opnamedatum Gemeenschappelijke variabele !! Herkomst: VLIS-DC Definitie: De datum waarop de cliënt de behandeling startte in het centrum. Bij residentiële programma’s spreekt dit voor zich. Bij ambulante settings dient de RIZIV-conventie gerespecteerd te worden !!!! Codetabel: Datumveld Opmerkingen: Op basis van de opnamedatum worden de gegevens geselecteerd en verwerkt. Mag dus niet ontbreken !!!!!! 3.8. Behandelingsrangnummer Herkomst: DARTS Definitie: De hoeveelste behandeling van de betrokken persoon in het centrum Codetabel: Vrij
177
3.9. Start/ Opname-uur Herkomst: DARTS Definitie: Het uur waarop de behandeling van de cliënt startte/ de cliënt werd opgenomen in het centrum Codetabel: Uurveld 3.10. Ontslagdatum Herkomst: VLIS-DC Definitie: De datum waarop de cliënt werd ontslagen het centrum. Voor de residentiële centra is dit de ontslagdatum. Bij de ambulante centra is dit de datum van het laatste factureerbare gesprek van de cliënt, conform de RIZIV-conventie !! Codetabel: Datumveld Opmerkingen: Mag niet ontbreken !! 3.11. Ontslaguur Naam Variabele: Ontslaguur Herkomst: DARTS Definitie: Het uur waarop de cliënt werd ontslagen in het centrum Codetabel: Uurveld 3.12. Wijze van ontslag Herkomst: Vlis-DC Definitie: Beschrijving van de manier van vertrek van de cliënt uit het betrokken centrum. Bij een administratief ontslag loopt de behandeling loopt verder, het ontslag is louter administratief. Onbekend wil zeggen dat het niet bekend is op welke manier de cliënt het centrum heeft verlaten. Codetabel: Wijze van ontslag Met advies vertrokken Tegen advies vertrokken Buitengezet Nog opgenomen Administratief ontslag Onbekend
Code 10 20 30 40 55 99
3.13. Afloop behandeling: vertrokken naar Herkomst:Vlis-DC Definitie: Naar waar is de cliënt gegaan na vertrek uit het betrokken centrum Codetabel: Zie 2.19 Opmerkingen: Elk centrum krijgt hier de mogelijkheid om organisaties aan de lijst toe te voegen binnen de bestaande hoofdcategorieën. 3.14. Commentaar bij ontslag Herkomst: DARTS Definitie: Vrij tekstveld. Hier kan je eventuele commentaar bij dit ontslag weergeven Codetabel: Vrij 3.15. Verwijzer Gemeenschappelijke variabele !!! Herkomst: Vlis-DC Definitie: De laatste verwijzer in de keten wordt gedefinieerd. 178
Codetabel: Zie 2.16 Opmerkingen: Elk centrum krijgt hier de mogelijkheid om organisaties aan de lijst toe te voegen binnen de bestaande hoofdcategorieën.Gelinkt met aanmeldingscherm. 3.16. Type behandeling Herkomst: VAD17 Definitie: Bij soort behandeling die wordt opgestart wordt de combinatie van behandelingen bevraagd. Indien mogelijk worden er vier behandelingen ingevuld: wat de onmiddellijke behandeling zal zijn, onmiddellijk na intake én wat de voorziene behandeling zal zijn op termijn. De detox slaat op een detoxificatie waarbij verschillende mogelijkheden voorhanden zijn. Vooreerst is er de mogelijkheid tot een onmiddellijke stopzetting van het middelengebruik (de zogenaamde cold turkey). Ten tweede kan er gedetoxifieerd worden d.m.v. het toedienen van een substitutieproduct. Ten derde is er de geleidelijke afbouw van het middelengebruik. Naast die detoxificaties bestaat de mogelijkheid tot een medicamenteuze behandeling. Met de niet-detoxbehandelingen worden onderhoudsbehandelingen bedoeld. Bij de psychosociale behandelingen wordt een onderscheid gemaakt tussen psychosociale begeleiding (bijvoorbeeld het in orde brengen van mutualiteit, huisvesting, OCMW, werk, justitiële contacten,…) en (psycho-)therapie (zoals ergotherapie, gezins- en relatietherapie, kinesitherapie,…). Tenslotte wordt de mogelijkheid voorzien om “geen behandeling” aan te kruisen. Codetabel: Type behandeling detox – cold turkey detox – substitutie detox – afbouw non-detox onderhoudsbehandeling Medicamenteuze behandeling Psychosociale begeleiding Psychotherapie geen behandeling opgestart/doorverwijzing Onbekend
Code 1 2 3 4 5 6 7 8 9
Opmerkingen: Afkomstig uit Europ-ASI. Voor crisisprogramma’s stelt de Vlis-DC werkgroep voor de codes 3-6-7 te gebruiken, voor behandelingsprogramma’s 6,7. Voor de MSOC’s hebben we geen specifieke code afgesproken. Het belangrijkste is dat elk centrum consequent dezelfde code gebruikt. 3.17. Type behandeling 2 Opmerkingen: Zie 3.16 3.18. Type behandeling 3 Opmerkingen: Zie 3.16. 3.19. Type behandeling 4 Opmerkingen: Zie 3.16. 3.20. Postcode woonplaats Herkomst: Vlis-DC Definitie: De postcode van de gemeente waar de cliënt officieel gedomicilieerd is of waar hij/zij het laatst ingeschreven was, juist voor opname van de cliënt in het betrokken centrum.
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Hiervoor kan je de lijst gebruiken. Indien de cliënt in het buitenland gedomicilieerd is, geef dan de telefooncode van het land in. Codetabel: Lijst van de postcodes, gemeenten steden Onbekend : 9999 3.21. Postcode verblijfplaats Gemeenschappelijke variabele !!! Herkomst: DARTS Definitie: De postcode van de gemeente waar de cliënt verbleef, juist voor de start van de behandeling in het betrokken centrum. Hiervoor kan je de lijst gebruiken. Indien de cliënt in het buitenland verbleef, geef dan de telefooncode van het land in. Dit heeft niets met het domicilieadres te maken !! Codetabel: lijst van de postcodes, steden en gemeenten Onbekend : 9999 3.22. In gecontroleerde verblijfplaats laatste 30 dagen Herkomst: Europ-ASI Alg-8 Definitie: Deze vraag heeft betrekking op een leefsituatie waarin de cliënt niet vrij is om te gaan en staan waar hij/zij wil en waarin restricties zijn opgelegd in de beschikbaarheid van alcohol en drugs. Over het algemeen betekent dit opname in een kliniek of verblijf in een penitentiaire inrichting. Een begeleid-wonenproject is meestal GEEN gecontroleerde omgeving. Als de ondervraagde in twee verschillende gecontroleerde omgevingen heeft verbleven, vul dan het nummer in van de omgeving waarin hij/zij het langst heeft verbleven. Periode : de laatste 30 dagen !!
Codetabel: Verblijf gecontroleerde omgeving afgelopen 30 dgn Nee Gevangenis Alcohol- of drugbehandeling Medische behandeling Psychiatrische behandeling Detoxificatie zonder vervolgbehandeling Andere Onbekend
Code 1 2 3 4 5 6 7 9
Interpretatie : “Alcohol- of drugbehandeling” : gespecialiseerde drughulpverlening “Medische behandeling” : behandeling in een algemeen ziekenhuis “Psychiatrische behandeling” : behandeling in residentiële psychiatrie “Detoxificatie zonder vervolgbehandeling” : specifiëring van alcohol-of drugbehandeling 3.23. Nationaliteit Gemeenschappelijke variabele !!! Herkomst: VAD7 Definitie: Met Belg wordt de persoon bedoeld die een Belgische identiteitskaart heeft. Alle andere personen zijn “niet-Belg”. Daarbij zijn personen die op hun identiteitskaart één van volgende landen hebben “Niet-Belg uit de Europese Gemeenschap”: Nederland, Luxemburg, Frankrijk, Duitsland, Verenigd Koninkrijk, Ierland, Spanje, Portugal, Griekenland, Zweden, Denemarken, Italië, Finland, Oostenrijk. 180
Alle andere personen zijn “Niet-Belg, niet-Europese Gemeenschap”. Codetabel: Nationaliteit Belg Niet-Belg, EG Niet-Belg, Niet EG Onbekend
code_nat 1 2 3 9
3.24. Geboorteland Gemeenschappelijke variabele !!! Herkomst: ASI-7A Definitie: Land waarin de persoon geboren is Codetabel: Code Geboorteland geboorteland 402 België 408 Frankrijk 410 Duitsland 414 Griekenland 418 Italië 419 Luxemburg 421 Nederland 423 Polen 428 Spanje 131 Marokko 340 Turkije 434 Joegoslavië
Opmerking : deze lijst dient nog uitgebreid te worden !! Dit zal gebeuren aan de hand van een recente ASI-lijst. Alcohol- en druggebruik 3.25. Leeftijd eerste gebruik drugs Gemeenschappelijke variabele !! Herkomst: VAD32 Definitie: De leeftijd van de persoon bij het gebruik van illegale drugs (niet van toepassing bij alcohol) is de leeftijd waarop de persoon voor het eerst een vorm van drugs gebruikt heeft. Indien deze leeftijd onbekend is, geef dan niet “99” in, maar laat je het veld gewoon leeg. 3.26. Probleemniveau gebruik Herkomst:VAD33 Definitie: Als het middelenmisbruik het hoofdprobleem is dan wordt “hoofdprobleem” aangekruist. Wanneer daarentegen bijvoorbeeld een psychiatrisch probleem het hoofdprobleem is dan wordt “nevenprobleem” gescoord voor middelenmisbruik. Wanneer er geen duidelijk onderscheid is, scoor dan “3”.
181
Codetabel: Probleemniveau Gebruik Hoofdprobleem Nevenprobleem Geen onderscheid Onbekend
Code 1 2 3 9
Opmerkingen: Gelinkt met aanmeldingscherm.
3.27. Voornaamste product Gemeenschappelijke variabele !!! Herkomst:VAD20 Product slaat op de naam van het belangrijkste product, het tweede product, en het derde product. Hierbij wordt als uitgangspunt genomen dat de persoon die registreert, bepaalt welk product het belangrijkste is. Dit gebeurt volgens de methode van de DSM. Je overloopt samen alle producten en selecteert dan de belangrijkste inzake afhankelijkheid en verslaving. Als twee middelen even belangrijk zijn, noteer dan het recente belangrijkste middel. Het onderscheid tussen voorgeschreven methadon en niet-voorgeschreven methadon is dat de eerste categorie wordt gescoord op het ogenblik dat de persoon verslaafd is in het kader van een ontwenningsprogramma, terwijl de tweede categorie een verslaving is die los staat van ontwenningsprogramma’s. Wanneer bijvoorbeeld iemand zich in een instelling aanbiedt, die eigenlijk in een andere instelling afkickt van een heroïneverslaving en daardoor methadon gebruikt, dan wordt deze persoon gescoord als verslaafd aan “voorgeschreven methadon”. Het gewicht van het tweede en derde product is onderling verwisselbaar. Er wordt dus geen onderscheid gemaakt in tweede en derde product wat betreft de volgorde. Opgemerkt moet worden dat de huidige categorieën worden voorgesteld door het Europese Drugsobservatorium. Bij de verwerking zal een dusdanige indeling waarschijnlijk niet zo strak worden aangehouden. Codetabel: Product Opiaten Heroïne opium-morfine Codeïne Voorgeschreven methadon niet-voorgeschreven methadon andere opiaten Stimulantia Cocaïne Amfetamine MDMA (xtc) PMA 2 CB andere stimulantia slaap- en kalmeermiddelen Barbituraten Benzodiazepines
Code 10 11 12 13 14 15 18 20 21 22 23 24 25 28 30 31 32
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GHB (Liquid XTC) andere slaap- en kalmeermiddelen Hallucinogenen LSD Paddestoelen en andere plantenafleidingen Ketamine andere hallucinogene producten vluchtige snuifmiddelen Cannabis Hasj Marihuana andere cannabisderivaten Alcohol Bier Wijn sterke drank Aperitieven andere alcohol andere psychoactieve drugs onbepaalde drugs of substanties niet-gespecifieerde geneesmiddelen Speedball anti-parkinson anti-depressiva Snowball Andere specifieke drugs geen tweede/derde product geen product Onbekend
33 38 40 41 42 43 48 50 60 61 62 68 70 71 72 73 74 78 80 81 82 83 84 85 86 88 90 98 99
Opmerkingen: De hoofdcategorie volstaat indien het specifieke product niet bekend is. Bijvoorbeeld cannabis volstaat indien het niet bekend is of het marihuana of hasj is. Indien er geen tweede of derde product gebruikt wordt, geef dan de code 90 in. Code 98 wordt enkel ingevuld als de cliënt effectief geen enkel product gebruikt. Interpretatieverduidelijking : Hoe moet er geregistreerd worden bij de ‘overgangen’ tussen verschillende onderdelen van een programma ? Bijvoorbeeld tussen een crisisprogramma en een TG of KTP. Inzake registratie maken we geen onderscheid. Dus waneer iemand zich aanmeldt in een crisiscentrum (met als voornaamste product bijvoorbeeld amfetamine) en na een aantal weken overgaat naar de TG, dan wordt bij de ‘TG-registratie’ ook amfetamine geregistreerd. 3.28. Toedieningswijze Herkomst:VAD21,25,29 Definitie: Toedieningswijze van de probleemdrug slaat op de manier waarop de drug wordt gebruikt. Indien twee gebruikswijzen van hetzelfde product sterk uiteenlopen, scoor anders de gebruikswijze die het hoogst in de lijst staat (hogere code). De volgorde die voorgesteld werd weerspiegelt de mate van risico. De categorie “Andere” slaat op sublinguaal, via de huid,…
183
Codetabel: Toedieningswijze Slikken, drinken Snuiven Inhaleren of roken Spuiten (niet IV) Intraveneus Andere Onbekend
Code 1 2 3 4 5 8 9
3.29. Frequentie Gebruik Herkomst:VAD22,26,30 Definitie:Frequentie van het druggebruik gedurende de laatste maand Codetabel: Frequentie Gebruik Niets in het laatste jaar Minder dan eens per maand Éénmaal per week of minder twee tot zes dagen per week Dagelijks n.v.t. Onbekend
Code 1 2 3 4 5 8 9
3.30. Leeftijd eerste gebruik Gemeenschappelijke variabele !!! Herkomst: VAD23,27,31 Definitie: De leeftijd bij het eerste gebruik van de drug in jaren vraagt naar de leeftijd waarop de persoon voor het eerst gebruik maakte van de probleemdrug vermeld in 3.27 Voornaamste product, 3.31 Tweede product, 3.35 Derde product (vb.15 wanneer de persoon 15 jaar was). Opmerking : Indien die variabele onbekend is, kan er geen 99 ingevuld worden. Je laat het veld leeg, indien onbekend. 3.31. Tweede product Opmerkingen: Zie 3.27 3.32. Toedieningswijze Opmerkingen: Zie 3.28 3.33. Frequentie Gebruik Opmerkingen: Zie 3.29 3.34. Leeftijd eerste gebruik Opmerkingen: Zie 3.30 3.35.Derde product Opmerkingen: Zie 3.27 3.36. Toedieningswijze Opmerkingen: Zie 3.28
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3.37. Frequentie Gebruik Opmerkingen: Zie 3.29 3.38. Leeftijd eerste gebruik Opmerkingen: Zie 3.30 3.39. Gebruikte dosis Vervangmedicatie Herkomst: DARTS Definitie: Vrij veld voor de gebruikte dosis van vervangmedicatie in te geven Codetabel: Vrij Opmerkingen: Gelinkt met aanmeldingscherm Gebruik van injectiemateriaal 3.40. Ooit geïnjecteerd Gemeenschappelijke variabele !!! Herkomst:VAD34 Definitie:Ooit geïnjecteerd wil nagaan of de persoon ooit gebruik maakte van injectiemateriaal. Zo ja, dan worden de vragen 3.41. Momenteel injecterend tijdens vorige 30 dagen, 3.42. Ooit gemeenschappelijk gebruik injectiemateriaal, 3.43. Gemeenschappelijk gebruik injectiemateriaal laatste maand, 3.44. Leeftijd eerste injectie gesteld. Codetabel: Ooit geinjecteerd Neen Ja Onbekend
Code 0 1 9
3.41. Momenteel injecterend tijdens vorige 30 dagen Herkomst:VAD35 Definitie: men gaat na of de persoon nog een keer gebruik gemaakt heeft van injectiemateriaal tijdens de laatste 30 dagen. Codetabel: Momenteel Injecterend Neen Ja Onbekend
Code 0 1 9
3.42. Ooit gemeenschappelijk gebruik injectiemateriaal Herkomst: VAD36 Definitie: Ooit gemeenschappelijk gebruik injectiemateriaal onderzoekt of de persoon ooit, al was het maar één keer, injectiemateriaal gedeeld heeft met anderen. Codetabel: Spuiten delen ooit Neen Ja Onbekend
Code 0 1 9
185
3.43. Gemeenschappelijk gebruik injectiemateriaal laatste maand Herkomst: VAD37-Europ-ASI Definitie: Gemeenschappelijk injectiemateriaal wil nagaan of de persoon gedurende de laatste maand gebruik gemaakt heeft van gemeenschappelijk injectiemateriaal (watjes, lepels, spuiten, naalden,...). Codetabel: Spuiten delen 30 dagen Neen Ja Onbekend
Code 0 1 9
3.44. Leeftijd eerste injectie Herkomst: VAD38 Definitie: Leeftijd eerste injectie vraagt naar de leeftijd van de eerste injectie (vb.15) ongeacht de verdere ontwikkeling van het injectiegedrag. Indien de persoon nog nooit gespoten heeft, geef dan niets in.
3.45. Hepatitis A ooit Herkomst: VAD40 Definitie: Heeft de cliënt ooit hepatitis gehad. Deze vraag controleert in welke mate de patiënt ooit hepatitis heeft gehad. Indien “Ja” dan wordt gevraagd naar welke hepatitis . Codetabel: Ja/Nee Nee Ja Onbekend
Code 0 1 9
3.46. Datum Hepatitis A vaststelling Herkomst:VAD Definitie: Wanneer werd de hepatitis vastgesteld. Dit mag ook de datum van de screening in het centrum zijn. 3.47. Hepatitis B ooit Opmerkingen: Zie
3.45. Hepatitis A ooit 3.48. Datum Hepatitis B vaststelling Opmerkingen: Zie 3.46. Datum Hepatitis A vaststelling 3.49. Hepatitis C ooit Opmerkingen: Zie
3.45. Hepatitis A ooit
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3.50. Datum Hepatitis C vaststelling Opmerkingen: Zie 3.46. Datum Hepatitis A vaststelling Justitie
Herkomst: Definitie: Codetabel: Ja/Nee Nee Ja Onbekend
3.51. Justitiële verwijzing Darts Werd de cliënt door justitie verwezen naar het centrum? Code 0 1 9
Opmerkingen: We spreken van een justitiële doorverwijzing als er door contact (schriftelijk of mondeling) met de betrokken justitiële dienst duidelijk is dat de justitiële contactpersoon opdrachtgever is tot intake, begeleiding of behandeling. Het moet duidelijk zijn dat het contact met de cliënt het gevolg is van een justitiële beslissing. Noodzakelijke voorwaarde : het moet duidelijk zijn dat justitie opdrachtgever is. Deze duidelijk kan er komen door : - contact (schriftelijk of mondeling) met de justitiële contactpersoon - documenten die door de cliënt worden meegebracht 3.52. Justitiële situatie Gemeenschappelijke variabele !!! Herkomst:Vlis-DC Definitie: Justitiële situatie van de cliënt, zoals weergegeven door de cliënt, juist voor de opname/contactname in het betrokken centrum De hoofdcategorieën VRIJ, INVRIJHEIDSTELLING, VRIJHEIDSBEROVING, BIJZONDERE JEUGDZORG, ALTERNATIEVE MAATREGELEN GAM kunnen enkel gebruikt worden wanneer verdere specifiëring niet geweten is. Codetabel: Justitiële situatie VRIJ Zonder juridisch verleden
Met juridisch verleden Zaak nog in behandeling
Vrij in afwachting effectief uitgesproken straf INVRIJHEIDSTELLING Vrijheid onder voorwaarden
Code Definitie 10 11 De persoon heeft geen strafblad. Hij of zij heeft in het verleden nog niet in aanraking geweest met het justitiële apparaat. 12 De persoon heeft in het verleden al een veroordeling opgelopen. 13 Dit is te situeren in het kader van het vooronderzoek. Er hebben bijvoorbeeld al een huiszoeking en verschillenden verhoren plaatsgevonden maar de persoon heeft nog geen ‘oproep’ gekregen om zich op parket of rechtbank te melden. 14 De persoon is vrij (zonder voorwaarden), maar is in afwachting van een effectief uitgesproken straf. 20 21 VOV is een alternatief voor de voorlopige hechtenis.
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Preatoriaanse probatie
Probatie opschorting van strafuitspraak Probatie uitstel strafuitvoering Voorwaardelijke invrijheidstelling VI
Voorlopige invrijheidstelling
Elektronisch Toezicht VRIJHEIDSBEROVING
Stelsel halve vrijheid
Stelsel week-end arrest
Wanneer een voorlopige hechtenis kan worden bevolen, kan een verdachte onder bepaalde voorwaarden toch zijn vrijheid behouden of terugkrijgen. Deze mogelijkheid situeert zich in het kader van het vooronderzoek. Opmerking : Het gerechtelijke statuut ‘voorhechtenis’ staat niet in de lijst. Heel wat aanvragen vanuit de gevangenis gebeuren tijdens een ‘voorhechtenis’-situatie. Bij de aanmelding zou er dan eigenlijk voorhechtenis moeten aangeduid worden. Het is weliswaar zo dat op het moment dat iemand naar het centrum komt de voorhechtenis een VOV is geworden. Het lijkt ons het best om iemand die onder het statuut ‘voorhechtenis’ valt bij de VOV aan te klikken. 22 De praetoriaanse probatie houdt in dat de betrokkene niet wordt vervolgd op voorwaarde dat hij zich aan -door het parket - opgelegde voorwaarden houdt. De praetoriaanse maatregel is niet wettelijk-geregeld. Deze maatregel situeert zich dus op het niveau van het parket !! 23 Bij opschorting beschouwt de rechter, met instemming van de beklaagde, de strafbare feiten als bewezen, maar er wordt geen veroordeling uitgesproken. 24 Betekent dat een uitgesproken straf niet wordt uitgevoerd. 25 Hier bevinden we ons op het niveau van de strafuitvoering. Er is dus reeds een vonnis uitgesproken. De betrokkenen kan, mits het naleven van een aantal voorwaarden, na één derde van de straf hebben uitgezeten vervroegd vrij komen. Bij een voorwaardelijke invrijheidsstelling gaat het over straffen van meer dan 3 jaar. De kans tot een voorwaardelijke invrijheidstelling wordt bepaald door de VI-commissie. De voorwaardelijke invrijheidsstelling kan leiden tot een definitieve invrijheidsstelling. 26 Omwille van opportuniteitsredenen wordt de tenuitvoerlegging van de vrijheidsstraf opgeschort. Bijvoorbeeld: - Met het oog op gratie, op een VI. - Wanneer de veroordeelde gezondheidsproblemen heeft. - Bij vreemdelingen met het oog op verwijdering uit het land. De voorlopige invrijheidstelling leidt niet automatisch tot een definitieve invrijheidsstelling. 27 Betrokken is onder elektronisch toezicht geplaatst. 30 Wordt enkel ingevuld wanneer onderstaande mogelijkheden (binnen deze categorie) niet voldoende zijn of wanneer geen verdere specifiëring geweten is. 31 (Beperkte hechtenis) Het is een ononderbroken vrijheidsberoving waarbij de veroordeelde de mogelijkheid krijgt gedurende de dag de penitentiaire instelling te verlaten om zijn normale activiteiten voort te zetten 32 Weekendarrest is een vrijheidsberoving in “schijven” : de
188
Gecolloceerd
Geïnterneerd
BIJZONDERE JEUGDZORG
comite bijzondere jeugdzorg Bemiddelingscommissie Jeugdrechtbank ALTERNATIEVE MAATREGELEN GAM Bemiddeling in strafzaken
ter beschikking van de regering Alternatieve straf Probatie-dienstverlening Diversiemaatregelen (minderjarigen) ANDERE MET JUSTITIËLE DRUK NIET VAN TOEPASSING ONBEKEND
straf wordt ondergaan tijdens het weekend. Het is een gunst die door het parket aan de veroordeelde wordt toegestaan. 33 Deze sanctie wordt uitgesproken door een vrederechter. Op vraag van familie kan de rijkswacht iemand voor de vrederechter brengen. Iemand die onder het statuut ‘gecolloceerd’ valt en naar een hulpverleningscentrum gaat noemt men gedecolloceerd op proef. 34 De rechtbank beslist tot internering als ze van oordeel is dat de dader van een misdrijf een gevaar is voor de samenleving omdat hij niet in staat wordt geacht om zijn daden te controleren. Deze maatregel kan worden uitgesproken door de onderzoeksgerechten (raadkamer en Kamer van inbeschuldigingsstelling) of door een vonnisrechtbank. 40 Deze categorie gaat enkel over minderjarigen. In het beschermingsrecht van minderjarigen onderscheidt men de drie volgende ‘statuten’ 41 de maatregel wordt niet uitgesproken door een rechter, maar door een consulent. 42 43 Een rechter legt in dit geval een maatregel op. 50 Dit kan worden ingevuld wanneer het een alternatieve maatregel betreft, en onderstaande mogelijkheden ontoereikend zijn. 51 De procureur des Konings (niveau van het parket) kan via een bemiddeling in strafzaken een dossier pogen af te handelen zonder de tussenkomst van een rechter. 52 TBR-maatregel, uitgesproken door Minister van Justitie 53 54 Alternatieve maatregel in het kader van probatie 55 Uitgesproken door jeugdparket 97 98 Dit wordt enkel ingevuld bij de tweede mogelijkheid wanneer er geen tweede justitiële situatie is. 99
Opmerkingen: 2 plaatsen voor indien nodig 2 verschillende situaties in te vullen. De hoofdcategorie volstaat indien de specifieke situatie niet bekend is. Duiding bij interpretatie : - Code 10 (“vrij”) moet eigenlijk geïnterpreteerd worden als “geen”. Betreffende persoon heeft op het moment van de aanmelding geen justitiële situatie. - Probatiemaatregelen (code 22,23 en 24). Indien het niet duidelijk is onder welke probatiemaatregelen mensen vallen, geef je code 24 in. Meestal gaat het over deze maatregel. - Code 98 kan enkel ingevuld worden bij de 2e mogelijkheid - Code 99 is onbekend 3.53. Justitiële situatie 2 Opmerkingen: Zie hierboven. Familiale en Sociale relaties
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3.54. Burgerlijke staat Gemeenschappelijke variabele !!! Herkomst:Europ-ASI Definitie:De huidige burgerlijke staat Codetabel: Burgerlijke staat Gehuwd (1e huwelijk) Hertrouwd (2e of later huwelijk) Weduwstaat
Code 1 2 3
Gescheiden van tafel en bed (incl. gehuwd maar apart wonend) Gescheiden
4
Nooit gehuwd geweest Onbekend
6 9
5
3.55. Aantal kinderen Herkomst: Vlis-DC Definitie: Het aantal kinderen waarvan de cliënt de natuurlijke vader of moeder is. Codetabel : vrij 3.56. Situatie natuurlijke ouders Herkomst:Vlis-DC Definitie:Beschrijving de feitelijke situatie van de natuurlijke ouders van de cliënt, juist voor de opname van de cliënt in het betrokken centrum. Codetabel: Natuurlijke ouders beide ouders samenwonend ( al dan niet gehuwd) Ouders gescheiden één van beide ouders overleden beide ouders overleden Adoptieouders beide ouders onbekend Ongehuwde moeder of 1 ouder onbekend voor betrokkene n.v.t. Anderen Onbekend
Code 10 20 30 33 40 50 51
88 97 99
3.57. Belangrijkste opvoeder Herkomst: Vlis-DC Definitie: De personen of de instantie die door de cliënt worden benoemd als zijn voornaamste opvoeders. Kijk hiervoor naar de periode voor 18-jarige leeftijd van de cliënt. Moeder met stiefvader coderen met 1, 7 'andere': indien de cliënt niet kan kiezen tussen verschillende opvoeders. Codetabel: Voornaamste opvoeders Ouder(s)
Code 1
190
Adoptieouders Pleegouders Grootouders Andere familie Instellingen Andere Onbekend
2 3 4 5 6 7 9
3.58. Leefsituatie Gemeenschappelijke variabele !! Herkomst: ASI V4-VAD14 Definitie: Gebruikelijke Leefsituatie Kijk naar het leven dat de cliënt de afgelopen 3 jaar heeft geleid en vraag hem/haar naar hoeveel tijd hij/zij binnen die periode heeft doorgebracht in gevangenissen, ziekenhuizen of andere instellingen. Als dit het grootste deel van de tijd is, vul dan een ‘8’ in. Als de cliënt in verschillende situaties heeft geleefd, kies dan de situatie die de situatie van de afgelopen drie jaar het beste weergeeft. Als de verschillende situaties allen ongeveer even lang hebben geduurd, kies dan de meest recente. Codetabel: Leefsituatie met sexuele partner en kind(eren) alleen met sexuele partner alleen met kind(eren) met ouders met familie met vrienden/vriendinnen Alleen in een gecontroleerde omgeving Wisselende leefsituaties Onbekend
Code 1 2 3 4 5 6 7 8 9 99
Arbeid, opleiding 3.59. Hoogste diploma Gemeenschappelijke variabele !!! Herkomst: VAD8 Definitie: Hoogste opleidingsniveau : Deze variabele bevraagt de laatst-beëindigde studierichting, ongeacht de wijze waarop het niveau bereikt is (dagonderwijs, avondonderwijs, deeltijds onderwijs,...), ongeacht eventuele onderbrekingen. • Geen schoolse opleiding wordt aangeduid wanneer de cliënt geen lagere school heeft afgemaakt. • Buitengewoon lager onderwijs wordt gescoord wanneer iemand hoogstens BLO heeft afgewerkt. • Lagere school wordt aangegeven op het ogenblik dat de persoon de lagere school heeft beëindigd. • Buitengewoon secundair onderwijs heeft betrekking op het succesvol beëindigen van het BUSO. • Beroeps Sec. Ond. (BSO) of 2de graad of vroeger lager middelbaar • Beroeps Sec. Ond. 3de (ev. 4de) graad / Deeltijds leren (ook “leercontract”)
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• • • • •
Technische secundair onderwijs heeft betrekking op het succesvol beëindigen van een richting in het TSO of KSO. Algemeen secundair onderwijs heeft betrekking op het succesvol beëindigen van een richting in het ASO. Hoger niet-universitair onderwijs wordt aangegeven wanneer de persoon HOBU heeft afgemaakt. Universitair onderwijs geldt wanneer de cliënt een universitair diploma heeft. Andere wordt van toepassing wanneer de cliënt bijvoorbeeld een opleiding in het buitenland heeft afgewerkt die niet te vergelijken is met een Belgisch opleidingsniveau. Ook beroepsopleidingen, leercontracten, specialisatiejaren,… worden hierbij gerekend.
Codetabel: Hoogste opleiding Geen schoolse opleiding Buitengewoon Lager Ond. (BLO) Lager onderwijs Buitengewoon Sec. Ond. (BUSO) Beroeps Sec. Ond. (BSO) of 2de graad of vroeger lager middelbaar Beroeps Sec. Ond. 3de (ev. 4de) graad Deeltijds leren Technisch Sec. Ond. (TSO) of Kunst Sec. Ond. Algemeen Sec. Ond. (ASO) Hoger niet-universitair Ond. (HOBU) Universitair Ond. Andere Onbekend
Code 1 2 3 4 5 51 6 7 8 9 98 99
3.60. Gebruikelijk Beroep Gemeenschappelijk variabele !! Herkomst: VAD9 Definitie: Beroep : Indien de persoon een wisselende beroepsstatus kent, vermeld dan de langstdurende status die gedurende de laatste zes maanden werd uitgeoefend. Mocht dit nog gelijk zijn dan de beroepsstatus met het hoogste inkomensniveau. Mocht een andere termijn worden aangehouden dan wordt dit vermeld in het rapport. Vooraf is het belangrijk op te merken dat voor bepaalde hiërarchische beroepscategorieën, de cliënt de score krijgt die het nauwst aanleunt bij de onderstaande categorieën: zo zal rijkswachter gescoord worden als bediende, soldaat, brandweerman zullen gescoord worden als arbeider, terwijl generaal of brandweercommandant als directie zullen gescoord worden. Houd dus, bij deze beroepscategorieën, zoveel mogelijk rekening met de graden. • arbeider : hoofdzakelijk handenarbeid • bediende : overwegend hoofdarbeid, lagere bedienden worden hier ook toe gerekend • middenkader : overwegend hoofdarbeid, hogere bedienden worden hier ook toe gerekend • directie • vrij beroep : hiertoe behoren advocaten, dokters, apothekers, architecten, notarissen, ... die hun beroep enkel als zelfstandige uitoefenen. Een dokter die bijvoorbeeld, als hoofdberoep, directeur is van een centrum wordt als directie gescoord en krijgt hier dus GEEN score.
192
•
ander zelfstandig beroep : kruidenier, bakker, landbouwer, zelfstandig fotograaf, of andere zaakvoerder • andere (vb. incidentieel interimwerk, dealen, prostitutie, …) Codetabel: Gebruikelijk beroep Arbeider Bediende Middenkader Directie vrij beroep ander zelfstandig beroep niet actief Student Andere Onbekend
Code 1 2 3 4 5 6 7 8 98 99
3.61. Sociaal statuut/Werksituatie Gemeenschappelijke variabele !!! Herkomst: ASI-II8 Definitie: Vul hier niet simpelweg de meest recente situatie in, maar bepaal welk antwoord het beste bij de afgelopen drie jaar past. Werk kan als full-time worden beschouwd als het vast werk is (of lange-termijn uitzendwerk en ander werk dat gedurende langere tijd gedaan wordt) dat 32 uur per week of meer in beslag neemt. Zwart werk dient hier ook meegerekend te worden. Een vaste of lange termijn part-time baan is een baan waarin de cliënt minder dan 32 uur per week werkt, maar wel gedurende langere tijd of op vaste basis. Onregelmatig part-time werk is werk waar de cliënt wel part-time werkt, maar niet in een rooster waar hij of zij op kan rekenen (bijvoorbeeld oproepkrachten en incidenteel uitzendwerk). Als de cliënt ongeveer even lang in meerdere categorieën heeft gewerkt, noteer dan de categorie die het beste aansluit op de huidige situatie. Codetabel: Gebruikelijke werksituatie Volledige werkweek Parttime (regelmatige tijden) Parttime (onregelmatig) Student Gepensioneerd/arbeidsongeschikt/ziekte of invaliditeit Werkloos/brugpensioen/bijstand/huisvrouw in gecontroleerde omgeving/ n.v.t. Onbekend
Code 1 2 3 4 6 7 8 9
3.62. Gebruikelijke Bron van inkomsten Gemeenschappelijk variabele !!! Herkomst:VAD10 Definitie: Bron van inkomsten : Hier wordt de belangrijkste bron van inkomsten gescoord, d.w.z. de bron van inkomsten die het hoogste bedrag genereert gedurende de laatste 30 dagen. • Geen bron van inkomsten, personen zonder inkomen. • Eigen beroepsactiviteiten slaat op iedereen die een inkomen heeft uit zelfgepresteerde arbeid zoals arbeiders, bedienden, ambtenaren, kaderleden, zelfstandigen,....
193
•
Met “partner of ex-partner” worden enerzijds huismoeders of -vaders bedoeld, anderzijds wordt dit ook toegekend aan personen die genieten van alimentatiegeld. Wanneer deze categorie niet voorhanden is wordt (3.) andere familieleden gescoord. • Andere familieleden zijn bijvoorbeeld ouders of grootouders waar de cliënt bij inwoont. • RVA slaat op personen die een werkloosheidsuitkering hebben • OCMW slaat op personen met een bestaansminimum of een vervangingspensioen • Ziekte/invaliditeit wordt toegekend aan personen die een inkomen verwerven via een ziekte- of invaliditeitsuitkering • Bij gepensioneerden worden ook bruggepensioneerden gerekend. • Andere slaat op personen die een inkomen verwerven via een studiebeurs, studentenjob, prostitutie, dealen, illegaal werk,.... Codetabel: Bron van inkomsten Geen Eigen beroepsactiviteiten Partner, ex-partner Andere familieleden RVA OCMW Ziekte/invaliditeit Pensioen Andere Onbekend
Code 0 1 2 3 4 5 6 7 8 9
Duiding bij interpretatie : - een student die bij zijn ouders inwoont wordt gescoord onder code 3 - ouders behoren tot code 3 - “geen” inkomen moet eerder beschouwd worden als een uitzonderlijke variabele. Bijvoorbeeld wanneer iemand nog wat financiële reserves heeft en overigens geen inkomen heeft. Bijvoorbeeld sommige ex-gedetineerden. 3.63. Uitkering Herkomst: Darts Definitie: Heeft de cliënt een uitkering? Codetabel: Ja/Nee Nee Ja Onbekend
Code 0 1 9
4. Formulier : Medische gegevens 5. Formulier : RIZIVdossier 6. Formulier : Behandelingsadvies 7. EuropASI-scherm
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