Implementing the “Treatment Demand Indicator” in Belgium

Transcription

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
27
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
Sentinelle reporting system
31
Addibru reporting system
33
TABLE 7: Main characteristics of the clients registered in 2002 through the De
Sleutel reporting system
35
MEDAR reporting system
42
MPD extra module reporting system
43
DARTS reporting system
45
CCAD and Sentinelle reporting systems
46
VRM
48
TABLE 13: Types of existing treatment centres in Belgium in combination with
the existing treatment reporting systems
55
FIGURE 1: Conceptual framework for different methods to investigate the
nature and extent of drug use and drug problems
10
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.
8
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
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
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).
11
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.
13
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).
14
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
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.
16
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).
17
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).
18
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
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
“ 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
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
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
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
Charlerloi
specialised
case register
1995
CTB/ODB
Addibru
Brussels
specialised
case-reporting
system
1996
De Sleutel*
/
type based:
RIZIV Convention (Flanders)
De Sleutel
specialised
case register
1998
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
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
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.
analysis and reporting, is in the hands of the “Cellule Recherche et Concertation
30
(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)
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
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
Table 6 : Main characteristics of the clients registered in 1999 through the Addibru reporting
system (CTB/ODB, 2000)
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
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.
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
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
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
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
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.
37
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
“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
38
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.
39
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.
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
40
(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).
41
Table 8: Main characteristics of the clients registered in 1999 through the MEDAR reporting
system (Samenwerkingsplatform FDGG/VVI, 2001).
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
42
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)
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
43
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
44
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)
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.
45
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)
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
46
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).
47
Table 12: Main characteristics of the clients registered in 1999 through the VRM (Vandenbussche,
2000)
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.
48
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.
49
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
50
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
51
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
52
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
53
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.
54
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
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
56
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
57
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).
58
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).
59
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.
60
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
61
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.
62
-
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:
63
-
-
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
64
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
65
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.
66
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
67
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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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.
69
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
70
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
71
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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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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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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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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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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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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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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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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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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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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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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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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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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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
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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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.
86
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
87
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
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
89
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.
90
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.
91
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
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.
93
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.
94
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
95
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.
96
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.
97
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
98
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
99
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.
100
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.
101
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.
102
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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
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
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 :
résultat positif
résultat négatif
résultat inconnu
non
26.
STATUT SEROLOGIQUE HCV
rapporté par le patien
basé sur un test de
laboratoire
· Date du dernier test : _ _ / _ _ / _ _ _ _
26.a) testé :
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
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
41 individuel
42 familial
43 de couple
44 de groupe
50 rééducation
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
60 universitaire
61-62-63-64-65-+66 selon l’année
70 enseig. et formation
réussie
en alternance (CEFA)
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
19 autre :………………….
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
41 individuel
42 familial
43 de couple
44 de groupe
50 rééducation
51 logopédie
52 psychomotricité
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 inconnu
£ 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
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
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
héroïne
Stimulants du SNC
cocaïne
amphétamines
benzodiazépines
"Rohypnol"
Hallucinogènes
Inhalants volatils
Cannabis
Alcool
Jeux, paris
?? Inconnu
95
11
16
18
21
22
24
32
33
38
40
50
60
70
80
85
99
136
Aucun ou sans objet
héroïne
Stimulants du SNC
cocaïne
amphétamines
benzodiazépines
"Rohypnol"
Hallucinogènes
Inhalants volatils
Cannabis
Alcool
Jeux, paris
?? Inconnu
Aucun ou sans objet
héroïne
Stimulants du SNC
cocaïne
amphétamines
benzodiazépines
"Rohypnol"
Hallucinogènes
Inhalants volatils
Cannabis
Alcool
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
§ 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
SI04
voor BeWo
SI05
voor Bewo
SI06
voor BeWo
SI07
voor BeWo
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
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
DSM-IV
DSM-IV
ICD9CM Somatische aandoeningen
DSM-IV
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
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
DSM-IV
DSM-IV
As1 / 3 Tertiaire diagnose volgens as 1 van de
DSM-IV
Persoonlijkheidsstoornissen, Zwakzinnigheid
DSM-IV
DSMIV
ICD9CM Somatische aandoeningen
DSM-IV
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
Verwacht aantal dagen
Bestemming
Reden
Datum intermediaire heropname
MEDISCH ONTSLAG
ID-nummer patiënt
Volgnummer medisch-psychiatrisch
verblijf
Volgnummer beweging
Datum medisch ontslag
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
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
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
PT12
PT13
PT14
PT15
PT16
PT17
PT18
PT19
PT20
PT21
PT22
PT23
PT24
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
157
RR10
RR11
RR12
RR13
RR14
RR15
RR16
verpleegdagen 2
Maand 3
verpleegdagen 3
158
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
159
MVG:
Standaard:
Ja
0 (geen product)
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:
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
160
Toedieningswijze
Formulier:
Veldnaam:
Drugs
Toediening1
Toediening2
Toediening3
Numeriek
Byte
P_Drug_Toediening
Ja
Ja
0 (-kies een toedieningswijze-)
Veldtype:
Formaat:
Parameter:
Verplicht:
MVG:
Standaard:
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:
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-)
Frequentie van het druggebruik gedurende de laatste maand.
Men kan dit invullen voor “Produkt 1”, “Produkt 2” en “Produkt 3”.
Werkwijze:
161
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
Is er sprake van risicogedrag?
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-)
HIV-status wil nagaan of de cliënt ooit werd getest op HIV.
Werkwijze:
HIV_ID
0
1
2
3
4
9
HIV
- kies HIV-status getest positief
getest negatief
getest onbekend
nooit getest
onbekend
162
Hepatitis
Formulier:
Veldnaam:
Veldtype:
Formaat:
Parameter:
Verplicht:
MVG:
Standaard:
Drugs
Hepatitis
Numeriek
Byte
P_Drug_Hepatitis
Ja
Ja
0 (-kies Hepatitis-status)
Hepatitis-status bevraagt of de persoon ooit hepatitis gehad heeft en zo ja welke vorm.
Werkwijze:
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
163
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
164
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
165
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
166
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
167
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
168
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
170
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
171
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
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
172
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
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
173
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
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
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
2.10. Frequentie Gebruik
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
174
Herkomst: DARTS
Definitie: Vrij veld voor de gebruikte dosis van vervangmedicatie in te geven
Codetabel: Vrij
2.13. Probleemniveau gebruik
2.14. Justitiële situatie
2.15. Justitiële situatie 2
2.16. Verwijzer
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
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
-
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
2.21. Commentaar bij aanmelding
Herkomst: DARTS
Definitie: Vrij tekstveld. Hier kan je eventuele commentaar bij deze aanmelding weergeven.
Codetabel: ‘memoveld’
176
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
3.5. Aanmeldingsdatum
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 !!
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
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
Herkomst: Vlis-DC
Definitie: De laatste verwijzer in de keten wordt gedefinieerd.
178
Codetabel: Zie 2.16
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
Opmerkingen: Zie 3.16.
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.
179
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
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
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
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
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
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
182
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.
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
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
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
3.35.Derde product
Opmerkingen:
Zie 3.27
184
3.39. Gebruikte dosis Vervangmedicatie
Herkomst: DARTS
Definitie: Vrij veld voor de gebruikte dosis van vervangmedicatie in te geven
Codetabel: Vrij
Gebruik van injectiemateriaal
3.40. Ooit geïnjecteerd
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
3.48. Datum Hepatitis B vaststelling
Opmerkingen: Zie
3.49. Hepatitis C ooit
Opmerkingen: Zie
186
3.50. Datum Hepatitis C vaststelling
Opmerkingen: Zie
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
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.
187
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
189
3.54. Burgerlijke staat
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
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
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”)
191
•
•
•
•
•
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
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
194

Implementing the “Treatment Demand Indicator” in Belgium

Transcription

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