Self-referral – referred on Yes CM A person (not a current service user) self-refers to a mental health and addiction service stating they are in a crisis because they have no money and nowhere to live. After triage/ screening, although they are upset, it is determined that the person is not experiencing an acute mental health crisis nor meets the criteria for entry to the service. They are referred to a local housing provider and the case is closed with no further planned care. The ‘crisis’, as described by the person, is not attributable to mental health issues. Subjectively the person feels in crisis, but there is no mental health problem/diagnosis, so the person is not eligible to receive mental health and addiction services. A triage has been completed. Family member telephone contact No PH A family member of a current service user phones the crisis team stating their family member is having a severe panic attack and needs urgent help. The service user is not spoken to by the crisis team. The crisis team agree to do a home visit. Although the situation is a ‘crisis’, the service user was not the direct recipient of the activity (was not present and did not speak to the crisis team on the phone). After contact with the service user, a T01 could result.
T07 – Group programme session attendances Keywords HISO PRIMHD description Additional comments Treatment focus Session designed for two or more service users Mental health and/or alcohol and other addiction services (excluding residential and inpatient teams) Direct contact with service users in a group setting for: assessment treatment care planning review discharge Assessment, treatment (eg, DBT group, AOD group, talking therapies, relapse prevention), care planning, review and discharge services provided and designed for more than two consumers in a group setting These sessions often use a cognitive behaviour therapy (CBT) format, or cover care planning – discussing an individual’s plans for change in behaviour, or thinking, and setting goals for what they wish to achieve. This may include looking at skills to improve self-soothing, emotional regulation, distress tolerance and, in relaxation, the use of mindfulness. Treatment examples include: dialectical behaviour therapy (DBT) cognitive behaviour therapy (CBT) mindfulness and sensory connection stress management distress tolerance emotional self-regulation and assertiveness. The focus of programmes may include: addictions self-harm suicidal thoughts mood disorders traumatic brain injuries eating disorders. Regardless of the number of staff involved in a group session with a service user, including family/whānau involvement, only one activity record should be submitted to PRIMHD. The most significant activity in the service user’s journey should be the activity reported. The staff members involved must agree on which activity is the most significant. Attendance of a couple, family or group, only one of whom is a mental health service user, is one attendance.
T10 – Completed needs assessment Keywords HISO PRIMHD description Additional comments Finalising a needs assessment Contracted needs assessors only One T10 per completed needs assessment or formal reassessment Completion of a formal needs assessment by an individual (Needs Assessor) contracted to provide needs assessment and service coordination (NASC). The intent of this activity is to be able to separate out the number of completed needs assessments or formal reassessments. This activity should only be entered by contracted needs assessors. It is only entered once at the end of the process. The needs assessment process is often more than a one-off contact. Any other activity the needs assessor undertakes leading up to the finalisation should be recorded as the appropriate activity code, and then on completion a formal needs assessment T10 is entered. Activity purpose Is the service user a direct recipient? example Case scenario PRIMHD activity type code Relevant business rules or rationale Finalisation of needs assessment or reassessment Yes CM A worker contracted to provide NASC (needs assessment and service coordination) services finalises a needs assessment completion or finalises a formal reassessment. The session takes 30 minutes. T10 Contact duration is 30 minutes. Contact with service user leading up to the completion of a needs assessment Yes CM Leading up to the completion of a needs assessment there had been four half-hour sessions with the service user over several days. Four separate sessions with the service user are entered as code T42 for 30 minutes each. Contact with service user’s family leading up to the completion of a needs assessment No CM Leading up to the completion of a needs assessment there is an hour-long session with the service user’s family without the service user present. The session with the service user’s family is coded as T32 with a 60-minute contact duration. Contact with service user’s case manager leading up to the completion of a needs assessment No CM Leading up to the completion of a needs assessment there is contact with the service user’s case manager, who works in a different team within the same agency or organisation. Not reported to PRIMHD If the two workers are in the same organisation or agency, this activity is not sent to PRIMHD. Contact with the service user’s case manager is coded T08 only if the case manager is from an external agency.
T18 – Methadone treatment specialist service attendances Keywords HISO PRIMHD description Additional comments Service users of OST Direct contact Community based Treatment or counselling services provided by staff from an alcohol and drug treatment provider or facility for people receiving Opioid substitution (eg, Methadone or Suboxone [Buprenorphine]) under specialist A&D service case management (excludes tāngata whaiora/consumers of authorised GPs). The intent of T18 is to record all activity (not simply prescribing activity) related to a service user in an AOD opioid substitution treatment (OST) service. People who are receiving services for OST will have received, or will be receiving, drugs prescribed under the Misuse of Drugs Act 1975 under special authority. This code is not for use in inpatient or residential team settings. This relaters to community-based alcohol and other drug (AOD) teams and co-existing problems (CEP) teams only. Activity purpose Is the service user a direct recipient? example Case scenario PRIMHD activity type code Relevant business rules or rationale Attendance at service Yes CM The service user attends a 3-monthly care plan review. T18 Must not be GP prescribed. Group attendance, OST service Yes CM The service user attends a mindfulness group with other OST service users. T18 Related to treatment within an OST setting. Text conversations between OST service staff and service users relating to their treatment Yes SM The service user’s treatment plan includes weekly text conversations with their OST clinician relating to their treatment, goals, etc. T18 Texts relate to OST treatment. Group attendance, non-OST service Yes CM The service user attends a 1-week impaired driving course run by an NGO service provider (not an OST service) with service users who are not OST. Methadone prescription request Yes CM A visitor from another region walks into a community mental health service and asks for a methadone prescription: ‘I just ran out of meds yesterday and haven’t had a dose for 24 hours’. Use T01– Crisis attendance because the contact is unplanned, immediate, urgent and aimed at mitigating risk. Contact would be made with the issuing provider of the script to see if a replacement is possible and referred to a local AOD team.
T22 – Day treatment programme attendances Keywords HISO PRIMHD description Additional comments Day treatment programme Specialised and/or intensive care Excludes residential and inpatient teams Provision of non-residential assessment, treatment and rehabilitative programme services to non-inpatient tāngata whaiora/consumers requiring specialised programmes and/or more intensive care than can be provided within outpatient services. This code is intended to be used for day treatment programmes where individualised specialised care is the focus. Treatment examples include: behaviour therapies, such as: dialectical behavioural therapy (DBT) cognitive behaviour therapy (CBT) solution-focused therapy distress tolerance emotional self-regulation and stress management mindfulness and sensory connection exercises. The focus of programmes may include: addictions self-harm suicidal thoughts borderline personality disorders mood disorders traumatic brain injuries eating disorders. Count each service user attendance at the programme only once in a day. Attendance of a couple, family, or group, only one of whom is a mental health service user, is one attendance. Where programmes involve overnight stays, providers must report an activity end time of midnight. Bed nights cannot be reported for T22. Each day treatment programme day needs to be recorded separately.
NGOs providing day activity programme off site that include overnight stays Yes CM An NGO mental health and addiction service provides a day activity programme off site, including overnight stays (eg, camping sites, marae or other overnight facilities). T23 Providers must report this service with an end time of midnight if the activity involves overnight stays. Bed nights should not be reported for this activity. Health and fitness (family/whānau present) Yes CM A service user has a goal of being able to walk 5 km by a certain date. The support worker meets the service user at the local park to complete an action step where they walk for 1 km. The service user is accompanied by a family member (eg, child). There is no group involvement so this is not a T23 activity. If a family member accompanies them for the walk, it is still T43. T36 would only be used if assessment, treatment, care planning, review or discharge were taking place during the session. Therapeutic day programme for treatment Yes CM, DM, DP, ES, MC, NP, OS, PC or PR The service user takes part in a specialised and/or intensive day programme, as an outpatient, with a focus on individual treatment. Therapeutic group programme for treatment and review Yes AV, CM, DP, ES, MC, OM, OS, PH or PR The service user attends a short outing as part of their group session (intended for two or more service users). It is led by a support worker with the intention of utilising mindfulness and distress tolerance to treat a social phobia. This is T07 because there is a treatment and review focus to the group session. Therapeutic group programme for assessment and/or treatment Yes CM The service user attends a 2-hour group programme. It is led by a clinician/support worker who utilises CBT with the intention of reducing self-harm tendencies. Two-day Māori activity programme Yes MC A service user participates in a 2-day Māori activity programme using cultural practices in a Māori setting. T38 – Māori specific interventions (non-clinical) should be reported with an end time of midnight if an overnight stay is involved. Each day needs to be recorded separately, even if the service provided involves a 3-day hui.
T35 – Did not attend Keywords HISO PRIMHD description Additional comments Do not record a DNA Record DNA No notice or reschedule prior to appointment start Use flow chart The tangata whaiora/consumer did not participate in a pre-arranged meeting, appointment, programme or activity. The purpose of recording DNA (did not attend) in PRIMHD is to monitor the quality of engagement with the service user: it is not driven by productivity requirements. It forms part of the record of significant events in a service user’s journey. The number of DNAs reported to PRIMHD is an important national indicator. The exact time associated with DNAs may be more significant at the local/service user level. Local initiatives and protocols should be implemented to help reduce overall DNA rates and cancellations for family-only appointments, specifically in Child & Adolescent Mental Health Services (CAMHS) and cultural services. Use the flow chart. Do not record travel time associated with DNA for PRIMHD: report or record travel time locally only, if required. Report the scheduled appointment duration when reporting T35 activity. If a service user calls at any stage prior to the appointment start time to say they cannot attend – establish local protocols to reschedule or cancel (not DNA) and ensure visibility of the process. For a family-only meeting when the family do not turn up: cancel or reschedule. If a service user turns up late to a scheduled appointment but within the appointment time. If an appointment is cancelled because the staff member cannot attend: cancel or reschedule. If a service user telephones within the appointment time and has a clinically significant conversation: record the telephone activity as T42, or as appropriate. If no notice was given, or no request for reschedule was received, prior to the appointment start time. If the service user calls after the booked appointment start time and they cannot or will not be attending. If there is no prior contact by telephone and the service user either comes in after the scheduled appointment end time or completes a consult over the telephone after the appointment end time: record DNA and also the actual activity that took place. If the service user does not attend and cannot be contacted by telephone and has made no contact prior to the appointment time. Figure 1: Did Not Attend Recording flow chart
Service user participates in a therapeutic day programme for treatment Yes CM The service user takes part in a specialised and/or intensive day programme, as an outpatient, with a focus on individual treatment. T38 can only be reported for culturally specific programme activity. Where the focus of a day programme is on intensive or specialised treatment, T22 should be reported. T39 – Integrated Māori and clinical interventions Keywords HISO PRIMHD description Additional comments Challenges with the collection of cultural activity Medical model and Māori interventions One-to one-support or group programme Māori or clinical setting Provider arm or NGO clinical staff In addition to receiving mainstream clinical interventions and services, the tangata whaiora/consumer also received integrated Māori specific services and clinical interventions (for example, application of Māori Models of practice, traditional and contemporary, which recognise the value of culture to the healing process including, but not limited to whakawhānaungatanga and increased access to te ao Māori, incorporating but not limited to: purakau; mau rakau; waiata; te reo; raranga; karakia; whakapapa; mirimiri; and rongoa. This would also include services provided by tohunga, kaumatua, kuia, Māori staff and Māori cultural advisors. It would also include those cultural interventions that are supported by a Western approach such as bio-medical, etc. Use T36 for one-to-one support or group programmes that use both a western medical model as well as Māori interventions, and which are usually held in a Māori setting. Where integrated clinical and Māori culturally specific activity or interventions are the focus of a group session or programme, use T39 instead of T07 or T22. The following point should be noted in the collection and analysis of cultural activity information in PRIMHD: There is no way to identify if cultural support was provided during the assessment and treatment stages of a service user’s journey (ie, T01), or if integrated clinical/cultural interventions with service users have included family/whānau or not.
Activity purpose Is the service user a direct recipient? example Case scenario PRIMHD activity type code Relevant business rules or rationale Assessment Yes CM At the family’s request, a Pacific cultural support worker attends a court report assessment with the psychologist to explain questions/answers from the psychologist in the family’s language. T40 The support worker’s presence is to provide cultural support, which is significant in that it assists in the process of assessment. The clinician should record this activity as T42 – Individual treatment attendance. Assessment in a youth forensic setting; service user and family present Yes CT The Pacific cultural support worker attends the youth court to support a young person and family with the assessment process. T40 Contact with service user for cultural assessment, whānau present Yes DM A service user is visited at home for cultural assessment and their family/whānau are present and involved. T40 Use T40 where the main activity is culturally specific. Where the focus is on assessment, treatment, care, planning review and discharge, use T36. Contact with only whānau present No CM A clinician meets with a service user’s family to discuss the service user’s care without the service user being present. Use T32 – Contact with family, service user not present. The main focus of the activity is discussing the service user’s care. The service user is not present. T41 – Other cultural activity Keywords HISO PRIMHD description Additional comments Cultural or clinical setting Non-inpatient/residential team settings only Excludes Māori or Pacific peoples cultural activity One-to-one support or a group programme Application of other cultural models of practice, traditional and contemporary, which recognise the value of culture to the healing process. Māori or Pacific peoples cultural activity should be reported as , or . Cultural activity is activity provided by non-clinical staff, cultural advisors, other.
Activity purpose Is the service user a direct recipient? example Case scenario PRIMHD activity type code Relevant business rules or rationale Assisting service user with WINZ application Yes PH A service user comes to their support worker and tells them that they have had their WINZ application rejected and they don’t understand why. They ask for the support worker’s help. The support worker gives the WINZ case worker a call to find out why the application was rejected and to find out what information the service user needs to provide. The call takes 20 minutes. T44 Contact duration is 20 minutes. Service user requests advocacy support at next CMH appointment Yes CM A service user meets with an advocate at an NGO provider service and requests advocacy support at their next community mental health psychiatrist appointment. The service user feels their psychiatrist was not giving them any choice in their treatment and medication. The service user and advocate attend the next appointment, where the advocate is able to communicate to the psychiatrist the concerns and requests of the service user. After discussion and negotiation, the service user and psychiatrist agree on a change in medication. T44 Travel time is not included. Service user requests advocacy to assist in WINZ appointment – advocate is involved in discussion Yes CM A service user is applying for an increase in disability allowance to cover their medication and related travel costs and asks an advocate to attend their WINZ appointment. At the appointment, after review, the case manager declines the application. On behalf of the service user, the advocate asks for clarification on what is covered by the disability allowance, copies of the legislation, and a review of the decision. A meeting is held with the centre manager, advocate and service user. T44 Service user requests advocacy support at next CMH appointment Yes CM The service user and advocate attend an appointment together. The service user self-advocates with the psychiatrist, and the advocate does not need to speak at all. The psychiatrist takes on what has been said and creates a new plan of care and arranges a medication review. T43 – Community support contact. Service user requests advocacy to assist in WINZ appointment – advocate is not involved in discussion Yes CM The advocate attends a WINZ appointment with the service user. The service user hands over the paperwork requested and answers questions from the case manager without any involvement by or assistance from the advocate. The service user’s application is approved. T43 – Community support contact.
T45 – Peer support Keywords HISO PRIMHD description Additional comments Peer support services One-to-one or group Contracted peer support service Contact with a tangata whaiora/consumer for the primary purpose of providing Peer Support. Note – this activity should only be recorded by a person contracted to provide Peer Support. Other activity types relevant to the delivery of Peer Support should be used where appropriate in conjunction with tangata whaiora/consumer driven Team Service Type; eg T08 when liaising with other agencies/providers; T32 when meeting with family/whānau members; T35 if the tangata whaiora/consumer misses a planned appointment. None. Activity purpose Is the service user a direct recipient? example Case scenario PRIMHD activity type code Relevant business rules or rationale Service user attends peer support group Yes CM The service user attends a fortnightly peer support group at the local community house. T45 The peer support group is specifically contracted to provide this service. Service user attends peer support group with CMH nurse Yes CM The service user attends a peer support meeting with their community mental health nurse and peer support worker from an external agency. They are the only attendees of the meeting, and the staff member, mental health nurse and service user proceed to discuss the service user’s package of care. T45 and The peer support worker records a T45. If the community mental health nurse was not part of the group, but was attending with the service user, the nurse records a T08 because the peer support worker is from an external agency.
Activity purpose Is the service user* a direct recipient? example Case scenario PRIMHD activity type code Relevant business rules or rationale Support the family member of service user No Can be delivered in any setting A family member of the service user participates in a group support session to gain knowledge and skills in supporting their family member who experiences mental health or addiction issues. T47 Record against the family member’s NHI Support for whānau member of service user No Can be delivered in any setting A whānau member/close friend or colleague of a person with a mental health diagnosis or problematic substance use attends a session to gain knowledge and skills to respond to the service user’s mental health issues. T47 Record against the whānau member’s, close friend’s or colleague’s NHI. Discussion about service user’s care No Can be delivered in any setting A mother, whose daughter is a service user, meets the clinician without the daughter present to discuss issues related to her daughter’s care. Record against the daughter’s NHI. This is not T47 because the meeting is about daughter’s care, not support for the mother Discussion about service user’s care No Can be delivered in any setting Parents meet the clinician with their child present to discuss issues related to their child’s mental health care or problematic substance use. Record against the child’s NHI. This is not T47 because the meeting is about the child’s care, not support for the parents. * ‘Service user’ here refers to a person with a mental illness. T49 – Support for Children of Parents with Mental Illness and Addictions (COPMIA) – from 1 July 2016 Keywords HISO PRIMHD description Additional comments Support for the child of a service user Children 0–19 years old Reported against the child’s NHI Supportive activity delivered to children of parents with mental health and addiction issues regarding the effects of these issues on the child. For example, provision of information, psycho-education facilitation of peer-group support, and tools to promote resilience, self-esteem and coping strategies. Report against the child’s NHI. This applies to children 0–19 years old. This activity type and definition are for use from 1 July 2016.
Activity purpose Is the service user* a direct recipient? example Case scenario PRIMHD activity type code Relevant business rules or rationale Support the child of a service user No Can be delivered in any setting The child of a service user attends a peer group support session with other children to gain support in living with their parent who experiences mental health or addiction issues. T49 Record against the child’s NHI. Support the child of the service user No Can be delivered in any setting A young person who is a service user receives support in living with their parent who experiences mental health or addiction issues. T49 Record against the child’s NHI. The fact that the child has a mental health diagnosis is immaterial here; this session is related to their parent’s mental illness, therefore it is a COPMIA contact. Discussion about service user’s care No Can be delivered in any setting The adult child of an elderly parent who is a service user receives information and support regarding their parent. Record against the adult child’s NHI. This is not T49 because COPMIA is only for children 0–19 years old. Treatment for a service user Yes Can be delivered in any setting A young person who is a service user receives assessment and treatment for their mental health diagnosis/problematic substance use. This is not T49 because it is related to the young person’s mental illness rather than support to cope with their parent’s mental illness. Discussion about service user’s care Yes Can be delivered in any setting A child with a parent who is a service user both attend a meeting to discuss the care and treatment of the parent. This is not T49 because the discussion is about the parent’s care, not support to the child. Discussion about service user’s care No Can be delivered in any setting The daughter of a mother who is a service user, meets the clinician without her mother present to discuss issues related to her mother’s mental health care/ problematic substance use. This is not T49 because the meeting is about the mother’s care, not support for the daughter. Parenting support to a service user Yes Can be delivered in any setting A service user who is a parent receives parenting advice and support. This is not T49 because the support is to the parent and not the child. * ‘Service user’ here refers to a person with a mental illness.