Addictions Advisory Committee. First Quarter Report

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Kerry Peters
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1 First Quarter Report November January 2010

2 June 30, 2010 Honourable Don McMorris Minister of Health Room 302 Legislative Building 2402 Legislative Drive Regina, Saskatchewan S4S 0B3 Dear Minister McMorris: On behalf of the members of the Addictions Advisory Committee, it is my pleasure to submit to you the first quarterly report of the Addictions Advisory Committee. As Chair of the committee, I am extremely fortunate to have a group of professional and dedicated individuals who have demonstrated a high level of engagement throughout this process. These initial recommendations are the result of three committee meetings, stakeholder consultation, research and literature reviews, and an awareness of initiatives being undertaken across the country. It is the committee s belief that if adopted, these initial recommendations will enhance addiction services within the province, provide client-centred care that is consistent with the Patient First Review, and lay a strong foundation for the work of the new addictions agency. It is our hope that consideration of these recommendations would be taken in the short-term in order to begin a process of renewal and develop a comprehensive framework for addictions services. I look forward to an opportunity to discuss these recommendations in the near future. Sincerely, Dr. Peter Butt Chair, Addictions Advisory Committee

3 Introduction The Addictions Advisory Committee was established on November 12, 2009 to guide the creation of a new addictions agency in the province. As part of this process, the Advisory Committee gave special consideration to the recommendations made in the Patient First Review, addiction service delivery models of other provinces, and the principles of the National Treatment Strategy, in order to connect the agency s work with the overall direction of health provincially and addiction services nationally. The committee s deliberations involved literature reviews, consultations with stakeholders, an environmental scan of services within the Regional Health Authorities, a review of core competencies for workers in the substance abuse field, and much discussion with respect to how the committee could best deliver the tasks as outlined in the Terms of Reference. The theme of this quarter s recommendations is standards of care. Standards of care form the foundation for quality services throughout the continuum of care. A strong foundation for a continuum of care is built on leadership, coordinated workforce development, training and professional competencies, and program standards. It is the committee s hope that this set of recommendations will lay the foundation for the future of addiction services in the province and that the new agency will play a key role in facilitating standards and continuous quality improvement in order to better serve clients. The continuum of care can be enhanced by improving the integration of addictions and mental health services, filling gaps in service delivery, and focusing on a coordinated and collaborative care model. A more fluid system of care that puts the patient first will ultimately improve access to timely and quality treatment, provided that there is adequate support for addiction services throughout the system. To enhance the coordination and collaboration of care, and provide continuity in service delivery, a new framework for delivery is required. The National Treatment Strategy s tiered model consists of five tiers that organize services and supports beginning with prevention and population health efforts in Tier 1, to intensive services for highly acute and chronic clients in Tier 5. The guiding principle of the National Treatment Strategy is that no point of contact is the wrong door. Clients should be able to move seamlessly throughout the various levels of services depending on need. In addition, consistent program standards are required with the flexibility to accommodate the specific needs of client populations. Care providers need to recognize and accept the continuum of care and work more collaboratively to provide a more seamless system of care that prevents clients from slipping through the cracks. Program funding criteria should be transparent, evidence-informed or based on promising practices, based on need, demonstrate fairness and equity, and include performance monitoring, evaluation, and accountability mechanisms. The recommendations outlined below achieve these principles and can be applied to existing and new program initiatives, as well as faith-based and First Nations and Métis programs. The application of standardized program

4 funding criteria will facilitate the delivery of more consistent standards of care, while at the same time accounting for the diverse needs of the Saskatchewan population. Next Steps The committee recognizes that the form and function of the new agency are of the utmost importance in order to enhance addiction services and best meet the needs of clients. The committee s work continues on identifying gaps and priorities in the continuum of care, and developing the core functions of the agency that will afford it the ability to influence and enhance access, capacity, and effective service delivery in the province. Recommendation #1 That the government work with stakeholders to implement the National Treatment Strategy and give priority to addressing the identified gaps in the continuum of care. Rationale Addictions programming requires different levels of engagement and intensity of treatment depending on the client s situation and needs. It is important to note that addictions treatment does not follow a linear progression. Therefore, the system of care must provide multiple pathways for client entry, allowing the client to move back and forth between services according to need. The committee has identified a number of gaps and barriers in the continuum of care which often leads to clients not initially accessing services, or progressing to other stages of services and support. Specific gaps and barriers will be addressed in subsequent reports. The Five Tiers of the National Treatment Strategy identify the range of services in each tier, ranging from broad population health efforts in Tier 1, to highly intensive treatment in Tier 5 to address highly acute, chronic, and complex substance abuse. The adoption of the Tiered Model will assist providers and clients in navigating the system by facilitating movement within each tier as well as between tiers with the goal of allowing clients access to the full continuum of services and supports. The overall philosophy is No Wrong Door. Priority should be given to bridging the identified service gaps within each tier of care in order to build capacity and improve access. By collaborating with other jurisdictions in Saskatchewan and nationally, who are undertaking a similar strategy, greater knowledge exchange can take place, enhancing efforts in research and evaluation, and monitoring system performance. Recommendation #2 That the government work towards adopting the Canadian Addictions Counsellor Certification Federation (CACCF) standards as the minimum standards for workers whose primary role is to deliver addictions services; and further, include cultural awareness, competency, and safety in addition to the CACCF standards. Rationale Currently no standardized criteria exists for workers whose primary role is to provide addiction counselling services. A minimum standard for addictions counsellors would improve the quality of services being delivered and assure the public of a standard of care and safety. 2

5 CACCF is recognized nationally and internationally as a credible certifying body. Some addictions counsellors have voluntarily become certified by the CACCF. A recent review of the National Native Alcohol and Drug Abuse Program (NNADAP) identified educational training gaps in First Nations delivered programs. Steps are being taken to implement CACCF standards. Adopting similar certification standards for addictions workers on-reserve and offreserve would help align program standards for future coordination and collaboration. SIAST and SIIT addictions counselling training programs meet the CACCF educational requirements. Recommendation #3 That the government initiate an addictions workforce sector study in partnership with SIAST, SIIT, and other stakeholders where possible to identify training gaps, to determine how core competencies relate to current hiring practices, and future recruitment needs. continuum of care and have expressed an interest in participating. The primary purpose of the study is to evaluate the core competencies of frontline workers with respect to the CACCF standards. The study should also include clinical supervisors and employers to determine knowledge of core competencies and hiring practices. The sector study should take into consideration the NNADAP Needs Assessment for the Saskatchewan Region and explore future possibilities for collaboration on training needs. Partnering with SIAST, SIIT, and other stakeholders provides the ability to leverage existing research resources to assist with the workforce sector study. Recommendation #4 That the government adopt the following funding criteria for government funded addictions treatment programming: Complies with relevant legislation (e.g. Residential Services Act, Non- Profit Corporations Act, Saskatchewan Human Rights Code, Labour Standards Act); Rationale A sector study of the addictions workforce could identify training gaps with respect to the CACCF standards as well as training needs and the capacity to meet these needs within the province. This study should build on the Ministry of Health s 10-Year Health Human Resource Plan by specifically addressing the future educational requirements of frontline addictions workers. The sector study should include workers in provincially funded addictions programs, communitybased organizations, First Nations and Métis organizations and other relevant agencies who are involved in the Existing programs continue to provide a service with demonstrated need within the continuum of care; New initiatives address an identified gap in the treatment continuum; Program content is consistent with evidence-informed practice or promising practices within the field of addictions and if innovative, should have an objective evaluation framework in place; Place of residence within the province is not a barrier to access; 3

6 Diversity awareness and sensitive practices are evident in the program and its delivery; Programming is client and familycentered; Clients are assured the right and freedom to explore and practice their personal spiritual and/or religious beliefs; Program staff has an appropriate combination of skills, knowledge, academic training and experience required to meet the goals of the program; Accepts clients with concurrent disorders; Determines, in collaboration with other health professionals, the acceptance of clients who are taking prescribed medication; Where program resources and logistics permit, accepts clients taking prescribed methadone; Complies with program guidelines set out by the Ministry of Health and/or the addictions agency; Provides sustainable governance, financial accountability, program plans and standards; Reflects a strong governance model with the appropriate competencies and representation from the broader stakeholder community; Coordinates and integrates with other programs along the continuum of care, including Regional Health Authorities and relevant community partnerships; Includes an evaluation plan based on continuous quality improvement. Rationale Addictions Advisory Committee Standardized funding criteria will ensure the efficient and effective use of public funds for addiction services. The recommended criteria will promote evidence-informed or promising practices, coordinated service delivery throughout the continuum of care, and improve performance by initiating standards for treatment, evaluation and monitoring. Whether existing or new services, all addictions services should provide a service for which an identified need has been established. Funding for new programs should be prioritized based on an identified gap in the continuum of care and the population s needs. In part, service gaps can be identified by wait times, unmet needs for specific populations such as women and youth, and the flow of clients through the various tiers of the care pathway. To be eligible for government funding, programming should reflect evidenceinformed or promising practices and comply with the program guidelines set out by the Ministry of Health and/or the addictions agency. Program planning should include details such as written treatment protocols, admission criteria, assessment, care planning and review, treatment completion, and who will be involved during each phase of treatment. Human Rights and patient dignity should be upheld at all times. Discrimination should not occur based on any prohibited grounds. A sufficient complement of staff with addictions related core competencies is essential for successful programming as well as establishing a collaborative work environment. Staff should have a level of education that allows them to understand and deliver evidence- 4

7 informed methodologies, and have ongoing opportunities for continuing education. A significant number of clients seeking addiction services have concurrent mental health disorders. In the past, clients with concurrent disorders who were on psychiatric medications or other prescribed medications were not accepted into addictions treatment programs. Best practice suggests treating concurrent disorders simultaneously, which requires the collaboration of health professionals. Similarly, clients who are prescribed methadone have also been excluded from addictions treatment in the past. While recognizing that not every program may have staff available with specialized training to manage clients on methadone, programmers should be encouraged to consider this option when feasible and collaborate with other health professionals. Exclusionary practices should be minimized in order to maximize access to treatment. Clients with addiction disorders often have multiple needs across a range of personal, social and economic areas that must be addressed for treatment to be successful. A multi-sectoral approach to treatment should be considered which may include assistance with housing, employment, health needs, social supports and education. Evaluation of programs is necessary to ensure continuous quality improvement and to ensure that clients are receiving the best care possible. Evidence of effectiveness and cost-effectiveness should guide future investments in treatment programs. Innovative programs should have an objective evaluation framework in place. Given that boards set direction and policy, and monitor performance, boards should have a strong governance model in place that reflects the appropriate competencies. Sustainable board governance which includes board training is essential, along with a viable business and program plan. Financial investments should be made on a sound program plan that is affordable and ensures value for money. Financial skills and resource management should be evident with proper financial management and accountability mechanisms in place in order to sustain funding and ensure appropriate service delivery. Boards should also have representation from the broader stakeholder community. Addiction is a relapsing and remitting chronic disorder that requires a seamless continuum of services ranging from outpatient services, brief and social detox, in-patient treatment, supportive transitional programming, outreach, and aftercare. Inpatient treatment is only one step along the journey to recovery. Therefore, it is important to establish linkages between community-based organizations and government programs to effectively establish a continuum of care. Since the need for clients to establish a healthy connection back into the community is critical to success, community partnerships and supports are essential for programming to be effective. Government funded programs should fit the overall direction of the government and the Ministry of Health, and be accountable to the funder(s). 5

8 Presenters Dave Hedlund, Canadian Centre for Substance Abuse Darren Tait, Addictions Professional Association of Saskatchewan Sandra Cripps, Workforce Planning, Ministry of Health Colleen Dell, Research Chair on Substance Abuse, University of Saskatchewan Sharon Doyle & Jeremy Shaw, First Nations Inuit Health, Health Canada Vice-Chief Dutch Lerat, Federation of Saskatchewan Indian Nations Other Consultations Barry Andres, Executive Director Rehabilitation and Recovery, Addiction and Mental Health, Alberta Health Services Canadian Addiction Counsellors Certification Federation John Borody, CEO, Addictions Foundation of Manitoba Executive Directors, Mental Health & Addictions Services, Saskatchewan Regional Health Authorities

9 Bibliography Arnada, M. (2008). Relationship between Religious Involvement and Psychological Well-Being: A Social Justice Perspective. Health and Social Work, 33(1), Addictions Task Group Report, Kaiser Youth Foundation. (2001). Weaving Threads Together: A New Approach to Address Addictions in BC. Alberta Alcohol and Drug Abuse Commission. (2005). Alberta Drug Strategy: A Provincial Framework for Action on Alcohol and Other Drug Use. Alberta Alcohol and Drug Abuse Commission. (2005). Building Capacity: A framework for serving Albertans affected by addiction and mental health issues. Alberta Health Service Delivery Framework Working Group. (2009). Integrated Service Delivery Framework: Every door is the right door.there is no wrong door. Ball, J., & Graff, H. (1975). Drug Treatment Programs in Pennsylvania: A Statewide Evaluation. American Journal of Public Health, 65(6), BC Mental Health & Addiction Services. (2006). The Addiction Services Continuum Project: Documenting the Current Status of Substance Abuse Treatment Services in Canada. Brown, A., Whitney, S., Schneider, M. & Vega, C. (2006). Alcohol Recovery and Spirituality: Strangers, Friends, or Partners? Southern Medical Journal, 99(6), Canadian Centre on Substance Abuse. (2005). National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada. Canadian Centre on Substance Abuse. (2007). Core Competencies for Canada s Substance Abuse Field: Final Report. Canadian Centre on Substance Abuse. (2009) Behavioural Competencies for Canada s Substance Abuse Workforce, V1.0. Dagnone, Tony. (2009), For Patients Sake: Patient First Review Commissioner s Report to the Saskatchewan Minister of Health. Delaney, H., Forcehimes, A., Campbell, W. & Smith, B. (2009). Integrating Spirituality into Alcohol Treatment. Journal of Clinical Psychology: In session, 65(2), Ebaugh, H., Pipes, P., Chafetz, J. & Daniels, M. (2003). Where Is The Religion? Distinguishing Faith-Based From Secular Social Service. Journal for the Scientific Study of Religion, 42(3),

10 Els, C. (2007). Addiction is a Mental Disorder, Best Managed in a (Public) Mental Health Setting But Our System is Failing Us. The Canadian Journal of Psychiatry, 52(3), European Monitoring Centre for Drugs and Drug Addiction. (2003). Standards and quality assurance in treatment related to illegal drugs and social reintegration in EU Member States and Norway. Lisbon. Faith-Based Self-Help Groups Are Cost-Effective, Efficient in Treating Substance Abuse, Say Stanford Researchers. (2001). Ascribe Newswire: Medicine, 2-4. First Nations and Inuit Health, Saskatchewan Region. (2009). First Nations and Inuit Health, Saskatchewan Region Mental Health and Addictions Needs Assessment: Volume 1, Final Report. Galanter. M. (2006). Spirituality and Addiction: A Research and Clinical Perspective. The American Journal on Addictions, 15, Goodstein, L. (2001, April 24). Church-Based Projects lack Data on Results. New York Times. Graves, G., Csiernik, R., Foy, J., & Cesar, J. (2008). An Examination of Substance Abuse Core Competencies in Academic Curriculum: The Social Work Example. Ottawa: Canadian Centre on Substance Abuse. Hansen, H. (2005). Isla Evangelista A Story of Church and State: Puerto Rico s Faith-Based Initiatives in Drug Treatment. Culture, Medicine and Psychiatry, 29, MacMaster, S., Crawford, S., Jones, J., Rasch, R., Thompson, S. & Sanders, E. (2007). Metropolitan Community AIDS Network: Faith-Based Culturally Relevant Services for African American Substance Users at Risk of HIV. Health and Social Work, 32(6), Maton, K., Dodgen, D., Domingo, M. & Larson, D. (2005). Religion as a Meaning System: Policy Implications for the New Millennium. Journal of Social Issues, 61(4), Miller, W. (1998). Researching the Spiritual Dimensions of Alcohol and Other Drug Problems. Addiction, 93(7), Ministry of Health. Community Profiles Regina, Saskatchewan: Canada Ministry of Health. Community Profiles Regina, Saskatchewan: Canada National Treatment Agency for Substance Misuse. (2006). Models of Care for treatment of adult drug misusers: Update London: UK. National Treatment Agency for Substance Misuse. (2010). Commissioning for Recovery: Drug Treatment, reintegration and recovery in the community and prisons: a guide for drug partnerships. London: UK. National Treatment Strategy Working Group. (2008). A Systems Approach to 8

11 Substance Use in Canada: Recommendations for a National Treatment Strategy. Ottawa: National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada. Neff, J., MacMaster, S. (2005). Applying Behavior Change Models to Understand Spiritual Mechanisms Underlying Change in Substance Abuse Treatment. The American Journal of Drug and Alcohol Abuse, 31, Minister s Advisory Group on Addictions and Mental Health. (2009). Every Door is the Right Door: Towards a 10-Year Mental Health and Addictions Strategy Discussion Paper. Toronto, Ontario: Canada. Pew Research Center for the People and the Press & the Pew Forum on Religion and Public Life. (2009). Faith-Based Programs still Popular, Less Visible. Richard, A., Bell, D. & Carlson, J. (2000). Individual Religiosity, Moral Community, and Drug User Treatment. Journal for the Scientific Study of Religion, Rush, B., Fogg, B., Nadeau, L., Furlong, A. (2008) On the Integration of Mental Health and Substance Use Services and Systems: Main Report. Ottawa: Canadian Executive Council on Addictions Rush, B., Fogg, B., Nadeau, L., Furlong, A. (2008). On the Integration of Mental Health and Substance Use Services and Systems: Summary Report. Ottawa: Canadian Executive Council on Addictions Smith, S., & Sosin, M. (2001). The Varieties of Faith-Related Agencies. Public Administration Review, 61 (6), United Nations Office on Drugs and Crime, World Health Organization. (2008). Principles of Drug Dependence Treatment: Discussion Paper. 9

Part 1: Introduction & Overview

Part 1: Introduction & Overview We envision a collaborative, participative partnership around IDU that: Provides all relevant and interested stakeholders with a voice and role. Promotes awareness of the