A NEW WAY FOR ADDICTION TREATMENT SERVICES. A Compendium to Focusing the Effort

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1 A NEW WAY FOR ADDICTION TREATMENT SERVICES Association of Substance Abuse Programs of British Columbia 2007

2 A NEW WAY FOR ADDICTION TREATMENT SERVICES Association of Substance Abuse Programs of British Columbia web: asap-bc.org

3 The recent focus on integrating Addiction Services into Mental Health organizational structures, while showing early benefits for some individuals with concurrent serious mental illness, has also slowed much-needed work to develop the broader health system s responses to people with problematic substance use. The Association of Substance Abuse Programs of BC is committed to refocusing efforts in the direction of a new, broader vision of an Addiction Services system of care that sets high standards for accessibility, effectiveness and cost-beneficial services. A full continuum of addiction services, including primary prevention programming, is necessary to reduce the individual, community and societal harms and costs. Beyond primary prevention, an accessible, effective, cost-beneficial system of secondary and tertiary services would include all of the following components: Early intervention and outreach (secondary prevention) Detoxification and crisis intervention Intake, brief interventions and assessment Treatment/rehabilitation services, including continuing care Treatment system management and capacity development, including workforce development, research and evaluation 3

4 Early intervention and outreach People with problematic substance use have contact with many parts of the health system whether for the direct effects of their substance use, or when their substance use becomes a complicating factor in successfully addressing other health problems. All health services in BC must provide a welcoming, skilful and timely response (including on the spot brief intervention services) for people with problematic substance use, no matter where in the health care system they turn for help. This requires education for the overall health workforce, as well as consistent, reliable coaching, support and consultation from Addiction Services specialists. Primary medical care providers, school-based counselling services, and Employee and Family Assistance Programs in the workplace, must be linked closely to the provincial Addictions system of care. Outreach services to the most marginalized and/or at risk people must be capable of successfully engaging and providing support for those with problematic substance use, including provision of brief services, as well as bridging to harm reduction or treatment programs where appropriate. 4

5 Detoxification and crisis stabilization Medical and social crises often attend problematic substance use. Reducing costs to communities and families means these services must be available to all, whether or not they choose to abstain from problem substance use, or to enter a process of recovery. A full range of withdrawal management services from medically-supported at home detox through daytox to in-hospital medical services should be available throughout BC s regions. Crisis stabilization and sobering services must be available seven days a week, 24 hours a day. 5

6 Intake, assessment and collaborative care planning Feedback from workers throughout the health and social service system, as well as from persons served indicates frustration about the lack of access, or lack of understanding of how to access, addiction treatment services within Health Authorities. People frequently use the service they know most about, rather than working with an addiction specialist to assess their needs and resource options and develop a treatment plan that will give them the best outcomes. Clear and workable pathways into addiction treatment resources, and through the continuum of care must be defined and broadly communicated Provision of support and assistance with an addiction problem should begin as soon as it is requested. That is, necessary intake and assessment processes should parallel rather than delay the immediate provision of an empathic and hopeful counselling response. Services responsible for screening and assessment for people with problematic substance use (whether they are integrated with Mental Health or other programs, or are stand-alone) must know of and use respectful and evidence- based processes appropriate to each level and type of addiction service request Treatment planning must, with the person served at the centre, involve all natural supports and service providers who are expected to participate in and support the plan. 6

7 Treatment (rehabilitation) services, including continuing care The evidence is clear: addiction treatment works when it is skilfully provided. As with other serious and persistent health problems, addiction s non-acute phases can be well-managed by the individual in the context of their community, culture, and family, when available. In acute phases, when a person s addiction often requires time-limited treatment services, it is important for professional service providers to integrate and build on the strengths of the natural and informal support systems in place for each individual. Family and community education and support services are essential, as are strong linkages between peer- and self-help groups and addiction service providers. When professional interventions are required, content and structure must address diversity and individual differences with regard to gender, life stage, and cultural norms and practices. Community-based addiction treatment services can be effective for the majority of people with problematic substance use. When the treatment plan includes a period of residential programming, the Addictions community case manager or counsellor assists the person served in preparing for residential treatment, and also does the follow up treatment following residential treatment. For the smaller percentage of people who do require a period of stabilization and support in a residential program, access has been decreasing since 2002 when individual Health Authorities took over responsibility for managing those in their geographic area. As well, access to residential treatment is currently dependent on each person s ability to pay, or alternately to qualify for financial assistance from the Ministry of Employment and Income Assistance or (extremely limited) Health Authority per diem budgets. Communication tools are necessary for both professionals and community members, to help people understand the value and role of community-based addiction treatment programs, and how they facilitate access to, and follow up after, residential treatment when it is indicated by a comprehensive assessment of each person s needs and strengths. 7

8 Residential treatment programs are not necessarily needed in every area of every health region. However, work must be done immediately to determine how best to ensure equality of access by all people, regardless of geographic area, or their ability to secure funds to pay the additional daily fees for residential treatment programs. Methods must be in place to ensure sound utilization management of all components of the Addiction Services system of care to ensure the right service for the right person at the right time. 8

9 Treatment system management and capacity development, including workforce development, research and evaluation Ongoing improvement in services for people with problematic substance use will require leadership and management by people who are able to priorize and focus on these activities. Such leaders must have a depth of understanding and skill in providing addiction services across the continuum, and in partnership with all key players in health and social services. As the evidence base continues to grow, and planning and development proceeds, those providing services will require leadership, education and support to incorporate new concepts and practices. Organizational structures and budgets (at provincial, regional and local levels) must incorporate Addiction Services leadership functions, and provide resources for research and evaluation, workforce development (including pre-employment professional preparation programs as well as continuing education for staff), and other continuing quality improvement activities. For the present, Health Authorities including but not limited to Mental Health Service structures as responsible stewards of Addiction Services within integrated health systems, must first ensure that all health professionals expected to provide specialized addiction treatment services have the required knowledge and skills to do so. This requires adoption of performance standards, and implementation of competency-based job descriptions, recruitment practices, clinical supervision as well as provision of education and training to assure both initial and ongoing learning. 9

10 Federal/Provincial/Territorial Committee on Substance Use and Abuse. (2006). Generic Evaluation Framework Substance Abuse Treatment Programs in Canada (in draft) Miller, William and Kathleen M. Carroll. (2006. Rethinking Substance Abuse: What the Science Shows and What We Should Do about It. Guildford Press, New York. Reist, D., Marlatt, G.A., Goldner, E.M., Parks, G.A., Fox, J., Kang, S., and Dive, L. (2004). Every Door is the Right Door: A British Columbia Planning Framework to Address Problematic Substance Use and Addiction. British Columbia Ministry of Health Services. Victoria. Skinner, Wayne. (2006) Towards a Model of Systems and Supports for Addictions: A Background Paper for the National Thematic Workshop on Improving the Quality, Accessibility, and Range of Options to Treat Harmful Substance Use Including Substance Use Disorders (Treatment) Centre for Addictions Research of BC, Following the evidence : preventing harms from substance use in BC. March 2006 Prepared by the Centre for Addictions Research of BC for the British Columbia Ministry of Health --p. verso. Available in PDF format on the British Columbia Ministry of Health website: prevent/pdf/followingtheevidence.pdf 10

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