Bridging Research and Clinical Practice: Key strategies to creating innovative addiction treatment services Kim Corace, Ph.D., C. Psych Director, Research and Program Development Melanie Willows, B.Sc. M.D. C.C.F.P. C.A.S.A.M. C.C.S.A.M. Clinical Director Substance Use and Concurrent Disorders Program Royal Ottawa Health Care Group Faculty of Medicine, University of Ottawa Ottawa, Ontario, Canada October 17, 2014
CSAM Disclosure of Relevant Financial Relationships Content of Activity: CSAM Conference 2014 Name Commercial Interests Relevant Financial Relationships: What Was Received Relevant Financial Relationships: For What Role No Relevant Financial Relationships with Any Commercial Interests M. Willows and K. Corace Reckitt- Benckiser Unrestricted educational grant to The Royal Education/ Training
Overview and Objectives Our healthcare system is in need of creative solutions to transform how we deliver equitable, high quality care for all How can we create innovative and sustainable addiction treatment services in our region through research and evaluation projects? How can we increase capacity to offer more services to enhance health outcomes?
Road Map to System-Based Change Complex mental health and addictions needs unmet for people with opioid use problems Regional program and treatment network for opioid addiction and mental health problems
It all starts with the clients we work with. Are we (our system) providing optimal care for our clients?
Initiate the Process and Identify Gaps
Opioid Addiction: What are the treatment gaps? Canada is the world s second largest per capita consumer of opioids. Ontario tops the list in Canada. Prescription opioid misuse, abuse and dependence is a major public health issue Increase in number of individuals seeking treatment for opioid dependence in the last 10 years More young people and those using opioids for shorter periods of time are seeking treatment, and many have concurrent mental health issues.
Opioid Addiction: What are the treatment gaps? Effective delivery of opioid addiction treatment is challenging, given the high level of mental health comorbidities Identified need for an integrative and coordinated system of multidisciplinary care for those with opioid addiction and concurrent mental illness to improve treatment access and outcomes
Form and Foster Multidisciplinary Collaborations and Partnerships
Engage stakeholders at all sectors, including policy and government
Fostering relationships and partnerships In different sectors, we recognized our patients were struggling with similar problems Held a meeting to generate potential solutions about how we could work together Brought internal stakeholders to the table to see if there was support Reached out to external community stakeholders Champlain region Local Health Integration Network (LHIN)
Seed funding to grow a clinical solution
Growing programs for clinically-driven research projects In collaboration with physicians, psychologist, nurses, other multi-d team members across sectors, and community partners, applied to The Royal s Academic Health Science Centre and Ministry of Health Innovation Fund Ensured proposal fit into the mandate of the hospital, region, ministry and local community stakeholders and partner organizations
Regional Opioid Intervention Service (ROIS) Overall goal: To develop, implement, and evaluate a regional integrative model of concurrent disorders care for opioid detoxification and maintenance services targeted at early intervention The ROIS has 4 pillars: Patient care and family support Training, education, and capacity building Integration and coordination of services Program and outcome evaluation
Regional Opioid Intervention Service One of the first of it s kind in Ontario Multidisciplinary team provides accessible outpatient intervention for opioid addiction and mental health problems Target youth and young adults (age 16 and up) and those using for shorter period of times Form a network of community and hospital service providers partnering agencies throughout the Champlain LHIN to offer a full spectrum of care close to where our clients live
Regional Opioid Intervention Service Treatment is based on client s unique needs: Outpatient opioid detoxification and maintenance Mental health assessment and treatment Counseling and case management supports Follow up services Linkages with other community services and programs
Regional Capacity Building Provide opioid addiction and mental health training and mentorship for our partners, primary care physicians, and other mental health and addictions workers to build capacity within the system. Family physician observerships Provide ongoing mentorship and consultation
Seed funding to grow a clinical solution
Growing programs for clinically-driven research projects Received 2 years of Innovation funding for pilot work Outcome of preliminary evaluation: High uptake, access and adherence to treatment Formed system linkages and collaborative partnerships with 15+ community and hospital agencies region-wide Successful initial capacity building initiatives Presented to hospital leadership, LHIN, as well as external federal and international agencies (i.e., CCSA and International Narcotics Control Board)
Get a seat at the table or better yet, all tables.
From pilot funding to more pilot funding..
Know the table where we sit. Key priority of the region was finding communityfocused solutions to manage opioid use problems, including major issues in rural areas Presented a clinical solution with a program of research that fit into the priority LHIN provided one-time year-end funding and these funds to allow the service to continue
Knowledge translation and exchange..
Share the innovation and results. Applied to present at The Innovation Fund Showcase Needed to demonstrate our Service was innovative: Change health care delivery Be adoptable by other institutions Improve health care outcomes Invited to present in Toronto at The Showcase Awarded Best Innovation in Mental Health Care Delivery Now a seat at another table and another way to advocate
From pilot funding to sustained funding..
Evaluation for sustained clinical and capacity building services. Evaluation and research presented at multiple venues to stakeholders, administration, and the LHIN In November 2013, LHIN announced ongoing base funding to support the Regional Opioid Intervention Service
Where are we at now..
Key Evaluation Results High burden of mental illness and polysubstance abuse in patients with opioid problems Patients can adhere to and complete an opioid taper with the help of an intensive outpatient treatment program that integrates mental health and opioid addiction treatment Highlights the need to treat mental health and substance use disorders concurrently.
Regional Capacity Building. 300+ HCWs received training, education, mentorship Formation of links and integration between primary care and community MH&A agencies Targeting under-served areas so that patients can be treated in their home communities Use of telemedicine to mitigate access barriers Increased access to care where clients live Increased capacity of the region to identify and treat opioid addiction and mental health problems
Road Map to System-Based Change Complex mental health and addictions needs unmet for people with opioid use problems Regional program and treatment network for opioid addiction and mental health problems
Revisiting the clients we work with. How are we doing now? Are we (our system) providing optimal care for our clients?
More gaps identified.. Youth with substance use problems struggle more.how can we work with our community to better meet their needs.
And the process starts again.
Road Map to System-Based Change Complex mental health and addictions needs unmet for youth?
In summary Lessons Learned... It s ALL about the patient- So let s make it about this Identify gaps and innovate Foster collaborations and partnerships in all professions and across all sectors to bridge the gaps we get nowhere unless we work together Know your stakeholders and the tables where you sit Data and evaluation is key Communicate your vision Take a leadership role Be patient and persevere
And advocate everywhere.bridging spheres outside of where we usually go Sometimes the tables we think are not important turn out to be very important
If we don t advocate for our vulnerable patients, who will? If we don t advocate for the benefit of addiction services, who will?
Strength in team work.. We can foster collaborations to make a difference and create system change
Questions?