Integrated Withdrawal Management Program for Sarnia-Lambton October 30, 2013 1
Addiction “ Heavy substance use, abuse and/or dependence frequently co-occurs with mental health problems, physical illness and a range of social needs .” “Three interrelated dimensions – acuity, chronicity and complexity .” Dr Brian Rush, CAMH Tiered frameworks for planning substance use service delivery systems: Origins and key principles, 2010 2
Withdrawal Management Definition Assistance with voluntary withdrawal from alcohol and/or other drugs for clients who are under the influence of these substances and/or in withdrawal or otherwise in crisis related to these substances. Assistance with voluntary withdrawal from gambling. Components Evaluation Stabilization Foster client/patient readiness for change – harm reduction or entry into substance abuse treatment Referrals by: Self Law enforcement Hospital staff/healthcare workers Social service agencies, shelters Family, friends, volunteers Requirement for treatment 3
Current Situation in Sarnia-Lambton “ A vulnerable population” • People who are homeless and/or living in unsafe environments with little to no hope of moving away to make lifestyle changes • Significant drug and alcohol use, people often using two or more drugs together • Number of mental health problems, issues growing • More youth using drugs in a more dangerous fashion at a younger age • Complex health problems with three inter-related dimensions acuity, complexity, chronicity • People are not getting help because they can’t/ won’t go out of town, don’t know about available services or feel that the wait for service is too long and access to service is too complicated “ With Urgent Needs ” • Addiction treatment or support for making healthy changes to lifestyle • A safe place to stay while withdrawing, while waiting for treatment, after treatment • Navigation support to treatment • Information about harm reduction, treatment options • Motivational support while waiting for treatment or after treatment • Education for general population, health professionals to destigmatize addictions • Education for prevention and promotion about dangers of drug use “ Facing barriers to addictions services ” • Few local treatment services • Long wait lists, complicated processes to get to treatment • Poor communication with local service providers • Few/no treatment options for specific populations including methadone substitution clients, people with co-occurring mental health and addictions problems, Youth, First Nations, people with childcare responsibilities, marginalized population • Services being used presently for withdrawal management - Shelters, Emergency Room- BWH, jail, BMC, peer support groups 4
Withdrawal Management needed to: • Increase success in recovery and harm reduction for individuals &their families • Increase service awareness and understanding of addictions in the community • Provide easy access to information: self, family, employer, etc • Reduce visits, repeat visits to ED, hospital admissions identified as intoxicated/in withdrawal, use of inpatient medical and MH beds, front-line care providers - stress, overwork, improve patient flow • Reduce police interventions, legal charges, hours spent in jail by target populations • Reduce use of other services/settings for withdrawal • Reduce disruption, criminality, risks in community • Reduce costs of substance use problems in the hospital, health care system, community • Enable care and support using appropriate resources in an evidence-based, cost-efficient manner 5
Levels of Withdrawal Management Day Withdrawal Management Service (DWMS) Will address difficulty in accessing information and support for wide variety of clients. Service can be mobile (different locations in the community) with a walk-in format. • Provides early recovery education for many people about symptoms experiencing, coping and self-protective behavior strategies (ie. harm reduction), aftercare and stabilization support • Relaxation techniques, mindfulness, auricular acupuncture, life skills • Widespread engagement, service awareness possible • Counseling, navigation support • Family groups 6
Levels of Withdrawal Management Community Withdrawal Management Service (CWMS) Will address differing needs of clients to withdraw in their own home or safe environment, facing barriers for access service. Quick turnaround time between call for service and response by professional. • Provides an approach to better serve people with child care responsibilities, youth, seniors, First Nations, people who don’t do well in group/residential setting • Client not isolated from family; family significant other engaged in process • Greater accessibility in rural regions • Collaboration with client’s physician or prescribing doctor in development of tapering regimes • Services can be youth-specific • Telewithdrawal through the Internet and Skype can increase access to more people farther afield • OTN support can increase - reach to specialists, assessments for treatment and other info from call 7
Levels of Withdrawal Management Residential Withdrawal Management (RWMS) Will address Drug, Housing, Criminality problems, inappropriate use of health and other services for withdrawal, intoxication. • Increase ability of people to safely withdraw from drugs/alcohol Safe housing away from dangerous environments, influences Reduce/eliminate use of jail, ED, etc for withdrawal Education, counseling, motivational support readily available 24/7 (when needed – not office hours) Close monitoring of physical and psychological symptoms while withdrawing • Reduce inappropriate use of more costly resources for withdrawal Seamless and timely flow of patients from ED, Inpatient Departments of BWH, Inpatient Mental Health to appropriate level of withdrawal management service • Increase safe/secure housing capacity in Sarnia-Lambton Other social service agencies can concentrate on core business Women, youth able to undertake lifestyle changes in a appropriate, structured, stable environment 8
Levels of Withdrawal Management Stabilization Beds Will enable more people to enter treatment , stay” in recovery, practice harm reduction. • Provides safe housing options while waiting for treatment, aftercare, making lifestyle changes • Clients more “treatment - ready” • Chance to practice life skills and safety and feel success 9
Related Services Prevention and Health Promotion Services Will nestled in all levels and service partners dealing with housing, income support, public health and justice issues will be encouraged to develop these services in collaboration with the IWMP professional • Awareness and brief screening interventions (SBIRT) ED Jail, shelters Parole and Probation • Outreach Youth Families Service partner professionals – ie. police • Wrap around Services walk-in clinics – Hepatitis C, Harm Reduction measures, Concurrent Disorder Support Groups Community Addictions Services 10
Integrated Withdrawal Management Program (IWMP) • Bedded Services 10 Residential WM Beds 6 Stabilization Bed • Non-bedded Services Day Withdrawal Management Community Withdrawal Management (including Telewithdrawal) • Wrap around services related to withdrawal management services and addictions • Prevention and Health Promotion nestled in all levels and shared with Partners “ Located at one location, welcoming with easy access, green spaces, ample parking, room to grow” “ Open, easy access to mobile services that facilitate access to information and addiction services” 11
Integrated Withdrawal Management Program (IWMP) Phased-in approach DWMS and CWMS, certain wrap-around services implemented while securing final location and capital funding for construction and ensuring complete operations for complete IWMP. Advantages: Rapid response to a very obvious need for services Commencing with flexible, mobile services will reach an important number of people with substance use problems Enables development of links with partners and building service capacity where people are typically engaged Important impact on education and reducing stigma and discrimination of people with substance use problems. 12
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