Withdrawal Management Cathy McFarland, Director – Mental Health & Addiction Services Deb Hook, Manager – Outpatient Mental Health & Addiction Services February 25, 2015
Context Substance Use Problems are multi-dimensional comprised of substance use (frequency, quantity and variability), substance abuse (essentially negative consequences of use), and substance dependency.” “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, 2010 Social Services Model …change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilizes theories of human behavior and social systems, social work intervenes at the points where people interact with their environments General Assembly of the International Federation of Social Workers, July 2000
Withdrawal Management • 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
Needs Assessment Findings • Significant percentage of arrests related to drug use • Vulnerable housing situation for many • Relevant mental health indicators point to a high risk population • Few addictions services available • Few to no options for important groups of population • Crystal methamphetamine, prescription opioids • Almost 100% polysubstance use • Alcohol - “culture of drinking” • Marijuana - “…and uses pot”
Situation – Spring 2014 Withdrawal management workers hired February 2014, First clients seen on April 4, 2014 Community Withdrawal Management Support and monitoring for individuals who can safely withdraw from substances in a supportive community environment. Develop an individualized plan of care for withdrawal with the client. Support the client in selecting their own treatment goal. Day Withdrawal Management Daily program that supports people who want help with stopping/managing their alcohol or other drug addictions. Education related to issues of addictions, life skills and relapse prevention in order to make healthier lifestyle choices. Communication and Outreach Activities Presentations, participation in community partner initiatives, sharing of training Initiatives.
Ten months later…in February 2015 *Steady monthly increase of clients (except November) Interactions with 250 individuals • Information calls • WM Screens • WM treatment Incoming referrals • 33% - self referrals • 16% - family/friends • 10% - other legal system, excluding police Outgoing referrals • 67% to a service/treatment • 23% discharged with no referrals Operations in January 2015 • 25 individuals seen • 186 interventions • 28 group participants
Situation in 2015 - Clients Demographics • Clients - 60% male, 40% female; 7% First Nations • Ages: o Under 18 = 7% o Adults: 59% (18 - 34) 30% (35 – 64) 4% (Over 65 ) • Service recipient location – majority Lambton (75% clients are from Sarnia), Chatham-Kent, Bruce, Essex, Niagara • Employment status 24% working full or part time 27% Ontario Works
Situation in 2015 - Clients Drug Use at admission ( More than one problem substance may be reported for a client, per admission): • Injected within the last year – 24% (64% men and 36% women) Percentage of Open Admissions: (higher statistics for men than women) • 66% - Alcohol • 59% - Cannabis • 50% - prescription opioids • 50% - tobacco • 34% - crystal meth • Cocaine use noted, but not reported as a problem substance Age related to drug use: • 16 to 65+ • highest drug use is 16-34 • pot, crystal meth, prescription opioids: 16 - 34 are 3x higher than older age cohorts
Situation in 2015 - Clients Issues at Admission Mental Health Diagnoses at admission - 16-24 cohort – highest percentages • Major Depressive Disorder – 22% of open admissions (3x more women) • Anxiety – 11 % of open admissions (men/women equal) Health conditions/problems • Allergies • chronic pain • blood pressure problems • gastrointestinal problems • Hepatitis C • history of head injuries Other • family problems – men higher than women • sexual and physical abuse victim – women higher than men • Awaiting trial, incarcerated or probation = 28%
Situation in 2015 - Activities Withdrawal Management Groups Day groups • Walk-in format • presently underutilized • recent requests for WM group animation in other service provider locations Evening groups - WMS Family Support Groups • walk-in format • steady attendance • quality questionnaires report enthusiasm, engagement Outreach activities • 25+ community activities since April 2014 • Information drop-offs, presentations, participation in community activities, joint training • CAS, CMHA, Lambton College, Bench and Bar, Probation, Racing Against Drugs – 500 students (9-10 years), 75 teachers • Impact – publicity in general community, knowledge and understanding about service by community partners, capacity for appropriate referrals and warm handoffs
Situation in 2015 - Evaluation Quality of Care Surveys WM Services • “ The whole team is excellent and coming in for the first time, I could not have understood the positive effect they would have on my life ” • “Awesome program”. Thank you so much for everything, you guys saved my life” Family Support Group • “…I feel much better about life when I leave ” • “A lot of talk about self -care, sometimes we get so consumed with the addict we forget about ourselves; great to be reminded” • “… K nowing we are not alone…”
Conclusion Challenges • Low attendance at day groups • Difficult to convince CWMS clients of benefits of day groups Successes • Steady growth of clientele • Return clients • Seamless referrals from/to BWH Addictions Community Treatment • Requests for participation/presentations by other service providers • Going into jail to work on treatment plans for after release Positive Impact of Withdrawal Management Services • Word of mouth about the service is generating referrals • Sharing of clients ie. CMHA/WMS, CAS/WMS • Warm referrals to appropriate treatment • Bluewater Health recognized as a valued community partner • Navigation support by WM Workers results in more streamlined, less complicated access to needed services
Next Steps • Modifications to Day Withdrawal Management • Development of Withdrawal Management services within the hospital • Moving forward with full implementation of the Integrated Withdrawal Management Program (Residential Service and Stabilization)
Thank You. Questions? Open 7 days/week Monday-Friday – 8am to 8:30pm Saturday, Sunday – 8am to 4:30pm • Contact Information: 519.332.HOPE; 844.778.HOPE ;possible@bluewaterhealth.ca; Bluewater Health website • Calls returned within 24 hours, walk-ins available for individual treatment and group activities
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