Systems Approach Workbook A Systems Approach to Substance Use Services and Supports in Canada

1. Systems Approach Workbook A Systems Approach to Substance Use Services and Supports in Canada Communication Tools: Sample PowerPoint presentation The original template text for this file, as well as other useful material, is available in the Tools & Templates section of the Systems Approach website (www.nts-snt.ca). Production of this material has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.

2. Outline • Background • Why pay attention to the treatment system? • Systems Approach recommendations • Tiered Model • Systems Approach implementation

3. Background • Treatment is one of 13 priorities under the National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances • 40+ National Treatment Strategy Working Group members were tasked with producing recommendations toward “improving the quality, accessibility and range of options to treat harmful substance use, including substance use disorders”

4. Background (cont’d) • The Working Group released its report in October 2008 • The report makes 20 system-level recommendations to • Improve the quality, range and accessibility of services and supports • Close the gap between “need” and “response”

5. Why Pay Attention to the Treatment System? • Treatment for problematic substance use works and is an efficient use of resources • Substance use problems drive health and social costs beyond the addictions treatment field • Substance use is a major contributor to chronic diseases such as cancer and diabetes • There are large gaps in service and barriers to accessing the help people need

6. Systems Approach Recommendations • Develop a continuum of services and supports • Improve care, coordinate services and make better use of existing investments by shifting the focus toward integrated, community-based care rather than specialized care • Look at the system using a tiered framework representing logical groupings of services and supports and varying levels of risk and harm • Develop knowledge exchange capacity • Promote evidence-informed policy and practice

7. Systems Approach Recommendations • Reduce stigma and discrimination • Develop a targeted, evidence-based approach • Increase the understanding of substance use problems and the treatment system to reduce the barriers faced by those who might access the system and those who work within it • Develop a research program • Support and enhance efforts to build system capacity

8. Systems Approach Recommendations • Measure and monitor system performance • Collect information in a consistent way to inform and monitor system improvements • Promote leadership and implementation • Coordinate allocation of resources • Develop collaborations across systems and sectors

9. Tiered Model: A Service Perspective • Each tier represents a cluster of services and supports that • Respond to varying levels of risk and harm • Address problems of similar severity and provide services of similar intensity and specialization • Movement within and across tiers is facilitated • In a comprehensive continuum, each tier has the tools, resources and supports required to meet population needs

10. Tiered Model: A Service Perspective • Lower-tier services and supports • Meet the needs of the greater number of people • Represent a higher level of community integration and lower degree of specialization • Upper-tier services and supports • Meet the needs of people with more severe substance use issues • Represent a higher level of specialization

11. Tiered Model: A Population Perspective • Tiers represent groupings according to levels of individual risk and harm • Movement through connected tiers is facilitated as individual needs and risk/harm profiles change over time • Five Tiers • 1: Individuals with low risk/harm • 2: Individuals with moderate risk/harm • 3: Individuals at risk of acute harm • 4: Individuals experiencing harm • 5: Individuals experiencing harm and with complex risk profiles (e.g., concurrent disorders)

12. Tiered Model: Guiding Principles • No wrong door • Availability and accessibility • Matching • Choice and eligibility • Flexibility • Responsiveness • Collaboration • Coordination

13. Benefits of the Tiered Model • Flexible • Responds to the particular needs of Canada’s jurisdictions and populations, but… • Based on common principles that can be applied in any context • Promotes the efficient use of resources • Emphasis on developing capacity in the lower tiers rather than relying on more resource-intensive, specialized services

14. Variations of the Tiered Model • Variations of the Tiered Model can be found in • Healthy Minds, Healthy People: A Ten-Year Plan to Address Mental Health and Substance Use in British Columbia (2010) • The Action Plan for Mental Health in New Brunswick, 2011-18 (2011) • Creating Connections: Alberta’s Addiction and Mental Health Strategy (2011)

15. Systems Approach: Rationale for Change EXAMPLES OF WHAT TO INCLUDE: • The reasons improvements are needed in your jurisdiction; for example: • Responding to or proactively addressing • New research evidence • Population trends • An emerging problem • An identified gap • The ways areas that are working well can support and be supported by system change

16. Systems Approach: Rationale for Change EXAMPLES OF WHAT TO INCLUDE: • Address benefits to • The clients • The services • The practitioners • The system • Cost savings associated with earlier intervention • Reduced reliance on specialized, intensive services • Reduced health and social impact of substance use

17. Systems Approach: Outcomes and Benefits EXAMPLES OF OUTCOMES AND BENEFITS: [TO BE CUSTOMIZED] • Increased partnerships and coordination between services • Improved client outcomes through increased access to appropriate services • Increased capacity to identify and address gaps in the service continuum

18. Systems Approach: Work to Date EXAMPLES OF ACTIVITIES: [TO BE CUSTOMIZED] • Examined provincial strategy for consistency and guidance • Examined strategic plans for consistency with the Systems Approach • Identified areas of the system that need improvement or are working well • Identified benchmarks through provincial reports and national indicators (e.g., CIHI, National Treatment Indicators)

19. Systems Approach: Decisions Required [TO BE CUSTOMIZED]

20. Systems Approach: Next Steps [TO BE CUSTOMIZED]

21. Additional Information • www.nts-snt.ca • www.ccsa.ca • [ADD RELEVANT REGIONAL LINKS]