Service Model and Provincial Standards for Adult Residential Substance Use Services September 2011 British Columbia Ministry of Health Service Model and Provincial Standards for Adult Residential Substance Use Services. Print: ISBN 978-0-7726-6518-8 Electronic: ISBN 978-0-7726-6519-5 Contents Acknowledgements .................................................................................1 THE SERVICE MODEL ...........................................................................3 1. Introduction ..................................................................................5 2. Model of Substance Use Services and Supports ...............................................6 3. Residential Substance Use Services and Supports in British Columbia ..........................8 3.1 Who benefits from residential substance use services and supports? 9 4. The Provincial Standards for Adult Residential Substance Use Services .........................10 4.1 What are the goals of the standards? 11 4.2 What are the concepts that inform the standards? 11 4.3 How will the standards be used? 12 5. The Evidence that Informs the Standards ......................................................13 5.1 In the community: Identifying the right service(s) for each individual 13 Men . 14 Parents of Young Children . 15 5.2 At the residence: Providing effective treatment and supports 15 Aboriginal People . 16. Lesbian, Gay, Bisexual, Two-Spirit, Transgender or Questioning (LGB2STQ) People . 17 Pregnant Women . 18. 5.3 Returning to the community: Building on the individual’s success 18 Seniors . 19 Women . 20 The standards now and in the future 20 THE STANDARDS ................................................................................21 A word about the standards ..........................................................................22 In the community: Identifying the right service(s) for each individual 23 Standard 1: Screening and Assessment ...............................................................24 Standard 2: Informed Decision Making ...............................................................27 Standard 3: Community Supports .....................................................................29 At the residence: Providing effective treatment and supports 30 Standard 4: Staff Experience and Qualifications .......................................................31 Standard 5: Settling into the Residence ...............................................................32 Standard 6: Medical Needs ............................................................................34 Contents (continued) Standard 7: Treatment Planning .......................................................................36 Standard 8: Evidence-based Practice ..................................................................38 Standard 9: Safety ....................................................................................40 Standard 10: Monitoring and Evaluation ..............................................................41 Standard 11: Transition Planning . 42 Returning to the community: Building upon the individual’s success 44 Standard 12: Aftercare Treatment and Supports .......................................................45 Glossary ..............................................................................................46 Works Consulted .....................................................................................49 Appendix 1: National Treatment Strategy Tiered Service Model ........................................63 Appendix 2: Relevant legislation, standards and organizations which may apply to residential substance use services and supports in British Columbia ..............64 1 Service Model and Provincial Standards for Adult Residential Substance Use Services Acknowledgements We would like to acknowledge the many people and organizations whose work has contributed to this Service Model and Provincial Standards for Adult Residential Substance Use Services: Project Leaders Provincial Health Services Authority Jane Collins, Program Manager, BC Mental Health & Amanda Seymour, Manager, Mental Health and Addiction Services Substance Use, Ministry of Health Annette Harding, Project Manager, Ministry of Children Vancouver Coastal Health Authority and Family Development (ex. Ministry of Health) Lorraine Grieves, Manager, Vancouver Mental Health and Youth Addictions, HIV AIDS & Harm Researchers/Writers Reduction Mary Marlow, Professional Practice Lead - Addiction Tracy Byrne, Senior Researcher, Knowledge and Services, Vancouver Mental Health & Addictions Information Services Branch, Office of the Chief Information Officer, Ministry of Citizens’ Services Marelyn Rugg, Addiction Knowledge Exchange Leader Shyla Warner, Researcher, Knowledge and Information Vancouver Island Health Authority Services Branch, Office of the Chief Information Michelle Dartnall, Manager, Youth & Family Substance Officer, Ministry of Citizens’ Services Use Services, Child, Youth & Family Programs Louise Hill, Manager, Quadra Clinic Working Group Janet James, Area Manager, Mental Health & Fraser Health Authority Addictions, Oceanside, Port Alberni & West Coast Sherry Mumford, Director Clinical Programs, Mental Paula Beltgens, Addiction Knowledge Exchange Leader Health & Substance Use Services Marika Sandrelli, Addiction Knowledge Exchange Consultations/Reviewers Leader Many thanks to all the service providers, participants and Mark Goheen, Clinical Specialist, Mental Health & other key stakeholders who participated in focus groups Substance Use Services held around the province, those who submitted electronic Interior Health Authority questionnaires and those who reviewed the documents Carol Todd, Director of Addiction and Residential BC Substance Use Network Services, Thompson-Cariboo Mental Health and Addiction Services BC Mental Health and Substance Use Planning Council Rae Samson, Community Integrated Service Manager, Adult and youth service providers, participants and allied Mental Health and Addiction Services professionals in FHA, VIHA, NHA, VCHA, and VIHA Aurora Women’s Treatment Centre Northern Health Authority Sherri Hevenor, Director, NI Regional Programs, Mental Round Lake Treatment Centre Health and Addictions Crossroads Treatment Centre Franca Petrucci, Addiction Knowledge Exchange Ministry of Children and Family Development Leader Ministry of Social Development Providence Health Care Ministry of Health: Home, Community & Integrated Rosemarie Riddell, MSN, Clinical Nurse Specialist HIV & Care, Mental Health & Substance Use, Population Addiction, St. Paul’s Hospital and Public Health, Primary care, Office of the Assisted Living Registrar Production of this document has been made possible through a financial contribution from Health Canada . The views expressed herein do not necessarily represent the views of Health Canada . The Service Model 4 5 Service Model and Provincial Standards for Adult Residential Substance Use Services 1. Introduction Substance use occurs along a spectrum from beneficial use to non-problematic use to problematic use (including potentially harmful use and substance use disorders). Those programs that provide services to individuals who are experiencing problematic substance use or substance use disorders are the primary target of this service model and standards. Problematic substance use can affect British Columbians of all ages and from all social groups. It is a complex issue that confers a wide range of risks and harms to individuals, their families and communities. People living with a substance use problem or disorder have diverse life experiences, personal circumstances, needs and concerns. Helping individuals to change their problematic substance use requires a variety of services that are capable of responding to the specific characteristics and preferences of each person seeking help. The Province of British Columbia provides a continuum of specialized problematic substance use services and supports through the six health authorities. This continuum includes community services such as outreach programs, community counselling, day treatment, home and community based withdrawal management, and needle- exchange facilities, as well as residential services such as hospital or facility withdrawal management, residential treatment, supportive recovery facilities and stabilization programs. In addition, some health authorities have developed partnerships with agencies such as B.C. Housing to make available longer-term supported housing where residents can also access specialized substance use supports. The services that provide treatment for substance use in B.C. focus on the whole person. They offer support for the physical, emotional, cultural and spiritual wellbeing of the individual. In addition, increasing integration between mental health and substance use services means that the significant numbers of people who present with concurrent disorders may receive mental health interventions and substance use treatment simultaneously. Substance use services and supports also help the individuals they serve to access housing, employment, education, and training as well as to improve their relationships with family, friends and significant others. Residential substance use treatment is just one component of the continuum of substance use services in B.C. The majority of British Columbians needing help to change their substance use will find the appropriate supports in non-residential community-based services. Some,