Strengthening treatment systems project (Nova Scotia)

Province

Nova Scotia

Description and objectives

The overall goal of Nova Scotia’s Strengthening Treatment Systems Project is to strengthen the evidence-informed addiction treatment system in Nova Scotia. The specific objectives are to increase:

  • Access to evidence that informs policy and practice;
  • Collaboration related to policy development, system planning and knowledge exchange within and among jurisdictions and stakeholders;
  • Provincial coordination of workforce development initiatives across addiction and mental health systems;
  • Uptake of evidence-informed information leading to changes in standards, clinical guidelines, policies and practices;
  • Capacity to monitor the performance of the treatment system;
  • System readiness to respond effectively to problematic substance use in primary care and acute care settings; and
  • Consistency in the provision of quality addiction treatment services across the province.

Target audiences

The primary target of the project is the approximately 2,200 staff working with Nova Scotia’s provincial Mental Health and Addiction Services system. There are several unique and high-need populations of clients that we are targeting with our proposal: opioid-dependent individuals; individuals with concurrent disorders and individuals in need of medical withdrawal management. We will also be targeting provincial primary care staff (family physicians, nurse practitioners, nurses, etc.) as part of our Screening Brief Intervention and Referral (SBIR) project and acute care staff for the development of a Training Framework for Emergency Department Staff.

Through continued enhancement of the continuum of supports and services, and training and support for those health professionals within the targeted healthcare sectors, it is anticipated that the primary benefactors of this project will be the individuals, families and communities who seek help for substance use and mental health problems.

Nova Scotia is seeking funding in all three DTFP investment areas. Below are the key project activities under each investment area:

Supporting the Implementation of Evidence-Informed Practices

Revision and Implementation of Provincial Addiction Services System-Level Standards: Over the next two years Nova Scotia will continue to revise provincial Addiction Services System-Level standards, including revision and implementation of System-Level Standards for Withdrawal Management and System-Level Standards for Opioid Dependence Treatment (ODT) also known as methadone maintenance treatment (MMT).
New Service Delivery Model for Inpatient Withdrawal Management Services: Nova Scotia has undergone a substantial review of its inpatient withdrawal management services and is in the process of developing a new service delivery model for inpatient withdrawal management. We will use DTFP funds to develop a comprehensive implementation strategy that includes change management planning.
Concurrent Disorders Initiatives: Concurrent disorders are a key priority of the project. As part of our previous DTFP project, Nova Scotia developed System-Level Standards for Concurrent Disorders that have been adopted provincially by both Addiction Services and Mental Health. Dedicated DTFP funding over the next two years will enable ongoing implementation of the System-Level Standards for Concurrent Disorders; expansion of the Concurrent Disorders Basic Competency toolkit to include an adolescent supplement and the development of a training framework for Addiction Services and Mental Health staff to meet advanced concurrent disorders competencies.
Screening, Brief Intervention and Referral (SBIR): Nova Scotia will use DTFP funds to explore various models and identify a model best suited to our context.
Building Capacity within Provincial Emergency Department Staff to Address Problematic Substance Use: Nova Scotia will use DTFP funding to build capacity to address problematic substance use within this sector of the health system by developing and implementing a training framework targeted specifically for provincial emergency department staff.

Opioid Dependence Treatment Initiatives

Revision of the College of Physicians and Surgeons of Nova Scotia (CPSNS) Methadone Maintenance Treatment Handbook: In 2012, CPSNS released its Methadone Maintenance Treatment Handbook, a guide for physicians with their exemptions for methadone for dependency. We will use DTFP funds to support CPSNS to revise the MMT Handbook to include guidelines and standards for the use of Buprenorphine/Naloxone in the treatment of opioid dependence.
Revision of System-Level Standards for Opioid Dependence Treatment (ODT): Nova Scotia will use DTFP funds to revise our System-Level Standards for Opioid Dependence Treatment to reflect the changes in Nova Scotia and Atlantic context as well as emerging evidence and best practices. Nova Scotia hopes to work in collaboration with our counterparts from the other Atlantic Provinces on this project.
Workforce Development Strategy: The creation of a Workforce Development Strategy for Addiction Services and Mental Health has been identified as a top priority by the Provincial Addictions and Mental Health Committee. Nova Scotia will use DTFP funds to support the development of this strategy with the goal to identify core competencies for the Addiction Services and Mental Health workforce and develop a shared, coordinated provincial training strategy to support competency development.

Strengthening Performance Measurement and Evaluation

Outcomes Monitoring System (OMS) for Addiction Services: Nova Scotia will use DTFP funds to further analyze OMS options for Nova Scotia Addiction Services.
Hire DHW Evaluation Specialist: An Evaluation Specialist will be hired to build evaluation capacity within the Mental Health Children’s Services and Addictions branch. The Evaluation Specialist will be responsible for the development and implementation of the DTFP Evaluation Framework and reporting back to Health Canada on progress made on project’s outputs and outcomes. In addition, the Evaluation Specialist will lead the analysis and identification of an OMS model for Addiction Services and will provide evaluation support to several other DTFP initiatives. The Evaluation Specialist will also work collaboratively with other provincial staff to evaluate the effectiveness and impact of provincial addiction treatment programs.

Linkage and Knowledge Exchange

Restructure Knowledge Exchange Infrastructure and Hire a Second Knowledge Exchange Coordinator: During the last iteration of DTFP, Nova Scotia invested in the development of a knowledge exchange infrastructure for Addiction Services by hiring knowledge exchange staff for the province. The implementation of these positions significantly increased Addiction Services capacity to engage in knowledge exchange activities. In this iteration of DTFP, Nova Scotia will restructure and centralize the knowledge exchange positions at the Department of Health and Wellness and the focus of these positions will be to support the development and implementation of system level projects, including DTFP projects that will benefit the whole province.
Host Semi-Annual Knowledge Exchange Events for DTFP Counterparts in the Other Atlantic Provinces: The Atlantic Provinces share many commonalities in terms of geography and culture, the size of our addiction treatment systems, limited resources as compared to larger provinces, and significant out migration to other provinces for employment opportunities, which often results in vulnerability to substance use problems. In the last iteration of DTFP, Atlantic DTFP program leads organized an Atlantic DTFP Knowledge Exchange Event in which we shared information about our DTFP projects and lessons learned in the process. In this iteration, we will use DTFP funds to support ongoing Atlantic collaboration by organizing semi-annual meetings to discuss common priorities and share evidence-based policies, practices, guidelines, standards and system planning ideas. We believe collaboration will prevent duplication of effort and provide a valuable opportunity to share information, tools, resources and, equally important, lessons learned.

This project is made possible through a financial contribution from Health Canada. The views expressed do not necessarily represent the views of Health Canada. © 2015 EENet.

Project Contact: 

Project leads

Carolyn Davison, Director, Addiction Services, Mental Health, Children’s Services, and Addictions Branch
Wanda McDonald, Manager, Addiction Services, Mental Health, Children’s Services and Addictions, Department of Health and Wellness
Lynn MacNeil, Knowledge Exchange Coordinator, Mental Health, Children’s Services and Addictions, Department of Health and Wellness

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