CLINICAL APPLICABILITY AND

COMMUNITY CAPACITY BUILDING IN SUBSTANCE

USE AND MENTAL HEALTH EDUCATION Presented by:

Debora Steele, RN BScN C.P.M.H.N.(C) GNC(C),

Providence Care Mental Health Services

Jennifer Barr, B.A., CAMH Healthy Aging Project Lead

Centre for Addiction and Mental Health

Conflict of Interest Declaration

• CAMH led project – quantitative and qualitative evaluation results

• Collaborative agreement with

P.I.E.C.E.S. Consult Group

Developing Training and Education Resources

“Making the Connection Work:Identification and Support for

Older Adults with Substance Use and/or Mental Health Problems”

• A one-day community based workshop

Training Description

• Developed and piloted by the Centre for Addiction and Mental Health in partnership with P.I.E.C.E.S. Consult Group

• Target audience for this training is Ontario professionals working with older adults in a variety of roles, as well as those in the addiction and mental health fields.

Training Team

• Integral to this training is the model of an older adult addiction specialist teaming up with a Psychogeriatric Resource Consultant as co-facilitators.

Ontario older persons specific addiction programs

• COPA (Toronto)• LESA (Ottawa)• Sister Margaret Smith (Thunder

Bay)

Content of the Workshop

• Information on older adults with mental health issues &/or substance use

• Integrates a P.I.E.C.E.S. approach • Community capacity building

component

Learning Objectives

To increase knowledge, skills and understanding required in the identification, referral and support for older adults who have substance use &/or mental health problems.

To increase awareness of how substance use and mental health issues may present in the older adult and how services can improve outcomes.

To recognize the P.I.E.C.E.S. framework is a systematic approach to understanding and enhancing care for the older person at risk.

To utilize case consultation and service coordination to improvecommunity capacity to respond.

.

Alcohol Issues

• Alcohol is still most common problem substance

• As people get older they become more sensitive to the effects of alcohol and may be more vulnerable to alcohol’s negative effects

• Injuries due to falls• Liver disease• Can worsen:

– Diabetes– Heart disease or elevated BP – Stomach problems– Mental Health Issues

• 44.5% of Canadian have tried marijuana in their lifetime.

• Important fact is that drug use as a whole has increased in the last decade.

• Are we screening for it? Older Adults are still largely not seen as users.

• Beginning to see use of drugs like crack cocaine in men 55+

-- homeless and marginally housed

Illicit Drugs - The Next Generation

Prescription Medication Misuse

• Benzodiazepines

• Sedatives/Sleep• Analgesics/Opiates

Signs of Aging or an Alcohol/Drug Problem?

• Confusion

• Depression

• Disorientation

• Unsteady gait/falls

• Recent memory loss

• Loss of interest in activities

• Social isolation

• Tremors

• Irregular heart rate

• Poor appetite

• Stomach complaints

Barriers to Treatment

• Personal Barriers:– Shame– Guilt– Stigma– Uncertainty about

the process

• Accessibility

• Attitudes:– Societal– Family– Health– Cultural– Health Prof.

• Health Status

Best Practices

• Recognizes that isolation and on-going losses are risk factors for addictions

• Is client-centred & older adult specific

• Utilizes outreach services

• Takes a harm reduction approach

• Is flexible, non-threatening, unhurried

• Addresses basic living needs

Best Practices

• Addresses socio-cultural differences• Demands collaboration among treatment and

health care professionals

Key Approaches

• Go to where the client is at physically, mentally and emotionally

• Assess stage of change

• Employ principles of harm reduction

Putting the P.I.E.C.E.S. ...Together

PPhysicalCornerstones

IIntellectual of the

EEmotional P.I.E.C.E.S.

CCapabilities philosophy EEnvironment of care

SSocial/ Cultural

Goals of P.I.E.C.E.S.Learning Initiative:

To provide: a common vision and set of values

a common language and knowledge for communicating across the system

a common yet comprehensive approach for thinking through problems

3-Question P.I.E.C.E.S. Template

Q. 1Q. 1 What has changed?

Avoid assumptions; think atypical.

Q. 2Q. 2 What are the RISKS and possible causes?

Think P.I.E.C.E.S.

Q. 3Q. 3 What is the action?

Investigations

Interactions

Information

Community Capacity Building

• Understanding the Problems and Identifying Stakeholders

• Building Community Capacity • Leveraging Resources

• Follow-Up

Evaluation

• Three-month post-event evaluation of first pilot training has shown that participants are able to recall and have applied concepts that they have learned in the training to their clinical practice.

• Of 43 participants tested after the second pilot 15 reported they were “quite likely to” and 21 “definitely will” implement some of the things they learned in the workshop into their work/practice.

Promotion and Roll Out

• To all Ontario Communities (Fr & Eng) • Promoted to PRC’s and CAMH Project

Consultants • Presentation Kit includes

– Sample Agenda– Presentation Slides– Training exercises and case studies– Promotional flyer – Budget template– Letter of Agreement

For more information:

Jennifer Barr

CAMH Healthy Aging Project

Centre for Addiction and Mental Health

Tel. 613 256 1397

Jennifer_Barr@camh.net