brian rush – Matters of Substance

As researchers, our ultimate goal is to provide evidence-based information that will go on to inform policy and practice. Recently, we were lucky enough to have the opportunity to do just that.

For 18 months, the Centre for Addictions Research of BC (CARBC) has been collaborating on a project with the BC Ministry of Health. The Ministry’s initiative was to create 500 substance-use treatment spaces throughout the province; however, they wanted to know where these spaces would be best utilized. Would it be in the more Northern communities where substance-use treatment is scarcer? Or would it be in more busy urban areas where demand for these services is higher? These were some questions that a small team here at CARBC, alongside some key individuals within the Ministry, sought to answer.

From a health service delivery perspective, British Columbia is divided geographically into health authorities (HAs), health service delivery areas (HSDAs), and local health areas (LHAs). This is a nested structure where the 89 LHAs nest within the 16 HSDAs, which in turn nest within the five larger HAs.

We set forth to replicate a needs-based planning model developed by Brian Rush and colleagues (2014). This model applies a number of different parameter estimates based on substance-use issues reported by population survey data. The estimates were derived from an extensive literature review as well as input from a national review of experts. For example, in tier 4 (i.e., specialized care functions targeted to people assessed/diagnosed as in need of more intensive or specialized care), Rush’s model estimates that 60% of the help-seeking population will require withdrawal management services.

Further subdividing withdrawal services into three specialized types the model estimates that 36.8% of those people will require home-based/mobile treatment, 52.6% will require community/residential treatment, and 10.5% will require complexity-enhanced/hospital-based treatment. We created population estimates from aggregated 2009/2010 results of the Canadian Alcohol and Drug Use Survey (CADUMS), a national telephone-based survey that has been ongoing since 2008, for each of the five tiers or levels of substance issue needs, stratified by problem severity. The parameter estimates were applied and the number of individuals 15 and older in each Health Authority (i.e., Interior, Fraser, Northern, Vancouver Coastal, and Vancouver Island) requiring specialized services and supports (e.g., withdrawal management services, community services and supports or residential services and supports) was calculated.

The aforementioned collaborative project resulted in a report for the health authority representatives. The estimated number of in-need services was then compared to current capacity to create a gap analysis. This gap analysis is being used to explore opportunities to re-allocate resources to better match need-based planning.

This collaborative project between CARBC and the Ministry of Health provided evidence-based research to inform British Columbia’s future substance use treatment planning. This project also helped foster a long-term working relationship with Ministry of Health and Health Authority staff that will continue to build on the experiences and lessons learned from this successful collaboration.

Authors:

Chantele Joordens and Scott Macdonald, Centre for Addictions Research of BC

Joanne MacMillan, Ministry of Health

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

When I entered the substance-use field as an outpatient counsellor many years ago, I thought my biggest challenge was to concentrate on what the client was trying to communicate to me as being their main issue. It turns out I was only partially correct in this assumption. In actuality, the biggest challenge was to make some sense of how funding and resource decisions were being made to support the development or growth of different services for the people we serve at the larger systems level.

It turns out I wasn’t alone in my belief of the apparent complexities in understanding how “funders” (for example, various government ministries) chose to fund the “providers,” such as day treatment, detox, or outpatient support. It seemed to me the process might be comparable to entering a large supermarket and randomly going down the aisle picking up products based on their packaging — colourful, enticing, or currently popular — which are some of the least essential things to consider when grocery shopping. It’s far more important to consider things like value, need, listed ingredients, quality, and budget.

Haphazard shopping might be the best descriptor for the majority of British Columbia’s treatment systems planning and funding over the past many years. Influences like strong advocates and lobbying by certain groups to get funding for their service; quick fixes being advertised for “emerging” drug issues; political decisions not necessarily based on evidence; changes in government; and perhaps even some measure of favouritism have all come in to play when selecting what to fund, who to fund and where that resource should go.

However, despite this seemingly disorganized landscape, hope recently emerged with the implementation of the Drug Treatment Funding Strategy put forth by Dr. Brian Rush and his associates at Centre for Addiction and Mental Health (CAMH) in Toronto. Their team put together a National Advisory Committee of representatives from every province and territory, developing a Needs Based Planning (NBP) model for substance use services. Based on a population health foundation, and utilizing a Delphi process (where subject matter experts assign percentages to each type of service category and then build consensus to settle on the final numbers), formulas were developed which allowed systems planners to plug in their utilization rates to identify gaps across residential, withdrawal management and community services.

Imagine being able to utilize a more scientific based process to determine gaps, needs and resource allocations for substance use treatment services in BC! Thanks to this team, each province now has a model that examines the gaps, considers available resources, and includes community and population characteristics to make better decisions on the development, implementation and placement of various substance use treatment services and supports. Work is already underway to apply this model to our substance use treatment services in BC so we can start being strategic and doing some “needs based” shopping!

Author: Sherry Mumford, Director, Substance Use services, Mental Health and Substance Use program, Fraser Health

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.

Tag: brian rush

Evidence-based planning of alcohol and other drug treatment services in BC: A collaborative effort between CARBC and the Ministry of Health

Systems planning – like grocery shopping