National Native Alcohol and Drug Abuse Program (NNADAP) - General Review 1998 - Final Report

Results of the NNADAP Review

Training

Finding:

• There is an inconsistent level of training, particularly for remote or northern communities. Basic training is not related to positions and there isn't a systematic orientation available for new workers to assist them in carrying out functions before basic training is scheduled.
  
  
• Advanced Counselor Training does not occur in an organized fashion in every region. Also when workers do complete advanced training, there is not a process to adjust salaries as an incentive for advancement.
  
  
• Advanced Specialized Training in either addictions or addictions- related topics is not systematically available. That community prevention and health promotion needs to be made available or developed to better serve the 60% of the First Nations and Inuit population who are 30 years or younger.
  
  
• Health Canada in collaboration with First Nations and Inuit representatives should negotiate accreditation with a group such as the Ontario Interventionist Association to utilize the title of Certified Alcoholism Counselor or to develop a similar accreditation process.• General Training, such as computer programs, the Internet, financial systems and other similar areas which would benefit NNADAP workers are not systematically available
  
  
• General Training, such as computer programs, the Internet, financial systems and other similar areas which would benefit NNADAP workers are not systematically available

There will be additional comments made about training requirements in the section on the information systems requirements to support both community based and treatment programs. However, there has to be rethinking of the NNADAP training (or capacity building) process, based on the sweeping changes in the training environment which have occurred since the training programs were initially implemented. For example, Canada Employment and Immigration Commission, (CEIC now Human Resource Development) programs have undergone several fundamental shifts, which now have serious impacts on the current training situation.

The Pathways program has evolved from Regional Area Management Boards, which tended to support general capacity building efforts such as NNADAP and the Community Health Representative (CHR) training, to Local Area Management Boards. These local area boards have many competing local interests that may not place a priority on NNADAP training. This situation is exacerbated by training demands of other workers such as the Community Health Representatives, Mental Health Workers, and Child and Family Services Workers. Training has been done with no additional resources as may be seen from the National NNADAP Financial Study, included as part of this review.

Interviews conducted during the community visits indicated that there were NNADAP workers who did not have access to training, particularly in northern and remote communities. The reasons cited were a lack of resources, workers who did not meet prerequisites for admission, and the existence of a long waiting list for training. One alternative strategy is to target training seats or resources to new or vacant positions. Such a strategy would be similar to that described in the Treasury Board Submission establishing NNADAP which had targeted resources to positions.

The original design of NNADAP envisioned that there would be advanced and basic counseling level positions. The most effective way to implement different levels of positions would be to correlate increased salaries to the attainment of certification. One of the most common models for this is the Ontario Interventionist Association, which has the Canadian rights to accredit individuals with the title, Certified Alcoholism Counselor, CAC. As may be seen by the following tabulation on the degree of importance placed upon various responses of desired training, the scenario, which emerges, is that there should be a process to involve First Nations and Inuit organizations in the design and delivery of training. The responses indicate a desire to have training recognized by a professional body, followed by provincial addiction agencies through diploma programs and bachelor programs.

Existing training curricula would need to be reviewed to assure that graduates would meet the knowledge areas of the certification program that emerges. However, the certified alcoholism counselor program is familiar to most training agencies. To a certain degree, there are existing accreditation panels in each region. It should be possible to negotiate the certified alcohol counselor concept targeted at First Nations and Inuit workers. Health Canada and First Nations and Inuit organizations should consider attaining accreditation with such group to utilize certified alcoholism counselor title or develop a similar accreditation process. The program could also consider granting parallel privileges to individuals with certain educational qualifications such as Bachelor of Social Work, Master of Social Work, psychology, or other fields, which would be considered equivalent.

The following is a summary chart showing by descending order of importance, the factors considered important by First Nations leaders, NNADAP community workers and management of NNADAP treatment centers. There is remarkable consistency in the reported preferences. There is a slight variation indicated by treatment center respondents showing a lower rating for recognition by provincial addictions agency. In part, this may be explained by the differing views for each type of worker with respect to recognition by the respective provincial addiction agencies. For example, in Manitoba, the province does not recognize assessments performed by Health Canada trained NNADAP community based workers for clients cited for driving under the influence. This leads to frustration on the part of workers, not to mention duplication and inconvenience for clients.

Developing A Resource Pool of Trained Workers

In the mid-1980's, Quebec region had developed a strategy to train individuals before employment in community addictions and treatment programs. The Treatment Center at Kitigan Zibi reserve in Quebec carried out the most recent example of this approach to training. A benefit of this approach is that it enables use of retraining and skills development funds through Human Resource Development and from social assistance programs. Training of a cadre of potential workers prior to actual employment would seem to make a great deal of sense since both NNADAP workers (51%) and treatment centers (63%) report problems in recruiting qualified staff.

Treatment Centers as training centres

The previous discussion of utilizing treatment centers as training hubs for catchment areas remains a practical approach to dealing with orientation and advance training. This is evident from the current pattern of preference and utilization of training sources rated by treatment center and community workers as summarized below:

Reported rates for participation in advanced training are high, with 64% of community based NNADAP workers and 68% of treatment center respondents indicating participation in advanced training.

The Review Team also found that 75% of centers conduct on the job training. We also asked the staff in the treatment centers whether they received advanced or specialized training, to which 68% responded yes. Specialized training was most frequently obtained through community college courses followed by in-service training. The use of workshops was ranked third in frequency for receiving specialized training.

General NNADAP Training

Diploma programs, recognition by a professional body, and recognition by First Nations/Inuit ranked high in importance for elements of training. These three training elements were expressed with the most frustration by not just treatment center staff, but also by the staff we interviewed in our community site visits and at the Regional meetings. The source of their frustrations appears to lie in the fact that many of the staff working in the alcohol and drug field have taken much training that has been rated as good to excellent. However, many find that all their training has no credit value and/or is not recognized by other educational institutes, accreditation bodies, and even by their own peer groups. For example many felt they could not apply for other jobs in the helping field because their training is not equivalent in value for meeting the requirements. This is further highlighted when compared to their counterparts working in the alcohol and drug field but not attached to the NNADAP system such as provincial alcohol and drug workers.

Both the treatment center counselors and the community alcohol and drug workers identified specialized training in several areas. Though they were not ranked in this Review, feedback from the field visits and the regional focus group meetings consistently identified the following areas;

1. advanced counseling;
2. residential school affects;
3. sexual abuse/violence; and
4. depression.

The above issues of residential school affects and sexual abuse/violence and depression are also consistent with the major mental health problem areas that clients present in both their communities and reasons for treatment.

First Nation educational institutions that have achieved provincial postsecondary need to be supported and promoted by not just First Nation communities and their political bodies, but also by the Provinces and the Federal Government. Financial and political support from both the Federal and Provincial levels are needed to assist First Nation educational agencies to carry out the research and curriculum development needed to reach first class status and recognition that are afforded to colleges, universities, and provincial and national accreditation bodies.

Related Training Needs

In addition to areas relating to training on addictions or related topics, it is evident that there should be an additional focus on capacity building by Health Canada in at least two areas.

This study has identified the types of equipment available at the community level. 72% of workers reported availability of computers and 47% reported availability of the Internet. It should also be noted that every First Nation school in Canada is being equipped with computers and Internet access that should serve as a tool for communication, information and training. This is significant when considering that only 14% of persons report competency with those tools that are already available such as internet.

A second area of need is multi-disciplinary training. 79% of Social Workers and 70% of Health Workers expressed interest in areas of joint training that would promote effective approaches to addressing community needs. Suggestions from health and social services workers on the open-ended questions regarding areas of joint training covered a range of potential topics. The most common suggestions were case management including areas of addictions such as aftercare processes, fetal alcohol syndrome, general information on alcohol and drug abuse, referrals and assessment processes. In addition, there was considerable interest in topics such as suicide prevention and intervention, family violence, child sexual abuse, crisis intervention and other topics of a similar level of impact upon the community level.