National Native Alcohol and Drug Abuse Program (NNADAP) -
General Review 1998 - Final Report
Summary
The future effectiveness of addictions programs will to a large degree be
dependent on:
- The commitment of Health Canada and key representatives from First Nations
and Inuit organizations to make addictions a priority.
- The commitment to support effective capacity building through developing
First Nations and Inuit institutions to support community based efforts.
Recommendations
- The use of legally obtained and illegally produced or sold alcohol remains
a major issue that affects the whole community. It is recommended that there
be a renewed focus and commitment which comes both from Health Canada and
First Nations to deal with this issue. This should also be coordinated with
law enforcement and crime prevention specialists.
- The use of illegal drugs is a rising and pernicious concern at the community
level. The establishment of a task force to examine means of dealing with
the issue of illegal drugs is recommended. Further, that this task force
be composed at minimum of First Nations and Inuit, Health Canada, Justice,
RCMP, and Solicitor General. The focus for this task force would be the development
of strategies to improve coordination, planning and funding of community
needs.
Further that the Justice Department, Health Canada with First Nations and
Inuit organizations have joint discussions on coordination and funding priorities
within the crime prevention funding initiative to deal with the illegal sale
of alcohol and drugs.
- The issue of prescription drug abuse should be examined. This could be
achieved through a review of system delivery and a more thorough examination
of this issue through surveys coordinated with the Health Promotion Branch
Senior Research Program. The possibility of devoting one or more centers
to deal with prescription drug abuse and/or to provide training to communities
should seriously be considered.
- Gambling is an issue that is on the rise and should be dealt with before
it becomes even more pervasive. Health Canada and First Nations and Inuit
leaders must jointly negotiate with respective provincial and national beneficiaries
of various types of gambling such as lotteries, pull-tabs, and casinos. Resources
should be negotiated for determining incidence levels, in designing appropriate
information campaigns and in providing necessary intervention and treatment
services.
- Solvent is an important issue. It is recommended that the solvent abuse
program be integrated into the overall NNADAP program to enhance success
of both programs.
- Health Canada should reinstate a structured research program that would
provide a means of tracking and anticipating areas of program need. In developing
this structured program there should be an implementation committee consisting
of persons experienced in research from First Nations and Inuit communities
and organizations such as in Addictions Research Foundation (ARF) of Ontario
and the Alberta Addictions and Drug Abuse Commission of Alberta. It is also
recommended that both Health Canada, the Assembly of First Nations
(AFN) and Regional and Provincial First
Nations organizations make a commitment to include addictions questions in
the next iteration of the First Nations longitudinal health survey currently
underway.
- To develop revised scope of duties for the community workers, which should
take into consideration advanced and basic counseling. There should also
be recognition and a training strategy developed to assure that NNADAP workers
have skills in areas of grief and loss, family violence, sexual abuse, tobacco,
gambling, and other areas. Sample protocols should be developed to assist
communities in dealing with 24-hour requirements and means for handling oncall
within communities. (This should be related to the recommendation on a national
accreditation process.)
- There should be work plans and procedures developed to assist workers
to focus on areas of need within communities. Health Canada and First Nations
should develop strategic and annual priorities that will assist the program
in providing necessary focus, leadership, and support to communities. In
developing work plans and procedures, there needs to be particular emphasis
on dealing with prevention, intervention, and treatment strategies for adolescents
and in coordinating with other health and social programs within the community.
- That there be a National Social Marketing Strategy developed with Medical
Services Branch to support program goals in prevention to correspond with
the population health model.
- There should be an overall program estimate developed for basic coverage
for communities to deal with addictions. This costing should be developed
from the perspective of types of services and programs that should be made
available in each community. Part of the package should identify the context
in which advanced counselors would be recognized and those circumstances
whereby part-time workers are necessary. This will facilitate a process by
which First Nations leadership can more effectively allocate funds available
for the programs and to determine potential short-falls. Health Canada and
First Nations should consider these estimates as a benchmark for all communities
and determine opportunities to meet needs. Such a process should be linked
to the implementation of an outcome based reporting system.
- As part of an overall accreditation process, a group of stakeholders should
be involved in developing a code of conduct for NNADAP workers which could
be posted in First Nations' buildings and in NNADAP offices. This would
outline expectations relating to confidentiality, obligations, possible remedies
and penalties where there are violations. (See recommendations on training).
- Health Canada in a lead role with First Nations organizations should conduct
the necessary legal and programmatic research to develop standard protocols
for release and sharing of information. There should be a particular focus
on networking, information sharing, and protocols with social programs such
as child and family services and social assistance programs.
- Various organizational models should be documented which will assist in
communities to coordinate services and/or integrate NNADAP with other programs
and services in particular with health and or social services agencies.
- Health Canada should take a lead role in collaboration with a steering
committee of stakeholders to develop facility models, which would enhance
client perceptions of confidentiality. This concern is also related to similar
requirements associated with program initiatives in mental health, child
welfare, and social services. Part of the study should identify costs to
make facility, equipment, or office furniture modifications for ensuring
confidentiality.
- That Health Canada determine opportunities to supplement funding from
other sources including provincial and other federal departments for NNADAP
Treatment Centers.
- It is recommended that treatment centers consider reorienting their summer
programs to assist in the delivery of programs carried out in their area
cultural camps. It is also recommended that treatment centers who deliver
programs in cultural camps do not lose funding.
- It is recommended models be developed to for "couples" treatment.
This would be a practical alternative to family treatment, which would eliminate
complications arising from having multiple age groups and family units in
programs.
- It is recommended that Health Canada review its present funding process
and formula and factor in isolation, actual costs, effectiveness and efficiency
to ensure they are equitable with other services such as provincial addictions
agencies.
Further that Health Canada and First Nations examine means by which Treatment
Center budgets could be increased to provide orientation, training and treatment
in grief, loss, cultural programs and in treating other emerging addiction
areas such as gambling, prescription drug abuse, etc. This could be achieved
through better coordination and seeking interest with other federal and provincial
governments in cost sharing, applying fee for service with other programs
including child welfare, alternate sentencing and early release programs,
etc. Additional monies should be made available to residential treatment
centers for the purpose of providing their counseling staff training in mental
health areas such as victims of sexual abuse, violence, residential school
affects, loss and grief and abandonment issues and general posttrauma
processes.
- That pre-treatment programs be developed or models for both the community
level and treatment centers. Pre-treatment can be defined as an assessment,
orientation, and readiness phase to treatment for clients. Length of pre-treatment
programs should vary depending on the treatment program itself and range
in length from one week to three weeks.
That existing pre-treatment programs such as the one developed by Society
of Aboriginal Addictions Recovery (SOAR) for Corrections Services Canada
be considered as a possible resource.
- The Treatment
Activity Reporting System (TARS) needs to be revisited with input from all the treatment centers that
use this system. Efficiency and cost analysis of either developing a new
national system or allowing treatment centers to develop their own data system
needs to be explored in order to determine the most effective response to
drug and alcohol issues.
TARS or its replacement needs to have additional capabilities such as tracking
client outcome and measuring quality assurance programs for the
treatment centers.
- Health Canada, First Nations and Inuit organizations should negotiate
accreditation with groups such as Ontario Interventionist Association 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 as well such as Bachelor
of Social Work (BSW), Master of Social Work (MSW), psychology, or other fields
which would be considered as equivalent.
- That Health Canada and Human Resources Development Canada conduct a labour
market survey in aboriginal health training particularly in areas of alcohol
and drug abuse, early childhood, health promotion, mental health. This survey
should be aimed at determining resources required due to the changing needs
of community.
- Health Canada in collaboration with a steering committee of First Nations
and Inuit representatives and representative stakeholders within the various
NNADAP workers should develop a new training strategy to enable the communities
to respond to the directions contained in this review. A second task would
be to develop an inventory of courses that may be shared with different jurisdictions.
This strategy should include a review of accreditation options and should
include development of a strategy to meet the considerations of recognition,
targeting of training resources to positions,
advance training, and multi-disciplinary training.
Health Canada in collaboration with First Nations and Inuit representation
should finalize concrete measures through an organized system of capacity
building at the community level. That strengthening capacity within the management,
planning and evaluation receive priority in the work plan.
In finalizing these measures, the concepts presented on Centers of Excellence,
Treatment centers as training centers, and promotion of communities as models
of best practice should be considered within the overall plan.
Coordination with other federal departments such as the Department of Indian and Northern Affairs (DIAND) and Regional Advisory
Board, Human Resources Development (HRD), Corrections Services Canada will
be essential to the implementation of common areas of interest.
- It is recommended that all addictions programs within Health Canada be
integrated into one system for dealing with addictions. This integration
should include the development of common strategies for research, information
gathering, training, and information dissemination.
- That the federal government and First Nations and Inuit organizations
encourages models of integrated programming through recognition of such communities
as role models and centers for information exchange and training. Further
to provide resources to community-based resource centers to ensure their
communities do not suffer when they assist other
communities.
It is further recommended that Health Canada support development of integrated
models of health care through funding of an Aboriginal Health Institute and
centers of excellence.
- It is recommended that Health Canada review financial and program development
requirements for treatment in advance of allowing use of treatment centers
for other purposes.
It is recommended that Health Canada and First Nations consider development
of regional and national healing strategies, which would involve working
groups consisting of relevant groups such as community NNADAP workers and
treatment centers among others.
It is further recommended that a study of existing healing lodges be carried
out to investigate the potential benefits and liabilities of this approach.
Finally, as part of an overall strategy, there is merit in having a pilot
project, which would examine in detail, and implications of changing focus
for treatment centers.
- It is recommended that Health Canada and First Nations and Inuit organizations
support communities and treatment programs through funding a National Aboriginal
Addictions organization or by funding a strong and distinct addictions element
within a National Aboriginal Health Institute.
It is further recommended that a directed research program be partially reconstituted
as a priority by Health Canada, and potentially augmented by funds from the
Non-Insured Health Benefits program to deal with alcohol, drugs, solvents
as well as emerging addictions issues such as prescription drug abuse and
gambling.
- It is recommended that Health Canada and First Nations and Inuit representatives
implement the center of excellence concept to promote communities and treatment
centers with recognized strengths and expertise as training and support mechanisms
for other communities and treatment centers.
- Discussions should be held with treatment centers to determine feasibility
of having treatment centers as service hubs for community workers in such
issues as general orientation, training on referral and assessment, information
on addictions and other addictions and coordination needs which have been
expressed from both treatment centers and the community level.
- Health Canada, through a steering committee of stakeholders should develop
and implement a system similar to the Ontario Drug and Alcohol Abuse Rehabilitation
and Treatment (DART) system which will assist community workers in determining
availability of treatment programs and in matching needs of clients to those
system.
It is further recommended that Health Canada develop a basic mandatory aftercare/follow-up
system. The Round Lake Treatment center system should either be adopted or
revised to take advantage of quality work done in this area. Similar to the
preceding recommendation, this work should be done through use of a steering
committee of key stakeholders. This work would be critical in implementing
an outcome system as described in the preceding paragraph.
Ideally, this system would interact with provincial treatment systems as
well to make use of other services available; for cocaine addiction, prescription
drug misuse, gambling or detoxification.
- The Health Information System developed by Ontario region within Health
Canada should by reviewed and revised to serve as an outcome measurement
system. This system should be oriented to providing a schedule for follow-up
on clients as well as case management with other providers within the health
system such as Community Health Nurses, Mental Health services and other
providers using this system.
- Health Canada should develop a training package on program evaluation
which could be used to train NNADAP staff and treatment centres at the community
level to perform effective program evaluation. This training package should
address both process evaluation and impact evaluation.
- Health Canada in partnership with various stakeholders should develop
a list of core indicators to conduct process and impact evaluation of the
NNADAP.
- There is a need for a reliable data collection processes that will provide
data on an ongoing basis for case management and for program evaluation.
A working group should be established to examine data requirements and potential
sources of data for effective case management and for the evaluation of the
NNADAP on an ongoing basis. This working group should examine the use of
the abuse profile subsystem of the Health Information System as one of the
potential sources of data for the NNADAP.
It is imperative that any system for collecting data for program evaluation
also data to NNADAP staff for case management purposes. The primary focus
of such a computerized system should be to support the day to day activities
of NNADAP staff. If the system does not support the work of NNADAP staff
in case management, there will be little support for the system at the community
level and the availability of data for program evaluation will be significantly
diminished.
- Health Canada should clarify or eliminate policies, which have resulted
in unwanted barriers to treatment in areas such as transportation to treatment
in order to eliminate problem areas in multi-regional issues such as access
to specialized programs.
- That internet support be considered for aboriginal youth focusing on prevention
initiatives.
Further, that resources to access internet at a program level be establish
to assist in national program communications.
- That Health Canada in a partnership approach with First Nations and Inuit
organizations representatives develop a working group to develop a work plan
to oversee response to this review. It is further recommended to establish
a 6 month deadline for this work plan. Further consideration should be given
to establishing regional groups to examine recommendations from this review.
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