News

EENet is pleased to share the Drug Treatment Funding Program (DTFP) Ontario Systems Projects video, “Working Together for Change.”

In a series of interviews with DTFP stakeholders, the video tells the story of coming together to lay the groundwork for a substance use treatment system that is more connected and evidence-informed.

The video was a truly collaborative effort, and EENet wishes to thank all participants for their contributions!

SARM project shares its message

The Screening, Assessment, and Recovery Monitoring (SARM) Project has developed a staged protocol to screen and assess clients who are entering publicly‐funded agencies that provide specialized addiction treatment. Five addictions pilot sites participated in this study.

The SARM project team met with stakeholders and decision-makers from Ontario and across Canada on March 7, 2013, at the Ontario DTFP Knowledge Exchange Event. Project lead Dr. Brian Rush (pictured right with Nancy Chau at the event) said there’s significant support for the staged screening and assessment protocol to replace the currently mandated assessment package (ADAT).

The project is also developing a model and measures to monitor the outcomes of clients who are treated at the same agencies. To see the main messages of his presentation click here. Or you can see the slides here.

New season of webinars

Evidence Exchange Network (EENet) is starting a new season of webinars that aim to bring together mental health and addictions stakeholders from across the province—and the country!

Our first webinar of the year, a continuation of the Health Canada Drug Treatment Funding Program (DTFP) Webinar series, looks at the Screening, Assessment and Recovery Monitoring (SARM) project, one of eleven Ontario DTFP Systems Projects.

Screening and assessment tools help service providers determine the appropriate level and intensity of care for clients who are entering the substance use treatment system. The SARM project is drawing on the best available evidence as well as the feedback of key stakeholders throughout the province to develop and pilot new screening and assessment tools and procedures. The SARM Project is also piloting an evidence-based protocol for recovery monitoring. The monitoring of client outcomes is a crucial part of assessing the performance of the substance use treatment system. The project team hopes to determine if it is feasible to implement a recovery monitoring system for Ontario.

The focus of the webinar is an overview of the project, the process, preliminary results, and next steps.

Date: Friday, January 25, 2013
Time: 1:00 p.m. to 2:00 p.m. EST
Presenter: Dr. Brian Rush, Project Lead and Group Head of the Health Systems and Health Equity Research Group, CAMH

To register for this webinar, go here or see the flyer for more information. Please also visit Ontario DTFP.

GAINing ground in Ontario

December 2012

Screening and assessment tools help service providers determine the appropriate level and intensity of care that is needed for clients who are entering the substance use treatment system. The Screening, Assessment, and Recovery Monitoring (SARM) Project is drawing on the best available evidence as well as the feedback of key stakeholders throughout the province to develop and pilot new screening and assessment tools and procedures.

The SARM Project, led by Dr. Brian Rush (pictured left) is also piloting an evidence‐based protocol for recovery monitoring since monitoring the outcome of clients is a crucial part of the process of measuring the performance of the system. The project team hopes to determine if it is feasible to implement a recovery monitoring system for Ontario.

Since June, the SARM protocol has been piloted in four agencies across the province. (A fifth site started recruiting clients in fall 2012.) As of the beginning of December, 232 clients have joined the study! These clients receive the standard assessment protocol—the Admission and Discharge Criteria and Assessment Tools (ADAT)—which is currently mandated for publicly funded Ontario substance use agencies. Clients also receive the newly developed screening and assessment protocol, and are regularly monitored by agency staff, using a brief questionnaire, during the course of their treatment. Clients are also followed up 3- and 6-months post-intake using a standardized instrument.  Study recruitment ended in September of this year for four of the pilot sites (and will end in December for the fifth pilot site). All follow-up interviews will wrap up by the end of February 2013.

While the formal results from the SARM Project are not yet in, preliminary feedback from the pilot sites has been positive, particularly related to the GAIN‐Q3 instrument, which is being used for both the assessment and follow-up components of the project. This widely used tool was selected for inclusion in the project based on its comprehensive assessment of several life areas, including mental health, its high validity and reliability, its administration time, its relatively low cost, and its ability to automatically generate treatment planning and referral reports via the GAIN Assessment Building System (ABS) the web-based platform used to administer the GAIN-Q3. An Ontario version of the tool, developed as part of this project, reflects substantial input from key stakeholders in the province’s addiction treatment system.

The SARM project has also resulted in substantial capacity building around the GAIN instruments. To date, of the 14 pilot agency staff who attended GAIN training, 12 have achieved Administration Certification. Ten have also achieved Local Trainer Certification, an accomplishment that represents many, many hours of work—all done on a voluntary basis! These Local Trainers have since gone on to train staff at their own agencies and recommend them for Administration Certification.

Ultimately, by using a common, evidence‐based approach, the SARM Project aims to improve the quality of the screening, assessment, and outcome monitoring processes in Ontario’s substance use treatment system. A more effective system will benefit funders, administrators, researchers, clinicians, and clients.

“There’s a lot of really good work that’s taken place…”

November 2012

So says Dr. Brian Rush (pictured left, with team), the lead on four projects that are part of a larger suite funded by the Drug Treatment Funding Program. Evidence Exchange Network (EENet), working with Dr. Rush’s project teams, has produced an update about this really good work for Fall 2012.

Discover how the Costing Project is taking on costly issues and how the Screening, Assessment, and Recovery Monitoring (SARM) Project is gaining ground in Ontario. Some (preliminary) results for the Client Satisfaction Project are in; the DATIS Project, meanwhile, has been developing a Data Dictionary. The goal of the projects: to improve assessment and performance monitoring in Ontario’s addiction system.

Also, learn about how these projects have been informed by the perspectives of diverse stakeholders, including the Advisory Committee (pictured above) and the Ontario Systems DTFP Persons with Lived Experiences and Families Panel, hosted by EENet. It’s all here. And for the French version, go here.

New environmental scan available!

Fall 2012

In order to learn about screening and assessment tools and processes being used throughout Ontario, Dr. Brian Rush’s project team conducted an environmental scan. An online survey was sent to 190 addiction treatment agencies across the province.  This list of agencies was provided by ConnexOntario. To read the scan, click here.

After many hours, milestones reached

August 2012

Screening and assessment tools are important. They help service providers determine the appropriate level and intensity of care for clients who are entering the addiction treatment system. Monitoring the outcome of these clients is also a key part of the process. Dr. Brian Rush’s project team is pilot testing the Screening, Assessment and Recovery Monitoring (SARM) protocol at four pilot sites in Ontario. The fifth pilot site is scheduled to start study recruitment in early fall. As of August 8, 2012, 108 clients have been recruited into the study.

Two major milestones were reached leading up to pilot launch: development of the Ontario GAIN-Q3 and related certification and delivery of pilot site training.

Outside Manitoulin Community Withdrawal Management Service
Top (l to r): Kristie Fabian, Rob D. Wabegijig, Barb A. Deschamps, Barbara Kosky
Bottom (l to r): Bridget Douglas, Dr. Nooshin Rotondi, Nancy Chau

Following selection of the GAIN-Q3 instrument as a Stage 1 assessment tool for the SARM protocol, the project Working Group provided recommendations for revisions to “Canadianize” the language of this tool, which was developed in the United States. The Working Group also made sure to cross-walk the tool with existing ADAT admission and discharge criteria, working to ensure that the information generated by the tool is relevant to the existing criteria. (ADAT stands for Admission and Discharge Criteria and Assessment Tools.) The Ontario version of the GAIN-Q3 reflects substantial input from key stakeholders in the Ontario addiction treatment system. The instrument itself, along with the accompanying administration and report software, was launched via Catalyst in July. Catalyst is the browser-based computer application which houses client-level clinical and administrative data for MOHLTC-funded addictions agencies in Ontario.

A train-the-trainer model is being used for the GAIN tools. To date, of the 14 pilot agency staff who attended the four-day training session in Illinois, 11 have achieved Administration Certification. Eight have also achieved Local Trainer Certification, an accomplishment that represents many, many hours of work – all done on a voluntary basis! As planned, these certified local trainers have also provided training to all staff in their pilot agency on the GAIN-Q3 instrument.

In terms of pilot site training, Dr. Rush’s team provided a day and a half of intensive training to all agency staff. The training included an overview of: the SARM protocol; SARM tool administration and interpretation; the relationship of the SARM protocol with the ADAT; and study logistics and next steps.

“We spent very valuable time at the Manitoulin Community Withdrawal Management Service,” said team member Nancy Chau, who visited the pilot site, one of five, in the spring. “We learned a lot about how they operate as an agency and some of the challenges they face as an addiction services provider due to their geographic location in Northern Ontario.”

Agency staff were also provided with a standardized and detailed study manual. Local study leads at each of the pilot sites were also engaged to act as a key liaison between the pilot agency staff and the study team. In addition, study leads are responsible for collecting and storing study recruitment materials, collecting staff feedback on the protocol, and providing assistance with study monitoring visits. During pilot testing, the study team also complete regular, on-site visits to provide support to agency staff to ensure that the protocol is implemented as designed.

Study recruitment will extend through September of this year (November for the fifth pilot site) with the 3- and 6-month recovery monitoring components wrapping up at the end of March 2013.

Screening, Assessment, and Outcome Monitoring project gains understanding

April 2012

Led by Dr. Brian Rush at CAMH, the Screening, Assessment, and Outcome Monitoring project has completed on-site engagement visits with each of six participating agencies. During these visits, agency staff were provided with an overview of the feasibility study as well as a more in-depth look at the screening, assessment, and outcome monitoring instruments and related protocol. In return, Dr. Rush’s project team has gained a more detailed understanding of the local processes at each agency in order to integrate the protocol with minimal burden on agency staff and clients.

Screening and assessment tools help treatment agencies determine the most appropriate level and intensity of care for clients who are entering the addiction treatment system. Monitoring the outcome of clients is also an important part of the system. Dr. Rush’s team is working to pilot new screening and assessment tools and procedures, as well as an evidence-based protocol for outcome monitoring.

As we head into May, the team will be busy with pilot site training activities. For the GAIN assessment instrument and other screening tools – included in the study protocol and used in screening and assessment – a train-the-trainer model will be used. The team gratefully acknowledges the clinicians from each pilot agency who have already volunteered substantial time toward obtaining GAIN trainer certification.

The team will also be providing a day and a half of training at each agency, focused on the objectives of staged screening, assessment, and outcome monitoring; a detailed overview of the project protocol and instruments, ethics and recruitment procedures; and study quality assurance and feedback.

Following completion of the customized, Ontario-version of the GAIN-Q instrument—targeted for late May/early June—client recruitment and data collection will commence.

The Screening, Assessment, and Outcome Monitoring project was originally structured as two projects. They have since been combined, given their interrelatedness.

Improving Assessment and Performance Monitoring in Ontario’s Addiction System

February 2012

Click below to read an overview of 5 projects funded by the Drug Treatment Funding Program – including the Best Practice Screening and Assessment Procedures Project – and how they will impact participating agencies:

 Improving Assessment and Performance Monitoring in Ontario’s Addiction System (Click here for French version)

Participating Agency Locations Insert

Screening and Assessment and Recovery Monitoring projects submit study protocol to Research Ethics Board

December 2011

A comprehensive literature review on screening and assessment tools and outcome monitoring processes has been conducted, and two Environmental Scans (screening and assessment and recovery monitoring) of substance use agencies across Ontario have been completed.  Agencies were asked about the tools and processes they use, the outcomes they measure and overall satisfaction.

Preliminary findings include:

• 90 – 97% reported using screening and/or assessment tools
• There was considerable confusion regarding the definitions of, and differences between, screening and assessment processes
• Agencies conducting within-treatment monitoring: 80%
• Agencies conducting post-treatment monitoring: 40%

Since the Best Practice Screening and Assessment Procedures, Client Outcome Monitoring, Client Satisfaction and Assessment/Benchmark Addictions Treatment Costs projects and outcomes are closely linked, they have jointly developed an Advisory Group with separate Working Groups to address unique project content.

The project team has consulted with addiction and mental health stakeholders, via the Advisory Group and Working Groups, and other networks to obtain feedback regarding the results of the review process, proposed tools and protocol.  Consultations regarding potential overlay with existing Admission and Discharge Criteria and Assessment Tools (ADAT) have also been conducted.

Click image for larger view.

The following pilot sites have been confirmed:

• Rideauwood Addiction and Family Services (Ottawa)
• Four Counties Addiction Services Team (Peterborough)
• Addiction Services ofThamesValley(SouthWestern Ontario)
• Hastings/Prince Edward County Addiction Program (Belleville)
• Youth Child and Family Program – CAMH (Toronto)

The team is also exploring the possibility of recruiting an additional 1-2 pilot agencies that provide withdrawal management and supportive residential options.

The study protocol was submitted to the Research Ethics Board (REB) on December 1st, 2011.

Please check back for project updates regularly.