Inventory of Addiction Treatment Programs and Services in HW Oct 1999 by jizhen1947

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									Hamilton-Wentworth District Health Council
Conseil régional de santé de Hamilton-Wentworth




    Inventory of Addiction
   Treatment Programs and
         Services in
     Hamilton-Wentworth

            October 1999
                     Inventory of Addiction Treatment
                          Programs and Services
                         in Hamilton-Wentworth


                                October 1999




                Hamilton-Wentworth District Health Council




10 George Street, Suite 301          www.hdhc.ca     Tel: 905-570-0354
Hamilton, ON L8P 1C8                                 Fax: 905-570-1202
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                                                                 October 1999


                                                 TABLE OF CONTENTS

INTRODUCTION......................................................................................................................... 1

PART A - OVERVIEW OF ADDICTION TREATMENT AGENCIES
  Alcohol, Drug & Gambling Services (ADGS) ........................................................................... 2
  Alternatives for Youth (AY)....................................................................................................... 3
  Mary Ellis House ........................................................................................................................ 4
  Hamilton Men's Detox Centre .................................................................................................... 5
  Moreland Addiction Treatment Centre ....................................................................................... 6
  Alcohol and Drug Relapse Prevention Program......................................................................... 7
  Mission Services - "Suntrac" Recovery Program and Discovery............................................... 8
  T.A. Patterson & Associates Inc. ................................................................................................ 9
  Hamilton Women's Detox Centre ............................................................................................. 10
  Wayside House ......................................................................................................................... 11
  New Choices ............................................................................................................................. 12


PART B - INVENTORY OF ADDICTION TREATMENT SERVICES
                                                   BY SERVICE FUNCTION
  Education .................................................................................................................................. 13
  Entry.......................................................................................................................................... 15
  Assessment................................................................................................................................ 18
  Case Management Services ...................................................................................................... 20
  Harm Reduction........................................................................................................................ 22
  Community Treatment Services................................................................................................ 24
  Community Day/Evening Treatment Services ........................................................................ 27
  Services for Populations with Special Needs............................................................................ 28
  Community Medical/Psychiatric Treatment Services .............................................................. 29
  Residential Treatment Services................................................................................................. 30
  Residential Medical/Psychiatric Treatment Services ................................................................30
  Residential Support Services Level 1 ........................................................................................30
  Residential Support Services Level 2 ........................................................................................30
  Community Withdrawal Management Services........................................................................32
  Residential Withdrawal Management Services.............................................................................. 32
  Definitions of Levels of Withdrawal Management Services ....................................................32
  UNMET NEEDS .......................................................................................................................35


PART C - STAFFING, FUNDING, CLIENT DEMOGRAPHICS
  Staffing (FTE's) of Substance Abuse Treatment Agencies .......................................................37
  Age of Female Clients by Agency................................................................................................ 38
  Age of Male Clients by Agency................................................................................................... 39
  Age of All Clients by Agency....................................................................................................... 40
  Clients District of Residence........................................................................................................ 41
  Program Funding......................................................................................................................... 42

                                                                         i
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                              October 1999


INTRODUCTION

This service inventory describes the addiction treatment agencies from their own point of view. It
was undertaken through one-on-one interviews by a DHC planner, usually with the Executive
Director or Program Director of the agency, and reflects their interpretation of the services provided
by their agencies.

Only agencies included in the provincial addictions DART or DATIS databases were included1 .
Other agencies also provide addiction treatment services, usually to a specific population group.
Some of these include:
       • Centre de sante communautaire
       • Ministry of Corrections

In January, 1999, the Ontario Substance Abuse Bureau distributed a new set of service definitions
for the addiction treatment field. These definitions outline the expectations for the various services
provided. The field is still in transition from the old service definitions, and the agencies were not
yet using these definitions to describe their services, and thus in the collection of the data reflected
in this report. We have however, used the new definitions for this inventory of services, as they
reflect the new provincial approach to service delivery functions.

The Inventory is divided into three sections. Part A gives a short overview of each of the included
agencies as well as a listing of unmet needs identified by the agencies. Part B outlines the programs
and services in greater detail, and uses the new service definitions. Part C is a series of tables
describing staffing, funding and client demographics.




1
    . Other programs of these agencies were also included, whether or not they met the above criteria
                                                                    1
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                             October 1999


Name of Organization:               Alcohol, Drug & Gambling Services (ADGS)

Address:                            21 Hunter Street East, 3rd Floor, Hamilton, Ontario L8N 1M2

Telephone:                          (905) 546-3606

Fax:                                (905) 546-3608

Email:                              adgs@hamilton-went.on.ca

Contact Person (Admin):             Grant Corbett

Contact Person (Clinical):          Gambling: Rosemary Hilbert; Alcohol & Drug: Carol Melnick

Hours of Operation:                 9:00 a.m. -12 :00 p.m.; 1:30 - 4:30 p.m. Mon.- to Fri., also Wed 5 – 7
                                    p.m. Hours of Service are variable, based on demand for service.
                                    (Social work service provision continues to 5:00 p.m.)

Area Served:                        Hamilton-Wentworth

Mandate:
The program provides an initial intake and consultation with a social worker for clients and
professionals by telephone. For those who choose to meet with a social worker, there is an
assessment which includes a non-judgmental evaluation of substance-use and/or gambling history
and the personal and the social consequences of their behaviour. Depending on the needs and
preferences of the client treatment/counselling may be offered at ADGS or referrals made to other
centres.

Program Goals are:
• to provide persons with gambling, alcohol, drug or prescription medications abuse with a
   comprehensive assessment, appropriate referrals where indicated and coordination of treatment
   and support services. Services may include specialized outpatient group treatment, individual
   counselling, relapse prevention, telephone information & consultation and case management
• abstinence, moderation or harm reduction
• to develop and maintain the community and professionals’ awareness of the services available
• to develop new programs in collaboration with other agencies where there is an identified client
   need.

Program Specialties
  • Gambling                                            •    Remedial Measures program for convicted impaired
  • Services to significant others                           drivers
  • HIV/AIDS
  • Hard to reach populations
  • Pregnancy & substance abuse
  • Seniors
  • Problem drinking


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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                     October 1999


Name of Organization:               Alternatives for Youth (AY)

Address:                            101-105 Main Street East, Hamilton, Ontario L8N 1G6

Telephone:                          (905) 527-4469

Fax:                                (905) 527-8291

Email:                              cmcphersondoe@bigfoot.com

Contact Person (Admin):             Catherine McPherson-Doe

Contact Person (Clinical):          Catherine McPherson-Doe

Hours of Operation:                 Mon., Thurs. & Fri. 9:00 a.m. – 5:00 p.m.
                                    Tues. 9:00 a.m. – 7:00 p.m. Wed. 9:00 a.m. – 8:00 p.m.
                                    Hours vary in summer

Area Served:                        Hamilton-Wentworth & Burlington

Mandate:
Alternatives for Youth provides community counselling for youth aged 13 to 25 years of age, who
are experiencing difficulties related to the use of tobacco, alcohol and other drugs. Support and
counselling is also available for family members. The treatment approach is based on the needs of
the client, and tries to meet the needs of the client, in whatever way the client determines.
Accessibility and availability is achieved through clinical approach, geography, hours of service,
and immediate service availability.

A.Y. counsellors are located in a number of youth-serving facilities throughout Hamilton-
Wentworth in order to ease access for youth. The services are offered at no cost and there is no wait
list for most of our services. An appointment can be arranged by calling the Intake Worker.

Programs:
Community Counselling is comprised of Individual and Group modalities. Individual Counselling
typically occurs for 1.5 – 2 hours per week for an average of 3-4 months. Group Programs are
offered in a variety and address a number of issues including:
• Smoking Cessation
• Anger Management (for youth where problem-substance use is an issue)
• Parent Resource Group
• Alternatives (decision-making, problem-solving)
• Opening Doors (early intervention for Grade 9 students)
• Getting Ready (education group for youth who are quite ambivalent about engaging in
    counselling)
• Taking Charge (for youth who are prepared to make changes in the substance using behaviour)
• COSAP (Children Of Substance Abusing Parents)
• Training for anger management training for children’s services professionals


                                                             3
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                        October 1999


Name of Organization:               Mary Ellis House

Address:                            69 Bold Street, Hamilton, Ontario L8P 1T6

Telephone:                          (905) 521-9591

Fax:                                (905) 528-7255

Email:

Contact Person (Admin):             Linda Scarfone

Contact Person (Clinical):          Mary Rivers

Hours of Operation:                 24 hours

Area Served:                        Hamilton-Wentworth & Ontario

Mandate:

Mary Ellis Program provides residential services to women, 18 and older with self-identified
alcohol and/or drug dependencies. The non-medical program is eight weeks in duration and can
provide services for 8 residential clients. The program also provides 6 pre and post treatment beds
for those needing support until treatment beds are available or while searching for suitable
accommodations. The philosophy of the program works toward the empowerment of women, and
is abstinence-based.


Programs:

•   Residential;
      • Pre-treatment
      • Treatment

•   Continuing Care




                                                             4
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                            October 1999


Name of Organization:               Hamilton Health Sciences Corporation
                                                   - Hamilton Men’s Detox Centre

Address:                            595 Main Street East, Hamilton, Ontario L8M 1J4

Telephone:                          (905) 527-9264

Fax:                                (905) 527-2661

Email:

Contact Person (Admin):             Team Leader

Contact Person (Clinical):          Team Leader

Hours of Operation:                 24 hours/day, 7 days/week

Area Served:                        Hamilton-Wentworth Plus

Mandate:

The Men’s Detox Centre, sponsored by the Hamilton Health Sciences Corporation, provides an
empathetic, non-medical environment for men for the safe management of withdrawal from alcohol
and/or drugs. It operates 24 hours, 7 days a week. Once screened and admitted, the Detox
encourages clients to make positive behavioural and lifestyle changes, through providing recovery
information/material, assessment, and recovery focus groups. They then assist the client to develop
a plan to use the most appropriate resources after discharge.




                                                             5
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                            October 1999


Name of Organization:               Hamilton Health Sciences Corporation
                                           - Moreland Addiction Treatment Centre

Address:                            870 Scenic Drive, Box 2000, Hamilton, Ontario L8N 3Z5

Telephone:                          (905) 521-7925 .

Fax:                                (905) 521-4998

Email:                              murdock@exchange1.cmh.on.ca

Contact Person (Admin):             Debbie Russ

Contact Person (Clinical):          Team Leader

Hours of Operation:                 Closed Christmas Day – otherwise open at all times

Area Served:                        not limited

Mandate:

The Moreland Addiction Treatment Centre operates a three-week inpatient treatment program for
both men and women. Emphasis is on helping clients choose a healthy lifestyle in place of a
destructive lifestyle. Services provided include residential and after care programs. Skills to reduce
anxieties and life stresses are integrated into all aspects of the clients’ stay. Treatment is offered for
alcohol and drug addictions. There are 26 beds, 8 of which are ward beds, 16 semi-private beds and
2 private beds. Graduates of other programs may attend the Moreland aftercare program.
Individual, couple, and family therapy are provided on an inpatient and outpatient basis.

Programs:

In addition to services noted above:
• Couples group
• Family Education Series
• Pre-treatment services




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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                              October 1999


Name of Organization:               Hamilton Health Sciences Corporation
                                                  - Alcohol and Drug Relapse Prevention Program

Address:                            237 Barton Street East, Hamilton, Ontario L8L 2X2

Telephone:                          (905) 527-0271 Ext 4920

Fax:                                (905) 527-7885

Email:

Contact Person (Admin):             Team Leader

Contact Person (Clinical):          Team Leader

Hours of Operation:                 Tues/Thurs 8:30 a.m.– 4:30 p.m. Mon/Wed 8:30 a.m. 8:30 p.m.

Area Served:                        Hamilton-Wentworth

Mandate:

The Alcohol and Drug Relapse Prevention Program is a non-residential adult substance abuse
treatment program which provides day treatment and after care services for those with alcohol
and/or drug dependency. Clients learn relapse prevention strategies and resolve underlying issues
of alcohol/drug use. The program provides specialty services to women, concurrent disorder
clients, and in partnership with other community partners, provides pre-treatment support. Program
staff also offer consultation services to wards within the HHSC.

Core program is group counselling, two half-day sessions/week for 5 weeks and weekly after care
for 2 years. Individual counselling is available as needed. Accepts clients with correctional systems
issues.


Programs:
• Pre-treatment
• Intensive Treatment
• After Care
• Modified Programming
• Case Management
• Individual Therapy
• Marital Therapy
• Concurrent Disorders Service
• Anger Management for clients
• Community Outreach (Urban Core Community Health Centre, Hamilton-Wentworth Detention
   Centre, Acquired Brain Injury Program-Hamilton Psychiatric Hospital).



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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                          October 1999


Name of Organization:               Mission Services – Suntrac Recovery Program & Discovery House

Address:                            Discovery House - 325 James St. North, Hamilton, Ontario L8L 7W2
                                    Suntrac Recovery Program – 126 Emerald St. S., Hamilton, L8N 2V5

Telephone:                          (905) 528-7635 - Discovery House
                                    (905) 528-0389 - Suntrac Recovery Program

Fax:                                (905) 521-9995 – Discovery House
                                    (905) 528-9670 – Suntrac Recovery Program

Email:

Contact Person (Discovery House):                      Tom Heeney

Contact Person (Suntrac Recovery):                     Fred Sloss

Hours of Operation:                 8:00 a.m.– 4:00 p.m. Monday – Friday (staffed 24 hours/day)

Area Served:                        Hamilton Area and Ontario

Mandate:

The Suntrac Recovery Program is a 20 bed Residential and Aftercare Program, providing a
supportive environment that promotes personal healing and recovery. It includes an intensive three-
month residential treatment module leading to recovery from drug and alcohol abuse, followed by a
supportive “After Care” program.

The goals of the program are:
  •     To build a strong supportive network for clients through collaboration and coordination
        with local agencies whose purposes augment our recovery goals.
  •     To increasingly identify and develop opportunities for clients to integrate with and thus
        make a contribution to community.

Discovery House is a stabilization program for clients in crisis with a substance abuse issue who are
also homeless.

Programs:

•   12 bed pre-treatment stabilization program
•   Three-month residential treatment program with a capacity of 20 clients
•   9 month extended residential support program with a capacity of 9 clients




                                                             8
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                            October 1999


Name of Organization:               T.A. Patterson & Associates Inc.

Address:                            2077 Dundas Street East, Suite 105, Mississauga, ON L4K 1M2

Telephone:                          (905) 602-1830

Fax:                                (905) 629-1997

Email:                              info@stillwaterco.com

Contact Person (Admin):             Terry Patterson or Judy Patterson

Contact Person (Clinical):          Terry Patterson

Hours of Operation:                 9:00 a.m. -5:00 p.m. Evening group 6:30 - 8:30 p.m. Wednesday

Area Served:                        Hamilton-Wentworth

Mandate:

The program provides outpatient addictions treatment for clients of the Ministry of Corrections. It
provides an initial assessment after which there is an option for group or individual counselling.


Program Specialties

Youth Recovery Awareness Program (YRAP) - The objectives of the program include educating
participants about alcohol and drugs and their effects, assisting them towards identifying the
consequences of their alcohol and/or drug use/abuse, and encouraging the development of recovery
methods and support systems.

GRIP Substance Abuse Program – An education and treatment-readiness program which assists
participants to identify and acknowledge problems with their alcohol use, motivating them to
change through their own efforts or with the assistance of treatment programs and preventing the
recurrence of alcohol-related criminal offenses, particularly drinking and driving.




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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                           October 1999


Name of Organization:               Hamilton Women’s Detox Centre

Address:                            48 Rosslyn Avenue North, Hamilton, Ontario L8L 7P2

Telephone:                          (905) 545-9100

Fax:                                (905) 545-6385

Email:                              wmndetox@interlynx.net

Contact Person (Admin):             Lorraine Chapman

Contact Person (Clinical):          Dianne Taylor

Hours of Operation:                 24 hr/day 7 days/week

Area Served:                        Ontario

Mandate:

Hamilton Women’s Detox Centre is a withdrawal management centre for women sponsored by St.
Joseph’s Hospital. The Detox offers women-positive residential withdrawal management services,
a 24-hour telephone crisis line, a weekly follow-up support group, and an outreach service for short-
term support and case management.

While women are in the Detox Centre, they are monitored closely for any medical risks and referred
for medical assessment or intervention as necessary. Clients are assisted to identify problem areas
in their life, provided with information about their problems and community resources, and are
assisted with referrals to agencies and to self-help groups.

Referral relationships with other agencies are developed and maintained through direct negotiation
and through committee involvement in the community.

The Centre also pursues opportunities for public education and awareness and contributes to the
education of professional groups.


Programs:

As well as above:
• in-house AA meeting and NA meeting weekly
• chaplain/spiritual counsellor available
• pre-treatment group with Relapse Prevention Program, once per week
• off-site consultations to other agencies




                                                            10
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                              October 1999


Name of Organization:               Wayside House

Address:                            15 Charlton Avenue West, Hamilton, Ontario L8P 2B8

Telephone:                          (905) 528-8969

Fax:                                (905) 528-7057

Email:                              regananderson@home.com

Contact Person (Admin):             Regan Anderson

Contact Person (Clinical):          Doug Donaldson

Hours of Operation:                 24 hours/day (8:00 a.m. – 4:00 p.m. – Admin Support)

Area Served:                        Hamilton-Wentworth, Southern Ontario

Mandate:

Wayside House is a not-for profit community based 21 bed recovery home, dedicated to
empowering the alcohol/drug dependent male to accept and sustain a purposeful life of sobriety.

Through education, counselling, advocacy, support and caring, they strive to improve the quality of
life for substance dependent males through the provision of addiction knowledge, social and life
skills in a home-like substance free environment.

Programs:

Program supports one-on-one and group counselling, relapse prevention, and attendance at
community based 12 step groups. Additional services include support groups, assistance with life-
skills training, vocational/leisure counselling and educational upgrading. As well as the residential
program, the agency offers continuing care.




                                                            11
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                         October 1999


Name of Organization:               New Choices

Address:                            c/o Grace Haven, 138 Herkimer St., Hamilton, ON, L8P 2H1

Telephone:                          (905) 522-5556

Fax:                                (905) 522-6046

Email:

Contact Person (Admin):

Contact Person (Clinical):

Hours of Operation:                 10:00 a.m. -3:00 p.m. Tuesdays & Fridays

Area Served:                        Hamilton-Wentworth

Mandate:

New Choices is a collaborative, centralized approach involving multiple partner agencies in
Hamilton-Wentworth to provide assistance and support to women/teens with substance use issues
who are pregnant and/or are parenting young children. The long term objective is to improve the
health and well-being of the women/teens and their children. These objectives are accomplished
through a flexible program that offers information, support, treatment and advocacy services in a
safe, welcoming environment. Clients are assisted in defining their needs and goals in relation to
substance use, parenting and other problems or concerns, as well as in designing their own program
of change and outcomes. Addiction assessment, child development assessment, prenatal education,
and linking families with prenatal services and a primary care physician are integral parts of the
program. In addition, it offers addiction groups/counselling, health teaching and skill development,
parenting education, and a children’s program. New Choices is closely linked with the Healthy
Babies/Healthy Children initiative and clients have access to home visiting by a Public Health
Nurse and a Family Home Visitor.

Program Specialties
• Health information
• Children’s developmental program
• Support groups for moms
• Lunch, bus tickets, food vouchers
• Access to donations of women/children’s clothing, baby equipment
• Counselling
• Referrals




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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                               October 1999


EDUCATION

Although education services were not considered treatment services by the Ontario Substance
Abuse Bureau, they are included here as a number of them directly support the capacity of the
larger human services system to provide support to individuals with a substance abuse issue.
Along with the activities undertaken by the treatment agencies, the Hamilton Community Programs
& Services Office of the Centre for Addictions and Mental Health also participates actively in
educational activities.

Most agencies participate in Drug and Alcohol Awareness Week.

Alcohol, Drug and Gambling Services

Provides telephone consultation to professionals, family members and other support persons. Staff
also provide in-service training on alcohol, other substance and problem gambling services to
healthcare professionals and healthcare student education programs. This includes B.S.W., M.D.
and Nursing student placements at the agency.

ADGS staff provided 20 presentations to healthcare professionals and students in 1998/99.

Alternatives for Youth

Provide extensive education for parents, teachers about youth and substance abuse, as well as the
impact on children of their parents abusing. Also do sessions in the schools, and participate in
events in the high schools. From April 1998 to March 31, 1999, AY participated in 89 presentation
or events geared to youth, 15 presentations or events geared at the general community, and 30
presentation or events targeted specifically for professionals.

Have BSW/MSW students on placement, as well as child and youthcare students, addictions studies
students, and social service students. Have training for children’s services professionals on the
topics:
        • what are the substances and their impact;
        • how to talk to children/youth;
        • what dynamics do you see in an interview with children;
        • adolescent development ;
        • presentation of depression/substance use targeted to mental health professionals.

Peer consultation and support is facilitated by shared office space for clinical staff, as well as the
counsellors at the main office are contacted 2 – 3 times per week.

Mary Ellis House

Staff make approximately 24 presentations a year, mostly to women’s church groups, especially the
United Church. Also present to school classes, approximately 3 a year.




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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                               October 1999


Hamilton Health Sciences Addiction Services - Men’s Detox, Moreland, Relapse Prevention
Program

Staff from all three sites present regularly, with a focus targeted to health professionals. There are
placement students in all three programs, from the following programs:
• Human Service Worker;
• Addiction Worker
• Social Work
• Nursing
• Therapeutic Recreation

HHSC does not collect data on the number of inquiries/peer consultations that occur.

Mission Services - Suntrac Recovery & Discovery House

On invitation, staff will speak to church groups and support groups; approximately 5 – 6/year.

Will take students for placement from the George Brown and McMaster addictions studies
programs, as well as social work students. Student placements average 2 per year. Work with other
agencies on program development, as well as consulting with doctors and probation officers re
treatment issues. Approximately 50/year.

T.A. Patterson & Associates

Staff occasionally train staff of open custody houses, as well as probation and parole officers.
Provide peer consultation and support to Children’s Aid Society staff, addiction agencies staff,
primary care physicians, psychiatrists, and probation and parole officers. Volumes were not
available.

Women’s Detox

Staff present on request at agencies and at women’s groups. Have done training for women’s
shelter staff, family home visitors. Students have been accepted for placements from medical
elective program, social work/social services, child and youth worker program, and psychosocial
rehabilitation program. Regular site visits/sessions with nursing and medical students. Run
educational sessions for Year 2 family practice residents. Staff provide approximately 10 peer
consultations/supports per week.

Wayside House

Clinical staff provide peer consultation and support to the broader human services sector.




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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                                   October 1999


ENTRY

         Definition: ‘Entry’ refers to the activities and decision-making steps, which underlie
            the process by which someone obtains information about and/or enters the addiction
            treatment system. The various activities in entry services may occur by telephone,
            Internet, or face to face, and may be conducted in one session or more, in one or
            more locations, and individually or in a group.

         Includes:

         •   Inquiry contact - a request for information about agency programs, the treatment
             system, or other issues, made by a person from the community, a staff member from
             another agency, or another professional;
         •   Intake - contact with a person to determine whether he or she is eligible for agency
             services, to register the client into the agency, and to orient the client to services
             available at the agency
         •   Screening – a brief process that collects information in only enough detail to
             determine the client’s immediate needs and to provide direction for next steps in the
             assessment/treatment process. The screening process can also provide information
             to clients, which assists clients in clarifying their own position regarding next steps.
             Screening may occur in an individual or group format.

Alcohol, Drug and Gambling Services

ADGS has dedicated intake staff who are available to respond to walk-in clients and emergencies.
Inquiries are usually on the telephone, occasionally in person. Staff do motivational interviewing
on the intake call, which is considered brief intervention. Staff screen for substance use, and
physical and mental health problems, including depression and suicidal ideation. Staff determine
risk, need for priority service or referral to immediate treatment. Calls are not necessarily brief,
people are often in crisis state, and staff do some immediate facilitation/referral if required. If the
client is in crisis, staff focus on supportive problem solving and responding to immediate needs. If
the caller is pre-contemplative, staff focus on a more motivational approach. Staff have the option
of bringing in family members, or friends., especially if the client is in crisis. Staff do intake offsite
at the Van/Street Health Centre and New Choices weekly, as well as other sites as requested by
callers.

In 1998/99, 1212 clients called ADGS.

Alternatives for Youth

The initial contact determines only if the client is appropriate for the service based on age, where
they live, and if AY has a service they could make use of. Referrals come from other health
professionals, and there is a strong preference for self-referral. Youth are expected to call and make
their own appointments. There is a dedicated intake worker who does not carry a case load, and
thus is available for walk-in clients.


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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                               October 1999


Mary Ellis House

Individuals are screened by phone, and if they are appropriate for any of the beds are invited to
attend. Most clients are referred from detox, DART or other treatment centres. Most individuals
who phone want a longer term residential program.


Hamilton Health Sciences Addiction Services - Men’s Detox, Moreland, Relapse Prevention
Program

All clients are oriented to the agency, but clients are not “registered” until they physically come to
the agency. Screening is blended with assessment. At the RPP and Moreland, clients are screened
via the phone, and if appropriate are offered pre-treatment groups.

RPP staff are going to the jail to screen and do pre-admission assessment. They also visit Mission
Services every 2 months, and the Men’s Detox every Friday.


Mission Services - Suntrac Recovery & Discovery House

Client is first screened by telephone or in person. The goal is to find out if the client is suitable for
the program. Clients on methadone are eligible, but have to have been on methadone for 6 months.
Last year, 960 individuals were screened. Staff go offsite to the Men’s Detox and the Mission
Services Men’s Shelter. Discovery House will provide the venue for comprehensive assessment,
including the capacity to refer to other programs, both within and outside of the addictions field.

T.A. Patterson & Associates

T.A. Patterson & Associates receive all of their non-private referrals from probation officers.
Clients are often under judgments from the courts that they receive assessment and/or treatment.
There are three options for the probation officer. The first is direct referral to the YRAP program.
All clients are seen within 1 week, for an orientation session for the client which includes a brief
screening. The main purpose of the screening is to screen out those individuals with a primary
mental health issue. The probation officer may also refer for a brief assessment or to the GRIP
program, either directly or through a brief assessment as well.

Wayside House

The majority of Wayside clients are referred from detox, sometimes directly, but also through a
waiting list. They are briefly screened by telephone and are referred elsewhere if appropriate.
Potential clients are contacted within a week. Some of the considerations for intake include
whether or not the client is ready to live a different lifestyle, as well as their impact on the total
Wayside milieu. It is an open entry program, as long as space is available. Staff also screen
potential clients at the Men’s Detox.




                                                            16
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                         October 1999


Women’s Detox

First contacts are always made over the telephone. Clients are asked what they have been using;
how much and how long; previous contacts with the Detox; any medical problems; on any
medications; if appropriate for service; do they have a ride. The outreach worker will see women
off-site if needed – to coach them in or review the situation. The detoxes are currently working
with the Emergency Room to develop regional protocols.

Outreach worker and other staff are available to provide phone advice/see concerned families to
educate them about crisis management.




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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                              October 1999


ASSESSMENT

         Definition: The initial assessment is a process involving mutual investigation or
            exploration that provides the clinician with more detailed information for the
            purpose of determining specific client needs, goals, characteristics, problems
            and/or stage of change. Assessments vary in length according to the client’s
            situation, and comprehensive assessment may be reserved for clients with more
            complicated histories and problems. This assessment forms the basis for initial
            treatment planning, a process of negotiation based on feedback from the
            assessment results, the client’s strengths, prioritized problem areas, clinical
            judgment, client preferences and readiness for change, and the identification of
            potential barriers to treatment entry. This culminates in the development of a clear
            plan of action, including referrals as appropriate.


Alcohol, Drug and Gambling Services

The intake form completed at the initial telephone contact is considered a brief assessment.
Drinkwise Group clients are given a brief assessment with feedback in an hour and a half
appointment. A comprehensive assessment usually involves approximately 2 appointments, and
includes feedback. Prior to the second appointment the client usually completes standardized
questionnaires; for example, to assess dependency and high risk situations for use. Staff will go
offsite for an assessment when necessary, usually with another professional involved in the home.

The current waiting period for assessment with the Problem Gambling Program is within 1 week,
and from 1 – 4 weeks for the Alcohol and Drug program, depending on worker availability and
client risk. There are priority appointments for particular client groups, and fast access to enable
group participation. Clients are asked to confirm their appointment in advance, which is part of a
weekly protocol for assessing the waiting list.

Staff complete assessments in two off-site locations; the New Choices program and the Van/Street
Health Centre. They also provide assessments for the Jean Tweed Treatment Centre and northern
residential programs. Newport, St. Thomas and the Donwood will accept clients who have been
assessed at ADGS without a further assessment.

Alternatives for Youth

There are three intake streams. The first is probation and parole referrals for an assessment if
substance use is involved, especially with anger. There is a comprehensive assessment to determine
a treatment stream. The standard assessment includes the SASSI, a Problem substance inventory
and use questionnaire, a level of support scale, health status, stability of living situation, severity of
substance use, stages of change. Group intake varies depending on the group. If the referral is from
ADGS, the forms are usually filled out already. The waiting time between phone-call and
assessment is based on the acuity of client and the availability of the program. There is no waiting
list, and pre-group support is available.

Offsite staff can be asked to sit in on an assessment interview in another agency.

                                                            18
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                               October 1999


Mary Ellis House

All clients who do not have a referral to somewhere else receive a comprehensive assessment
during the first week of their program. This is also true of individuals who are in a pre-treatment
bed. The assessment includes observation, a literacy assessment, a drug and alcohol history, as
well as SASSI. Pre-treatment beds are available quite quickly.

Hamilton Health Sciences Addiction Services - Men’s Detox, Moreland, Relapse Prevention
Program

Waiting lists for assessment are 5 weeks at the RPP, as they immediately precede access to
treatment. At Moreland, a formal assessment occurs first , and then the client waits for treatment.
The waiting time for a public bed is up to 8 weeks, and is within a week for preferred
accommodation.

Mission Services - Suntrac Recovery & Discovery House

Currently the first week of the residential program is assessment. It includes collecting the DATIS
information, as well as the program’s unique tools. In the future, this assessment will be part of the
Discovery House program. Clients are sent to ADGS for a comprehensive assessment if required.

T.A. Patterson & Associates

Staff use the DSM-IV criteria for their assessment. This criteria distinguish between dependency
and abuse. Brief assessments can be done within 2 – 3 weeks. A written report is provided within a
week after that. Assessments are done offsite at the Probation Office. Last year, 220 individuals
received a brief assessment.

If the brief screening has determined that the YRAP program is the appropriate choice, clients will
be assessed on an individual basis over 3 – 4 sessions for further problem identification and
development of a treatment plan.

Wayside House

All clients are given a comprehensive assessment of 1 –2 hours. It includes a family history, a
substance use history, as well as a MAST score.

Women’s Detox

On admission, staff collect information to assess physical/withdrawal risk and as much information
as is possible, based on the client’s condition. If clients stay for several days, staff work on
determining client needs and matching them with appropriate resources. Clients complete some
formal assessment tools, which are supplemented by information about life circumstances and
social supports/barriers to treatment. Clients who do not wish to pursue treatment are given
motivational/educational information. Clients who wish to pursue formal treatment are referred to
appropriate outpatient and residential services, as well as to assessment services.


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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                              October 1999


CASE MANAGEMENT SERVICES

           Definition: A process which includes the designation of a primary worker whose
           responsibilities include the ongoing assessment of the client and his/her problems,
           ongoing adjustment of the treatment plan, linking to and coordination of required
           services, monitoring and support, developing and implementing the discharge plan, and
           advocating for the client. Case management services are offered regardless of where
           the individual is in the system.



Alcohol, Drug and Gambling Services

Staff do a form of case management for all clients, linking to and coordination of required services,
developing and implementing the discharge plan, and advocating for the client. Staff will do more
extensive case management depending on client need and the availability of a case manager from
another system. Staff will meet with clients for follow-up and continued case management.

Alternatives for Youth

Case management is viewed as part of the counselling function, and doesn’t continue when the
client leaves the agency.

Mary Ellis House

Every client in treatment has a primary counsellor who liaises with the appropriate agencies, such as
CAS, lawyers, courts. They’ll also facilitate job linkages, housing, academic upgrading, and refer
to other programs. Clients in pre and post treatment are also supported by a counsellor who
undertakes a case management function.

Hamilton Health Sciences Addiction Services - Men’s Detox, Moreland, Relapse Prevention
Program

At the RPP, there is individual case management for clients with a concurrent disorder while they
receive treatment at the RPP. At both organizations, case management is part of the prime
therapists function. Staff at the detox do case management on a short-term basis, facilitating
referrals and linkages.

Mission Services - Suntrac Recovery & Discovery House

Case Management is part of aftercare, and is available as long as the client wants it. In terms of the
case management function, the intake worker is responsible for case management during the first
week, the primary counsellor for the next 6 weeks and another primary counsellor for the last 6
weeks. After leaving the residential program, the client is supervised by the aftercare department.




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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                               October 1999


T.A. Patterson & Associates

Clients only occasionally receive case management services, and that is only if they have very
serious problems which need multiple services. They will case manage the addictions system for
clients with difficult issues. The Probation officer will case manage everything else.

Wayside House

Case management including treatment planning and linkage to other required services is included in
the treatment process, but doesn’t continue in a formal manner after the client leaves the residential
program.

Women’s Detox

Staff do some case management for hard to serve or recidivist clients, ones who do not ‘quite fit’ in
other agencies. Last year they provided this level of case management for approximately 12 clients.
Staff also provide interim case management services while the clients are resident at the detox –
connecting clients to appropriate services. This is usually done in partnership with the women’s
shelters, the mental health sector, and corrections.




                                                            21
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                          October 1999


HARM REDUCTION

         Definition: Programs and services to reduce the harm associated with alcohol and drug
            use, targeted to clients who will not accept a treatment goal of abstinence. (Setting
            the Course, p. 13)


Alcohol, Drug and Gambling Services

ADGS works within a harm reduction philosophy; that is, clients can choose their treatment goals
with feedback from their Social Worker.

Alternatives for Youth

The philosophy of the agency is harm reduction, and the goal of the majority of clients is harm
reduction.

Mary Ellis House

Mary Ellis House will admit clients who are using methadone.

Hamilton Health Sciences Addiction Services - Men’s Detox, Moreland, Relapse Prevention
Program

All services are based on complete abstinence, however RPP will take clients using methadone.

Mission Services - Suntrac Recovery & Discovery House

Suntrac will accept clients who are using methadone. During the program they are required to be
completely abstinent from other drugs. The aftercare program will work with clients who are still
using other drugs, although their ultimate goal is abstinence for the client.

T.A. Patterson & Associates

They will accept clients on methadone. The goal of the program is not necessarily abstinence, but
clients are required to look at abstinence as an option. Abstinence would be required for the use of
illegal drugs.

Wayside House

Wayside does not currently accept clients on methadone. They adhere to a zero-tolerance policy for
substance use of any kind.




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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                           October 1999


Women’s Detox

The philosophy of the agency is harm reduction – staff work with people with goals other than
abstinence, they admit women using methadone, they wean to help clients just get back to
therapeutic doses of prescription medicine, they assist clients who only want to quit/cut down one
of their many substances. They provide only as much service as the clients want.

The Women’s Detox Centre and the VAN work closely together. The VAN comes to the Detox
Centre to see clients identified with high-risk behaviours.

Other

There are three doctors in the Hamilton-Wentworth area currently prescribing methadone, as well as
2 with an authorization to prescribe, 1 taking training, and 3 considering taking the program. A
large number of their clients are from outside Hamilton-Wentworth. Approximately 10 pharmacies
dispense methadone. A group of agencies and individuals is working to provide appropriate support
for their clients.




                                                            23
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                               October 1999


COMMUNITY TREATMENT SERVICES

         Definition: 1 –2 hour sessions in group or individual format, typically once a week or
            less often, while the client resides elsewhere in the community. Community
            counselling/treatment includes brief intervention, lifestyle and personal counselling
            to assist the individual to develop skills to manage substance abuse/gambling and
            related problems, and/or maintain and enhance treatment goals. Such activities as
            relapse prevention, guided self-change, family intervention, follow-up and aftercare
            are included here. Care may be provided with or without medical/psychiatric
            treatment. Frequency and length of sessions may vary depending on client need and
            program format. May be offered in a variety of settings including outreach to the
            client’s home, school, an addiction agency or other service setting. Outreach
            includes activities such as early intervention but not prevention, education or public
            relations activities.

Alcohol, Drug and Gambling Services

Every interaction is considered a chance for “treatment”. ADGS has a number of packages it can
send to clients who are interested in managing their issues on their own. Staff do individual
counselling and individual aftercare, and also run a number of groups. Groups include:
• Drinkwise (Six groups were run with a total of 22 participants. Nine clients required further
    individual work)
• Agewise (One education group ran with a total of 10 participants)
• Remedial Measures (has not started yet)
• At Odds - Group for partners of problem gamblers (Two groups were run with a total of 11
    participants. Four clients received additional individual work. Two clients received couple
    counselling.)
• Program gambling group. (Two groups were run with 12 individuals. All clients received
    additional individual counselling)
• Spouses group for alcohol and drugs (Group is not currently running due to staff shortages)
• Aftercare group for Agewise (The Support Group runs throughout the year on an on-going
    basis. In 1998/99 there were 14 participants. In addition to individual assessments all
    participants also received additional individual work).

Staff provide counselling, based on a harm reduction model, for “harder to serve” clients at the
Van/Street Health Centre on Wednesday evening and Friday afternoons. Staff also run an
educational group at the Hamilton-Wentworth Detention Centre in collaboration with community
partners. They participate in New Choices. As well, they link within the Social and Public Health
Services Division, particularly in the area of prevention. There are specific links with seniors
organizations around the gambling initiatives, which includes consultation to the Catholic Family
Services Seniors program.

Alternatives for Youth

Although there are no structured brief intervention options, many clients leave after 1 or 2 sessions.
That’s the service delivery model that best meets the needs of adolescents so the agency has

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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                              October 1999


developed staff skills appropriately. There are individual counselling sessions and groups available,
for clients and their families. Relapse prevention services are provided in individual counselling
and the Taking Charge group.

Staff are offsite at:
• Chedoke Child & Family
• McMaster Health Services
• Baritone Secondary School
• Churchill Secondary School
• Hamilton Urban Core Community Health Centre
• Waterdown
• New Choices

There is also a program co-facilitated with public health or school staff called Opening Doors. The
anger management program is sometimes supported by public health or school staff. The smoking
cessation program uses teaching resources from the Lung Association but is delivered by AY staff.

AY will be training and mentoring volunteers at the Detention Centre, and will co-facilitate a group
there. Ancaster Teen Health Centre may become a joint programming initiative or may just have
offsite staff located there. The Hamilton Urban Core Community Health Centre is developing a
program for adolescent girls (wraparound health clinic) and AY will be participating in that.

Mary Ellis House

Mary Ellis House provides continuing care services up to 2 years, although most clients stop after
one year. The program is a 1 – 2 hour group session once a week. It is open to any client who has
completed treatment somewhere, not only those from Mary Ellis House. Staff will do crisis
counselling with group members if needed.

Hamilton Health Sciences Addiction Services - Men’s Detox, Moreland, Relapse Prevention
Program

RPP provides a pre-treatment group once a week in partnership with Women’s Detox. There were
235 individuals who attended from April 98 to March 1999. Moreland runs a pre-admission group
once a week, facilitated by staff.

Men’s Detox currently has morning video/discussion sessions for its clients. They are working on
becoming more treatment focused, geared at motivating individuals to continue on with other
treatment options.

Both Moreland and the RPP have a 2 year, no cost aftercare program. At RPP it operates once a
week for 1.5 hours, and there are day, afternoon and evening options. The sessions are co-led by
staff. A 12-week anger management group is available for clients in aftercare. At Moreland the
aftercare sessions are also once a week for 1.5 hours, and there are currently afternoon and evening
options. The sessions are co-led by staff , occasionally with volunteers. Both have women-only
groups, and the RPP also has a male only group. RPP has the option of providing individual
aftercare services.

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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                          October 1999


Moreland also supports an open-ended couples group, facilitated by staff. The RPP provides
limited family/couple counselling as required.

The RPP co-leads an offsite group at the Urban Core Community Health Centre, in partnership with
staff from that agency.

Individual counselling as needed is available in all settings at all times.

Mission Services - Suntrac Recovery & Discovery House

The aftercare program at Suntrac includes one-on-one counselling of an hour once every two weeks.
It also includes crisis counselling and recreational opportunities. They are in the process of
developing an alumnae, in order to expand the aftercare recreational activities.

T.A. Patterson & Associates

The Youth Recovery Awareness Program (YRAP) is delivered on an individual or group basis.
They often get clients in the pre-contemplation stage, before they’re ready for treatment. It is an
open intake program. Approximately 165 clients received individual service, once a week for about
an hour, while 25 – 30 individuals received group counselling once a week for approximately 2
hours. The group format runs about 15 weeks. The waiting time for this program is within 60 days,
but is complicated by client availability. For the active waiting list – those clients who would be
immediately available for treatment – the waiting time is within 30 days. The program is only
available to probation clients.

The GRIP program is a 6 week brief intervention group program of approximately 2 hours/session.
They are currently booking for September 2000, but changes in client circumstances may impact on
availability in earlier programs. Approximately 40 individuals went through the GRIP program last
year. The program is only available to probation clients.

Wayside House

There is an open peer-led aftercare program at Wayside, meeting once a week for 2 – 3 hours. It is
open to all men, but usually attended only by those who have gone through the program. It is not
structured, but rather responsive to the needs of the needs identified by the participants.
Recreational activities are included. Former residents are encouraged to come back and visit. This
averages from 25 – 30 men monthly.

Women’s Detox

Staff co-facilitate a women’s pre-treatment group with staff from the Relapse Prevention Program.
They also run a support group, which had 242 attendances from April 1998 to March 1999. The
outreach worker had 466 individual sessions with clients. These are not all necessarily community
treatment, they run the gamut from entry to case management/referral to withdrawal management.




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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                               October 1999


COMMUNITY DAY/EVENING TREATMENT SERVICES

         Definition: A structured, scheduled program of treatment activities typically provided
            five days or evenings per week (e.g. 3 – 4 hours per day) while the client resides at
            home or in another setting, including residential support services, to assist the
            individual to develop skills to manage substance abuse/gambling and related
            problems.



Hamilton Health Sciences Addiction Services - Men’s Detox, Moreland, Relapse Prevention
Program

RPP has a program which runs 2-three hour sessions/week for 5 weeks. It is mornings only. RPP
also has an Opportunities for Recovery Group, which is a modified program for those who have
special needs.

New Choices

New Choices is a collaborative, centralized program involving multiple partner agencies in
Hamilton-Wentworth to provide assistance and support to women/teens with substance use issues
who are pregnant and/or are parenting young children. The program offers information, support,
treatment and advocacy services. Addiction assessment, child development assessments, prenatal
education, and linking families with prenatal services and a primary care physician are integral parts
of the program. In addition it offers addiction groups/counselling, health education and skill
development, parenting education, peer mentors and a children’s program. The program runs two
full days per week.

New Choices provides bus tickets, food vouchers, donated clothing/baby equipment and food bank
access for clients as required.




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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                          October 1999


SERVICES FOR POPULATIONS WITH SPECIAL NEEDS

The Ontario Substance Bureau has identified that specific groups have unique treatment needs.
They include:
• Youth
• Older adults
• Women
• People with concurrent disorders
• People with HIV/AIDS
• Aboriginal people
• Francophones
• Ethnocultural communities
• People who are homeless
• Gays, Lesbians and Bisexuals
• People with disabilities
• People with Acquired Brain Injuries
• Problem gamblers
• Families

We have not included women, youth, families and problem gamblers in this section, as they are
dedicated agencies and/or programs in the Hamilton-Wentworth Region who address these
population groups. These include:
 • Alcohol, Drug and Gambling Services (problem gamblers)
 • Alternatives for Youth (Youth and families)
 • Mary Ellis House (women-only)
 • Women’s Detox
 • The New Choices collaboration (young women)

As well, all agencies routinely encompass the other groups in their treatment programs, but there are
only a few targeted programs.

Alcohol, Drug and Gambling Services

ADGS has a number of programs targeted at special population groups, including:
• The Agewise Program is targeted to adults 55+.
• The Van/Street Health Centre collaboration is targeted at the homeless population.
• The agency is developing targeted gambling programs for Italians and Vietnamese. They will
  based more on a capacity-building model.
• The Remedial Measures program is partnering with the Centre de sante to provide these services
  in French.
• Staff are providing a resource for the Acquired Brain Injury program at HPH.
• There is a targeted approach to facilitate access for people with concurrent disorders.




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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                       October 1999


Hamilton Health Sciences Addiction Services - Men’s Detox, Moreland, Relapse Prevention
Program

RPP has a particular focus on people with concurrent disorders, and provides case management
services for those individuals.

Mission Services - Suntrac Recovery & Discovery House

Discovery House will be a targeted program for homeless men. Suntrac currently runs a targeted
program for a maximum of 4 clients using methadone. A house doctor provides support, and there
is a relationship with a pharmacy who dispenses methadone.

T.A. Patterson & Associates

Their approach to specialized client groups is to train staff to address these issues.



COMMUNITY MEDICAL/PSYCHIATRIC TREATMENT SERVICES

         Definition: A specific non-residential service to meet the needs of individuals with
            concurrent disorders. This service may be offered either through a structured
            day/evening program or community treatment. These services are usually part of
            broader hospital services and employs physicians, nurses and staff specializing in
            the treatment of concurrent disorders.

There are no programs in Hamilton-Wentworth for this service function.




                                                            29
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                              October 1999


RESIDENTIAL TREATMENT SERVICES
         Definition: A structured, scheduled program of treatment and/or rehabilitation activities
            provided while the client resides in-house, to assist clients to develop and practice the
            skills to manage substance use and related problems. In addition to the scheduled
            program activities there is 24 hour access to support and the residential treatment
            milieu.



RESIDENTIAL MEDICAL/PSYCHIATRIC TREATMENT SERVICES

         Definition: A structured, scheduled program of addictions treatment and/or
            rehabilitation activities provided for clients whose biomedical, emotional and/or
            behavioural problems are severe enough to require individualized medical/psychiatric
            care, while the client resides in-house. The treatment and/or rehabilitation is intended
            to assist the individual in stabilizing and managing his/her medical/psychiatric
            problems while also addressing the addiction problem per se, or to allow for referral
            to appropriate substance abuse/gambling treatment. In addition to the scheduled
            program of addictions treatment and rehabilitation activities there is 24 hour access to
            support and the residential treatment milieu.



RESIDENTIAL SUPPORT SERVICES LEVEL 1

         Definition: Housing and related recovery/support services such as lifestyle
            counselling, coaching for activities of daily living, community reintegration,
            vocational counselling and mutual aid, provided to clients who require a stable,
            supportive environment prior to, during, or following treatment which is accessed
            elsewhere.



RESIDENTIAL SUPPORT SERVICES LEVEL 2

         Definition: Housing/accommodation in alcohol/drug-free setting. Addiction services
            are not offered on-site or as part of the housing service.



Mary Ellis House

The treatment program at Mary Ellis House is an 8-bed Residential Treatment Service, and the 6
transitional pre and post treatment beds are Residential Support Services Level 1. The treatment
service averages 3 groups a day for 8 weeks, focusing on physical recovery, emotional recovery,
mental recovery, and spirituality. There are also once-a-week individual counselling sessions, and

                                                            30
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                             October 1999


relapse prevention groups. Clients are expected to participate in house maintenance. The transition
beds are used as pre-treatment beds, to stabilize individuals, and as post-treatment beds, for those
women who have completed treatment at Mary Ellis House or elsewhere, and have not yet found
accommodations in the community.

Hamilton Health Sciences Addiction Services - Men’s Detox, Moreland, Relapse Prevention
Program

Moreland is a 21-day continuous intake residential treatment service. Although it may take clients
who have a concurrent disorder it does not provide a medical/psychiatric treatment service because
the substance abuse is always foremost. They will be providing appropriate clinical supports for
individuals with a concurrent disorder. Part of the goal at Moreland is to raise the level of physical
health of the client.

Mission Services - Suntrac Recovery & Discovery House

Suntrac is a Residential Support Services Level 1 program, with a Residential Support Services
Level 2 aftercare component. There is a capacity for 20 beds, and last year 120 clients attended the
program. The program includes group teaching every morning, one-on-one counselling,
recreational activities and opportunities, educational video’s , a group on feelings, and obligatory
attendance at an AA meeting. There is no programming on weekends. Y memberships are
provided.

Ten to twelve individuals lived in the 6 Suntrac aftercare apartments between April 98 and March
99 , but capacity will be expanding to 9 beds.

Discovery House is be a three week stabilization program which will assist individuals in decision-
making. It will provide assessment, some pre-treatment, and some development of life skills and
problem-solving skills.

Wayside House

Wayside is a Residential Support Services Level 1 program. During the year of April 1, 1998 –
March 31, 1999, 65 clients received this service. Occasionally, they provide Residential Support
Services Level 2, only for residents who have not yet found appropriate housing post treatment.
Clients receive one individual counselling session/week, three videos/wk focusing on relapse
prevention, and three house groups, focused on anger management, relapse prevention, and peer
support. Clients are also required to attend 3 AA meetings a week. There are structured
recreational/leisure activities available, and clients are encourage to participate in a physical
education program. A focus on addressing the housing and financial needs of clients is included in
the program.

The target group is males who have been through other treatment modalities, have a long-term
addiction, are usually not employed and do not have a lot of family supports. Clients are usually in
the program within a month. After the first month, some clients are allowed to go back to work, or
actively look for work, but are still required to participate in certain program elements. This
averages 6 – 7 men monthly.

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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                             October 1999


COMMUNITY WITHDRAWAL MANAGEMENT SERVICES
         Definition: Assistance with voluntary withdrawal from alcohol and/or other drugs to
         clients who are under the influence of these substances and/or in withdrawal or
         otherwise in crisis directly related to these substances. Clients may be simultaneously
         accessing residential support services, or they may be residing in their home, the home
         of a significant other or in another community setting, supervised or unsupervised.
         Care may be provided with or without the aid of drug therapy and/or other medical
         interventions. Additional support such as discharge planning and early recovery
         education is provided. Service is provided according to three levels.



RESIDENTIAL WITHDRAWAL MANAGEMENT SERVICES
         Definition: Assistance with voluntary withdrawal from alcohol and/or other drugs to
         clients who are under the influence of these substances and/or in withdrawal or
         otherwise in crisis directly related to these substances. This care is provided in a
         Withdrawal Management (detox) Centre, or on an inpatient basis in a hospital. Care
         may be provided with or without the aid of drug therapy, and/or other medical
         interventions. Additional support such as discharge planning and early recovery
         education is provided. Service is provided according to three levels.

         Level 1

         Client symptoms can be safely monitored by staff who are not medically trained.
         Intensity/severity of symptoms can be managed, as required, with medical consultation
         being provided by a physician/after hours clinic/health centre/hospital emergency
         department.
         Client/staff ratios do not permit high intensity symptom monitoring. In consultation with a
         physician, if necessary, consider/assess individuals for admission who are taking the
         following types of medication:
         •       Medications for medical problems
         •       Medications for diagnosed psychiatric problems
         •       Pain medications only for acute injuries or recent surgery

         Level 2

         Client symptoms can be safely monitored by staff who are not medically trained.
         Intensity/severity of symptoms can be managed, as required, with medical consultation
         being provided by a physician/after hours clinic/health centre/hospital emergency
         department.
         Routine medical consultation and sufficient staff resources are available to consider
         management of the following medications/situations:
         •       All medications as listed in Level 1
         •       Clients on methadone
         •       Clients being tapered from benzodiazepines or narcotics

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Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                             October 1999


     Level 3

     Client symptoms require monitoring by medically trained staff.
     Medical consultation and staff are available on a constant basis to monitor and mange the
     following medications/situations:
     • Add medications as listed in Level 1
     • Circumstances as listed in Level 2
     • Medically-assisted withdrawal

     Alcohol, Drug and Gambling Services

     Staff work in partnership with the community to assist clients who are detoxing at home, or in
     doctor’s offices. They facilitate appropriate linkages, referrals, problem solving and capacity
     building.

     Mary Ellis House

     Mary Ellis House will admit individuals into their transition beds who require Level 2
     Community Withdrawal Management services. This service is focused on tapering clients
     from benzodiazepines.

     Hamilton Health Sciences Addiction Services - Men’s Detox, Moreland, Relapse
     Prevention Program

     The Men’s Detox provides, with some limitations, residential withdrawal management services
     at levels 1 and 2. There are some limitations with the capacity to accept clients with
     medications for diagnosed psychiatric problems, and pain medications for acute injuries or
     recent surgery. It is difficult logistically to take individuals who use methadone or are tapering
     from benzodiazepines or narcotics. The Men’s Detox will have the capacity to assist clients
     tapering from benzo’s and narcotics shortly.

     The Men’s Detox will be working towards providing more of a level 3 service with nursing
     support and improved partnerships between the detoxes and the hospital emergency
     departments

     Men’s Detox is providing some Level 3 service because of increasing nursing support and
     improved partnerships between the ER and the detox. The model is really a hybrid model,
     more like a level 2.5.

     Mission Services - Suntrac Recovery & Discovery House

     Discovery House will have the capacity to house individuals who are in Levels 1 and 2 of
     community withdrawal management.




                                                            33
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                            October 1999


     T.A. Patterson & Associates

     Staff will provide support for Community Withdrawal Management, Level 1. Last year they
     worked with 5 – 10 clients.

     Women’s Detox

     Women’s Detox provides Level 1 & 2 Residential Withdrawal Management. They also
     provide some Level 1 & 2 Community Withdrawal Management, on an informal basis through
     the Outreach worker. She works with approximately 20 level 1 and 15 level 2 clients, with
     level 2 mostly weaning from benzodiazepines. In residential services, 425 clients were seen in
     level 1 and 25 clients in level 2 from April 1998 to March 1999. Staff also work with the
     community, mostly primary care physicians, the self-help community and Mary’s Place to
     support individuals. There is a plan to develop regional protocols between Detox/Emergency
     Departments and to circulate documents on medical management of withdrawal to family
     physicians.

     Other services

     Hospitals are doing short-term withdrawal management in the ER – i.e. stabilization

     The hospitals only support inpatient withdrawal if there’s an acute medical problem associated
     with substance abuse.




                                                            34
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                         October 1999


UNMET NEEDS

Agencies were asked to identify any unmet needs for the addictions treatment system. Their
responses are listed below, grouped by topic:

Treatment
• Pre-treatment/stabilization for men, especially homeless men
• Aftercare programs which are funded
• More outpatient counselling and in more locations (more accessible to the clients)
• A 15 week open GRIP program
• More aftercare programs
• More early intervention
• More residential services for men
• Variable lengths of stay in residential programs
• Pre-treatment/stabilization for men
• Fund existing programs
• More outpatient
• More day treatment
Harm Reduction
• Harm reduction approaches, including a “wet” hostel
• More accessibility for methadone clients, including a low threshold clinic
• Enhanced counselling services for individuals using methadone
• Coordinated methadone clinic
• Outreach workers for women
• Expansion of the VAN service
• More housing for concurrent disorder clients who are actively using
• Housing for women who are actively using

Services for Youth
• More specific services for youth around methadone
• More direct outreach to street youth
• Adolescent health/medical clinic
• Education for GP’s around teen substance use/depression/confidentiality
• More awareness/early intervention re the needs of 11-13 year olds using alcohol and drugs
• Programs for children under 16
• Youth residential programs

Concurrent Disorder
• Increased collaboration between mental health and addictions agencies
• Addiction workers in mental health outreach programs
• Targeted concurrent programming before 3 month abstinence “rule”, jointly with mental health
   agencies
• Access to physicians and psychiatrists specializing in addictions (need to be connected to the
   system right from physician training)

                                                            35
Inventory of Addiction Treatment Programs and Services in Hamilton-Wentworth
Hamilton-Wentworth District Health Council                                                       October 1999


Family Programs
• Family education opportunities on a regional basis
• Family programs – outpatient, group and individual
• Family programming
• Substance use and marital adjustment programs

Specialized Programs
• More services for batterers, i.e. longer-term therapeutically oriented programs
• Programs for men targeted at substance abuse and aggression
• More services for corrections clients
• More programs for abuse of prescription drugs


Other
   Dedicated resources to let clients know what services are available – need public education re:
what’s a problem, and where do you go. Problem gambling helpline is very helpful, DART doesn’t
do enough of that kind of public relations
   Culturally specific programming – need to work with community workers from various groups
• Better data base




                                                            36
 Inventory of Substance Abuse Programs and Services in Hamilton-Wentworth
 Hamilton-Wentworth District Health Council                                                                                October 1999




 STAFFING (FTE'S) OF SUBSTANCE ABUSE TREATMENT AGENCIES – APRIL 1, 1998 – MARCH 31, 1999


Agency                                                                                     Staffing

                                          Managers               Program Supervisor/   Clinical Program   Clerical Staff   Other
                                                                 Team Leader           Workers
Alcohol, Drug and Gambling                1                                            6.7                2.2
Services
Alternatives for Youth                    2                                            6.4                1.3              .3

Mary Ellis House                          1.5                    .5                    4 +relief

HHSC - Men’s Detox                        .3                     1                     13.43

HHSC - Moreland                           .4                                           13.6               1

HHSC - Relapse Prevention                 .3                                           4.6                1
Program
Mission Services Suntrac                  .5                     1.51                  5                  1                Support from
Recovery & Discovery House                                                                                                 hostel staff
T. A. Patterson & Associates              .4                     .4                    2.4                .4

Women’s Detox                             1                      1                     9.65               .5

Wayside House                             1                      1                     4.2 + relief       1                1 +casual

New Choices




                                                                              37
 Inventory of Substance Abuse Programs and Services in Hamilton-Wentworth
 Hamilton-Wentworth District Health Council                                                                                  October 1999




 AGE OF FEMALE CLIENTS BY AGENCY, APRIL 1, 1998 – MARCH 31, 1999

Agency                                                                                              Age ranges

                                              No date        Under 16          16 – 24        25-44       45-64   65+   Total
                                              of Birth
Alcohol, Drug and Gambling                    23             3                 52             240         88      8     414
Services
Alternatives for Youth                        1              30                201            29          20            281
(Discharges)
Mary Ellis House (January –                                                    5              47          12            64
December, 1998)
HHSC - Men’s Detox                            Not applicable

HHSC - Moreland                               4                                16             64          23            107

HHSC - Relapse Prevention                                                      20             112         29            161
Program
Mission Services - Suntrac                    Not applicable
Recovery
T. A. Patterson & Associates2                                                  7              8                         15
(YRAP program only,3
Jan-Dec 1998)
Women’s Detox (by unique                                     1                 53             287         91      6     438
client, residential and non)
Wayside House                                 Not applicable

New Choices                                                                    17             37                        54


 2
     The breakdown for the GRIP program and the assessments is very similar.
 3
     Ages 25-37




                                                                                         38
 Inventory of Substance Abuse Programs and Services in Hamilton-Wentworth
 Hamilton-Wentworth District Health Council                                                                                 October 1999




 AGE OF MALE CLIENTS BY AGENCY, APRIL 1, 1998 – MARCH 31, 1999

Agency                                                                                             Age ranges

                                             No date         Under 16         16 – 24        25-44       45-64   65+   Total
                                             of Birth
Alcohol, Drug and Gambling                   41              4                101            492         144     16    898
Services
Alternatives for Youth                       2               29               252            10          14            307
(Discharges)
Mary Ellis House                             Not applicable

HHSC - Men’s Detox                                                            93             810         536     72    1510
(admissions)
HHSC - Moreland                              12                               32             259         92      5     400

HHSC - Relapse Prevention                                                     21             187         74      4     286
Program
Suntrac Recovery (Oct. 1, 1997                                                14             61          25            100
– Sept. 31, 1998)
T. A. Patterson & Associates4                                                 113            64                        177
(YRAP program only5 ,
 Jan – Dec 1998)
Women’s Detox                                Not applicable

Wayside House                                                0                2              42          20      1     65

New Choices                                  Not applicable


 4
     The breakdown for the GRIP program and the assessments is very similar
 5
     Ages 25-37




                                                                                        39
 Inventory of Substance Abuse Programs and Services in Hamilton-Wentworth
 Hamilton-Wentworth District Health Council                                                                                 October 1999




 AGE OF ALL CLIENTS BY AGENCY, APRIL 1, 1998 – MARCH 31, 1999

Agency                                                                                             Age ranges

                                             No date         Under 16         16 – 24        25-44       45-64   65+   Total
                                             of Birth
Alcohol, Drug and Gambling                   64              7                153            732         232     24    1212
Services
Alternatives for Youth                       3               59               453            39          34            588
(Discharges)
Mary Ellis House                                                              5              47          12            64

HHSC - Men’s Detox                                                            93             810         536     72    1510
(admissions)
HHSC - Moreland                              16                               48             323         115     5     507

HHSC - Relapse Prevention                                                     41             299         103     4     447
Program
Suntrac Recovery (Oct. 1, 1997                                                14             61          25            100
– Sept. 30, 1998)
T. A. Patterson & Associates6                                                 120            72                        192
(YRAP program only7 ,
Jan. – Dec. 1998)
Women’s Detox (by unique                                     1                53             287         91      6     438
client, residential and non)
Wayside House                                                                 2              42          20      1     65

New Choices                                                                   17             37                        54


 6
     The breakdown for the GRIP program and the assessments is very similar
 7
     Ages 25-37




                                                                                        40
 Inventory of Substance Abuse Programs and Services in Hamilton-Wentworth
 Hamilton-Wentworth District Health Council                                                                                         October 1999




 CLIENTS DISTRICT OF RESIDENCE, APRIL 1, 1998 – MARCH 31, 1999

                                                                                       District of Residence

Agency                                  No fixed       Hamilton-        Niagara        Grand       Halton-     Other Central   Toronto    Rest of
                                        address        Wentworth                       River       Peel        West                       Province
Alcohol, Drug and                                      99%                                                     1%
Gambling Services
Alternatives for Youth (all                            583              10             3           9           3                          2
intakes)
Mary Ellis House                                       117*             1              1           9           4               16         2
(Jan – Dec, 1998)
HHSC - Men’s Detox                      .              1327             7              25          85          17                         49
(admissions)
HHSC - Moreland                                        275              20             19          93

HHSC - Relapse Prevention                              443                                         4
Program
Suntrac Recovery (Oct. 1,                              48               4              1                       5               14         28
1997 – Sept. 30, 1998)
T. A. Patterson &                                      455
Associates (Jan. – Dec.,
1998)
Women’s Detox                           83             386              8              17          46          20              12         1
(admissions, not individual
clients; residential and non)
Wayside House                                          54               1              3           5                                      2

New Choices                                            54


 * includes individuals with no fixed address




                                                                                  41
 Inventory of Substance Abuse Programs and Services in Hamilton-Wentworth
 Hamilton-Wentworth District Health Council                                                                                                      October 1999




 PROGRAM FUNDING – 1998/99

Agency                       OSAB                Other Ministry of            Local                    Fundraising              Other
                                                 Health or Other              Government
                                                 Ministries
Alcohol, Drug and            572,757             (funding for remedial
Gambling Services                                measures has not been
                                                 included)
Alternatives for             321,564                                          11,700                                            83,459 (United Way)
Youth (1999/2000)
Mary Ellis House             146,803                                          34.50 per diem for       Approximately            15,360 (United Church)
                                                                              pre-treatment beds       50,000
Men’s Detox                  787,196

Moreland                                                                                                                        1,099,000 (Insurance)

Relapse Prevention                               356,691 (Health,
Program                                          Institutions)
Mission Services             304,000                                          34.50 per diem for                                Individuals pay rent for aftercare
Suntrac Recovery &                                                            Discovery beds                                    apartments on a break-even basis
Discovery House
T. A. Patterson &                                213,400 (Ministry of                                                           Private treatment is available
Associates                                       Corrections)
Women’s Detox                612,997

Wayside House                436,000 + 27,000                                                          Approximately            Room & Board $16,915
                             BNA8                                                                      $50,000
New Choices                                                                                                                     Receives some funding from
                                                                                                                                foundations as well as in-kind donations
TOTALS                       2,904,621           570,091                                               100,000                  1,214,734

                                                                  R:\Reports - Final 1998-1999\Inventory of Addiction Treatment Programs and Services in HW Oct 1999.doc

 8
     Basic Needs Allowance




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