2. PHASE II - INTEGRATED DRUGS AND ADDICTIONS STRATEGY

PHASE II STRATÉGIE INTÉGRÉE DE LUTTE CONTRE LES DROGUES ET LA TOXICOMANIE

COMMITTEE RECOMMENDATIONs

That Council:

1. Endorse the four pillar approach to Drugs and Addictions for the City of Ottawa.

2. Endorse the projects proposed by the Community Network as follows:

Treatment

a. Endorse the Community Network’s pursuance of a 48-bed residential treatment facility for youth 13-17 of which 32 beds would be for Anglophone youth and 16 beds would be for Francophone youth.

b. Endorse the Community Network’s pursuance of funds to conduct a comprehensive gap analysis of housing availability for individuals who have problems with addictions both pre and post treatment in the City of Ottawa.

c. Endorse the Community Network’s pursuance of a peer intervention program for drugs and addictions.

d. Endorse the Community Network’s identified need for primary care and support services for people using substances and lobby the Provincial Government to increase both.

e. Endorse the Community Network’s identified need for increased employment opportunities for people with substance use and/or mental health issues and lobby the Provincial Government to increase employment opportunities for both.

Prevention

a. Endorse the Community Network’s development of a web based tool kit of information on substance use and abuse and support the project by directing staff to include a request for $19,000 in 2008 and $13,000 in 2009 and 2010 as part of their budget to support the management of the project.

b. Endorse the Community Network’s development of an Education program for youth, school staff, parents and youth services agencies.

c. Endorse the Community Network’s development of a 3 year public awareness campaign aimed at changing behaviour.

Harm Reduction

a. Endorse the Community Network’s proposal by directing staff to expand the membership of the Site Development Consultative Group membership (who provide guidance on harm reduction programming in Ottawa) to include Police, Crime Prevention Ottawa, BIA's, community representatives and service providers.

b. Endorse the Community Network’s proposal to complete a feasibility study on substitution therapy options for crack and cocaine addictions.

c. Endorse the Community Network’s proposal to conduct an independent operational review of the “Safer Inhalation Program” and its effectiveness and direct staff to include a request for required funding to complete an independent review of the Safer Inhalation Site program as part of the 2008 budget.

d. Endorse the Community Network’s development of a public information program for concerned communities about addictions, harm reduction policies and procedures and direct staff to participate in the development of the project plan.

e. Endorse the Community Network’s development of a joint education program for service providers and direct staff to participate in developing the project plan.

Enforcement

a. Endorse the Community Network’s proposal to pilot a coordinated single access approach to addressing drug related issues as part of existing City of Ottawa or Community led problem solving mechanisms and direct staff to participate on the project team.

b. Endorse the Community Network’s identified need for new or revised legislation to support efforts to address public disorder concerns and request Crime Prevention Ottawa to report back with detail on the needs and proposed legislation.

Recommandations du comité

Que le Conseil municipal :

1. Appuie la stratégie à quatre piliers du programme de lutte contre les drogues et la toxicomanie de la Ville d’Ottawa.

2. Appuie les projets proposés par le réseau communautaire :

Traitement

a. Appuyer l’intention du réseau communautaire d’aménager un établissement de traitement de 48 lits pour les jeunes âgés de 13 à 17 ans répartis comme suit : 32 lits pour les jeunes anglophones et 16 lits pour les jeunes francophones.

b. Appuyer le réseau communautaire dans sa demande de financement dans le but d’effectuer une analyse exhaustive de l’écart entre la disponibilité de logements dans la Ville d’Ottawa pour les personnes ayant des problèmes de toxicomanie, tant avant qu’après traitement.

c. Appuyer le réseau communautaire dans l’élaboration d’un programme d’intervention des pairs pour la lutte contre les drogues et la toxicomanie.

d. Appuyer le réseau communautaire en ce qui concerne les besoins de soins primaires et de services de soutien pour les personnes qui consomment diverses substances et faire pression auprès du gouvernement provincial pour augmenter les deux services.

e. Appuyer le réseau communautaire en ce qui concerne les besoins d’augmenter les occasions d’emploi pour les personnes ayant des problèmes de consommation de substances ou de santé mentale et faire pression auprès du gouvernement provincial pour qu’il fasse de même.

Prévention

a. Appuyer le réseau communautaire dans l’élaboration d’un outil d’information sur le Web portant sur la consommation et l’abus de substances et appuyer le projet en demandant au personnel d’ajouter au budget de soutien à la gestion du projet une demande de 19 000 $ en 2008 et de 13 000 $ en 2009 et 2010.

b. Appuyer le réseau communautaire dans l’élaboration d’un programme d’éducation pour les jeunes, le personnel scolaire, les parents et les organismes de service pour les jeunes.

c. Appuyer le réseau communautaire dans l’élaboration d’une campagne de sensibilisation publique d’une durée de trois ans qui vise à changer les comportements.

Réduction des méfaits

a. Appuyer la proposition du réseau communautaire en demandant au personnel d’augmenter la composition du Groupe consultatif des services (qui donne des directives sur la programmation de la réduction des méfaits à Ottawa) afin d’inclure le Service de police, la Prévention du crime à Ottawa, les ZAC, les représentants de la collectivité et les fournisseurs de services.

b. Appuyer la proposition du réseau communautaire de demander une étude de faisabilité sur les options de thérapie par la substitution pour les dépendances au crac et à la cocaïne.

c. Appuyer la proposition du réseau communautaire d’effectuer un examen opérationnel indépendant du « Programme de consommation plus sûre » et de son efficacité, et demander au personnel d’ajouter au budget de l’année 2008 une demande de financement dans le but d’effectuer cet examen indépendant.

d. Appuyer le réseau communautaire dans l’élaboration d’un programme d’information publique pour les collectivités touchées portant sur la toxicomanie, les politiques et procédures de réduction des méfaits et demander au personnel de participer à l’élaboration du plan de projet.

e. Appuyer le réseau communautaire dans l’élaboration d’un programme éducatif conjoint pour les fournisseurs de services et demander au personnel de participer à l’élaboration du plan de projet.

Application de la loi

a. Appuyer la proposition du réseau communautaire d’essayer une méthode à accès unique coordonnée pour régler les problèmes reliés à la consommation de drogues dans le cadre des mécanismes actuels de résolution de problèmes à la Ville d’Ottawa ou des mécanismes menés par la collectivité, et demander au personnel de participer à l’équipe du projet.

b. Appuyer le réseau communautaire dans sa demande de législation nouvelle ou révisée en appui aux efforts visant à répondre aux préoccupations de désordre public et demander au Bureau de la prévention du crime d’Ottawa de présenter son rapport détaillé sur les besoins et la législation proposée.

DOCUMENTATION

1. Deputy City Manager report dated 2 June 2007 (ACS2007-CPS-DCM-0007).

2. Extract of Draft Minute, 21 June 2007

Report to/Rapport au:

Community and Protective Services Committee

Comité des services communautaires et de protection

and Council / et au Conseil

2 June 2007 / le 2 juin 2007

Submitted by/Soumis par: Steve Kanellakos, Deputy City Manager/Directeur municipal adjoint,

Community and Protective Services/Services communautaires et de protection

Contact Person/Personne ressource : Dr. David Salisbury, Medical Officer of Health

Medical Officer of Public Health/Médecin chef en Santé publique

(613) 580-2424 x23681, David.Salisbury@ottawa.ca

City-Wide/ À L'échelle De La Ville

Ref N°: ACS2007-CPS-DCM-0007

SUBJECT:	PHASE II - INTEGRATED DRUGS AND ADDICTIONS STRATEGY

OBJET :	PHASE II STRATÉGIE INTÉGRÉE DE LUTTE CONTRE LES DROGUES ET LA TOXICOMANIE

REPORT RECOMMENDATIONS

That Community and Protective Services Committee recommend that Council:

1. Endorse the four pillar approach to Drugs and Addictions for the City of Ottawa;

2. Endorse the projects proposed by the Community Network as follows:

Treatment

c. Endorse the Community Network’s pursuance of a peer intervention program for drugs and addictions.

d. Endorse the Community Network’s identified need for primary care and support services for people using substances and lobby the Provincial Government to increase both.

Prevention

b. Endorse the Community Network’s development of an Education program for youth, school staff, parents and youth services agencies.

c. Endorse the Community Network’s development of a 3 year public awareness campaign aimed at changing behaviour.

Harm Reduction

b. Endorse the Community Network’s proposal to complete a feasibility study on substitution therapy options for crack and cocaine addictions.

e. Endorse the Community Network’s development of a joint education program for service providers and direct staff to participate in developing the project plan.

Enforcement

RECOMMANDATIONS DU RAPPORT

Que le Comité des Services communautaires et de protection recommande au Conseil municipal :

1. d’appuyer la stratégie à quatre piliers du programme de lutte contre les drogues et la toxicomanie de la Ville d’Ottawa.

2. d’appuyer les projets proposés par le réseau communautaire :

Traitement

c. Appuyer le réseau communautaire dans l’élaboration d’un programme d’intervention des pairs pour la lutte contre les drogues et la toxicomanie.

Prévention

b. Appuyer le réseau communautaire dans l’élaboration d’un programme d’éducation pour les jeunes, le personnel scolaire, les parents et les organismes de service pour les jeunes.

c. Appuyer le réseau communautaire dans l’élaboration d’une campagne de sensibilisation publique d’une durée de trois ans qui vise à changer les comportements.

Réduction des méfaits

b. Appuyer la proposition du réseau communautaire de demander une étude de faisabilité sur les options de thérapie par la substitution pour les dépendances au crac et à la cocaïne.

Application de la loi

a. Appuyer la proposition du réseau communautaire d’essayer une méthode à accès unique coordonnée pour régler les problèmes reliés à la consommation de drogues dans le cadre des mécanismes actuels de résolution de problèmes à la Ville d’Ottawa ou des mécanismes menés par la collectivité, et demander au personnel de participer à l’équipe du projet.

EXECUTIVE SUMMARY

There are over 30,000 people in Ottawa reporting problems of substance abuse (Garabedian, 2002) with only 12% having accessed treatment in 2005 (OMHLTC, 2005). Moreover, substance abuse is costing local taxpayers approximately $625 million every year in lost productivity, premature deaths, increased health care and law enforcement costs (Rehm et al., 2006.)

With the problem of drugs and addictions on the rise and with resources to address them shrinking, a Community Network of over 50 stakeholders was established to address priority issues for the City of Ottawa and the surrounding area.

In June 2006, the Community Network reported to Council outlining the priority needs for Ottawa and potential options to address those issues; namely ideas on how to increase public education/prevention and treatment capacity in the region. The second phase of the strategy was targeted at developing detailed project plans and identifying resource requirements and potential funding sources.

Although a number of the solutions recommended in this report are not directly within the City’s mandate to support or fund, the issue of drugs and addictions significantly impacts the City and the services it provides. Accordingly, the City has an interest in facilitating and promoting an integrated approach to the full range of solutions proposed.

The Community Network is now seeking Council’s political support for the next phase of the strategy, which will be focused on seeking the funds and ultimately the implementation of the projects. (Outlined in the attached Community Network report Document 2).

RÉSUMÉ

Il y a plus de 30 000 personnes à Ottawa qui ont signalé avoir des problèmes de consommation (Garabedian, 2002) et seulement 12 % ont pu recevoir des traitements en 2005 (MSSLD, 2005). En outre, la consommation abusive coûte aux contribuables locaux environ 625 millions de dollars chaque année en perte de productivité, en décès prématurés, en augmentation des coûts de soins de santé et dans l’application de la loi (Rehm et al., 2006).

En raison de l’augmentation des problèmes de drogues et de toxicomanies et de la réduction des ressources permettant de régler ceux‑ci, un réseau communautaire de plus de 50 intervenants a été établi afin de régler les questions prioritaires pour la Ville d’Ottawa et la région immédiate.

En juin 2006, les représentants du réseau communautaire ont préparé un rapport pour le Conseil municipal dans lequel ils soulignaient les besoins prioritaires pour Ottawa et les options possibles pour régler ces problèmes, notamment, des idées sur la façon d’éduquer le public et d’augmenter la prévention et la capacité de traitement dans la région. La deuxième étape de la stratégie ciblait l’élaboration de plans de projets détaillés et la détermination des besoins en ressources et des sources de financement possibles.

Bien que le nombre de solutions recommandées dans le présent rapport ne respecte pas directement le mandat de la Ville en matière de soutien et de financement, la question des drogues et de la toxicomanie a une incidence importante sur la Ville et les services qu’elle offre et, par conséquent, la Ville a un intérêt certain dans l’amélioration et la promotion d’une approche intégrée de la gamme complète de solutions proposées.

Le réseau communautaire cherche maintenant l’appui politique du Conseil municipal pour la prochaine étape de la stratégie, qui sera axée sur la recherche de financement et, en dernier lieu, la mise en œuvre des projets. (Un aperçu de ces derniers se trouve dans le rapport du réseau communautaire joint à l’annexe 2)

BACKGROUND

While much of the responsibility for addressing drugs and addictions issues (such as treatment) is not within the mandate of the City, the issues continue to be a real problem for the citizens in the community. In June 2006, the former Heath, Recreation and Social Services Committee received a report (ACS2006-CCS-HRS-0012) that indicated that over 30,000 individuals in Ottawa, from all age groups, affecting individuals, families and the community in general, reported some form of substance use problem requiring treatment (Garabedian, 2002). Of those 30,000 individuals with problems, slightly more than 12% or approximately 3,725 people participated in community addictions interventions: ranging from early intervention to structured community counselling and treatment in 2005(MOHLTC, 2005). The Ottawa Withdrawal Management (Detoxification) Centre reported on their website that approximately 3000 people are turned away from their facility every year due to lack of capacity (Hamilton, 1997 as cited on Ottawa Detoxification Centre web site).

Based on an Ontario Student Drug Use Survey conducted in 2005 by the Centre for Addictions and Mental Health, approximately one-quarter, or approximately 13,000 students in Ottawa report binge drinking (5+ drinks on one occasion) at least once a month, with the equivalent of 4,800 students binge drinking 2 to 3 times in a month and about 16% or the equivalent of 8,500 Ottawa students report symptoms of a drug use problem (Adlaf & Paglia, 2005). An informal survey conducted with local Ottawa students (Child and Youth Friendly Ottawa, 2006) indicated that approximately 50% of those surveyed had tried drugs or had been around others using drugs by the age of thirteen and that 45% of students surveyed had their first contact with drugs in school.

Based on modelled estimates, there are approximately 3,270 intravenous drug users (IDU’s) in Ottawa of which approximately 75.8 % were infected with Hepatitis C (HCV). Ottawa also has the highest proportion of first time HIV diagnoses (based on data from 1985-2003) among IDU’s in Ontario at 26.2% (Millson, Leonard, Remis, Strike, and Challacombe, 2004). In a 2004 study conducted in Ottawa with the homeless, approximately 28% of homeless individuals reported alcohol problems and 39% reported problems with other drugs (Aubrey, Klodawsky, Hay and Runnels, 2004). In addition to generally high rates of substance issues in youth, the homeless and the general population, there are also very high rates of substance abuse among individuals suffering from mental health illnesses. Fifty-three (53%) of individuals with substance use disorders other than alcohol, will experience a mental illness during their lifetime (Concurrent Disorders Network Ontario, 2005). Furthermore, substance use factors highly in the prevalence of high-risk adolescent pregnancy and births with young teenaged mothers. St. Mary’s Home, a residential facility for pregnant teens in Ottawa, estimates that 80% of their clients are young, homeless and pregnant and that substance abuse occurs in most of the referrals to that facility.

Impact

The use of alcohol, tobacco and illegal drugs has a substantial impact on the Canadian economy. A report released in March 2006 from the Canadian Centre on Substance Abuse states that the social and economic costs of abuse of alcohol, tobacco and illegal drugs is draining almost $40 billion a year from the economy, through increased pressure on the health care and justice systems as well as lost productivity resulting from disability and premature death. In all, these pressures represent a cost of $1,267 to each individual Canadian. Approximately 37 percent of the yearly economic drain can be attributed to alcohol with illegal drugs such as marijuana, heroin, cocaine and crack accounting for an additional 20 per cent. Using these figures, the cost to the Ottawa economy of alcohol and drug abuse alone can be estimated at approximately $625 million annually (Rehm, et al., 2006). Confirming the pressure on the justice system of illegal substance use, Ottawa Police reported an approximate 60% increase in arrests related to cocaine and heroin between 2004 and 2005 (Ottawa Police RMS, 2005)

The impact of drugs and addictions cannot all be traced financially. For example, in Child Welfare in 2003 it was found that in 22 percent to 33 percent of the substantiated maltreatment investigations, caregiver functioning was impacted by alcohol/Drug/Solvent Abuse (Fallon, et al., 2003). Risky behaviours such as impaired driving are also a result. In 2005, 31.2% of Ontario East Region students from grades 7-12 reported riding with a driver who was drinking alcohol and 20.9% report riding with a driver who had been using drugs prior to driving. Whether through peer influence or parental role modeling, youth are increasingly being put at risk, by those with substance abuse issues. Although changing social norms and graduated licensing have reduced teen drinking and driving, it remains a serious concern for adults (Adlaf & Paglia-Boak, 2005).

Although the City does not specifically measure its resources expended daily addressing issues related to drugs and addictions, one can surmise that services such as police, by law services, public health, paramedics and shelter services are severely impacted by these issues and result in significant expense to the City.

Given these issues, a Community Network comprised of over 50 stakeholders (Document 1) was established in the summer of 2005 to investigate solutions for the City of Ottawa and the surrounding area. They reported in June 2006 with recommendations for needed projects for the City and proposed that the next phase (Phase II) of an Integrated Drugs and Addictions Strategy should be dedicated to detail project planning of those projects including scope, resource requirements, potential funding sources and time requirements for implementation.

In that same report, the Community Network endorsed a four pillar approach to drugs and addictions for the City of Ottawa.

Four Pillar Approach

The 4 pillars in the approach to dealing with drugs and addictions are prevention, treatment, harm reduction and enforcement and the Community Network clearly identified the need for communities to have a balanced approach of all 4 pillars when addressing issues in any community.

During the public consultation in the first phase, one participant compared the four pillars to the four legs of a chair, suggesting that all four pillars are required in balance to create a strong strategy just as all four legs are required in building a balanced and strong chair. The Four Pillars model seeks to develop recognition and consensus among service providers for the role of each pillar and to support the identification of opportunities for an integrated and coordinated approach.

The issue of increased integration and coordination of the four pillars of prevention, treatment, enforcement and harm reduction was seen as fundamental to the strategy and was confirmed as a priority by the Steering Committee and the Community Network going into the second phase of the strategy.

Phase I (Summer 2005 - Summer 2006)

In the first phase of the project, multiple stakeholder and public meetings were conducted to identify the issues being faced in Ottawa and were refined through public consultations to the top two priorities. The June 2006 report identified the top issues as the need to increase public education and prevention efforts and the need to increase treatment capacity. It also recommended that a team be established to further investigate the issues of public saftey concerns related to drugs as well as to investigate the issue of disease transmission among the drug using population. High level concepts were referred to Phase II for plan development. In addition, the Community Network identified the need to ensure ongoing stakeholder engagement during the next phase.

DISCUSSION

Phase II (Summer 2006-Summer 2007)

The intent of Phase II of the strategy was to develop detailed project scopes, resource requirements, and work plans as well as to identify potential funding sources in response to the top two priorities. These plans will then be referred to phase III of the strategy for implementation. Likewise, a project team in phase II was established to further study the issues related to public safety concerns and disease transmission as they relate to the issues of addictions and substance abuse.

The Community Network adopted a project management approach to the plan development for phase II of the initiative and was supported by many members of the Community Network both as working members of the teams as well as leads for the projects. Detailed membership is provided in the attached Community Network report; however, specific mention should be given to the Local Health Integration Network and the Champlain Addictions Coordinating Body who led the treatment team. In addition, recognition should be provided to Public Health (who led the prevention projects) as well as to the Ottawa Centre for Research and Innovation (OCRI) who provided significant support to the prevention team through their youth coalition group. Finally, recognition should go to the Centre for Addictions and Mental Health who in conjunction with the United Way took on the difficult issues planning table and should be commended on the progress they have made to date. Recogniton to all team members should be acknowledged as significant time commitments and/or resource donations (room, equipment, photocoping etc) were made by all who participated in the development of the recommendations listed below. Staff also want to recognize the committment of the Community Network Co-Chairs who have provided leadership and direction on accessing support from other levels of government.

Priority One: Development of Action Plans to increase capacity in the area of Treatment

Through the first phase of the strategy high level solutions were identified for the City of Ottawa and the surrounding region in the area of Treatment. Over the last year, teams have been working to identify specific projects for implementation, funding requirements and sources needed to complete the initiatives.

The closest residential addictions treatment facility for youth under 16 years of age is 19 hours away in Thunder Bay and received 80% of its admissions from outside of their region in 2005 - 17% were from Ottawa. There is no residential treatment programs for Francophone girls under the age of 18 in Ontario and the closest residential treatment facility for Francophone boys 15 years and over is in Opasatika, (16 hours from Ottawa). There is one treatment facility in Carleton Place for youth 16 - 22 years of age, however has capacity to admit only 60 of the 125 referrals it receives every year. This lack of capacity results in outpatient programs maintaining clients who need residential treatment which is not only detrimental to those clients requiring residential treatment but also to those clients who need to access outpatient programs. As a result, a youth residential facility for youth ages 13 -17 is a high priority for the region and the Community Network is recommending the following:

Build a 48 bed residential treatment faciltiy for male and female youth ages 13-17, 16 Francophone beds (8 male and 8 female) and 32 Anglophone beds (16 male and 16 female). It should have an academic component and should be located in rural Ottawa. Estimated capital costs would be $ 8 million with a combined operating cost for French and English of approximately $5 million. It is the Province's responsibility to provide treatment with jurisdiction for youth treatment falling within a number of different ministries. Therefore funds should be sought from the Ministry of Health and Long Term Care, the Champlain Local Health Integration Network (LHIN), the Ministry of Education and the Ministry of Children and Youth Services with the project being completed by the end of 2010 if funding is available.

Both in literature and through the stakeholder engagement sessions conducted during this phase of the strategy, safe affordable accomodations were identified as a priority and imperative to provide better treatment outcomes. As a result, the Community Network have identified the need for an analysis of the need vs. the availability of residential supportive housing II in Ottawa. In conjunction with this recommendation the analysis will also include availability and need for housing for individuals prior to entering treatment. They recommend the following study be conducted:

2. Conduct an indepth housing analysis to determine the need and availability for pre and post stabilization housing for those using substances or leaving treatment. This analysis would cost approximately $50,000 which could potentially be sought from the Trillium foundation, the Champlain LHIN, Ministry of Health and Long Term Care or from surplus funds from Health Service providers. The anticiapted time to complete this study would be by the end of 2009 pending funding.

The project teams also identified the need to have a centralized access to services as well as the need for more withdrawal management beds (detox). Since these were priorities identified on the Local Health Integration Network's workplan and since it is within the mandate of the Ministry of Health and Long Term Care, the community network is supportive of the LHIN in the devleopment of the plans rather than to duplicate effort. In addition, the Community Network will make available the feedback from the stakeholder engagment process that was received around both of these projects to the LHIN.

Priority Two: Development of Action Plans to increase capacity in the area of Public Education and Prevention

Through the first phase, the public engagement clearly identified the need for more public education and prevention services in the areas of drugs and addictions. The cost to the local economy of alcohol and drug abuse can be estimated at approximately $625 million annually. As a result, efforts are needed to avoid these costs and therefore the community network identified the need to increase public education and prevention capacity in the region. While prevention does fall within the mandate of the City of Ottawa's Public Health branch it also falls within many other service provider's mandate. Collectively, multiple stakeholders with public education and prevention within their mandate developed the following project plans for implementation which are aimed at increasing public education and prevention capacity as identified as a need in phase I:

Develop a web-based comprehensive tool kit of information on substance use and abuse for schools and the community. This project would cost approximately $100,000 and would take approximatly 3 years to complete. Potential sources of funding could be from the City, Trillium Foundation, Public Safety Canada's Research and Knowledge and Development Fund or the federal government through the proposed new National Anti-Drug Strategy.

Develop a training, education and information sessions for youth, school staff, parents and youth service agencies. The proposed program would cost approximately $250,000 and would be implemented over 3 years. Again the National Anti Drug strategy might be one source of funding with additional funding being potentially provided by Crime Prevention Action Fund.

Develop a three (3) year Public Education and Awareness Campaign directed at youth in year one, parents in year 2 and the general public in year 3. This campaign would cost approximately $600,000 over the 3 years and could be eligible for funding from Financial institutions who have youth and health promotion as their social responsibility initiative as well as from the National Anti Drug Strategy.

While there are many needs within the area of Drugs and Addictions, given the availability of resources, the project teams focused their efforts where they felt the largest impact could be made. (Details of each project are outlined in the attached Community Network report with full detailed plans on file with the City Clerk's office)

Issues Planning: Public Safety Concerns and Disease Transmission

Understanding that the issue of drugs and addictions is a large and complex issue, the Community Network developed an "issues planning table" to continue examining drug related issues experienced by affected communities as well as the issue of disease transmission in the drug using population. Both of these issues, although not priorities in the first phase from the public's perspective, were issues the Community Network felt needed further investigation.

The "issues planning group" was multi sectoral with representation from all 4 pillars as well individuals living in, or running a business in, areas of the City most effected by open drug use and other unintended peripheral behaviour.

The group is proposing a number of initiatives which should be referred to the next phase of the strategy for scope, plan and resource development.

The Key projects include:

A feasibility Study on Substitution Therapy options for crack and cocaine addictions similar to methadone maintenance for opiate users.

Development of a peer support program for people who use substances.

Development of a public information program which would include materials and sessions for concerned stakeholders to facilitate a dialogue with affected communities about addictions, harm reduction policies and procedures.

Development of a joint education and training program involving service providers from police, treatment, harm reduction and prevention in order to facilitate an integrated approach to drug related issues.

An independent review of the "Safer Inhalation Program" delivered in Ottawa to determine its effectiveness. Funding for such a study would be subject to development of detailed Terms of Reference and will be included as part of Public Health's 2008 budget pressures.

In addition to developing the above concepts for project plan development, the "issues planning table" also made the following recommendations:

The Site Development Consultative Group membership (who provide guidance on harm reduction programming in Ottawa) be expanded to include Police, Crime Prevention Ottawa, BIA's, community representatives and service providers.

Pilot a coordinated, single access approach to addressing drug related issues as part of existing City of Ottawa or Community led problem solving mechanisms.

The City of Ottawa Councillors should seek support at other levels of Government to:

§ Increase primary care and support services for people using substances

§ Increase employment opportunities for people with substance use/and or mental health problems.

The City should advocate other levels of government for new or revised legislation in order to support efforts to address public disorder concerns. An example of new legislation would be enacting legislation similar to Manitoba’s Safer Communities and Neighborhoods Act. Another example of revised legislation would be expanding the mandate of the drug treatment court.

It is understood by the Community Network that while most of the recommendations are not within the City's mandate, the issues of drugs and addictions affect the City and the citizens who live here and as such are a collective concern.

Stakeholder Engagement Strategy

In the report presented to Council in June 2006, the Community Network clearly identified the need to have ongoing stakeholder engagement in the development of the proposed solutions. Specifically, the community network wanted to ensure engagement happened with the drug using population do determine what solutions would be most beneficial and how the solutions should be implemented to be most effective – the voice of experience.

In December 2006, a group of consultants specializing in engaging the community, were hired to develop and implement a stakeholder engagement strategy to ensure that not only were key stakeholders identified but also to ensure that they were given an opportunity to provide input into the process which will improve the likelihood of success of the recommended solutions.

Stakeholder Engagement Strategy

The stakeholder Engagement Strategy was conducted in two stages. The first stage of the process was to interview Community Network and Steering Committee members as well as to meet with individual project teams to determine who the key stakeholders would be. Through that process, a list of over 40 stakeholder groups ranging from service providers, aboriginals, youth, immigrants, educators and users were identified. A work plan was developed which identified key contacts for the groups, best method of engagement, as well as timelines for implementation.

The second stage of the engagement strategy was to conduct focus groups aimed at engaging the key stakeholders identified in the first stage and to receive feedback on behalf of the project teams. This would help to determine: if the project plans were appropriate to meet the objectives; what if anything needed to be changed or considered, and; how to best implement the plan to make it the most effective to those involved.

The same group of consultants were engaged to implement the work plan and they completed their sessions and compiled their findings in May 2007. Sixteen (16) focus groups ranging from current users, service providers, educators to those in treatment and families affected by substance use were conducted in April 2007 and May 2007. Generally the stakeholders were supportive of the recommendations presented by the project teams and felt that progress in the field of drugs and addictions would be made if these projects are implemented in Ottawa and the surrounding region. Findings for specific projects were forwarded to the teams for consideration and inclusion in their individual work plans.

Findings

Stakeholders from virtually all focus groups highlighted the cyclical nature of the journey from uncontrolled use of addictive substances to complete abstinence. Along that journey from pre-contemplation, to contemplation, to preparation, to action, to maintenance, to relapse, and then back to the beginning again – virtually no one makes the journey only once, with each step in order. Hence, all strategies, services and plans dedicated to helping people travel that journey must recognize the cycles and not impose barriers that prevent repeated attempts by people on the journey to change. Likewise, the proposed projects must be developed with this philosophy in mind. In addition, there was broad agreement that residential youth treatment is a serious need in our community as is the need for supportive housing for individuals post treatment to support the extension of controlled use or abstinence for individuals.

Important feedback from a survey of some stakeholders indicated that they felt that a large number of affected individuals would not benefit from a web-based toolkit as it had originally been recommended. The team has responded that the project will include making information available through other mediums for populations who do not have access to the INTERNET. There was also some concern that a public awareness campaign would not work for youth; however, the prevention team is committed to working with target audiences in the development of these campaigns to ensure effectiveness using similar approaches to the highly effective youth delivered, adult guided expose campaign against tobacco.

Overall, the feedback from stakeholders supported the need for the strategy to remove barriers to accessing services along a continuum. As well, the strategy should not only focus on abstinence as a goal but should also place emphasis on harm reduction. Costs of harm reduction and treatment programs are considerably less than the health and social costs of not offering these options. Likewise, there was belief that schools were the best way to provide prevention services to youth.

In all instances ongoing stakeholder engagement was endorsed as a part of the implementation plans. Teams are committed to continuing to engage partners to ensure success.

Funding Strategy

The implementation of the projects proposed by the Community Network is subject to the receipt of adequate funding. The challenge faced in the next phase of the strategy will be seeking, coordinating and securing funding from the numerous potential sources and coordinating the applications for those funds. The Community Network will develop a detailed funding strategy prior to initiating the implementation phase (Phase III).

Phase III (Summer 2007 - ongoing)

The focus of the next phase will be to acquire the required project funds from the various identified sources and then to organize project teams to implement the projects based on the plans developed in phase II.

Transition Strategy

The ensuing report from the Community Network will clearly identify solutions, timelines, funding requirements and potential sources for the implementation phase of the project. Going forward there needs to be an ongoing coordination effort both for the Community Network itself as well as the fund raising, grant applications and the ongoing project implementation. The Community Network will develop a structure that maximizes community ownership, respects jurisdictional responsibilities and facilitates funding opportunities in support of the next phase.

CONCLUSION

Over the past number of years, funding support to address substance abuse issues have been shrinking with a number of programs being discontinued and many others having been reduced due to lack of resources. Over the same time period, there has been an increase in the demand for services resulting in serious gaps in service provision. Ottawa is now at a critical juncture.

In an attempt to address the gaps in service and reduce the number of individuals affected by addictions, the Integrated Drugs and Addictions Strategy Community Network has identified a number of projects for implementation. Key to the success of these projects is the proposed collaborative approach to funding requests and the integrated approach to implementation and ultimately services delivery. No one solution is the answer.

While the majority of the projects proposed are not within the City’s mandate to fund, the support of the local politicians and their advocacy efforts are needed to allow the community network to lobby for support for the projects both to other levels of government as well as other potential funding sources.

The Community Network is seeking the support of City Council by having them endorse the proposed plans, by directing staff to implement specific recommendations as well as by lobbying their provincial and federal counterparts to address drugs and addictions in Ottawa and the surrounding region.

CONSULTATION

Ongoing Stakeholder Engagement was conducted in the development of the attached Community Network Report.

FINANCIAL IMPLICATIONS

Approval of the recommendations would increase the Public Health Branch operating budget in 2008, 2009 & 2010 by $13,200/year a total of $39,600. The funds would support the operating cost of the Web-based Comprehensive “Toolkit”. One-time funds of $6,000 would also be required in 2008 to fund a provision of a temporary project manager for the host agency. These funds are contingent upon securing additional funding for the “Toolkit” project of $73,600.

Additional funds are required in 2008 to fund a review of the “Safer Inhalation Program”. This review is dependant upon the Terms of Reference and the required funds and will be included in the 2008 Public Health Draft Budget.

SUPPORTING DOCUMENTATION

Document 1: Community Network Membership

Document 2: Integrated Drugs and Addictions Strategy Phase II – Project Plans

Document 3: Treatment- Youth Treatment Facility (On File with City Clerk’s Office)

Document 4: Treatment- Supportive Housing (On File with City Clerk’s Office)

Document 5: Treatment- Withdrawal Management (On File with City Clerk’s Office)

Document 6: Treatment – Coordinated Access (On File with City Clerk’s Office)

Document 7: Prevention - Public Education and Prevention Plans: Comprehensive Web-based “Toolkit” (On File with City Clerk’s Office)

Document 8: Issues Planning – Executive Summary (On File with City Clerk’s Office)

Document 9: Issues Planning- Addressing Public Disorder Issues (On File with City Clerk’s Office)

Document 10: Issues Planning- Addressing Health Issues & the Epidemic of HIV/HCV (On File with City Clerk’s Office)

DISPOSITION

The Community and Protective Services department to facilitate the Committee and Council directions.

DOCUMENT 1

Integrated Drugs and Addictions Strategy

Community Network

Addictions & Problem Gambling Services of Ottawa

Algonquin College Police and Public Safety Sector

Alliance to End Homelessness

Business Leader – O.C.R.I

Canadian Mental Health Association

Centre for Addiction and Mental Health

Chair of the Ottawa Crime Prevention Council

Chair Ottawa Youth Justice Services Network

Champlain Addictions Coordinating Body

Champlain Local Health Integration Network

Chief of Police

Children’s Aid Society

Children’s Hospital of Eastern Ontario

Conseil des écoles catholiques de langue française du Centre-Est.

Conseil des écoles publiques de l’Est de l’Ontario

Crisis Intervention – Ottawa Hospital

Dave Smith Youth Treatment Centre

Faculty of Medicine, Ottawa Hospital - University of Ottawa

Deputy Chief of Police

Deputy City Manager, Community & Protective Services

Director, Centre for Research on Community Services

Director, Employment & Financial Assistance

Emergency Room Physicians on staff with Ottawa Hospital

Executive Director Crime Prevention Ottawa

Focus Vanier(Action antidrogue Vanier)

Insurance Industry

Maison Fraternité

Media

Medical Officer of Health

Multicultural Health Representative,

OCCSB Ottawa-Carleton Catholic School Board

Ontario Ministry of Health & LTC - Local Health Integration Network

Ottawa Carleton District School Board

Ottawa Centre for Research and Innovation

Ottawa Coalition on HIV/AIDS

Ottawa Community Housing Corporation

Ottawa Hospital

Ottawa Youth Justice Network

Parent’s Advisory Committee

Parks and Recreation

Pharmacist, Bell Pharmacy

Popcorn Group

Operation Go Home

Residential Services, Housing Branch,

Rideauwood, Addiction & Family Services

Roberts Smart Centre

Royal Ottawa Hospital

SEM-ENG International Ltd. (Crime Prevention)

Superintendent of Special Education and Student Services

Superintendent of the French Public School Board

United Way Ottawa

University of Ottawa

Urban Aboriginal Coalition

Young/Single Parent Support Network

Youth Services bureau

DOCUMENT 2

Integrated Drugs and Addictions Strategy

Phase II – Project Plans

Submitted by: the Community Network

Introduction

The community network was and is very committed to ensuring that ongoing involvement was and continues to be sought from all affected individuals. Integral to the development of the second phase of the Integrated Drug Strategy was the concept of ongoing stakeholder engagement inclusive of service providers, educators, youth and most importantly those most effected by the substance abuse – the user themselves. Very early on in the stakeholder engagement phase of the project, the concept that a “One size fits all” strategy is not only ineffective, it is not desired.

Encouraging people affected by addictions to make positive changes and to engage in treatment

One of the most successful treatment models recognized in the field of addictions is the ‘Stages of Change’ model introduced by Prochaska & DiClemente[1] in the early 1980’s. This model recognized that people who are affected by addictions experience distinct stages in the journey to recovery. Each of these stages is associated with characteristic cognitive, emotional and behavioral traits and as such each stage require a unique set of intervention strategies and approaches in order to motivate the person living with addiction to make positive changes in their lives and to eventually engage in a treatment process.

The five stages of change outlined by Prochaska & DiClemente are referred to as : Pre-contemplation, Contemplation, Preparation, Action and Maintenance. At any point of this motivational change process the person may relapse. One of the important implications of the Stages of Change model is that each ‘stage of change’ requires a different treatment intervention.

For example, lets consider a youth who is engaged in dependent substance use. In this case, this youth is not considering treatment for his/her substance use problem and would be considered at the “Pre-contemplation Stage.” At this stage, the primary goal of an outreach worker in contact with this youth would be “engagement” in order to develop a working relationship. This may involve helping the person to secure housing, social assistance, medical services or food and may also involve the distribution of harm reduction supplies, such as clean needles or safe inhalation equipment, in order to reduce the risk of HIV and HCV while they are continuing to use substances. While these activities are being delivered the goal of intervention is to establish positive rapport with the youth.

Once a working relationship is developed, the person using substances may be more open to discussing the risks associated with their substance use, as well as the various treatment options. It is at this stage that the outreach worker uses motivational interviewing techniques to help the person to recognize how the risks may outweigh the benefits and to believe that change is possible. A significant part of this process is to help the person to articulate their life goals and to help them to see how their substance use may be preventing them from achieving these goals. It may take several such discussions over a period of time before the person is ready to enter into treatment.

Once a person is open to change, the outreach worker can assist the person to choose the treatment option that best fits their goals and circumstances. This may involve entering into an addiction program and/or support group to help them to reduce their use or stop using altogether, or it may involve addressing their cravings through a prescribed medication, such as methadone. It may involve an outpatient program, residential program, detox and/or peer support group. Although the explicit goal of any treatment program is to reduce substance use, treatment also includes helping the person to address some of the other psychiatric, psychological and social factors that may be contributing to substance use.

Unfortunately, a 21-day treatment program, or whatever treatment program the person chooses, is not necessarily the end of the journey. The majority of people who go through a treatment program will relapse along the journey to recovery. Part of a good treatment program is to provide the person with a “relapse prevention plan” that helps the person to understand the particular circumstances that lead to their substance use and what steps to take to either avoid these circumstances or intervene early before things get out of control.

Building a drug strategy on evidenced-based practices

It is with evidenced-based practices such as the Stages of Change and other models that the following project were identified, scoped and planned for the City of Ottawa and the surrounding area.

In addition, imperative to the success of any of the subsequent projects and recommendations is the requirement for ongoing integration and coordination among the four pillars of addictions and that strong leadership is required from all participants throughout next phase.

Finally, common among all the recommendations and project plans is the necessary evaluation process that will be conducted to insure that proposed projects and recommendations have been effective and achieved the stated objectives.

Substance Use and Abuse Education and Prevention Plan

Introduction:

The IDAS Substance Use and Abuse Education and Prevention Plan is comprised of three proposed projects to be delivered over a three year period in combination as a model for prevention substance use and abuse. Public Education and Prevention strategies about substance use and abuse were endorsed by the former Health Recreation and Social Services Committee in June 2006 as the priority issue identified by the community. The three combined projects will be A) A Web-based Comprehensive “Toolkit” B) Training, Education and Information Sessions and C) Public Education and Awareness Campaign(s). Each project will be defined separately below.

This proposed model can be adapted to various target populations addressing the needs of individuals over the lifespan. While IDAS has identified a need for public education and prevention activities directed at all age groups, it was determined that a simpler focused approach was more likely to lead to initial success. The initial three-year project plan has a youth focus as a pilot with an evaluation component built in on an ongoing basis. The community identified that youth was where they felt the greatest need for prevention existed. In addition, a comprehensive literature review indicated the need to develop tools for delivering an education and prevention program. The project plan envisages community leadership and will allow for the integration and coordination of existing key messaging, information and educational resources around substance use and abuse prevention. The model allows opportunity for the incorporation of messaging, information and resources around positive family functioning, communication and education to prevent substance use and abuse amongst youth. This project has the flexibility to be developed and implemented in alignment with future substance use and abuse public education and prevention initiatives regionally, provincially and federally.

The comprehensive prevention project plan requires the continued commitment and partnership of the various stakeholders in prevention, treatment, enforcement and issues planning to successfully address the needs of the community around substance use and abuse. The project allows for the integration and coordination of all of the stakeholders in implementation.

Project: Web-based Comprehensive “Toolkit” (Detailed Plan on file at the City Clerk’s office)

Team Membership for the IDAS Prevention Taskforce: The Prevention Taskforce comprised individuals representing a diverse range of agencies from Ottawa Public Health (Injury and Substance Abuse Prevention, School Health and Surveillance Epidemiology Evaluation and Research), Centre for Addiction and Mental Health, Ottawa Police Services, Royal Canadian Mounted Police, Crime Prevention Ottawa, Ottawa Carleton District School Board, Focus Vanier, Operation Go Home, Maison Fraternité, Rideauwood, Dave Smith Youth Treatment Centre, Algonquin College, Conseil des écoles catholiques de langue française du Centre-Est, Dave Smith Youth Treatment Centre, Royal Ottawa Health Care Group, Ottawa Centre for Research and Innovation and the City of Ottawa (Employment and Financial Assistance).

Objective: The objective of the Web-based Comprehensive “Toolkit” is to integrate, disseminate and enhance education around preventing substance use/abuse for youth from elementary through high school age.

Scope: The scope of the Web-based Comprehensive “Toolkit” is substance use and abuse prevention resources to be integrated and disseminated in the schools and the community. The Web-based Comprehensive “Toolkit” will be a clearinghouse that will include primary, secondary and tertiary prevention components with the identification of current resources including agencies and networks that are delivering the various services.

Estimated Costs: Total development, implementation and evaluation over 3 years: $119K

Funding Strategy: The Web-based Comprehensive “Toolkit” is financially the smallest of the three proposed projects. It has the advantage of being well defined with a visible product. Funders and sponsors can be readily acknowledged as part of the website for both financial and in-kind support. The initial development cost is the major component with the annual operating costs being approximately $13K/year X 3 years.

It is therefore proposed that the City consider taking on the operating costs of this project, plus $6K in Year 1 for the provision of a temporary project manager for the host agency. Once funding is secured the host agency within the community would then be required to take over the lead and develop and implement the prevention plan.

The evaluation (budgeted at $6500) could be separated into an initial development component and annual operational assessments/updates. A more thorough evaluation could also be potentially funded via Public Safety Canada’s Research and Knowledge Development Fund, although a link to crime prevention would have to be demonstrated.

The Trillium Foundation’s Community Program provides maximum contributions of $75K/year. Their priorities include enhanced student success and community engagement, which are compatible with the objectives of the “Toolkit”. Community partners, agencies and stakeholders should be approached to gauge their interest in this project.

The substance use and abuse prevention plan has a direct fit with the proposed new National Anti-Drug Strategy proposed funding commitment of $64M over two years for prevention, treatment and enforcement. If the funding strategy maintains a focus on community initiatives and is announced in time it could provide a source of support for all the projects identified in the prevention plan.

Table 1.0 Funding Strategy for the Web-based Comprehensive “Toolkit”

Potential Funding Sources	C. Year 1	D. Year 2	E. Year 3	F. Total Cost
City of Ottawa Operating Costs	$13,200	$13,200	$13,200	$39,600
Cost of a Temporary Project Manager	$6,000			$6,000
Trillium Development Cost	$66,600			$66,600
Public Safety Canada’s Research and Knowledge Fund Evaluation Costs	$2,000	$2,000	$2,500	$6,500
National Anti-Drug Strategy	tbd	tbd	tbd
			Total “Toolkit” Cost	$118,700

Timelines: The Web-based Comprehensive “Toolkit” work plan includes: Funding, Planning/Web- based Development, Implementation/Launch and Evaluation to be implemented over a three-year period once the funding has be acquired.

Stakeholder Engagement Feedback:

Feedback from the engagement consultation was as follows:

Web-based comprehensive toolkit

§ less access to web in public places for people without home access[is an issue].

§ Website is okay idea, but needs to be simple for adults, interactive for youth and kids; some accessibility issues for some users

Recommendation:

Strategies around how people without home access to the web could be explored further in the development phase of the project and the host agency who takes the lead would need to address this as part of their dissemination strategy. The concept design of the “toolkit” calls for input from community stakeholders into the development of the “toolkit” that would also allow for further brainstorming around access to substance use and abuse information on the web. This would require a further investigation into promoting access to computer locations in the community.

The host agency would also need to ensure in the development stage in consultation with the community stakeholders and partners that it is simple to use and interactive for youth. The concept design for the “Toolkit” allows for the flexibility to include these key points in the process towards implementation.

Final recommendations for Implementation (“Toolkit”):

The following recommendations are being proposed to ensure the success of the “Toolkit” implementation:

1) The host agency will be responsible for the overall project development and implementation and will be required to secure funding through the “coordinating committee”. The agency that hosts the Web-based Comprehensive “Toolkit” should have a local presence with the credibility within the community to be the “clearinghouse” for substance use and abuse prevention for the City of Ottawa. This agency needs to have the capacity to communicate efficiently and effectively in French and English.

2) It is recommended that the City of Ottawa fund the three-year operating cost of this project ($13K X 3 years) plus $6K in Year 1 for the provision of a temporary project lead to work with the host agency.

3) The temporary project lead needs to be retained by early fall 2007 to begin coordination of the development and implementation phase of the “toolkit” plan

4) The temporary project lead will work with the host agency to begin the process of writing a proposal in order to secure the resources to start the development of the “clearinghouse”.

5) Once funding has been secured by the host agency, they will then be required to take over the lead of the project. The host agency will be required to hire a web developer to assist them with the development and implementation of the “clearinghouse” and secure the staff required as outlined in the work plan and follow the concept design and scope of the “Toolkit”. The host agency will be responsible for the ongoing evaluation of the Web-based Comprehensive “Toolkit”.

6) Long-term sustainability of the Web-based Comprehensive “Toolkit” clearinghouse will require a commitment of continued financial support by funders. The host agency will be required to resubmit requests for financial support as required to sustain the “clearinghouse” after the three year proposed plan.

Project: Training, Education and Information Sessions (Detailed Plan on file at the City Clerk’s office)

Objective: The objective of the “Training, Education and Information sessions” is to increase and/or enhance school staff, parent, youth service agencies and youth awareness, understanding, comfort level around preventing substance use and abuse.

Scope: The scope of the “Training, Education and Information Sessions” are on youth substance use and abuse to youth, school staff, parents, youth serving agencies, around primary, secondary and tertiary prevention.

Estimated Costs: Total development and delivery over 3 years: $257K

Funding Strategy: The “Training, Education and Information Sessions” carry a relatively small development cost, but require over $76K/year for delivery to target audiences i.e., youth, parents, school staff and youth serving agencies over three years. A significant evaluation of the initiative will be required to justify continuation beyond the proposed 3-year prevention project plan. It is also possible that after an intensive period of delivery, the frequency of training and/or education sessions could be decreased for certain target audiences. A well planned thorough evaluation will required to assess the frequency of need (For example, once a core group of school staff have received training, there will be less need to fund annual release days for this purpose.)

This project may be well suited for support through the Crime Prevention Action Fund. The Action Fund offers up to $100K/year for up to 3 years. Consultation with the Action Fund program officers is recommended to ensure the training, education and information sessions component of the IDAS prevention plan project fit within their guidelines.

Table 2.0 Funding Strategy “Training, Education and Information Sessions”

Funding Source	Year 1	Year 2	Year 3	Total Cost
Crime Prevention Action Fund Development, Delivery and Evaluation	$100,000	$75,000	$81,500 (includes $6,500 for evaluation)
National Anti-Drug Strategy	tbd	tbd	tbd
			Total Training, Education and Information Costs	$256,508

Timelines: The “Training, Education and Information Sessions” work plan is divided into the following phases: Funding, Planning/Development, Implementation and Evaluation to be delivered over a three-year period once funding has be acquired.

Stakeholder Engagement Feedback:

The feedback on the implementation plan for the training, education and information sessions was as follow:

Prevention training, education and information sessions for school age youth

§ emphasis that it must be youth to youth, and that people need to be ready to hear the message, so one time is not enough

§ suggestion of “walk a mile in the shoes of an addict” – a video made “one day in the life of an addict”

§ Education/training needs to be youth-to-youth, and provided by the voice of experience. A minority think there is a need to use positive messages; most, especially users, think “a day in the life” in detox or treatment or on the street would be helpful, perhaps by video?

Recommendation:

The concept design for the education sessions for youth includes the provision of positive youth role model(s) being involved in the development and implementation of the education sessions. This allows for a youth to youth emphasis with adult guidance. The education sessions are to run over three years once funding is secured and can be revisited after the final evaluations are received after year 3 on the outcomes to ensure the best approach to ensure sustainability over the long term.

The suggestion of including the “walk a mile in the shoes of an addict” video should be explored by the host agency to determine how it could be incorporated appropriately into the education modules as one of the resources for reference and use. It would require further input and feedback from youth, parents, educators and youth serving agencies during the development and implementation phase. All resources considered for inclusion in any of the education modules should have a primary, secondary and tertiary focus which will compliment the prevention scope in a broader range.

Final recommendation for Implementation:

The following recommendations are proposed to ensure the success of the ‘Training, Educations and Information Sessions”:

1) A host agency within the community needs to develop, deliver and evaluate the “Training, Education and Information Sessions.

2) The host agency will be required to secure funding through the “coordinating committee” and hire a project lead to assist with the coordination and initial development of the project. This should begin by mid fall 2007. The community agencies with the capacity to provide bilingual, training, education and information would be encouraged to write proposals.

3) The project lead needs to work with the host agency to build on the partnerships that were created with the multi-sectoral agencies and school boards in phase II of the prevention project planning. This should occur by mid to late fall 2007.

4) Any necessary committees and coalitions required to organize the training, information and education sessions would need to be in place by late fall, early winter of 2007. There should be continued collaboration with the Substance Abuse and Youth in Schools Coalition to leverage efforts with the school boards and their officials.

5) The evaluation would be carried out on an ongoing-basis by the host agency.

Project: Public Education and Awareness Campaigns (Detailed Plan on file at the City Clerk’s office)

Objective: The objective of the campaign(s) is to reduce the rate of youth substance use and abuse and to increase public awareness by providing accurate and current information about the risk and protective factors associated with youth substance use and abuse.

Scope: The scope of the Public Education and Awareness Campaigns is youth substance use/abuse prevention geared toward Youth (Year 1), Parents (Year 2) and the General Public (Year 3).

Estimated Costs: Total cost approximately is $615K ($200K - $218K per year for each of the 3 campaigns).

Funding Strategy:

Public Education and Awareness Campaigns (Youth, Parents and General Public):

The three-year consecutive “Public Education and Awareness Campaign” carry the highest total cost, and exceed levels typically provided by established funding programs and foundations. However, the campaigns have the advantage of being designed to be highly visible to a broad cross-section of the community, and therefore may have some appeal to certain private sector partners.

Some of the financial institutions have a focus on youth and/or health promotion for their social responsibility initiatives. Depending on the nature of the advertisements some financial institutions may consider sponsorship of positive community messages around substance use and abuse prevention a worthwhile investment. Even so, any one company is likely to contribute only a fraction of the total project cost, given that the visibility is limited to Ottawa. A small number of compatible private partners may need to be assembled.

Timelines: The Public Education and Awareness Campaigns work plan is divided into the following phases: Funding, Planning/Development, Launch and Evaluation with a three year roll out plan starting once funding has been acquired. The roll out of the campaigns is broken up into Year 1 (Youth focus), Year 2 (Parent focus), and Year 3 (General public focus).

Stakeholder Engagement Feedback:

Feedback from the stakeholder engagement consultation on the public awareness campaign for Youth for Year 1is as follows:

Public Awareness Campaign

§ Priority should be given to interactive youth outreach.

Recommendation:

The concept design for the campaign for Year 1 includes the provision of youth being involved in the development component and implementation during the next phase. Youth could look at building a part of a campaign around a youth interactive outreach approach. It would also be the responsibility of the social marketing firm and host agency to ensure that the campaign has a primary prevention focus for youth during the development and implementation phase.

There are many successful youth delivered adult guided campaigns that have raised awareness and reduced rates and changed attitudes around substance use and abuse. Raised awareness is a predecessor to attitudinal and behavioural change. It is recommended that youth participate in the establishment of key messages and approaches. Education and Awareness campaigns that avoid dictating to youth are considered best practice and have a greater impact.

Final recommendation for Implementation:

The following recommendations are being proposed to ensure the success of the “Education and Awareness Campaigns”:

1) The interested host agencies will be required to write a proposal to the “coordination committee” to secure funding. The host agency should have a local presence and capacity to work in collaboration with multi-sectoral agencies and organizations.

2) Once a host agency has secured funding they need to retain a project lead to coordinate the project and assist the agency in hiring a social marketing firm who will be retained to start developing the campaigns. The social marketing firm would need to be retained by mid fall 2007.

3) Any funds secured to develop and implement the campaign project would be held in trust by the sponsorship member of the “coordination committee” and administered to the host agency as per the project resource plan.

4) It would then be the responsibility of the Social Marketing firm to carry out the implementation campaign plan as per the scope, concept design and work plan, working collaboratively with all the stakeholders and multi-sectoral agencies and target groups and host agency. The social marketing firm would need to have a local presence with the capacity to work in French and English.

5) The host agency would be required to oversee the social marketing firm for support and to ensure project success and to distribute the resources and complete any necessary reports.

6) The social marketing firm would be required to carry out the evaluation of the campaigns as outlined in the project scope, concept design, work plan and resource plan.

Treatment Introduction

Addiction and mental health reform remain incomplete in the Champlain region and addiction services were reaffirmed as key themes through the Integrated Drugs and Addictions Strategy City of Ottawa stakeholder engagement process.

In order to address gaps in service and achieve better outcomes for clients affected by addictions and mental health, the Treatment Task Force has identified four projects for implementation. The projects include: a) Residential Addiction Treatment for Youth; b) Development of Additional Withdrawal Management Capacity; c) Coordinated Access and; d) Supportive Housing Level II.

Project: Youth Residential Addiction Treatment (Detailed Plan on file at the City Clerk’s office)

Team Membership for the IDAS Treatment Taskforce: The Treatment Taskforce comprised individuals representing a diverse range of agencies within the Addictions, mental health and other health sectors including: the Youth Residential Treatment Working Group, Parent Representative, Dave Smith Youth Treatment Centre, Maison Fraternité, Roberts Smart Centre, Rideauwood Addiction and Family Services, Children’s Hospital of Eastern Ontario and Royal Ottawa Health Care Group, Alwood Treatment Centre, Ottawa Police Services; and additional stakeholders/consultants including: Addiction Services of Eastern Ontario, Centre for Addiction and Mental Health, Addiction and Problem Gambling Services of Ottawa, Wabano, Youth Services Bureau, Addiction Referral Services Renfrew County, Le Guichet pour francophones, Canadian Mental Health Association and Champlain LHIN.

Objective: The objective of the Youth Residential Addiction Treatment is to increase service

capacity throughout the substance abuse continuum by developing Residential Addiction Treatment Programs for Youth.

Scope: Develop Residential Addiction Treatment Programs for Youth between the ages of 13

and 17 years within the central Champlain area with distinct programs for Anglophone

and Francophone youth and males and females.

Estimated Costs: Projected total annual operating costs for the Anglophone male and female youth residential addiction treatment programs including academic component (32 beds): $3,156,650

Projected total annual operating costs for Francophone male and female youth residential addiction treatment programs including the academic component (16 beds): $1,759,225

Projected capital costs: $7,920,000

Funding Strategy: This project has a youth focus and requires annualized operating costs and could fall under the purview of the following provincial governments: Ministry of Health and Long Term Care, Champlain LHIN, Ministry of Education, Ministry of Child and Youth Services, municipalities and other.

The funding strategy for the capital costs of this project can potentially seek financial support from the following: Ministry of Health and Long-Term Care, Trillium Foundation, the municipalities, Senators’ Foundation, private fundraising and other.

Timelines: It is hoped that the youth residential treatment programs would be up and running by September 2009/10

Stakeholder Engagement Feedback: There was broad consensus that such facilities are an urgent priority. When asked about preferred location, there was broad agreement that the setting should be rural, but not too far to make visits from family difficult. One youth group felt that young women-only groups were a key component of treatment.

Final recommendation for Implementation:

The following recommendations are being proposed to ensure the success of the “Youth Residential Addiction Treatment”:

1) It is recommended that the Youth Treatment Working Group of the Champlain Addiction Coordinating Body (CACB) seek funding and that a lead transfer payment agency be identified once funding has been secured.

2) It is recommended that contribution (in-kind and other) from the City of Ottawa be provided for permits, service hook ups and review design drawings and building code by city staff.

Project: Coordinated Access (Detailed Plan on file at the City Clerk’s office)

Objective: The objective of the Coordinated Access project is to offer an entry into the treatment system to individuals with addiction and/or mental health problems who do not have established access linkages. The Coordinated Access would provide preliminary screening to callers to determine the most appropriate treatment provider(s), refer to that (those) services(s) and follow up at appropriate intervals to determine continue engagement and client satisfaction.

Scope: Develop a coordinated system for both addiction and mental health, which recognizes and responds to the needs of the Francophone population, as well as other linguistic, cultural, and gender needs. This Coordinated System would include centralized information regarding local and provincial treatment service information, coordinated screening and referral processes and protocols, as well coordinated linkage and follow-up services.

Estimated Costs: TBD

Timelines: Ongoing

Stakeholder Engagement Feedback: The City of Ottawa conducted focus groups, gaining important feedback from the stakeholders. The concerns identified will be brought forward to the appropriate health service providers’ network. Following is a summary of some issues raised during the discussions.

Some concerns that co-ordinated access may mean a road block, as was currently described with one assessment tool being used in too few locations.
Also concern that it may not recognize distinct needs, e.g. youth rather than adults, or Inuit who prefer to do thing as a group

Final recommendation for Implementation:

Access is currently a health priority under the Integrated Health Service Plan of the Champlain LHIN

1) It is recommended that the Champlain Addiction Coordinating Body and the Champlain Mental Health Network look at gaps in coordination and system linkages, to assess Champlain-wide existing capacity and to gain consensus on a comprehensive region-wide model

2) It is recommended that a user-friendly access point (for example one telephone number/website) to the addictions and mental health treatment systems be considered

3) It is recommended that a common screening process and protocols can be established with service providers Champlain-wide

4) It recommended that this project builds on the existing infrastructure work done by the Five Counties and Le Guichet pour francophones

Project: Withdrawal Management Services (Detox Services) (Detailed Plan on file at the City Clerk’s office)

Objective: The objective of this project is to increase the capacity of withdrawal management services in Ottawa.

Scope: The scope of the Withdrawal Management Services Project (WMS) is to increase the Ottawa Residential Withdrawal Management Services residential capacity from 20 to 26 beds; enhance current services to a level II and eventually to a level III; establish a comprehensive Community Withdrawal Management service targeting primarily women, seniors and youth.

Estimated Costs: Work within the current operating allocation for withdrawal management services provided by the Champlain LHIN and make application for additional operating funds as required.

Funding Strategy: Currently funded by the Champlain LHIN

Timelines: Secure a new location by the end 2008/09 fiscal year

Stakeholder Engagement Feedback: The concerns identified were at the program level and will be brought forward to the appropriate health service providers’ network. Following is a summary of some issues raised during the discussions.

o Issues with reference to abstinence as measure of withdrawal success, when for many, even reduction or control of use is success.

o issues raised with complete withdrawal of services if there is any movement from abstinence to use, when the reality is that there are cycles, and it is rare for someone to go from heavy use and addiction to complete and permanent abstinence

o Consistent message about inadequacy of existing programs – not enough to do, boredom leads to recidivism, and programs don’t address underlying issues that led to addiction in the first place, making it more likely to return to drug use as a way to deal with lack of life skills, anger management, affordable housing, adequate nutrition, and so on.

Final recommendation for Implementation:

The Ottawa Residential Withdrawal Management Services is under the purview of the Champlain LHIN and withdrawal management services are currently a stated objective of the Integrated Health Services Plan of the Champlain LHIN.

As per the recommendation identified in the planning report prepared in the fall of 2006 “The Gateway to Ongoing Treatment”, it is recommended that Billy Buffett’s House of Welcome consider changing its mandate to meet the community need for stabilization beds for 4-8 weeks.

Project: Supportive Housing Level II – Analysis (Detailed Plan on file at the City Clerk’s office)

Team Membership for the IDAS Treatment Taskforce: The Treatment Taskforce comprised individuals representing a diverse range of agencies within the Addictions, mental health and other health sectors including: the Youth Residential Treatment Working Group, Parent Representative, Dave Smith Youth Treatment Centre, Maison Fraternité, Roberts Smart Centre, Rideauwood Addiction and Family Services, Children’s Hospital of Eastern Ontario and Royal Ottawa Health Care Group, Alwood Treatment Centre, Ottawa Police Services; and additional stakeholders/consultants including: Addiction Services of Eastern Ontario, Centre for Addiction and Mental Health, Addiction and Problem Gambling Services of Ottawa, Wabano, Youth Services Bureau, Addiction Referral Services Renfrew County, Le Guichet pour francophones, Canadian Mental Health Association and Champlain LHIN.

Objective: The objective of this project is to develop an analysis of what is available and what is required in increasing Champlain’s region capacity to provide safe, affordable accommodations to clients following treatment for youth.

Scope: The scope of the Support Housing Level II project is to develop a more in depth analysis in order to have a clearer understanding of what is available, what is required and what options exist for partnership development. Primary need areas for this service have been set as Francophone, youth, women and Aboriginal peoples.

Estimated Costs: The estimated cost is $50,000

Funding Strategy: The Supportive Housing Level II Analysis project would carry one-time cost. This project may be well suited for support from the Trillium Foundation, Champlain LHIN, Ministry of Health and Long-Term Care, surplus funds from Health Service Providers in the sector, municipalities and other.

Timelines: Fiscal year ending 2008/09

Stakeholder Engagement Feedback: The response to questions about supportive housing from many, especially front-line workers, and those with direct experience with using drugs, indicated that supportive housing was the most important single program that could support reduced use or abstinence.

Final recommendation for Implementation:

1) It is recommended that a committee be struck to coordinate a detailed analysis and develop a business case identifying inventory, client group, needs, and gap analysis including cost.

Issues Planning

On May 11, 2005 Council directed that an Integrated Drug Strategy for Ottawa be developed in response to the need to address the most critical drug-related issues in an integrated way across the whole population. Based on service provider and community consultations, it was recommended that issue planning tables be established to seek solutions related to:

a) The co-ordination between City services, other service providers and key community stakeholders enabling neighbourhoods to deal with drug-related problems; and

b) Balancing the need to address the HIV and Hepatitis C rate among the drug using population in Ottawa while addressing the concerns of the community and the safety of front line workers.

The complexity of this task is best summarized in the following statement from an interview with Wolfgang Götz, Director of European Monitoring Centre for Drugs and Addiction:

Local authorities have to deal with an apparent conflict. On the one hand, they are expected to help drug users, guiding them into treatment and making sure they have a certain quality of life. On the other hand, they need to protect the wider community against crime and public nuisance. From this perspective, local authorities always have to find the best compromise between law enforcement and social and healthcare interventions (http://www.eukn.org/eukn/news/2007/04/interview-mr-gotz-emcdda_1011.html)

Over several months, a diversity of stakeholders, including community representatives, consumers, police, public health, addiction and social service agencies, met to identify key issues of concern surrounding drug use, including its impact on HIV/HCV rates and its impact on public disorder, as well as solutions which incorporate a 4-pillar coordinated and integrated approach. Although the Issues Committee came up with 20 recommendations, only 14 recommendations received majority support, indicating the diversity of viewpoints and the importance of on-going dialogue.

Guiding Principles

The issues planning table working group endorsed the following guiding principles in the development of the recommendations:

§ All solutions should be guided by evidence based practices

§ Adoption of the “stages of change” intervention model

Issue: The co-ordination between City services, other service providers and key community stakeholders enabling neighbourhoods to deal with drug-related problems (Detailed Plan on file at the City Clerk’s office)

Team Membership (organizations represented): Public Health, Ottawa Police, Rideau-Vanier BIA, Dalhousie Safety Committee, Sandy Hill CHC- OASIS, Salvation Army, CMHA, Maison Fraternité, CAMH, Crime Prevention Ottawa, Youth Services Bureau, United Way, Consumers (youth & adult), Roberts Smart Centre, Carleton University Mass Communication Student team.

Background: A number of neighbourhood issues were identified including: pan-handling, drug dealing, street prostitution, crack houses, crack use in public, overall increase in drug use, noise & fights, violence, fear, break-ins, shoplifting, property damage, discarded drug equipment and gangs.

Although there is no “quick fix” to most of these issues, there was consensus among members of the committee that any response needed to be multi-disciplinary, coordinated and easy to access.

One of the community representatives put it this way:

We understand that the addiction to crack cocaine and other substances present a serious risk to increased HIV and HepC rates in Ottawa. However we also recognize that certain communities are experiencing unrelenting pressure on their businesses and family life. We recognize that the agencies who counsel addicted persons have a responsibility to continually educate their clients about the effects of their open drug use on the life of their community. We believe that our harm reduction programme must be fully supported by full police enforcement, excellent prevention strategies and increased treatment options.

Objective: Develop integrated solutions intended to respond to community safety and address public disorder concerns as it pertains to illegal drug activities

Stakeholder Engagement:

Recommendation:

1. Develop a one-year pilot initiative, with an evaluation component (report card), that coordinates existing internal city services (police, public health, bylaw services, fire, paramedics and employment and financial assistance), the drug court, private security, community services (eg. outreach, mental health & addiction), people who use substances and other stakeholders to respond proactively to non-crisis public disorder incidents (eg. police address illegal drug use while a community outreach worker engages the person who is using drugs in motivational counselling). The feasibility of integrating or coordinating this initiative with other existing initiatives would be explored.

This would not replace 9-1-1 calls in the case of life-threatening emergencies and/or crime in progress. There would be a centralized telephone number for the general public to use to access this integrated response, although the integrated service response would be proactive and not wait for the community to call. The feasibility of using the city’s 3-1-1 number to triage the calls would be explored, as would the feasibility of offering this service in French as well as English. The initiative would be focused on a particular neighbourhood and the mandate would be clearly communicated through the BIA and existing Neighbourhood and Business Watch programs, so as not to encourage unrealistic expectations.

Note: As part of this recommendation, the Issues Planning Committee supports the motion accepted by the Community Protective Services Committee and brought forward by Councillor Bédard that is aimed at integrating a coordinated response to problematic addresses in Rideau-Vanier. Implementation should explore the need for any coordination between these two initiatives.

The pilot initiative would include the following steps:

o Establish a multi-disciplinary steering committee (including representatives from public health, police, addiction and mental health outreach programs, shelters, BIA, neighbourhoods and people who use drugs) to oversee the project, identify multisectoral solutions and to resolve any conflicts which may arise.

o Develop a partnership agreement between member organizations to work together to address drug use and safety concerns.

o Conduct an inventory of existing outreach services and related programs in the affected neighbourhood.

o Develop a proactive response model that coordinates member agencies and outreach services, along with a one-stop shopping telephone number for the general public to use to access these integrated services.

o Build in an evaluation component to measure the impact of this initiative on the community and of the ability of the committee to implement multisectoral solutions and resolve complex issues. The evaluation would include recommendations concerning its continuation and transferability to other neighbourhoods.

o Implement and oversee the initiative.

o Evaluate its effectiveness and make recommendations concerning its sustainability and transferability.

The City should advocate other levels of government for new or revised legislation in order to support efforts to address public disorder concerns. An example of new legislation would be enacting legislation similar to Manitoba’s Safer Communities and Neighborhoods Act. Another example of revised legislation would be expanding the mandate of the drug court.

Funding Strategy

Costs:

In the event that the 311 number is not a feasible option, the main recommendation that would require additional funding is the one-stop shopping telephone line to access the multidisciplinary response team. Besides establishing the line, the main cost would be the salaries of trained staff to triage the calls and coordinate an effective and timely response. Since there is already a similar model in place for mental health through the “Mental Health Crisis Line” and corresponding “Mobile Crisis Team,” the committee recommends consulting with the manager to determine how much it would cost to operate a similar service. An additional cost would be to hire a researcher to evaluate the model’s effectiveness.

Sources of potential funding

(1) Provincial Government- Ministry of Health

(2) Federal Government- Ministry of Justice

(3) Crime Prevention Ottawa

(4) Community Foundation of Ottawa

Issue: Balancing the need to address the HIV and Hepatitis C rate among the drug using population in Ottawa while addressing the concerns of the community and the safety of front line workers (Detailed Plan on file at the City Clerk’s office)

Background:

Ottawa has an HIV and HCV rates that are cause for concern. The HIV and HCV rates among injection drug users are the highest in the province and the HIV rate is the second highest in the country after Vancouver (Injection Drug Use, HIV and HCV Infection in Ontario: The Evidence 1992 to 2004, Faculty of Medicine, University of Toronto, 2004: 16, 38). Although the various harm reduction programs, including needle exchange and glass stem distribution have helped to reduce the transmission of HIV and HCV, there is still cause for concern. More needs to be done to reduce the sharing of drug equipment and to encourage people who use drugs to consider treatment.

Team Membership: Public Health, Ottawa Police, Rideau-Vanier BIA, Dalhousie Safety Committee, Sandy Hill CHC- OASIS, Salvation Army, CMHA, Maison Fraternité, CAMH, Crime Prevention Ottawa, Youth Services Bureau, United Way, Consumers (youth & adult), Roberts Smart Centre, Carleton University Mass Communication Student team.

Objective: Develop integrated solutions intended to respond to the epidemic of HIV and HepC among Ottawa’s drug using populations

Recommendation: The working group recommend that the following projects be referred to phase III for project plan development

Projects:

Increase in treatment options and in particular explore the feasibility of substitution therapy for crack and cocaine addictions similar to methadone maintenance for opiate users.

The establishment of a sustainable peer driven intervention plan for people who use substances

Joint education and training sessions with key stakeholders from enforcement, treatment, harm reduction and prevention in order to create an integrated approach

Public Information materials and sessions with all concerned stakeholders, to dialogue with affected communities about addictions, harm reduction policies and procedures and their immediate and long-term impact on the individual and neighborhoods

An independent operation review of the “Safer Inhalation Program” delivered in Ottawa to determine its effectiveness. Funding for such a study would be subject to detailed Terms of Reference and should be included as part of Public Health’s 2008 budget pressures.

Priority Actions: The working group recommends the following for immediate implementation

1. The Site Development Consultative group be expanded and be used as a vehicle to bring various stakeholders together including Public Health, Police, Crime Prevention Ottawa, BIAs, community representatives, Service Providers and Service Users to provide ongoing guidance to harm reduction programming in the City.

2. The Supportive Housing Level II Analysis Project (identified in the treatment priority section) be expanded to include supportive housing for individuals not yet involved in a treatment program (ie., Housing First)

3. City advocate other levels of government to:

§ Increase Primary care and support services for people using substance

§ Increase Employment opportunities for people with substance use and/or mental health problems (ie., Rideau BIA youth employment initiative in partnership with Operation Go Home)

Stakeholder Engagement:

Funding Strategy

The cost of each of these projects and potential sources of funding will subject to project development plans in the next phase of the initiative.

[1] Prochaska, S.G., J.A. et C.C. DiClemente. The trans-theoretical Approach: Toward a more integrative model of change, Psychotherapy: Theory, Research and Practice, 19 (3), 1983, 276-288.

COMMITTEE RECOMMENDATIONs

Four Pillar Approach

DISCUSSION

Stakeholder Engagement Strategy

Funding Strategy

Phase III (Summer 2007 - ongoing)

Transition Strategy

Project: Web-based Comprehensive “Toolkit” (Detailed Plan on file at the City Clerk’s office)

Table 1.0 Funding Strategy for the Web-based Comprehensive “Toolkit”

C. Year 1

D. Year 2

E. Year 3

F. Total Cost

Project: Training, Education and Information Sessions (Detailed Plan on file at the City Clerk’s office)

Estimated Costs: Total development and delivery over 3 years: $257K

Table 2.0 Funding Strategy “Training, Education and Information Sessions”

Year 1

Year 2

Year 3

Total Cost

Total Training, Education and Information Costs

Estimated Costs: Total cost approximately is $615K ($200K - $218K per year for each of the 3 campaigns).

Funding Strategy:

Objective: Develop integrated solutions intended to respond to community safety and address public disorder concerns as it pertains to illegal drug activities

Funding Strategy

Objective: Develop integrated solutions intended to respond to the epidemic of HIV and HepC among Ottawa’s drug using populations

Recommendation: The working group recommend that the following projects be referred to phase III for project plan development

Funding Strategy