1. CLINICAL APPLICABILITY AND COMMUNITY CAPACITY BUILDING IN SUBSTANCE USE AND MENTAL HEALTH EDUCATION Presented by: Debora Steele, RN BScN C.P.M.H.N.(C) GNC(C), Providence Care Mental Health Services Jennifer Barr, B.A., CAMH Healthy Aging Project Lead Centre for Addiction and Mental Health

2. Conflict of Interest Declaration CAMH led project – quantitative and qualitative evaluation results Collaborative agreement with P.I.E.C.E.S. Consult Group

3. Developing Training and Education Resources “Making the Connection Work: Identification and Support for Older Adults with Substance Use and/or Mental Health Problems” A one-day community based workshop

4. Training Description Developed and piloted by the Centre for Addiction and Mental Health in partnership with P.I.E.C.E.S. Consult Group Target audience for this training is Ontario professionals working with older adults in a variety of roles, as well as those in the addiction and mental health fields.

5. Training Team Integral to this training is the model of an older adult addiction specialist teaming up with a Psychogeriatric Resource Consultant as co- facilitators.

6. Ontario older persons specific addiction programs COPA (Toronto) LESA (Ottawa) Sister Margaret Smith (Thunder Bay)

7. Content of the Workshop Information on older adults with mental health issues &/or substance use Integrates a P.I.E.C.E.S. approach Community capacity building component

9. Alcohol Issues Alcohol is still most common problem substance As people get older they become more sensitive to the effects of alcohol and may be more vulnerable to alcohol’s negative effects Injuries due to falls Liver disease Can worsen: –Diabetes –Heart disease or elevated BP –Stomach problems –Mental Health Issues

10. 44.5% of Canadian have tried marijuana in their lifetime. Important fact is that drug use as a whole has increased in the last decade. Are we screening for it? Older Adults are still largely not seen as users. Beginning to see use of drugs like crack cocaine in men 55+ -- homeless and marginally housed Illicit Drugs - The Next Generation

11. Prescription Medication Misuse Benzodiazepines Sedatives/Sleep Analgesics/Opiates

12. Signs of Aging or an Alcohol/Drug Problem? Confusion Depression Disorientation Unsteady gait/falls Recent memory loss Loss of interest in activities Social isolation Tremors Irregular heart rate Poor appetite Stomach complaints

13. Barriers to Treatment Personal Barriers: –Shame –Guilt –Stigma –Uncertainty about the process Accessibility Attitudes: –Societal –Family –Health –Cultural –Health Prof. Health Status

14. Best Practices Recognizes that isolation and on-going losses are risk factors for addictions Is client-centred & older adult specific Utilizes outreach services Takes a harm reduction approach Is flexible, non-threatening, unhurried Addresses basic living needs

15. Best Practices Addresses socio-cultural differences Demands collaboration among treatment and health care professionals

16. Key Approaches Go to where the client is at physically, mentally and emotionally Assess stage of change Employ principles of harm reduction

17. Putting the P.I.E.C.E.S....Together P PhysicalCornerstones I Intellectual of the E Emotional P.I.E.C.E.S. C Capabilities philosophy E Environment of care S Social/ Cultural

18. Goals of P.I.E.C.E.S. Learning Initiative: To provide:  a common vision and set of values  a common language and knowledge for communicating across the system  a common yet comprehensive approach for thinking through problems

19. 3-Question P.I.E.C.E.S. Template Q. 1 Q. 1 What has changed?  Avoid assumptions; think atypical. Q. 2 Q. 2 What are the RISKS and possible causes?  Think P.I.E.C.E.S. Q. 3 Q. 3 What is the action?  Investigations  Interactions  Information

20. Community Capacity Building Understanding the Problems and Identifying Stakeholders Building Community Capacity Leveraging Resources Follow-Up

21. Evaluation Three-month post-event evaluation of first pilot training has shown that participants are able to recall and have applied concepts that they have learned in the training to their clinical practice. Of 43 participants tested after the second pilot 15 reported they were “quite likely to” and 21 “definitely will” implement some of the things they learned in the workshop into their work/practice.

22. Promotion and Roll Out To all Ontario Communities (Fr & Eng) Promoted to PRC’s and CAMH Project Consultants Presentation Kit includes –Sample Agenda –Presentation Slides –Training exercises and case studies –Promotional flyer –Budget template –Letter of Agreement

23. For more information: Jennifer Barr CAMH Healthy Aging Project Centre for Addiction and Mental Health Tel. 613 256 1397 Jennifer_Barr@camh.net