Table 1
Quebec substance-use disorder providers.
| Type | Services | Number |
|---|---|---|
| Public substance-abuse treatment centres | Specialised services | 16 |
| Certified substance-abuse treatment centres1 | Specialised services | 91 |
| University hospital centres | Specialised and ultra-specialised services | 3 |
| Health and social service centres | Primary care | 93 |
| Psychologists/psychotherapists who treat alcohol-use disorders1 | Primary care | 213 |
| Psychologists/psychotherapists who treat drug-use disorders1 | Primary care | 301 |
| General practitioners who follow up individuals with substance-use disorders | Primary care | Unknown |
| Alcohol anonymous (AA) groups | Primary care | 1385 |
| Narcotics anonymous (NA) groups | Primary care | 264 |
| Cocaine anonymous (CA) groups | Primary care | 31 |
[i] 1These are private or community-based organisations often supported by financial contributions from clients who fully or partially defray the costs of services received. With the exception of the AA, NA and CA, all other organisations are public, with no charge for services.
Table 2
Integration strategies* – analytical framework.
| A. Administrative | |||
| 1. Governance system: | ▪ Steering committees at strategic, tactical and operational levels | ||
| 2. Management system for the network: | ▪ Policies, orientations and planning | ▪ Care trajectory | ▪ Primary-care models |
| ▪ One-stop service | ▪ Inter-organisational agreements/service contracts | ▪ Information and monitoring management tools | |
| B. Clinical | |||
| 1. Service plans | ▪ Intervention plans | ▪ Individual service plans | ▪ Treatment/follow-up protocols |
| 2. Case management | ▪ Case managers | ▪ Intensive case management ▪ Assertive or non-assertive community treatment | |
| 3. Referral mechanisms between organisations | |||
| 4. Joint programmes | |||
| 5. Training, clinical coaching and inter-organisational internships | |||
| 6. Integrated care | |||
| 7. Shared staff between organisations | |||
| 8. Other clinical tools | ▪ Needs assessment tools, uniform registration forms, report cards, consent forms, etc. | ||
[i] *Adapted from: Ref. [32].
Table 3
Characteristics of the participants (N = 105).
| Variables | Mean% (SD) | |
|---|---|---|
| Region | Montreal | 61.2 |
| Mauricie | 38.8 | |
| Sex | Male | 28.6 |
| Female | 71.4 | |
| 20–29 | 16.3 | |
| 30–39 | 37.5 | |
| Age (years) | 40–49 | 26.0 |
| 50–59 | 15.4 | |
| ≥60 | 4.8 | |
| Education | High school | 5.8 |
| University | 94.2 | |
| Field of study | Social sciences | 65.0 |
| Health sciences | 32.0 | |
| Other | 2.9 | |
| Function | Clinicians | 61.9 |
| Managers | 38.1 (40) | |
| Years of experience in the local network | 15.66 (9.49) | |
| Years of experience in the current organisation | 9.96 (8.00) | |
| Years of experience in the substance-use disorder programme | 9.91 (9.26) |
Table 4
Summary of service integration strategies implemented.
| Strategies (type) | Description | Level of implementation |
|---|---|---|
| Governance (administrative) | ||
| Steering committee | Initiative of the Regional Health Agencies to oversee organisational development of substance-use disorder services. | Implemented in one region |
| Initiative of health and social service centre coordinators to oversee the development of substance-use disorder services at the local level. | Implemented in one region | |
| Planning | Local action plan or clinical project related to substance-use disorders that identify: (1) objectives to be achieved; (2) organisations (or people) responsible and collaborators; (3) expected results or indicators of success and measures required; (4) deadlines [36]. | Implemented in two local networks |
| Primary-care models in health and social service centres (administrative) | ||
| Primary-care consolidation models that aim to provide substance-use disorder services in parallel with other health service programmes offered at health and social service centres. All models enhance services with added substance-use disorder expertise, given the lack of knowledge on substance-use disorders among primarycare professionals. | Moderately implemented at the local level | |
| Information and monitoring management tools (administrative) | ||
| ‘I-CLSC’: information system on consumers and services in local community service centres. ‘SIC-SRD’: information system for substance-use disorder rehabilitation services in public substance-abuse treatment centres. | Systems set up to support clinicians and managers in better understanding the substance-use disorder clientele, to improve quality and efficiency of services provided in their respective organisations and to provide information on healthcare governance (to Ministry of Health and Social Services and regional agencies) with emphasis on data monitoring and resource control. | Moderately implemented in each local network |
| Coordination strategies (administrative or clinical) | ||
| Care trajectory | Administrative strategy established by health and social service centres to facilitate understanding by organisations of their role regarding integration of the substance-use disorder programme and also understanding by clinicians of their responsibilities for identification, screening and follow-up of clients with substance-use disorders. | Implemented in two local networks |
| Service contracts | Administrative strategy used in health and social service centres and substance-abuse treatment centres as one of the formalised mechanisms available for soliciting their partners and gaining their active support [36]. Service contracts facilitated access to and continuity of services. | Not sufficiently implemented in each local network |
| Service contracts | Administrative strategy used in health and social service centres and substance-abuse treatment centres as one of the formalised mechanisms available for soliciting their partners and gaining their active support [36]. Service contracts facilitated access to and continuity of services. | Not sufficiently implemented in each local network |
| Emergency room liaison teams | Clinical strategy that tracked individuals with substanceuse disorders in emergency rooms and directed them to the appropriate services. Emergency room liaison teams consist of clinicians from substance-abuse treatment centres working in partnership with ER clinical teams and hospital units. They provide substance-use disorder clients with quick access to substance-abuse treatment centres or other necessary services. | Implemented in the two regions |
| Joint programme or co-location | Clinical strategy to establish shared services across more than one organisation to ensure coverage of the required range of services. Joint programmes involve the sharing of staff; co-location involves the sharing of services. | Not sufficiently implemented in each local network |
| Individual service plans | A clinical strategy based on mutual agreement among several service providers, the client or his/her representative and members of his/her entourage that defines client care or service objectives [39]. Individual service plans are designed to ensure a better connection among the services used by clients, to reduce duplication, to better match services to client needs, to ensure effective service continuity and to allow clients to actively participate in decisions concerning them. | Not sufficiently implemented in each local network |
| Case management | Case management is a method of ensuring accessibility and continuity of care for clients with mental health disorders according their specific needs [40]. | Not implemented into services for individuals with substance-use disorders only |
| Assertive community treatment | Strategy based on the collective responsibility of a team (e.g. psychiatrist, nurses, social workers) who provide intensive treatment services, rehabilitation and monitoring in the living environment of individuals with serious mental health disorders and related functional disability, as well as very high risk of multiple admissions (‘revolving door’ syndrome) [41]. | Not implemented into services for individuals with substance-use disorders only |
| Intensive case management | An intervention by case managers that ensures continuity of care for individuals with mental health disorders who are more apt to integrate into the community than clients receiving Assertive Community Treatment [42]. | Not implemented into services for individuals with substance-use disorders only |
| Evaluation/clinical tools (Clinical) | ||
| substance-use disorder Screening questions in LSCCs | 3–6 questions. | Moderately implemented in each local service network |
| Assessment of Needs for Help for Alcohol, Drugs or Gambling in local community service centres (DÉBA: Dépistage/évaluation du besoin d’aide) [43] | Standardised tools designed to help direct clients to the service(s) or institution(s) best suited to their needs. Contents: alcohol: 28 questions; drugs: 24 questions; gambling: 8 questions. [36]. | Not sufficiently implemented in each local service network |
| Assessment of Needs: NIDEM (Niveau de désintoxication: évaluation par les intervenants médicaux), NIDEP (Niveau de désintoxication: évaluation par les intervenants psychosociaux). In public substance-abuse treatment centres: ASI (Addiction Severity Index) Global Appraisal of Individual Needs | Standardised evaluation tools used in
emergency rooms: NIDEM assesses level of detoxification and is used
by medical workers; NIDEP: assesses level of detoxification and is used by psychosocial workers; ASI [44]. Seven scales: Drugs, Alcohol, Medical condition, Family and social relationships, Psychological condition, Work and resources, Legal situation. Global Appraisal of Individual Needs [45]: A specialized evaluation tool to assess, plan treatment and monitor results. Eight sections: Background, Substance use, Physical health, Risk behaviours and disease prevention, Mental and emotional health, Environmental and living situation, Legal situation, Vocational situation. | Adequately implemented in each local service network |
| Training activities (Clinical) | ||
| Cross-training | A strategy to enhance collaborative environments by simultaneously training clinicians with expertise in substance-use disorders or mental health disorders. Interagency exchange days for case discussions, especially for dual diagnosis, were recommended as a strategy by the Centre of Substance Abuse Treatment in United States and Health Canada to improve the effectiveness of interventions and the development of an integrated system of care for this clientele [4647]. | Moderately implemented at the regional and local levels |