ADDICTION SERVICES OF THAMES VALLEY THE POSSIBLE OUTCOMES

1. ADDICTION SERVICES OF THAMES VALLEY THE POSSIBLE OUTCOMES MamtaChail-Teves mteves@adstv.on.ca Joanne Humphrey jhumphrey@adstv.on.ca

2. The Possible Outcomes: Re-defining success in community treatment to include addressing the social determinants of health Defining success with our clients How we re-defined success History & Definition of SDOH How we address & measure the SDOH Benefits of SDOH Client’s success through the SDOH lens

3. Addiction Services of Thames Valley (ADSTV) Addiction Services of Thames Valley is a community based service. Our agency operates in co-operation with local addiction and health care agencies, through the Southwest Local Health Integration Network. There are ten programs that are operated by Addiction Services of Thames Valley (ADSTV). 1. Substance Abuse Program 6. Addiction Supportive Housing Program 2. Problem Gambling 7. London Drug Treatment Court 3. Back on Track 8. Telewithdrawal & Crisis Support 4. Heartspace Program 9. Community Opiate Addiction Program 5. Fresh Start Program 10.London CAReS www.adstv.on.ca

4. Definition of Success How do you define success? “Accomplishment of an aim”-Oxford Dictionary

5. Redefining Success “How do you achieve success? Well, for one thing, you don't define it before you achieve it”. ~Robert Brault

6. Our Story

7. T.F. Hodge “To conquer frustration, one must remain intensely focused on the outcome, not the obstacles.”

8. HISTORY of SDOH The concept of Social Determinants of Health (SDOH) emerged in literature in the 1970’s but the evidence linking health status and health inequity to the SDOH has grown exponentially in recent years The social determinants of health, a term coined by the World Health Organization in the mid 1980’s

9. Defining it..... Social determinants of health are the economic and social conditions that influence the health of individuals, communities and countries. Social determinants of health refer to the quantity and quality of a variety of resources that a society makes available to its members. Source: Raphael, D. (2004). Social Determinants of Health: Canadian Perspectives. Canadian Scholar’s Press Inc. Toronto.

11. Evidence states quality of the social determinants of health Canadians experience explains the wide health inequalities that exist among Canadians. The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system.

12. Why are they important? SDOH can affect health in a number of ways: Social determinants define the prerequisites for health, such as shelter, food, warmth, and the ability to participate in society; Social determinants can cause stress and anxiety which can damage people’s health; Social determinants limit peoples’ choices and decreases likelihood of desirable changes in behaviour. Source: Adapted from Benzeval, Judge, & Whitehead, 1995, p.xxi, Tackling Inequalities in Health: An Agenda for Action

13. Health equity is when everyone has the opportunity to attain their full health potential Addressing social determinants of health is a primary approach to achieving health equity.

14. The Possible Outcomes = IMPROVED LIVING CONDITIONS

15. Joe’s Story

16. Addressing the SDOH at ADSTV: Heartspace Freshstart Specialized programs SIS (supportive information sessions) OTN / Telewithdrawal Wm’s only programs Family Group Yoga NRT training Harm Reduction Advocate Collaborate Many roads to recovery Recognize our limits Invite agencies in Culturally informed Value client experience Research & Consult Referrals & tracking

17. Citizen involvement is a primary means of influencing the quality of the Social Determinants of Health and affecting health and health care outcomes

18. RE-ADMINISTER: ADAT – PSS, DTCQ Drugs / Alcohol, Basis 32 GAIN Health Screens Add info to Intake / termination forms (ER visits, status of housing, family doctor) Surveys / Questionnaires Perception of Care Track Referrals Measuring SDOH

19. CREATING MEANING:What to do with the info? Integrate information into Tx planning What are our service delivery gaps? What are the gaps in the community? What are we doing right? What can we do better?

20. How do your existing programs address: - Culture Income & Social Status Social Support Networks Education Employment & Working conditions Physical Environments Biology & Genetics Personal Health Practices & Coping Skills Healthy Child Development Health Services & Social Services Social Environments Gender

21. The Benefits: How will supporting clients through this lens benefit clients, counsellors, your agency, the community and taxpayers?

22. CLIENT Collaborate Witness to their own changes Increase supports See no change Resources emotional & practical New perspective

23. “I learned that addiction is strong.” “The other necessities in life like finding a doctor, getting ID, getting a bank account, all the normal everyday things that people take for granted. It took a while, I had none of the above for about 10 years.” “Now I don’t wake up sick” “Now when something bothers me I tell you. Before I would just lie about my problems.” “My relationship with my family is better. I don’t see my kids all the time but when I do it’s quality time, not like before.” Anonymous ADSTV Clients

24. “I wouldn’t have known what to say about success before.” “I quit doing needles” “I saw a dentist” “I’m taking care of my Hep C for the first time.” “My relationship with my family is better. A family member told me he wants to see me now because I’m doing good. Last time it was upsetting for him because I was on pills”. Anonymous ADSTV Clients

25. Redefining failure

26. “I know that I wasn’t honest. I thought about everything when I was in jail and things started to make sense. Now I know what you were trying to do and tell me.” “I have learned to meditate” “I’ve started to eat healthier and exercise a lot more” “I went to treatment, I did programs and I did community service hours. I completed things I set out to do.” “I talk to more people” Anonymous ADSTV Clients

27. “I learned things that I never knew which was cool.” “I felt good about myself and for the first time I learned what my problem was, acknowledged it and talked about it for the first time. (client disclosed traumatic incidents for the first time)” “The most important thing is that I identified my real problem” Anonymous ADSTV Clients

28. Stage for Change 2012:TABITHA’S STORY http://www.youtube.com/watch?v=ei_RLtE58d0

29. COUNSELLOR Foster collaboration Know our role Effective Contributions Links become visible Understanding of client & barriers

30. We can’t do it all We can’t do it all We can’t do it all We can’t do it all We can’t do it all We can’t do it all We can’t do it all We can’t do it all We can’t do it all We can’t do it all We can’t do it all COUNSELLOR

31. COMMUNITY & TAXPAYERS Decrease stigma Resources used effectively Increase capacity for all Identify gaps in service Stats Decrease costs – duplication, less strain, increase in client’s overall health and stability

32. COMMUNITY & TAXPAYERS “I never had an address for more than a few months before – I used to travel light” “I have food in my fridge” “I’m not shoplifting anymore” “I’m not doing any crime and I’m not in jail” “Doing volunteer work has become a bit part of my recovery plan and an anchor”. “I’m trying to be a really good parent and taking parenting courses that I would never take when I was high” “Now I have more money. My welfare check lasted me almost until the end of the month last month” Anonymous ADSTV Clients

35. Joe’s story

36. http://adstv.on.ca/its-possible/

37. Resources 1. Social Determinants of Health /Canadian Best Practice Portal http://cbpp-pcpe.phac-aspc.gc.ca/public-health-topics/social-determinants-of-health/ 2. Social Determinants of Health –The Canadian Facts http://ywcacanada.ca/data/research_docs/00000131.pdf 3. Health Equity Assessment http://www.health.gov.on.ca/en/pro/programs/heia/ 4. World Health Organization Commission on Social Determinants of Health - final report ww.who.int/social_determinants/thecommission/finalreport/en/index.html

38. QUESTIONS?