Addictions Services responds to waitlists for inpatient treatment

Tuesday, February 10, 2015 - 3:04pm

By Brooke Stephen

By the time the waitlist for Capital Health’s Addictions and Mental Health Inpatient Treatment Program had grown to 185 people, leaders of the program knew something had to change.

Long waitlists for inpatient treatment had been the norm for several years. Staying in touch with 100 people or more to assess current health, maintain safety and triage people appropriately was difficult and time-consuming. Frequently, by the time people had the opportunity to access services, their circumstances had changed. This may have contributed to the high rates of no-shows for inpatient treatment.

Currently the waitlist is fewer than 20 people, and has remained below 40 for several months. This improvement is the result of a new process implemented by the Addictions and Mental Health Program called a treatment matching assessment. The inspiration came from South Shore District Health, where a similar initiative had achieved success.

“We offer a number of treatments matched to the patient’s individual needs,” says Dr. Philip Mills, Clinical Academic Leader and Psychiatrist with the Addictions Program. “The treatments range from counselling therapy in Community-Based Services (CBS) to inpatient detoxification treatment. Before treatment matching was introduced, patients often selected the level of care they thought was appropriate, leading to long wait times and variable success.”

With the new treatment matching process, those seeking help with an addiction still call the Central Intake Team to complete an intake. If the intake determines it is appropriate to pursue treatment through CBS, the client gets an appointment with a CBS clinician. If it is determined that more intensive treatment may be necessary, such as inpatient treatment or opioid (prescription painkillers) replacement therapy, the client is booked for a treatment matching assessment. If a person seeking inpatient treatment is already connected to a CBS clinician, the client is asked to make an appointment with that clinician in order to be assessed to determine if they need more intensive treatment.

“The goal of treatment matching is to significantly improve treatment outcomes for patients by navigating them to that level and type of care most specific to their current needs,” says Dr. Mills. In September 2014, two staff members were hired and trained to do the treatment matching assessments for new clients. Lasting about an hour, these sessions give staff time to get to know clients and gain a deeper understanding of their needs.

Treatment matching also gives staff the opportunity to prepare for clients’ needs in advance of admission. Rachel Boehm, program leader with the Addictions Program, recalls a time a client arrived to be admitted to the inpatient unit with mobility issues that required special adaptations, and staff were scrambling to address the client's needs. “Now, because of the assessment we understand people’s physical and mental health needs in a better way because we’ve had a more thorough interaction with the client,” she says.

Being able to spend more time with a potential client gives treatment matching staff time to discuss what treatments they have tried in the past, whether they were successful, and why or why not. For example, many people with addiction to opioids are unaware that methadone treatment has better outcomes than inpatient withdrawal management.

Treatment matching staff also have the opportunity to speak with other care providers, if necessary, such as the family doctor or the mental health clinician. One of the biggest advantages of a more in-depth assessment process is that it allows staff to explain treatment options more clearly to potential clients, enabling individuals to make a more informed choice and be better prepared to be actively involved in the treatment process.

“In many ways, it’s just so client-centered, it makes sense,” Trevor Briggs, director of the Addictions and Mental Health Program, says. “Sometimes the most simple, straightforward, practical changes make the most impact.”