Module 5: Trauma, Violence, and Cultural Safety – Topic J Collaborate interprofessionally and intersectorally in order for persons using opioids to receive ongoing support and treatment.

Learning Objectives

By the end of this topic, the student should be able to:

• Understand how to foster interprofessional teamwork for public education, treatment, prevention, and health promotion for opioid use.
• Effectively communicate with interprofessional team members.
• Discuss how health professionals can become involved in education in their community, province, or territory, or across Canada.

Key Concepts

• Traditional separation of substance use disorder treatment and mental health services creates obstacles to successful care coordination; integration can address disparities, reduce cost, and improve general health outcomes.
• A diverse group of people play roles in delivering health care to those with substance use disorder, such as nurses, doctors (including addiction specialists), counsellors, nurse practitioners, psychologists, care managers, social workers, health educators, peer workers, pharmacists, and others.
• In an Indigenous context, the team might also include Elders, knowledge keepers, thought leaders, healers, community health workers, and traditional medicine folks—to name a few.

How to Foster Interprofessional Teamwork

Traditional separation of substance use disorder treatment and mental health services creates obstacles to successful care coordination. This separation results in unintended impediments, reinforcing the notion that substance use disorders differ from other medical conditions.

Emergency departments, hospitals, and general medical care often fail to recognize or address health problems related to substance use.

Service integration can address disparities, reduce cost, and improve general health outcomes.

• Many individuals who use substances access health care for acute reasons, such as injury, illness, or overdose. They may also access health and social services because of HIV/AIDs, heart disease, depression, or other health or social issues.
• A diverse group of people play a role in delivering health care to those with substance use disorder, such as nurses, doctors, counsellors, nurse practitioners, psychologists, care managers, social workers, health educators, peer workers, pharmacists, and others.

NOTE: Doctors continue to prescribe for 91 percent of clients who suffered a non-fatal overdose (Office of the Surgeon General, 2016).

Collaboration between physicians, nurses, and other health and social service professionals leads to improved awareness of one another’s knowledge and skills.

• Fostering an attitude of mutual respect and trust helps health and social service professionals work together to the benefit of the service user (O’Daniel & Rosenstein, 2008).

Formal communication is fundamental as it provides the opportunity for all team members to work together, speak a common language, and come to a consensus.

• Building a shared agenda can help guide the direction of the meeting, and minutes are useful for people to refer to at a later date.
• Inter-team memos are also seen as efficient methods for updates.

NOTE: Emails are sometimes viewed negatively as some people do not have the time to read all the emails they receive, and some were not computer savvy (Brown et al., 2009).

Interprofessional Collaboration as Part of the Continuum of Care

To optimize health outcomes, team-based health care approaches that facilitate interprofessional collaboration are being recognized as effective interventions for opioid misuse and treatment.

Randomized control trials have shown improved client outcomes when the interprofessional team members collaborate in multi-modal care planning with the individual and their family (Matthys, Remmen & Van Bogaert, 2017). Referred to as collaborative care (CC), this model of care involves a number of health professionals working with a person who uses drugs to comprehensively address issues related with opioid use.

• Normally, the collaborative care team consists of a medical professional, a case manager (ideally someone who can offer help with medication), and a mental health specialist.
• It is based on the chronic care model, which integrates behavioural health into primary care (Van Eeghen, Littenberg & Kessler, 2018).

Evidence suggests that by using the collaborative care approach, treatment outcomes can be significantly improved.

• Watkins et al. (2017) carried out a randomized controlled trial of 377 clients to assess the impact of a collaborative care versus usual primary care.
  • Individuals who received collaborative care reported abstaining from opioids 6 months longer after treatment compared to the control group.

The stepwise collaborative process matches treatment intensity, pharmacotherapy, delivery setting, and support to indicators of user stability (Stoller, 2015).

Comprehensive addiction evaluation and individualized treatment plans should be supported over usual primary care. Treatment can include behavioural therapy (such as addiction treatment counselling, cognitive behavioural therapy, or motivational interviewing), medications, cultural interventions, or a combination of approaches.

• The specific type of treatment or combination of treatments will depend on the individual’s needs.
• A combination of approaches appears to be more effective than a single approach because each type of treatment works on a different aspect of addiction.
• People who use drugs often suffer from other health problems, as well as occupational, legal, family, and social problems that should be addressed simultaneously.

In the United States, different professions are implementing initiatives that can help to address the opioid crisis. These initiatives are outlined below.

Regis University Rueckert-Hartman College for Health Professions (RHCHP). Represented opioid panel health care professions and associated professional association opioid initiatives.

Adapted from Brooks et al. (2017)

Effective Communication with Interprofessional Team Members

Improved teamwork and communication were stated as the most important factors in improving clinical and job satisfaction (O’Daniel & Rosenstein, 2008).

• Structured communication tools provide a framework for communication and promote more information sharing with increased clarity.
  • It is useful to use structured communication techniques such as SBAR (situation, background, assessment, and recommendation).

NOTE: Health and social service teams that do not work together and have to collaborate are more likely to make a mistake (O’Daniel & Rosenstein, 2008).

Tips for Interprofessional Team Communication

Implement and Evaluate Programs with an Interprofessional Team

Health and social service professionals often fail to detect opioid use disorder (OUD) in their clients. However, various screening tools and strategies are available for health and social service professionals to cope with opioid addiction or overdose among people receiving services. See Module 3, Topic A for more information on screening tools.

Helping People Ask For and Get Help

Often, people who use opioids find it difficult to ask for help regarding a potential OUD because of reasons like:

• trust issues with health and social service professionals,
• fear of legal implications,
• stigma, or
• other societal factors such as inability to access the community resources readily (Monteiro et al., 2016).

Therefore, health and social service professionals are encouraged to offer early interventions in the form of motivational methods, when applicable. See Module 4, Topic G for more information on motivational methods.

Further, health and social service professionals must offer to counsel or refer people with possible OUD for assessment, prevention, and—when applicable—treatments for OUD.

Other Interprofessional Considerations

Proper communication and vigilant discharge prescription planning are essential for perioperative care and should include coordinating with post-discharge service “with referral to multidisciplinary pain and addiction medicine services” (Macintyre et al., 2020, p. 9).

Medication-assisted treatment (MAT) is the use of medications with counselling and behavioural therapies for OUD and help prevent opioid overdose. Therefore, primary care clinics, which develop treatment models for OUD, should all integrate MAT strategies to improve client outcomes (for example the use of Methadone, buprenorphine, and naltrexone, Naloxone).

Evaluating the Care Plan

Health and social service providers should ensure there is an evaluation of an interprofessional care plan, which involves:

• behaviour change counselling,
• referral to treatment, and other non-opioid treatment options for chronic pain, and
• approaches the person with OUD from a holistic perspective.

Evaluation should be incorporated into all program services for people with OUD. Effective approaches to assessment and treatment of people with OUD should be identified, incorporated, and revised, as necessary.

Getting the Interprofessional Word Out

Interprofessional workshops and health education programs can be developed whereby students and professionals from medicine, nursing, pharmacy, physical therapy, and social work participate in client-focused care with OUD (Monteiro et al., 2017).

• These workshops would demonstrate knowledge of opioid use prevention, risk factors for opioid overdose, appropriate use of naloxone, and proper training for its administration (Monteiro et al., 2017).

What Does Intersectionality Mean?

The concept of intersectionality recognizes the co-occurrence of multiple forms of oppression that intersect.

An intersectional approach considers the historical, social, and political context of drug use and recognizes the unique experience of the individual based on the intersection of all forms of oppression and discrimination.

If providers view substance use from an intersectional perspective, they are less likely to miss important contextual features of a person’s life that may be central to their health, well-being, and recovery, such as oppression associated with poverty, gender, ethnocultural identity, sexual orientation, ability, religion, and so on.

Intersectionality and Substance Use

Intersectionality can be applied to better understand how the intersection of identities (e.g., racialized persons, women, older adults) and structural inequalities (racism, classism, sexism, homophobia) may adversely impact access to health care and reproduce inequity within certain groups.

When applied to addiction, an intersectionality framework suggests that addiction stigma may also intersect with other forms of bias, such as racism and sexism.

Individuals with substance use disorders may be treated less favourably if they belong to other marginalized categories of difference or identity.

What Does Intersectoral Collaboration Mean?

Described as both a tool and a process, intersectoral collaboration is defined as

“A recognized relationship between part or parts of the health sector with part or parts of another sector which has been formed to take action on an issue to achieve health outcomes ... in a way that is more effective, efficient or sustainable than could be achieved by the health sector acting alone”

• Because issues relating to opioid use span multiple sectors, including medicine, health, well-being, housing, employment, personal and family supports, and law enforcement, and different systems (local, municipal, provincial, territorial, and federal), it is imperative for individuals and agencies within each sector to know and understand the roles each play, to work together, and to avoid conflicting messages and actions.
• Intersectoral collaboration is now recognized as an essential part of comprehensive strategies to address these issues and health disparities (Danaher, 2011).
• Many regions and municipalities work to align and engage sector cooperation with the establishment of drug task forces or drug strategies.
• One of the first drug strategies in Canada was established in Vancouver in 2000. This strategy, like many others, uses a four-pillar approach:
  • prevention
  • treatment
  • enforcement
  • harm reduction
• Many regions and municipalities have developed drug strategies tailored to the needs of a particular community, designed to guide improvements in services and approaches to substance use.
  • For example, since 2015, many of these have developed opioid-specific task forces to address the opioid crisis. The following case examples make explicit the intersectoral model in practice.

Case Examples

Stop and Think

Now that you have reviewed this content, consider the following:

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References