substance abuse service path and access mechanism … · substance abuse service path and access...
TRANSCRIPT
SubStance abuSe Service pathand acceSS mechaniSm for youth under the age of 18 years in the Montreal Area
This document was produced by the Centre Dollard-Cormier, Office of the Executive Director. The Centre Dollard-Cormier is an institution affiliated with the Université de Montréal and is accredited by the Conseil québécois d’agrément.
Note: The masculine gender is used in this document to designate both sexes, without discrimination.
© Centre Dollard-Cormier, April 11, 2006
This document is available from:
Centre québécois de documentation en toxicomanie (CQDT) Telephone: 514.385.0046
On the Internet site www.centredollardcormier.qc.ca
Complete or partial reproduction and translation of this document by any means whatsoever are authorized providing that the source is mentioned.
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SubStance abuSe Service pathand acceSS mechaniSmfor youth under the age of 18 years in the Montreal Area
5 Abbreviations
7 Acknowledgments
9 Introduction
9 MandateassignedtotheCentreDollard-Cormier
9 Quebecyouthandsubstanceabuse
11 Culturaldiversityandlanguagesspoken
11 Partnersofferingspecializedsubstanceabuseservices
11 Freeaccesstospecializedsubstanceabuseservicesforyouth
13 1. TheServiceOffer/DependencyProgram–MSSS
15 2. Front-LineServices
15 2.1. Roleandresponsibilitiesofhealthandsocialservicecentres(CSSS)
15 2.2. Partners
16 Lescentresjeunesse
16 Hospitals
16 2.3. Accessibility
17 2.4. Quality
17 2.5. Continuity
19 3. Second-LineServices
19 3.1. Theregionalassessmentservice
21 3.2. Detoxificationservices
22 3.3. Substanceabuserehabilitationservices:out-patientandin-patientservices
23 3.4. Consultationandsupportforthefamilyandfriends
24 3.5. School,occupationalandsocialreintegrationservices
table of contents
25 4. SubstanceAbuseAccessMechanismforYouthundertheAgeof18YearsintheMontrealArea
25 4.1. Presentation
25 4.2. Targetclientele
26 4.3. Objectives
27 4.4. Rolesandresponsibilitiesoffrontandsecond-linepartners
28 4.5. Rolesandapproachesofrehabilitationcentresandprivateorcommunityorganizationswhichofferspecializedsubstanceabuseservices
31 4.6. Clinicalcomponentsoftheaccessmechanism
31 A.Assessment/orientation
33 B.Theroleofthedesignatedresource
33 C.Interruptionofthestay
34 D.Crisissituations
34 E.Aftercare
34 4.7. Matching
35 4.8. Regionaloperationalizationoftheaccessmechanism
35 A.Regionaloperationalizationandcoordination
35 B.TheYouthProgramcoordinators’role
36 C.Theliaisonofficers’role
37 4.9. Administrativecomponents
37 A.Agreements
37 B.SteeringCommittee
37 C.Clinicalcommittee
39 5. SupportbytheResearch
41 6. Funding
43 7. Accountability
45 8. SupportfortheDevelopmentofFront-LineServicesintheMontrealArea
45 8.1. Responsibility
45 8.2. Workcompleted
45 8.3. Workinprocess
46 8.4. Worktobecontinued
46 8.5. Availabilityoftrainingtools
47 Appendixes
48 Appendix1–Matchingchartforthesubstanceabuseaccessmechanismforyouthundertheageof18yearsintheMontrealarea
55 Appendix2–Authorization,exchangeofinformation
56 Appendix3–Casefollow-upsheet
57 Appendix4–IndicatorFactSheet,DependencyProgram,Substanceabuse,MSSS,2005
5 ABBREVIATIONS
chum Centrehospitalierdel’UniversitédeMontréal
cJ Centrejeunesse
crdi Centrederéadaptationendéficienceintellectuelle(rehabilitationcentreforpersonswithanintellectualimpairment)
crdp Centrederéadaptationendéficiencephysique(rehabilitationcentreforpersonswithaphysicalimpairment)
crpat Centrederéadaptationpourpersonnesalcooliquesetautrestoxicomanes(publicrehabilitationcentreforalcoholandsubstanceabuse)
cQdt Centrequébécoisdedocumentationentoxicomanie(Quebecsubstanceabusedocumentationcentre)
cSSS Centredesantéetdeservicessociaux(healthandsocialservicecentre)
dep-adO Grille de dépistage de consommation problématique d’alcool et de drogues chez les adolescents et adolescentes(ScreeningChartforAdolescentAlcoholandSubstanceAbuse)
dpJ Directiondelaprotectiondelajeunesse(YouthProtectionDepartment)
Gain GlobalAppraisalofIndividualNeeds
iGt Indice de gravité d’une toxicomanie(AddictionSeverityIndex)
iGt–adO Indice de gravité d’une toxicomanie pour les adolescents(AddictionSeverityIndexforadolescents)
ip InterventionPlan
iSp IndividualizedServicePlan
matJm Mécanisme d’accès en toxicomanie pour les jeunes de la région de Montréal(SubstanceabuseaccessmechanismforyouthintheMontrealarea)
mSSS MinistèredelaSantéetdesServicessociaux(MinistryofHealthandSocialServices)
ni-dep Niveau de désintoxication – évaluation psychosociale(levelofdetoxificationandpsychosocialassessment)
YcJa YouthCriminalJusticeAct
Ypa YouthProtectionAct
abbreviations
7 ACKNOWLEDGMENTS
Preparationofthisdocument,Substance abuse service path and access mechanism for youth under the age of 18 years in the Montreal area,wasmadepossiblebyadedicatedteamwhichunderstoodhowtodrawonthediversityofapproachesandservicesofferedbytheinstitutions,centresandorganizations..
Thecontributionofthesecommittedpartnersthroughouttheprojectallowedustoidentifywaystoensuretheaccessibility,qualityandcontinuityofservicestomeettheneedsofyouthundertheageof18yearsintheMontrealareawhohavesubstanceabuseproblems.
Wewouldliketothankthefollowingpeoplefortheirvaluableparticipation:
acknowledgments
Samia ackadBatshawYouthandFamilyCentres
mario bélangerPavillonduNouveauPointdeVue
dominique bérubéLeGrandChemin*
diane bidégaréCentreDollard-Cormier
claude boilyPavillonduNouveauPointdeVue
Serge bouilléLePortage
Sophie buckiewiczPavillonFoster
Lise durocherCentrejeunessedeMontréal–Institutuniversitaire
ernesto FelacoLePortage
Luc GervaisLeGrandChemin*
andré LavoieAgencedelasantéetdesservicessociauxdeMontréal
France LecomteCentreDollard-Cormier
Jennifer mascittoPavillonFoster
Jean prémontCentrejeunessedeMontréal–Institutuniversitaire
hélène SimoneauCentreDollard-Cormier
monique tessier CentreDollard-Cormier
WewouldparticularlyliketothankMoniqueTessier,consultant,forleadingtheworkanddocumentpreparationcommittee.
Executive Director,
MadeleineRoy
* FormerlyknownasCentreJeanLapointepouradolescents
9 INTRODuCTION
MANDATE ASSIGNED TO THE CENTRE DOLLARD-CORMIER
InaletterdatedNovember3,2004toMadeleineRoy,ExecutiveDirectoroftheCentreDollard-Cormier,theAgencedelasantéetdesservicessociauxdeMontréalaskedtheinstitutiontocoordinateworktoestablisharegionalsubstanceabuseaccessmechanismforyouthundertheageof18years.
Intheautumnof2005,theagencyinformedtheinstitutionsandorganizationsintheMontrealareawhichoffersubstanceabuserehabilitationservicesofthemandateassignedtotheCentreDollard-Cormieranditsintentiontoinitiatethisworkinthenextfewweeks.
ThisdocumentproposesaservicepathandaccessmechanismforyouthintheMontrealareawhohaveasubstanceabuseproblemsandrequirespecializedsecond-lineservices.
Themodelproposed,adaptedtothesituationinourarea,adherestothestandardsofpracticeandprinciplespresentedaswellastherolesandresponsibilitiesoftheinstitutionsintheworkdocument,ServiceOffer/DependencyProgramdistributedbytheministèredelaSantéetdesServicessociaux(MSSS)inApril2005.
QUEBEC YOUTH AND SUBSTANCE ABUSE
In2002,theInstitutdelastatistiqueduQuébecpublishedthethirdeditionofl’Enquête québé-coise sur le tabagisme chez les élèves du secondaire1(QuebecsurveyontheuseoftobaccoamongsecondaryHighschoolstudents).Asacomponentrelatedtotheuseoftobacco,alcoholanddrugswereincludedinthissurveywhichoffersthefirstcomparisonoftheprevalenceofalcoholanddrugusebetween2000and2002.
The2002surveycollecteddatafromover4700studentsin154secondaryschoolsinQuebec.
introduction
1 InstitutdelastatistiqueduQuébec,Où en sont les jeunes face au tabac, à l’alcool, aux drogues et au jeu ?,2002.
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Theprincipalfindingsinregardtoalcoholandillegaldrugusewere:
1. In2002,69%ofsecondaryschoolstudentshadconsumedalcoholduringthe12monthspre-cedingthesurvey.Thisproportionissimilartothefindingsin2000(71%).
2. Therateofillegaldruguseduringthe12monthsprecedingthesurveyalsoremainedstablebetween2000(42%)and2002(41%).
3. Closetoonesecondaryschoolstudentinfive(18%)usesalcoholonaregularbasis,atleastonceaweek.
4. Moreboysthangirlsusealcoholregularly(20%versus16%)whiletheyhadasimilarrateofdruguseduringthe12monthsprecedingthesurvey.
5. Cannabisisthedrugmostoftenusedbysecondaryhighschoolstudents(39%),followedbyhallucinogens(13%).
6. Theaverageageofinitiationintoregularalcoholuseamongsecondaryschoolstudentsis13.4yearsand13.2yearsfordrugs.
7. Closetohalfofallsecondarystudents(44%)hadatleastoneepisodeofexcessivealcoholusein2002.
8. Thefrequencywithwhichyouthusealcoholanddrugsincreaseswiththenumberofyearsofschooling.
9. Theyouth’sfamilyenvironmenthasaninfluenceontheiruseofalcohol.Alittlemorethan70%(71%)ofyouthfrombrokenhomesabusedalcohol,comparedto60%ofthosewholivedinatwo-parentfamily.Thesituationissimilarfordrugabuse.
AftercheckingwiththeCentrequébécoisdedocumentationentoxicomanie(CQDT),itappearsthereisnovalidateddataonalcoholanddrugusebyyouthintheMontrealarea.
INTRODuCTION
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CULTURAL DIVERSITY AND LANGUAGES SPOKEN
ItshouldbenotedthatclienteleintheMontrealareamaybeFrancophone,Anglophoneorallo-phone.
TheCentreDollard-Cormier,theonlypublicrehabilitationcentreforpersonssufferingfromalcoholismandotheraddictionsintheMontrealarea,isresponsibleforensuringaccesstoitsservicestoall,withoutdistinctiontolanguagespoken.ThemajorityoftheCentre’sclientsareFrench-speaking,ormulticulturalallophoneclientswhospeakneitherFrenchnorEnglish.ThefewyoungAnglophoneswhorequestservicesfromtheCentreDollard-CormierdosobecauseofanaturalaffinitytotheCentreduetoitsgeographiclocationorapersonalreferral.
PavillonFoster,aprivate,supraregional,substanceabuserehabilitationcentrehasbeenprovidingoutpatientservicesinEnglish,toadolescentsintheMontrealregionsince1994.ThepersonnelofPavillonFoster,andthosefromCentreDollard-Cormierassignedtoitsservicesbyserviceagree-mentsince1997,arerepresentativeoftheculturaldiversityofMontreal.WhileservicesaremainlyofferedinEnglish,clientscanalsobeservedinoneofthemanylanguagesspokenbythestaff.
ThePortage,aprivaterehabilitationcentreunderagreementintheLaurentians(LacEchosite)andintheMontrealarea(Beaconsfieldsite),hasamandatetoprovideresidentialrehabilitationservicestoFrancophoneandAnglophoneyouthforperiodsfromsixtoeightmonths,accordingtothetherapeuticcommunities’model.
PARTNERS OFFERING SPECIALIZED SUBSTANCE ABUSE SERVICES
Inourarea,thefollowinginstitutionsorcommunityorganizationsofferspecializedsubstanceabuseservices:
CentreDollard-Cormier,publicinstitution;
PavillonFoster,privateinstitution;
LePortage,privateinstitution;
LeGrandChemin,communityorganization;
LePavillonduNouveauPointdeVue,communityorganization.
ThislastorganizationislocatedintheLanaudièreandworkscloselywiththecentresinMontreal.
FREE ACCESS TO SPECIALIZED SUBSTANCE ABUSE SERVICES FOR YOUTH
Accesstospecializedsubstanceabuseservicesforallyouthundertheageof18yearsintheMontrealareaisfree,exceptforthoseofferedbythePortage.TheAgencedelaSantéetdesServicessociauxdeMontréalhasbeenmadeawareofthefactthatmeasuresmustbetakentoensurethataccesstothePortageisalsofreeforallyouthinMontreal,includingyouthservedbytheCentresjeunesseinthearea.
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INTRODuCTION
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1the Service OFFer/ dependencY prOGram – mSSS
ThisserviceofferisbasedontheconceptoftheDependencyProgramintroducedbytheMSSSduringtherecentreorganizationofhealthandsocialservices.ThisProgramisoneofnineclienteleprogramsidentified.
Inthespringof2005,theMSSSpublishedtheServiceOffer/DependencyProgram2,announcingthestandardsofpracticeandprinciplesbasedonwhichitdefinestherolesandresponsibilitiesoftheinstitutionsinthefieldsofsubstanceabuseandpathologicalgambling.
Consultationshavebeenheldtodiscussthisserviceofferoverthepastfewmonths;thefinalversionwillprobablyincludechangeswhichwillundoubtedlyrequirecertainupdatestobemadetothisdocument.
populational approach
TheserviceofferoftheDependencyProgramisbasedonapopulationalapproach.“This approach supports an overall service offer at a reasonable cost, the appropriate prioritiza-tion of services and implementation of the appropriate standardization and coordination mechanisms. The populational approach is designed to facilitate the exercise of populational accountability.”3
Standards of practice
Theserviceofferisdefinedaccordingtostandardsofpracticeconcerningaccessibility,qual-ityandcontinuity.
2 MSSS,Service Offer/Dependency Program – working document,April13,2005.
3 Direction générale de la coordination, MSSS, Projet clinique : cadre de référence pour les réseaux locaux de services de santé et de services sociaux,2004(translation).
THE SERVICE OFFER / DEPENDENCY PROGRAM – MSSS
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principles
TheserviceofferoftheDependencyProgramisfoundedonfiveprinciples:
1. Aninterventionadaptedtothepersons’situation.
2. Individualaccountability,whichcallsontheindividual’sskillsandencouragespersonalindependence.
3. Collectiveresponsibility,whichcallsonallofus,individuallyandasagroup,topreventdependencies,reducerisksandalleviatetheconsequences.
4. Actionsfoundedonknowledgeandexperience,inwhichtheapproachisfoundedonup-to-dateknowledgeofthemanifestationsofthephenomenonofdependencyandtypesofuse.
5. Consensusbuilding,spearheadingaction,promotingajointeffortbyallthepartnersconcerned.
ThestandardsofpracticeandprinciplesannouncedintheDependencyProgram’sserviceofferwillserveasparametersforthepreparationandimplementationoftheregionalaccessmechanismforyouthundertheageof18yearsintheMontrealareawhosufferfromproblemsofsubstanceabuse.
THE SERVICE OFFER / DEPENDENCY PROGRAM – MSSS
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2FrOnt-Line ServiceS
2.1. ROLE AND RESPONSIBILITIES OF HEALTH AND SOCIAL SERVICE CENTRES
Theroleandresponsibilitiesofhealthandsocialservicecentres(centresdesantéetdeservicessociaux–CSSS)areasfollows:
Shortassessment(screening)4;
Orientation;
Briefinterventionandsocialreintegrationservicefollowingaspecializedtreatment(substanceabuse).
YouthreferredbytheCSSSmaybeprovidedwithanindividualizedserviceplan(ISP).
AccordingtotheMSSSserviceoffer,youthindifficultywhocallonhealthandsocialservicesmustautomaticallyundergoscreening.
2.2. PARTNERS
Inthefieldofdependency,otherpartnersarealsorecognizedtoplayafront-linerolewithyouth:schools,centresjeunesse(CJ),hospitals(thesesecond-lineinstitutionsplayafront-linefunctionregardingsubstanceabuse),andcommunityorganizations.
Severalofthesepartnersareabletocarryoutshortassessmentsusingtheadolescentscreeningassessmentchart(DEP-ADO).
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4 Inthisdocument,thetermsshort assessment, detectionandscreeninghavethesamemeaning.
FRONT-LINE SERVICES
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Les centres jeunesse
MontrealhastheCentrejeunessedeMontréal–InstitutuniversitaireandtheBatshawYouthandFamilyCentres.
Inaccordancewiththeirmission,Centresjeunesse,aresecond-lineinstitutions;neverthe-less,aspreviouslymentioned,theyalsocarryoutfront-linefunctionsinscreeningandreferringyouthtospecializedsubstanceabuseresources.
Intheseinstitutions,theinterventionincludesthreelevels:
1. ScreeningyouthwithalcoholanddruguseproblemsusingtheDEP-ADOtool.
2. Referringyouthwithasubstanceabuseordependencyproblem(youth“codered”)tospecializedsubstanceabuseservicesaccordingtotheregionalaccessmechanismpro-cedure.
3. Interveningwithyouthwhoareexperiencingdifficultiesrelatedtotheiralcoholordruguse,whoseuserisksbecomingaproblem(youth“codeyellow”)withsupportfromspecializedsubstanceabuseservices.
4. Interveningwithyouthwhohaveauseproblem(youth“codered”)whoarelittleornotatallmotivatedtoreceivespecializedsubstanceabuseservices,orwhoneedcriticalstaticsupervision(expressionàrevoir).Fortheseyouth,anadditionalinterventionisprovidedasacomplementtothesubstanceabuseservices.
YouthreferredbytheCentresjeunesseareprovidedwithanISP.
hospitals
Themissionofthesefacilitiesistooffersecond-lineservices;however,liketheCJs,theyalsocarryoutafront-linefunctionofscreeningandreferringyouthtospecializedsubstanceabuseresources.
Childpsychiatrydepartmentsarerecognizedasessentialpartnersinsupportingtherehabilitationofmanyyouthenrolledandadmittedinacentre.Ifayouthisbeingtreatedorfollowed-upinchildpsychiatryaswellasinasubstanceabuserehabilitationcentre,areferraltoasubstanceabuserehabilitationcentremustbeaccompaniedbyanISP.
2.3. ACCESSIBILITYEachCSSSmustadoptadependencydetectionandbriefinterventionpractice.
Twotypesofbriefinterventionforyouth,counsellingandamotivationalapproach,areaccessibleineachCSSSinQuebec.
EachCSSSconcludesanagreementwiththeCRPATinitsregiononareferralandaccessmechanismtospecificservicesdesignedtomaintainpersonswithadepend-encywithinthecommunity.
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FRONT-LINE SERVICES
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2.4. QUALITYArecognizedandvalidateddetectiontool,suchastheDEP-ADOassessmentchart,willbeused.
Practitionersofferingtheservicewillhavereceivedtheappropriatetrainingondetec-tionandbriefintervention.
TheCRPATmustoffersupportservices,expertiseandtrainingtotheCSSSpracti-tioners.
Reintegrationservicesmustbeadaptedtothecharacteristicsandneedsoftheyouth.
2.5. CONTINUITY
IntheDependencyProgramserviceofferpreparedbytheMSSS,theCRPATineachregionisresponsible,forintroducingacoordinatedjointaccessmechanismconnecting(linking)thepartnersintheservicenetworksinthevarioussectors.
TheMSSSsuggeststhattheCSSSparticipateinimplementingthesemechanismstoensureservicecontinuitybetweenthefrontandsecond-lines.
Partnersinthepublicservicenetwork,theCentresjeunesse,physicalorintellectualrehabili-tationcentres,andhospitals(includingchildpsychiatrydepartments)arealsoinvolvedindeliveringcontinuousservicestoyouthwithsubstanceabuseproblems.
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FRONT-LINE SERVICES
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33.1. THE REGIONAL ASSESSMENT SERVICE
ItshouldbenotedthatthistypeofassessmentisdifferentfromalegalassessmentinwhichexpertsmustapplyspecificstandardsnotcoveredintheCRPATpractitioners’training.
Amongtheinstitutionsthataremembersofthecommittee,threearedesignatedasCRPAT:theCentreDollard-Cormier(public),thePavillonFoster(private),andthePortage(private).
a. role and responsibilities of the crpat
Responsibleforevaluatingrequestsfromthehealthandsocialservicenetwork.
Assessmentstoidentifytheyouth’srequestandorienthimtothemostappropriateprogram.
Useofvalidatedassessmenttools,suchastheAddictionSeverityIndexforadolescents(Indice de gravité d’une toxicomanie pour adolescents–IGT-ADO),forFrancophoneclienteleandallophoneclientelewhospeakneitherFrenchnorEnglish,andtheGlobalAppraisalofIndividualNeeds(GAIN)foradolescents,forAnglophoneclienteleandallophoneclientelewhospeakEnglish.
Implementationofa regionalaccessmechanismforyouthunder theageof18years.
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SecOnd-Line ServiceS
SECOND-LINE SERVICES
20SECOND-LINE SERVICES
b. Sectors
Participationofthepartnersfromtheservicenetworksinvarioussectors(CSSS,CJ,hospitals,CRDI,CRDP).Thelattermaycontributetotheassessmentaccordingtotheirspecificmission.
ReferraltoservicesoftheCentresjeunesse.
WhenaCRPATorasubstanceabuseorganizationconsidersthatayouthneedstobereferredtoaCentrejeunesse,therearetwooptions:
Ifitisconsideredthatthesecurityanddevelopmentoftheyouthisindanger,itreportstheyouth’ssituationtotheYouthProtectionDepartment(Directiondelaprotectiondelajeunesse–DPJ)initsterritorytohavethechild’ssituationevaluated;
Inothersituations,itprovidesareferraltotheCSSSintheyouth’sterritorywhichhasarecognizedpopulationalresponsibilitytowardshim.TheCSSSevaluatesthepossibilityofprovidingservicesitselfinregardtoitsmissionor,ifnecessary,willrefertheyouthtoaCJforpsycho-socialorrehabilitationserviceswhicharepartofthemissionofthecentresjeunesse.
c. accessibility
TheCRPATmustestablishregionalassessmentservicesineachregionofQuebec.
Anassessmentmustbemadewithin15daysfollowingarequestforassessmentservicesforaclient.
d. Quality
TheassessmenttoolsusedforadolescentsaretheIGT-ADOandtheGAINforado-lescents.ThelatterisusedexclusivelyintheMontrealareabyPavillonFoster.
e. continuity
Acoordinated,jointaccessmechanisminvolvingpartnersfromtheservicenetworkinvarioussectorsisestablishedbythepublicCRPATineachregion.Followingtheassessment,theyouthisdirectedtotheservicewhichbestmeetshissituation.Theassessorworkswithamatchingcharttoidentifyandrecommendaresourcefortheyouth(seeAppendix1).
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21 SECOND-LINE SERVICES
3.2. DETOXIFICATION SERVICES
a. role and responsibilities of the crpat/cSSS
Detoxificationservicesareanintegralpartofthefrontandsecond-lineintervention.Thedetoxificationprocessinvolvesamedicalassessmenttospecifythelevelofcarerequiredandthecontextinwhichserviceswillbeprovided,andtoscreenformedical-psychiatricpathologiesrelatedtothesubstanceabuse.
Typesdetreatment:
Out-patientambulatorytreatmentwithambulatoryassistance(responsibilityoftheCSSS);
Residentialtreatmentinaresidentialenvironment:serviceprovidedbytheCRPAT.TheCentreDollard-Cormieralsooffersamoderateorsevere-typewithdrawalservicewithnursingandpsychosocialpersonnelondutyona24/7basis;
In-patienttreatmentinanacutecarehospitalenvironment.
b. accessibility
DetoxificationservicesareavailableineveryregionofQuebec.
TheCentrehospitalierdel’UniversitédeMontréal(CHUM)offersspecializeddetoxificationservices.
c. Quality
Standardizedtoolonthedetoxificationlevelandpsychosocialassessment(Niveau de désintoxication – évaluation psychosociale–NI-DEP).
Practitioners(physicians,nursesandsocialworkers)arerequiredtotaketrainingondetoxification.
Supportandsupervisionactivitiesareavailablefortheclientonadailybasis.
Eachpersonreceivesamedicalassessmentandmayhaveaccesstomedicalcareonrequest.
d. continuity
TheCSSSmustensureaccesstodetoxificationservicesandthematchingprocedureforclientele.
TheCRPATmayreceiverequestsfordetoxificationservicesdirectlyfromyoungclients.
Areferraltohospitalsspecializinginsubstanceabusemustbemade,whenneces-sary.
EachCSSSestablishesareferenceandaccessmechanismwiththeCRPATforspecial-izedsecond-lineservicesattheendofthedetoxificationtreatment.Atsuchtimeitusesthesubstanceabuseaccessmechanismforyouthundertheageof18years,ifithasbeenestablishedintheregion.
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22SECOND-LINE SERVICES
3.3. SUBSTANCE ABUSE REHABILITATION SERVICES: OUT-PATIENT AND IN-PATIENT SERVICES
a. role and responsibilities of the crpat
Individualorgrouptreatmentservices,familymeetings:
Goal:tosignificantlyimprovetheyouth’sconditiononthepsychological,physicalandsociallevelsbyencouraginghimtoreduceorstopusingdrugsoralcohol;
Treatmentintensity:
Non-intensiveout-patientservices,
Semi-intensiveout-patientservices,
Intensiveoutpatient(schooling)services,
Intensivein-patientservices:schooling(agreementswithlocalschoolboards).
b. accessibility
Eachregionoffersspecializedsecond-lineservicesonanout-patientbasisaswellasin-patientservices.
TheCRPATareresponsibleforofferingrehabilitationservicestoyouthineveryregionofQuebec.
ServiceagreementsbetweentheCRPATandcertifiedorganizationsmaycompensateforthelackofaspecificprogram.
Rapidaccesstorehabilitationservicesmustbeensuredfollowinganassessment.
c. Quality
Interventionplanforeachyouth;thetreatmentmustbealignedtotheobjectives.
Adequateclinicalandmedicalfollow-up.
Adequateandcontinuoustrainingforpractitioners.
Certificationforcommunityorganizationsandprivatebudget-basedcentresorcentresunderagreement,inaccordancewiththeMSSSnormativecertificationframeworkoraccreditationconditions.
d. continuity
AgreementsbetweenpublicandprivateCRPATsandrecognizedandcertifiedcom-munityorganizationswhenCRPATsarenotabletooffertherequiredservice.
Accompanimentoftheyouthtoaschool,socialoroccupationalreintegrationservicewhenthetreatmenthasbeencompleted.
Ifnecessary,preparationofanendoftreatmentplanforeachyouthandplanningofareferraltofront-lineservicestoensuresupportisprovidedinthecommunitywhentherehabilitationserviceshavebeencompleted.
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23 SECOND-LINE SERVICES
3.4. CONSULTATION AND SUPPORT FOR THE FAMILY AND FRIENDS
a. role and responsibilities of the crpat
Structuredassistancebasedontheneedsoftheyouth’sfamily.
Transmissionofclearinformationondifferentdependencies.
Informationonvarioustypesofbehaviourinyouthandtheinfluenceofpeers.
Typesofintervention:
Individual;
Group;
Family;
Crisissituationintervention.
Targetclientele:
Parents,siblingsorotherpersonsclosetotheyouth,whetherornotheisenrolled,andeveniftheydonothavedirectcontactorlivewithhimatthetimeoftheconsultation.
b. accessibility
Eachresourcewhichoffersrehabilitationservicestoyouthprovidessupport/consul-tationservicestotheyouth’sfamilyorclosefriends.
c. Quality
Practitionershavetakenarecognizedtrainingcourseinordertoprovidethistypeofservice.
Servicesareprovidedbyateamofprofessionalsrecognizedfortheirskillsandspe-cificknowledge.
d. continuity
Serviceagreementsmustbeconcludedwithotherinstitutionsororganizationswheretheyouth’sfamilyandfriendsneedssorequire(CSSS,hospital,CJ,privatecentres,communityorganizations).
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24SECOND-LINE SERVICES
3.5. SCHOOL, OCCUPATIONAL AND SOCIAL REINTEGRATION SERVICES
a. responsibilities shared by the crpat
Essentialservicestoconsolidatetheacquisitionsofthetreatmentandlearningofanewlifestyle.
Typesofservices:
Reintegrationintheschoolenvironment,pursuitoftheyouth’sstudies;
Occupationalreintegrationintheworkenvironment;
Socialreintegration.
Approach:individualorgroupmeetings,familymeetings,accordingtoneeds.
Servicesofferedtotheyouthwhetherornothehasbeenplaced.
b. accessibility
Eachregionoffersschool,occupationalandsocialreintegrationservicestoyouthwhoreceivespecializedsubstanceabuseservices.
Agreementswithcommunityorganizationsmaycompletetheserviceofferinsup-portingreintegration.
TheCRPATconcludesanagreementwiththeCSSSconcerninganaccessandreferralmechanismforspecificCSSSservicesdesignedtomaintaintheyouthinhiscom-munity.
c. Quality
Aninterventionplanensuresthattheschooloroccupationalsocialreintegrationprojectiscarriedout.
Appropriatetrainingforthepractitionersisrequired.
Theinterventionmustbeadaptedtomeetthecharacteristicsandvulnerabilitiesofyouth.
d. continuity
Ifnecessary,serviceagreementswillbeconcludedbetweentheCRPATsandcom-munityorganizationsrecognizedfortheirexpertiseinreintegration.
ServiceagreementsaredrawnupbetweentheCSSSandCRPATtoplantheendoftreatment.
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4SubStance abuSe acceSS mechaniSm FOr YOuth under the aGe OF 18 YearS in the mOntreaL area(mécanisme d’accès en toxicomanie pour les jeunes de moins de 18 ans de la région de montréal – matJm)
4.1. PRESENTATION
Thesubstanceabuseaccessmechanismforyouthundertheageof18yearsintheMontrealarea(MATJM)isthepointofentryforaccesstofreespecializedrehabilitationservicesonanout-patientorin-patientbasis.Toensureaccessibility,thismechanismofferstwoseparategatesofentry,oneforFrancophoneandallophoneclientsandtheotherforAnglophoneclients.
Itgroupstogetherinstitutionsandorganizationswhichorganizetheirvariousprogramsandservicesinacomplementarymanner,toensurethattheirresponseisadaptedtotheneedsoftheyouth.
4.2. TARGET CLIENTELE
Youthundertheageof18yearsintheMontrealareawhohaveasubstanceabuseproblemandwhorequirespecializedrehabilitationservices.
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4.3. OBJECTIVES
a. General objectives
Coordinateaccesstoin-patientorout-patientrehabilitationservicesforyouthwithdrugdependencies.
Coordinateaccesstospecializedsubstanceabuseconsultationservicesforthefamilyandfriendsofyouthindifficulty.
Makethebestpossibleuseofthespecializedresourcesavailableintheareaandexploitthespecificityoftheirprograms.
EnsurecomplementarityofspecializedsubstanceabuseservicesforyouthintheMontrealarea.
Enhancecollaborativeeffortswithotherestablishmentsintheregion,institutions,privatecentresandcommunityorganizationsinvolvedwithyouthclientele.
b. Specific objectives
Guaranteeaccess,takingintoaccountthediversityoftheFrancophone,AnglophoneandallophoneyouthpopulationsintheMontrealarea.
DefineaservicepathonthebasisoftheserviceprioritizationdescribedintheMSSSDependencyProgramserviceofferandaccordingtothespecificmissionsoffrontandsecond-lineinstitutions.
Usecommontoolsthatarerecognizedandvalidatedinregardtoscreening(DEP-ADO)andassessment(IGT-ADOandGAINforadolescents).
Establisharegionalconsensusconcerningtheapproachtobeusedincoordinatingassessmentsandaccesstospecializedsubstanceabuseservices.
Prepareachartpresentingmatchingcriteriawhichwillmakeitpossibletoestablishthebestpossibleconnectionbetweentheyouth’sneedsandthespecificityoftheservicesofferedbythespecializedsubstanceabuseresourcesavailableintheMontrealarea.
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4.4. ROLES AND RESPONSIBILITIES OF FRONT AND SECOND-LINE PARTNERS
rOLeS and reSpOnSibiLitieS
Front-line
Referents:→ CSSS→ Schools→ Hospitals(children)*→ Communityorganizations→ Centresjeunesse*→ Youth→ Parents
*Althoughthesearesecond-lineinstitutions,theyplayafront-linefunctioninsubstanceabusescreeningandreferral.
→ Identificationofriskandreferralfactors
→ Firstlevelassessment(screening):〕 DEP-ADO:CSSS,schools,communityorganizations,centres
jeunesse
Resultofthefirstlevelassessment:20+=codered
→ Partners(CSSS,schools,communityorganizations,hospitals,centresjeunesse)referforassessment:〕 Francophoneandallophoneclients:CentreDollard-Cormier〕 English-speakingclients:PavillonFoster
Second-line
Assessment
→ CentreDollard-CormierassessesFrancophoneandallophoneclientsreferredbythefront-line
→ PavillonFosterassessesEnglish-speakingclientsreferredbythefront-line
→ LeGrandChemin,thePortageandPavillonduNouveauPointdeVueassessrequestsreceiveddirectlybytheircentreandsendtheresultsoftheirassessmentaswellastheirrecommendationstothepersonresponsiblefortheregionalaccessmechanism
Coordination(MATJM):
SubstanceabuseaccessmechanismforyouthintheMontrealarea
→ TheMATJM(locatedinCentreDollard-CormierandPavillonFoster)receivestheresultsofassessmentsandrecommenda-tionsandvalidatesthemusingthematchingcriteriaadopted
→ Itsendstheresultsandrecommendationstotheassessorwhocaninformtheyouthandthereferent,withthelatter’swrit-tenauthorizationorhis/herparents,ifheisundertheageof14years.Followingthis,onacceptanceoftheclient,theaccessmechanismmakesareferraltothecentredesignatedfortheout-patientorin-patientservices
→ TheMATJMfollowsupthereferralwiththeparticipationofthedesignatedcentre
→ Itisinformedbythedesignatedresourceoftheyouth’sprogressintherehabilitationprogram
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4.5. ROLES AND APPROACHES OF REHABILITATION CENTRES AND PRIVATE OR COMMUNITY ORGANIZATIONS WHICH OFFER SPECIALIZED SUBSTANCE ABUSE SERVICES
centre dollard-cormier
TheYouthProgramattheCentreDollard-Cormierisdesignedforyouthundertheageof24yearswholiveontheIslandofMontrealwhosedrugoralcoholuseiscreatingdifficul-tiesofalltypes,aswellasforparentswhoareconcernedbytheirchildren’suse,whetherornottheyouthareparticipatingintheprogram.
Objectives:
Reducetheiralcoholordruguse;
Stabilizetheirlivingconditionsanddevelopasatisfyinglife-stylebyworkingontheprinciplethatsubstanceabuseisamulti-dimensionalphenomenon;
Informandsupportparentsandaccompanythemindevelopingtheirparentingskills.
Servicesoffered:
Out-patientservices:rehabilitationservicesareofferedonanout-patientbasistoyouthwhoaresufferingfromserioussubstanceabuseproblems,
Approach:bio-psychosocialwithaviewtoreducingharmfuleffects,
Clientele:24yearsandunderandtheirfamilyandfriends,
Lengthofstay:flexible,dependingontheyouth’sneeds,
Post-curefollow-up:individualorgroupmeetingsledbyamultidisciplinaryteam,
Particularities:walk-inreception,schoolprogram,trainingforschools,communitygroupsandfront-linepractitioners,
Reasonsforexclusion:violent,uncontrolledandrecurringbehaviour;inaddition,thelackofrespectforapsychiatrictreatmentmayresultintheyouth’stemporaryexclusion,
Servicesforfamilyandfriends:meetingsforindividualparents,couplesorfamiliesandgroupsofparents,eveniftheyouthisnotenrolledinaprogram,
In-patientservices:placementinayouthclinic,
Approach:bio-psychosocialwithaviewtoreducingharmfuleffects,
Clientele:mixed,aged17to24years,
Lengthofstay:approximatelyonemonthwiththepossibilityofleavingafter7days,
Post-curefollow-up:possibleout-patientfollow-upbyamultidisciplinaryteam,
Reasonsforexclusion:riskofphysicalwithdrawal,severementalhealthdisorder,
Particularities:placementinayouthclinicisdesignedtoprovideatimeouttostopthedown-wardspiralandinitiateareflectionprocess.
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pavillon Foster
PavillonFoster’sYouthProgramisdesignedforEnglish-speakingyouthfrom12to18yearsforwhomdrugandalcoholuseiscreatingdifficulties.
Withasupra-regionalmandate,theprogramservesthepopulationoftheIslandofMontrealandtheMontérégie.
PavillonFosteroffersthefollowingservices:
Bio-psychosocialassessmentandrecommendations;
Individual,groupandfamilytherapy;
GroupsofparentswhosechildrenmayormaynotparticipateintheProgram;
Servicesforthefamilyandfriends,whetherornottheyouthisenrolled;
Communityconsultations;
Trainingforschools,communitygroupsandfront-linepractitioners;
Interventionswithyouthintheschools;
Approachespromoted:bio-psychosocial,motivationalandcognitive-behaviouralinterviews.
Le Grand chemin
Servicesoffered:
Approach:bio-psychosocialtogetherwiththe12-stepAlcoholicsAnonymousmodel(changemotivationstage);
Clientele:mixed,agedbetween12and18years;
Lengthoftheprogram:from8to10weeks;
Post-curefollow-up:onceaweekforfourmonths;
Particularity:compulsoryschoolattendance;
Reasonsforexclusion:none,unlessseveremedicalandbehaviouralrestrictiondisorders;
Servicesforfamilyandfriends:parentalsupportanddirectinterventionwithfamiliestoworkondysfunctionsrelatedtothedrugoralcoholabuseoftheado-lescentsreceivingtherapy.
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portage
Servicesoffered:
Approach:therapeuticcommunity,self-help;
Clientele:mixed,aged14to18years;
Lengthofstay:sixtoeightmonths;
Post-curefollow-up:availableforaslongastheclientwishes;
ServiceagreementwiththeBatshawYouthandFamilyCentresandtheCentrejeunessetotheeffectthat12ofthe24placesintheBeaconsfieldfacilityarereservedforyouthfromtheBatshawYouthandFamilyCentres;
Particularities:schoolattendanceiscompulsoryandcoordinatedaroundaprogres-siveeducationalapproach.Theclientsplayasignificantroleinthemanagementoftheenvironmentandanimportantroleisassignedtothefamilyaswellasthereferents;
Reasonsforexclusion:uncontrolledviolence,unstabilizedmentaldisordersorthelackofanattendingprofessional;
Servicesforthefamilyandfriends:participationofthefamilyisconsideredtobeanimportantassetintheadolescent’ssuccess.Itisreceivedandsupportedbyfamilyservices,invitedtogetinvolvedandconsultedduringrevisionsoftheIP.Familieswithspecificneedsareaccompaniedbytheteamandotherfamilieswhousethesameservices.Attentionisparticularlyassignedattheendoftheresidentialstayinordertoensurethefamilyreunificationandcontinuoussupportisprovidedthroughoutthepost-curefollow-up.
Le pavillon du nouveau point de vue
Servicesoffered:
Approach:behavioural;assistedbyintensiveoutdooractivitiestogetherwiththe12-stepmodeladaptedforadolescentclientele,withinabio-psychosocialperspective;
Clientele:mixed,agedbetween13and18years;
Lengthoftheprogram:42days;
Post-curefollow-up:onceamonthforoneyear;
Particularities:beopentoparticipatinginintensiveoutdoorexperiences;
Reasonsforexclusion:riskofphysicalwithdrawal,highriskofsuicideandmedicalrestrictions;
Servicestothefamilyandfriends:theabilityforthefamilynetworktotakechargeoftheadolescentagainisencouragedandafollow-upaswellasvisitsareofferedduringthetreatment.
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4.6. CLINICAL COMPONENTS OF THE ACCESS MECHANISM5
Theclient-pathstepsforayouthadmittedtoarehabilitationcentreoranorganizationarethefollowing:
a. assessment/orientation
Theassessmentoftheyouthconcerned,carriedoutbyapractitionerfromCentreDollard-CormierorPavillonFosterorbyoneofthepartnersinvolvedintheagreements,mustbeforwardedtotheaccessmechanismforvalidationorrevisionandmatching.Thesameprincipleappliesinthecaseofare-admission.
Thecentresagreetoproduceassessmentswithinoneweekfollowingtherequestandwithin48hoursinurgentsituations.Iftheyhavetodealwithawaitinglist,theyforwardtherequesttotheaccessmechanismwhichwillprovidethefollow-up.Thecentresspecializinginsubstanceabusewillusecommon,validatedtoolstoassessthesubstanceabuseseriousnessindex,theIGT-ADOortheGAINforadolescents.
WithinthecontextoftheYouth Criminal Justice Act(YCJA):
Whenajudgerequestsasubstanceabuseassessmenttoclarifyhisdecisionforanorder
Inthissituation,thejudgewillaskforanassessmenttobecarriedoutbyanexperthiredbytheCentrejeunesse.AttherequestoftheCentrejeunesse,thisprofessional-expertwillbeaskedtocompletetheyouth’srecordbyaskingtherepresentativesoftheregionalsub-stanceabuseaccessmechanismforyouthundertheageof18yearstoassesstheseriousnessoftheyouth’ssubstanceabuse.Basedontheseresults,theassessor(IGTorGAIN),willrecommendthemostappropriateresourcetomeettheyouth’sneeds.
Followingvalidationoftheresultsoftheassessmentandrecommendations,theaccessmechanisminformstheprofessional-expertoftheavailabilityofthedesignatedresource.
IftheyouthisunderprovisionaldetentionattheCentrejeunesse,theIGTorGAINassess-mentmustbecarriedoutonthedetentionpremisesbyanassessorcertifiedbytheaccessmechanism.
Otherwise,theyouthmayreporttotheaccessmechanism(CentreDollard-CormierorPavillonFoster)toobtainanIGTorGAINassessment;hemaybeaccompaniedbyhisparentsortheyouthworker.
5 WewouldliketothanktheCentre André-Boudreauwhichprovidedthetextsusedinthisdocument.
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Whentheyouthisalreadyunderacourtorder
Iftheyouthhasadrugdependency,hemaytakeadvantageoftheservicesofferedbytheregionalsubstanceabuseaccessmechanism.Ascreeningtest(DEP-ADO)willbeadmin-isteredtohimbeforehandbyaworkerfromtheCentrejeunesse.
Iftheyouthiscoded“red”,hewillbereferredtotheregionalsubstanceabuseaccessmech-anism,eitherattheCentreDollard-CormierorthePavillonFoster,dependingonwhetherhespeaksFrenchorEnglish.Hemaybeaccompaniedbyhisparentsortheyouthworker.
Theprofessionalsinchargeoftheaccessmechanismwillassesstheyouth’saddictionseverityindex.Dependingontheresultsoftheassessment,theassessorwillrecommendthemostsuitableresourceforhisneeds.
Iftheapplicationofthisrecommendationrequiresthattheorderbemodified,theadolescent,hisparentsortheyouthworker(whicheverthecasemaybe)contactstheYouthDivision(Chambredelajeunesse)forarequesttochangethepenaltyorconditionimposedthatisaffectedbythismodification.
Inallcases,atthetimeofhisassessment,awrittenauthorizationfromtheyouth,orhisparents,ifheisundertheageof14years,isrequiredinordertoallowtheresultsoftheassessmentandrelatedrecommendationstobeforwardedtotheprofessionalswhowillprocesshisrecord.
Theevaluator’srole:
Theevaluatorgivesthevalidatedresultsandrecommendationforadesignatedcentretotheyouth.Thereferent(parentorworker)canalsohaveaccesstothemwiththeyouthauthorization.Theseresultsaregivenverbally.Theinformationis,nevertheless,availableintherecordthatmaybeconsultedbytheyouthifhewishesorbyhisparents,ifheisunder14yearsofage.Ifheisover14years,hisconsentisnecessaryforarecordconsultation.
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b. the role of the designated resource
Aftermakingamatch,theresourcedesignatedtoofferin-patientrehabilitationservices,suggeststotheadolescent,hisfamilyandanysocialworkerinvolvedinthecase,thattheycouldmakeapre-admissionvisittohelpdemystifyanypossibleprejudicesconcerningthein-patienttypestayandtobecomefamiliarwiththefacility.Thedayafterthisvisit,theyouthiscontactedagaintopursueorendtheadmissionsprocess.Thedesignatedresourceinformstheaccessmechanismoftheresultsofthesesteps.
Thereferral(out-patientservices):
Thedesignatedresourcepresentsitsvariousservicesandprogramstotheyouthandestablishesaninterventionplanwithhim,hisparents,hisguardianorworker,whicheverthecasemaybe.Ifothernetworkpartnersareinvolved,anISPmustbedrawnup.
Clinicalfollow-up:Followingtheadolescent’sadmissiontoanin-patientservice,aninformationtrans-missionprocessconcerningtheyouth’sprogressapplies,asfollows:
Aregulartelephonecallbytheaccessmechanismserviceproviderduringthestay;
Theyouth’sIPissenttotheaccessmechanismserviceproviderduringthestay;
Anendofstayreportissenttotheaccessmechanismserviceprovider.
Thisinformationisforwardedtothereferentwho,ifnecessary,ensuresthattheinterventionisfollowed-upincontinuitywiththeobjectivespursuedduringthestay.
Inthecaseofayouthplacedfollowinganorder,thejudgemayaskthedesignatedcentretokeephiminformedoftheyouth’sprogressduringhisrehabilitationprogram.
c. interruption of the stay
Intheeventtheadolescentdoesnotcompletehisstaybecauseofatimeout,orbecausehehasrunaway,wantstoreflect,refusestreatment,orsimplybecausehevoluntarilydecidestoleave,theaccessmechanismhasadoptedaFollow-up Sheet(seeAppendix3)whichisautomaticallycompletedwithin24hoursandsenttotheaccessmechanismserviceprovidertoinformhimofthesituation.Inthiscase,therehabilitationcentresareaskedtocontributeandoffertheyouththepossibilityofcontinuinghistreatmentasanout-patientor,ifnecessary,tobereoriented.Thisformservesastheendofstayreport.
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d. crisis situations
Theconceptofacrisisreferstoasuddenchange,aseriousincidentinayouth’sdevelopment(suicideofapeer,hospitalizationfollowinganoverdoseoralcoholpoisoning,expulsionfromthefamilyenvironment,etc.).Thisepisode,eventhoughitmaybebrief,maybeatriggeringelementleadingtheyouthtomakeachangebyincreasinghismotivation.Suchrequestsareprocessedbytheaccessmechanismasquicklyaspossible.
e. aftercare
Whenayouthhascompletedhisin-patientstay,theresourcewhichprovidedtheserviceoffershimthechoiceofcontinuingasanout-patientintheirserviceorwitharehabilitationcentreclosetohishome.Intheeventheisreferredtoarehabilitationcentre,thereportonhisstayissenttothepersonresponsibleforthecentre’sout-patientservices,eithertotheCentreDollard-CormierorthePavillonFoster,within20daysfollowingtheyouth’sdeparturetoencouragehimtopursuetheintervention.
Inallothertypesofdeparture,asidefromthosecompletedinfull,rehabilitationcentresareaskedtocontributebyofferingtheyouththepossibilityofcontinuingonanout-patientbasisorbyreorientinghimifapplicable.Atthispoint,theFollow-Up Sheet(seeappendix3)isusedasanendofstayreport.
4.7. MATCHING
Matchingisastepintheassessmentprocesswhichenablesthebestpossibleconnectiontobemadebetweentheyouth’sneedsandthespecificservicesofferedbyspecializedsubstanceabuseresourceswhicharemembersoftheaccessmechanism.
Theyouth’sneedsforthepurposeofmatchingareanalysedaccordingtothethemesintheIGT-ADOandGAINforadolescentstoolsalreadymentioned.
Amatchingcharthasbeendesignedforthispurpose(seeAppendix1).
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4.8. REGIONAL OPERATIONALIZATION OF THE ACCESS MECHANISM
a. regional operationalization and coordination
InaccordancewiththeresponsibilitiesvestedintheCRPATserviceoffer,theCentreDollard-Cormierisobligedtoprovideaccesstoallyouthclientele,whethertheyareFrancophone,Anglophoneorallophone.Tothisend,itisresponsiblefortheoperationalizationoftheMontrealmechanismaswellasforhiringandsupervisingthepersonnel.
TheCentreDollard-CormierprocessesapplicationsfromyoungFrancophonesandallophoneswhospeakneitherFrenchnorEnglish.
ForEnglish-speakingyouth,theCentreDollard-CormierwillconcludeanagreementwiththePavillonFosterwhichwillcoordinatetheresponsetorequestsforservicesforthisclientele.
ResponsibilityforcoordinatingtheaccessmechanismisassignedtothecoordinatorsoftheYouthProgramattheCentreDollard-CormierandthePavillonFoster.Undertheirauthority,theirrespectiveteams,composedofliaisonofficers,willrespondtorequestsfromyouthundertheageof18years.
Participants:
ServicesforFrancophones:LeGrandChemin,Portage(LacÉcho),PavillonduNouveauPointdeVue,CentrejeunessedeMontréal–Institutuniversitaire;
ServicesforAnglophones:Portage(Beaconsfield),BatshawYouthandFamilyCentres.
PavillonFosterwillparticipateinhiringtheAnglophonecoordinatorandwillsupervisethequal-ityofservicesofferedbythelatter,asitdoesfortheotherprofessionalsinitsorganizationwhocomeundertheadministrationoftheCentreDollard-Cormier.
b. the Youth program coordinators’ role
Tosupporttheaccessmechanismteaminimplementingandapplyingtheservice.
Toensuretheaccessmechanism’scomplementaritywithotherservicesofferedbytheYouthProgram.
Tocreatelinkswithfront-lineservices.
Tocallandleadmeetingsoftheclinicalcommitteeeachmonth.
Toparticipateinthesteeringcommittee.
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c. the liaison officers’ role
Toseetotheproperperformanceoftheaccessmechanismfortheclientele.
Whenrequired,toreferrequestsforanassessmenttoapartnermemberoftheaccessmechanism.
Toreceivetheresultsofassessmentsaccompaniedbyrecommendations.
Tovalidatetheresultsandrecommendationsaccordingtomatchingcriteria
Torapidlyinformtheassessorofthedecisionconcerningorientation
Tocoordinateandfollow-upregistrationatthedesignatedcentre.
Tofollow-upyouthwhoarewaitingforanin-patientservice.
Toorienttheyouthtoanout-patientservice,ifnecessary,whenthein-housestagehasbeencompleted.
Toprovidealiaisonwiththeresourcestofollow-upyouthenrolledintheprogram.
Tocarryoutoccasionalassessments(IGT-ADOorGAINforadolescents),whenprescribedwaitingperiodscannotberespected.
Tocarryoutassessmentsoutsidetheinstitutionwhenconsiderednecessary(inhospitals,CJorschools).
Tocompilestatisticsconcerningtheservice.
Toprepareanannualreportontheperformanceoftheaccessmechanism.
Toensurethat“codeyellow”youthandtheirfamilyandfriendsidentifiedattheCDCreceivetheappropriateservicesbyaccompanyingtheminthereferraltofirst-lineservicesintheirsector.
Tosupportyouthwhowantatherapeuticfollow-upwhenthewaitinglististoolong.
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4.9. ADMINISTRATIVE COMPONENTS
a. agreements
Thepartnersinvolvedintheaccessmechanismarelinkedthroughagreementsapprovedbytheirexecutivedirectors.Intheseagreements,theyagreetorespecttheprocedureadoptedandtoparticipateinensuringtheproperfunctioningofthemechanismbyassumingtheirrespectiverolesandresponsibilities.
b. Steering committee
Thiscommitteeiscomposedofthecoordinatorsordirectorsofthesubstanceabuseresourceswhicharemembersoftheaccessmechanism,thetwocentresjeunesseintheregion,theCSSSandtheresearcherconnectedtotheCentreDollard-Cormierappointedtosupportthemechanism.ThemembersofthiscommitteeareresponsibleforthegoodmanagementofboththeFrancophoneandtheAnglophonesectorsoftheaccessmechanism.
TherepresentativefromtheAgencedelasantéetdesservicessociauxdeMontréalisanex-officiomemberoftheSteeringCommittee.
Centre-DollardCormierisresponsibleforcallingandleadingtheCommittee’smeetings.
TheCommitteemeetsatleastonceayear.
c. clinical committee
Eachaspectoftheaccessmechanism,FrancophoneandAnglophone,willhaveitsownclinicalcommittee.
TheclinicalcommitteeiscomposedofonerepresentativeappointedbyeachspecializedsubstanceabuserehabilitationresourceaswellastheCJ.TheCSSSintheregionwillbeinvitedtoparticipateasthecasemaybe.Ifnecessary,thesupportresearcherfortheaccessmechanismmayalsoparticipateinthecommitteemeetings
Byreferringtothematchingcriteriaadopted,eachmonth,thecommitteewillstudydisputedcases,orientationsandreorientationsaswellastheyouths’follow-upassessments.
Itsmembersactasliaisonofficerswiththeaccessmechanismfortheirorganization.
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5SuppOrt bY the reSearch
TheresearcherattheCentreDollard-CormiersupportstheFrancophoneandAnglophoneregionalaccessmechanism.Hisroleconsistsofidentifyingindicators,establishingthedatainputsystemandtheassociateddataprocessingtools.Heparticipatesintheannualreportontheregionalaccessmechanism,anditsevaluation.
SuPPORT BY THE RESEARCH
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6FundinG
Arequestforfundingtocoverthecostofhiringtheaccessmechanismemployeesandtheadmin-istrativesupportrequiredwillbesubmittedtotheAgencedelasantéetdesservicessociauxdeMontréal.Therequestwillbesupportedbystatisticspresentingthenumberofnewrequestssubmittedtosubstanceabusepartnersin2004-2005concerningyouthintheregionundertheageof18yearsortheirparents.
FuNDING
43
7accOuntabiLitY
Attheendofeachyear,theCentreDollard-Cormier,whichisresponsibleforimplementingtheaccessmechanism,willsubmitareporttotheadvisorycommitteeandtheagency,producedbytheaccessmechanism,basedonindicatorsdefinedbytheministèredelaSantéetdesServicessociaux(seeAppendix4).
ACCOuNTABILITY
45
8SuppOrt FOr the deveLOpment OF FrOnt-Line ServiceS in the mOntreaL area
WithinthescopeofthecurrentreorganizationofhealthandsocialservicesintheMontrealregion,itisnecessarytosystematicallyintroducescreeningandreferralservicesinalltheCSSSsoastofacilitateaccesstotheDependencyProgram.Itisalsonecessarytosupporttheotherpartnersinthenetwork(CJ,hospitals,CRDI,CRDP,etc.),schoolsandcommunitygroupsinordertoimplementtheregionalsubstanceabuseaccessmechanismforyouthundertheageof18years,particularlywithaviewtomakingthebestpossibleuseoftheDEP-ADOassessmentchart.
8.1. RESPONSIBILITYTheCRPAT(see:ServiceOffer/DependencyProgram).
8.2. WORK COMPLETEDTrainingcarriedoutintheCSSS.
Trainingcarriedoutintheschools.
TrainingcarriedoutinthecentresjeunessewiththesupportoftheCentreDollard-CormierandthePavillonFoster.
8.3. WORK IN PROCESSMeetingsandserviceofferbytheexecutivedirectorsoftheCentreDollard-CormierandthePavillonFosterwiththeexecutivedirectorsofthe12CSSS:
Deadline:June30,2006;
Goal:toraisetheawarenessoftheCSSSoftheirfront-lineroleandprovidesup-portandtraining.
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8.4. WORK TO BE CONTINUEDSupportfortheimplementationoftheaccessmechanismandtheuseoftheDEP-ADObytheinstitutionsinthenetwork,theschoolsandcommunityorganizations.
8.5. AVAILABILITY OF TRAINING TOOLSThetrainingtoolsonapplyingtheDEP-ADOareavailablefromRecherche-Inter-vention sur les substances psychoactives du Québec(research-interventiononpsychotropicsubstancesserviceofQuebec)locatedintheCentreDollard-Cormier.Theymustbemadeaccessibletoallthepartnerswhoareinvolvedinapplyingtheregionalsubstanceabusemechanismforyouthundertheageof18years.
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appendiX 1 Matchingchartforthesubstanceabuseaccessmechanismforyouthundertheageof18yearsintheMontrealarea
appendiX 2 Authorization,exchangeofinformation
appendiX 3 Casefollow-upsheet
appendiX 4 IndicatorFactSheet,DependencyProgram,Substanceabuse,MSSS,2005
appendixes
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cen
tre
d
OLL
ard
-cO
rmie
r (O
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tient
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s)
cen
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OLL
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(clin
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f age
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LLO
n F
OSt
er
(You
th o
utpa
tient
se
rvic
e)
Le G
ran
d c
hem
inLe
pO
rtaG
e
(bea
cons
field
and
La
c Éc
ho)
pavi
LLO
n d
u n
Ou
veau
pO
int
de
vue
pOrt
rait
OF
the
aLcO
hO
L O
r d
ruG
uSe
Freq
uenc
yRe
gula
r pro
blem
atic
or
occ
asio
nal h
igh
risk
cons
umpt
ion
Regu
lar t
o he
avy
cons
umpt
ion
Alco
hol a
nd d
rugs
Mul
tiple
con
sum
ptio
n fo
r mor
e th
an o
ne y
ear
iGt:
Re
gula
r pro
blem
atic
or
occ
asio
nal h
igh
risk
cons
umpt
ion
Gai
n:
GAIN
-I A
SAM
crit
eria
A:
SPI-
M (P
ast-M
onth
Sub
stan
ce
Prob
lem
Inde
x) >
0: O
R SD
I-M
(P
ast-M
onth
Dep
ende
nce
Inde
x) M
ild to
mod
erat
e
Regu
lar t
o he
avy
cons
umpt
ion
Alco
hol,
drug
s, m
ultip
le u
se
for m
ore
than
one
yea
r, th
ree
times
or m
ore
per w
eek
Regu
lar t
o he
avy
cons
umpt
ion.
M
ultip
le u
se fo
r the
pas
t 12
mon
ths
Regu
lar t
o he
avy
cons
umpt
ion.
Al
coho
l and
dru
gs, m
ultip
le u
se
for m
ore
than
one
yea
r, th
ree
or m
ore
times
per
wee
k
Qua
ntity
See
Freq
uenc
ySe
e Fr
eque
ncy
iGt:
Re
gula
r pro
blem
atic
con
sum
p-tio
n or
occ
asio
nal h
igh
risk
Gai
n:
see
Freq
uenc
y
See
Freq
uenc
ySu
bsta
nce
abus
e va
ryin
g fr
om
occa
sion
ally
to c
onst
antly
Subs
tanc
e ab
use
vary
ing
from
oc
casi
onal
ly to
con
stan
tly
With
draw
al r
isk
Mild
- m
oder
ate
Mod
erat
e-hi
gh c
ravi
ng
obse
ssio
niG
t:
Mild
to m
oder
ate
Gai
n:
GAIN
-I A
SAM
dim
ensi
on A
, PM
SD s
ubsc
ale
(Pas
t Mon
th
Subs
tanc
e De
pend
ence
In
dex)
= M
ild to
mod
erat
e PL
US B
1:CW
I ( C
urre
nt
With
draw
al In
dex)
: Mild
to
mod
erat
e fo
r with
draw
al
com
plic
atio
ns (W
ithdr
awal
Kit
crite
ria)
Mod
erat
eM
oder
ate
Mod
erat
e
met
hod
of a
dmin
istr
atio
nEx
plor
ator
y or
occ
asio
nal
inje
ctio
nsOc
casi
onal
or f
requ
ent
inje
ctio
nsiG
t:
Expl
orat
ory/
occa
sion
al
inje
ctio
nsG
ain
: GA
IN_I
ASA
M c
riter
ia B
2,
Need
le R
isk
Inde
x sc
ore
in
Low
rang
e
Expl
orat
ory,
occa
sion
al o
r fr
eque
nt in
ject
ions
Regu
lar
Occa
sion
al in
ject
ions
Leng
th o
f abs
tinen
cePo
ssib
ility
of a
sho
rt p
erio
d of
ab
stin
ence
with
out r
esul
ts o
r no
per
iod
of a
bstin
ence
(les
s th
an 9
0 da
ys o
f abs
tinen
ce)
No p
erio
d of
abs
tinen
ceiG
t an
d G
ain
: Po
ssib
ility
of a
sho
rt p
erio
d of
ab
stin
ence
(up
to 9
0 da
ys) o
r no
per
iod
of a
bstin
ence
Shor
t per
iod
(less
than
two
wee
ks) w
ithou
t suc
cess
an
d/or
no
abst
inen
ce d
urin
g th
e pa
st 1
2 m
onth
s
Shor
t per
iod
(less
than
two
wee
ks) w
ithou
t suc
cess
an
d/or
no
abst
inen
ce d
urin
g th
e pa
st 1
2 m
onth
s
Shor
t per
iod
(less
than
two
wee
ks) w
ithou
t suc
cess
an
d/or
no
abst
inen
ce d
urin
g th
e pa
st 1
2 m
onth
s
APPENDIXES
APPE
NDIX
1 –
MAT
CHIN
G CH
ART
FOR
THE
SUBS
TANC
E AB
USE
ACCE
SS M
ECHA
NISM
FOR
YOU
TH U
NDER
THE
AGE
OF
18 Y
EARS
IN T
HE M
ONTR
EAL
AREA
NO
TE:
The
ass
esso
rm
ustg
ive
prio
rity
toth
efo
llow
ing
elem
ents
:the
you
ths
age,
his
use
,the
sup
port
ofh
ise
nvir
onm
ent(
fam
ilyo
rsu
bsti
tute
env
iron
men
t),
his
risk
beh
avio
ura
sw
ella
shi
sm
otiv
atio
nto
rec
eive
ass
ista
nce
and
his
mot
ivat
ion
inr
egar
dto
the
orie
ntat
ion
reco
mm
ende
d.
49
cen
tre
d
OLL
ard
-cO
rmie
r (O
utpa
tient
Ser
vice
s)
cen
tre
d
OLL
ard
-cO
rmie
r
(clin
ical
pla
cem
ent Y
outh
17
yea
rs o
f age
and
ove
r)
pavi
LLO
n F
OSt
er
(You
th o
utpa
tient
se
rvic
e)
Le G
ran
d c
hem
inLe
pO
rtaG
e
(bea
cons
field
and
La
c Éc
ho)
pavi
LLO
n d
u n
Ou
veau
pO
int
de
vue
pOrt
rait
OF
the
aLcO
hO
L O
r d
ruG
uSe
(cO
nt.
)
risk
of r
elap
se
Mod
erat
e-hi
ghM
oder
ate-
high
iGt:
M
oder
ate-
high
Gai
n:
GAIN
_I A
SAM
Crit
eria
B4,
B5,
B6
: clie
nt fa
lls in
mod
erat
e to
hi
gh ra
nge
on a
ssoc
iate
d GA
IN
subs
cale
s.Se
e es
peci
ally
ER
I6 (E
nviro
nmen
tal R
isk
Inde
x)
Obse
ssio
ns h
igh
Obse
ssio
ns h
igh
Obse
ssio
ns h
igh
risk
of o
verd
ose
Risk
of o
verd
ose
low
or
mod
erat
eRi
sk o
f ove
rdos
e –
mod
erat
e or
hig
h, h
isto
ry o
f fre
quen
t ov
erdo
se
iGt:
Ri
sk o
f ove
rdos
e: lo
w to
m
oder
ate
Gai
n:
Low
to m
oder
ate
base
d on
hi
stor
y of
use
High
or i
mm
edia
te w
ith
freq
uent
inci
dent
s in
pas
tRi
sk o
f ove
rdos
e –
mod
erat
e or
hig
h, h
isto
ry o
f fre
quen
t ov
erdo
ses
High
or i
mm
edia
te w
ith
freq
uent
inci
dent
s in
pas
t
Sour
ce o
f inc
ome
(ille
gal)
Cu
rren
t ille
gal a
ctiv
ities
but
ab
le to
sto
p th
ese
curr
ent
activ
ities
as
an o
utpa
tient
Curr
ent i
llega
l act
iviti
es o
r un
able
to s
top
thes
e ac
tiviti
esiG
t:
Curr
ent i
llega
l act
iviti
es b
ut
able
to s
top
thes
e cu
rren
t ac
tiviti
es a
s an
out
patie
ntG
ain
: GA
IN_I
ASA
M C
riter
ia B
6 (R
ecov
ery
Envi
ronm
ent)
Inde
x of
day
s of
ille
gal
activ
ities
for m
oney
: low
to
mod
erat
e
Curr
ent i
llega
l act
iviti
es o
r un
able
to s
top
thes
e ac
tiviti
esCu
rren
t ille
gal a
ctiv
ities
or
unab
le to
sto
p th
ese
activ
ities
Prev
ious
out
patie
nt tr
eatm
ent
insu
ffici
ent
trea
tmen
t his
tory
Poss
ible
pre
viou
s ou
tpat
ient
tr
eatm
ent
Poss
ible
pre
viou
s ou
tpat
ient
or
in-h
ouse
trea
tmen
tiG
t an
d G
ain
: Po
ssib
le p
revi
ous
outp
atie
nt
trea
tmen
t with
cha
nges
in th
e tr
eatm
ent p
lant
Prev
ious
out
patie
nt tr
eatm
ent
insu
ffici
ent
Poss
ible
pre
viou
s ou
tpat
ient
or
in-p
atie
nt tr
eatm
ent
insu
ffici
ent
Prev
ious
out
patie
nt o
r in-
patie
nt tr
eatm
ent i
nsuf
ficie
nt
phYS
icaL
hea
Lth
phys
ical
hea
lthCo
nsum
ptio
n in
volv
es a
slig
ht
or m
oder
ate
risk
to p
hysi
cal
heal
th
High
hea
lth ri
sk
Sign
ifica
nt p
robl
ems
(HIV
, HC
V)
iGt:
Co
nsum
ptio
n in
volv
es a
low
or
mod
erat
e ris
k to
phy
sica
l he
alth
Gai
n:
GAIN
_I A
SAM
Crit
eria
B2
: Ri
sk in
dex
for s
exua
l act
ivity
: lo
w
Poss
ibili
ty o
f cur
rent
sig
nifi-
cant
pro
blem
s re
late
d to
use
Curr
ent s
igni
fican
t pro
blem
s re
late
d to
use
Curr
ent s
igni
fican
t pro
blem
s re
late
d to
use
APPENDIXES
50
cen
tre
d
OLL
ard
-cO
rmie
r (O
utpa
tient
Ser
vice
s)
cen
tre
d
OLL
ard
-cO
rmie
r
(clin
ical
pla
cem
ent Y
outh
17
yea
rs o
f age
and
ove
r)
pavi
LLO
n F
OSt
er
(You
th o
utpa
tient
se
rvic
e)
Le G
ran
d c
hem
inLe
pO
rtaG
e
(bea
cons
field
and
La
c Éc
ho)
pavi
LLO
n d
u n
Ou
veau
pO
int
de
vue
Occ
upa
tiO
n
Scho
ol
Stud
ies
com
prom
ised
or
expu
lsio
nAl
l cat
egor
ies
iGt:
St
udie
s co
mpr
omis
ed o
r ex
puls
ion
Gai
n:
GAIN
_I A
SAM
Crit
eria
B6
GAIN
Rec
over
y En
viro
nmen
tTr
aini
ng P
robl
em In
dex:
Mod
e-ra
te to
Hig
hPr
oble
ms
at s
choo
l dur
ing
the
past
90
days
: > 0
Mot
ivat
ed to
pur
sue
his/
her
educ
atio
nM
otiv
ated
to p
ursu
e hi
s/he
r ed
ucat
ion
42 d
ays
with
out e
duca
tion
Wor
kPr
oble
ms
at w
ork,
diffi
culty
in
obta
inin
g an
d ke
epin
g a
job
With
out w
ork,
diffi
culty
in
obta
inin
g or
kee
ping
a jo
biG
t:
Prob
lem
s at
wor
k, d
ifficu
lty in
ob
tain
ing
and
keep
ing
a jo
bG
ain
: GA
IN_I
ASA
M c
riter
ia B
6 Re
cove
ry E
nviro
nmen
tW
ork
Prob
lem
Inde
x: M
ode-
rate
to H
igh
(=>
2)
Sign
ifica
nt p
robl
ems
at w
ork,
di
fficu
lty in
obt
aini
ng a
nd
keep
ing
a jo
b
Sign
ifica
nt p
robl
ems
at w
ork,
di
fficu
lty in
obt
aini
ng a
nd
keep
ing
a jo
b
Sign
ifica
nt p
robl
ems
at w
ork,
di
fficu
lty in
obt
aini
ng a
nd
keep
ing
a jo
b
pSYc
hO
LOG
icaL
Sta
te
dep
ress
ion
anxi
ety
conc
entr
atio
n
mem
ory
Loss
of s
elf-
este
em
agita
tion
beha
viou
ral d
isor
ders
eatin
g di
sord
ers
hal
luci
natio
ns
para
noia
No e
xclu
sion
Asse
ssm
ent o
f the
sev
erity
of
sym
ptom
s
Refe
rral
and
col
labo
ratio
n w
ith
the
child
psy
chia
tris
t or w
ith
the
Cent
re J
eune
sse
(rep
ort)
or th
e CS
SS
No e
xclu
sion
Asse
ssm
ent o
f the
sev
erity
of
sym
ptom
s
Refe
rral
and
col
labo
ratio
n w
ith
the
child
psy
chia
tris
t or w
ith
the
Cent
re J
eune
sse
(rep
ort)
or th
e CS
SS
iGt:
No
aut
omat
ic e
xclu
sion
bas
ed
on th
e sy
mpt
oms
as s
uch
Asse
ssm
ent o
f the
sev
erity
of
thes
e co
nditi
ons
from
the
begi
nnin
gEs
tabl
ish
whe
ther
the
cond
ition
exi
sted
bef
ore
the
cons
umpt
ion
beca
me
a pr
oble
mIn
tegr
ated
inte
rven
tion
or
refe
rral
, dep
endi
ng o
n th
e ca
seG
ain
: AS
AM c
riter
ia B
3 Ps
ycho
logi
cal
Cond
ition
s an
d co
mpl
icat
ions
:M
oder
ate
to h
igh
Pres
ence
of a
t lea
st fo
ur (4
) of
thes
e sy
mpt
oms
durin
g hi
s lif
etim
e
Curr
ent p
rese
nce
of a
t lea
st
four
(4) o
f the
se e
lem
ents
Pres
ence
of a
t lea
st fo
ur (4
) of
thes
e el
emen
ts, m
ore
spec
ific
to a
non
-con
form
ist p
rofil
e of
: diffi
culty
in c
once
ntra
ting,
ag
itatio
n, lo
ss o
f con
trol
and
im
puls
iven
ess
N.B.
: No
othe
r ele
men
t is
a re
ason
for e
xclu
sion
APPENDIXES
51
cen
tre
d
OLL
ard
-cO
rmie
r (O
utpa
tient
Ser
vice
s)
cen
tre
d
OLL
ard
-cO
rmie
r
(clin
ical
pla
cem
ent Y
outh
17
yea
rs o
f age
and
ove
r)
pavi
LLO
n F
OSt
er
(You
th o
utpa
tient
se
rvic
e)
Le G
ran
d c
hem
inLe
pO
rtaG
e
(bea
cons
field
and
La
c Éc
ho)
pavi
LLO
n d
u n
Ou
veau
pO
int
de
vue
pSYc
hO
LOG
icaL
Sta
te (
cOn
t.)
risk
of a
ggre
ssio
n/
viol
ence
Mild
-mod
erat
eM
oder
ate-
high
iGt:
M
ild-m
oder
ate
Gai
n:
GAIN
_I A
SAM
B3
Argu
ing
and
Aggr
essi
on s
ubsc
ale
scor
e PL
US h
isto
ry o
f vio
lenc
e to
war
d so
meo
ne w
ithin
the
last
90
days
(to
esta
blis
h th
e ris
k an
d m
ake
a re
ferr
al w
hen
appr
opria
te)
Mild
-mod
erat
eM
oder
ate-
high
Mod
erat
e-hi
gh
risk
of s
uici
de
Mod
erat
e pr
esen
ce o
f sui
cida
l id
eatio
n
If h
igh
risk,
col
labo
ratio
n w
ith
the
child
psy
chia
tris
t
High
pre
senc
e of
sui
cida
l id
eatio
n
If h
igh
risk,
col
labo
ratio
n w
ith
the
child
psy
chia
tris
t
iGt:
M
oder
ate
or h
igh
(with
col
la-
bora
tion
and
mon
itorin
g of
risk
du
ring
the
subs
tanc
e ab
use
trea
tmen
t)If
the
clie
nt h
as a
his
tory
of
PTSD
sym
ptom
s (A
SAM
crit
eria
B3
, TSS
(TSS
) = m
oder
ate
to
high
) ->
Asse
ss a
nd in
terv
ene
with
a b
rief i
nter
vent
ion
or
refe
r, de
pend
ing
on th
e ca
se
Mod
erat
eM
oder
ate
Mod
erat
e
Situ
atio
ns o
f abu
seCu
rren
t situ
atio
n of
abu
se b
ut
trea
tmen
t in
proc
ess
Curr
ent s
ituat
ion
of a
buse
iGt:
Cu
rren
t situ
atio
ns o
f abu
se b
ut
trea
tmen
t in
proc
ess
Gai
n:
GAIN
ASA
M c
riter
ia: G
VI
(Gen
eral
Vic
timiza
tion
Inde
x)
used
to id
entif
y cu
rren
t abu
seIf
abu
se is
iden
tified
for t
he
first
tim
e, re
port
the
case
to
the
DPJ
Curr
ent s
ituat
ions
of a
buse
Curr
ent s
ituat
ions
of a
buse
Curr
ent s
ituat
ions
of a
buse
inte
rper
SOn
aL r
eLat
iOn
Ship
S
Org
aniz
ed g
ang
Poss
ibili
ty o
f org
anize
d cr
ime
gang
with
abi
lity
to e
nd th
ese
asso
ciat
ions
Poss
ibili
ty o
f org
anize
d cr
ime
gang
iGt:
Po
ssib
ility
of o
rgan
ized
crim
e ga
ng w
ith a
bilit
y to
end
thes
e as
soci
atio
nsG
ain
: GA
IN_I
ASA
M c
riter
ia B
6:
Reco
very
Env
ironm
ent:
GCI (
Gene
ral C
rime
Inde
x) =
M
ild to
mod
erat
e PL
US D
ays
of Il
lega
l Act
ivity
fo
r Mon
ey In
dex
= M
ild to
m
oder
ate
Poss
ibili
ty o
f org
anize
d cr
ime
gang
Poss
ibili
ty o
f org
anize
d cr
ime
gang
Poss
ibili
ty o
f org
anize
d cr
ime
gang
APPENDIXES
52
cen
tre
d
OLL
ard
-cO
rmie
r (O
utpa
tient
Ser
vice
s)
cen
tre
d
OLL
ard
-cO
rmie
r
(clin
ical
pla
cem
ent Y
outh
17
yea
rs o
f age
and
ove
r)
pavi
LLO
n F
OSt
er
(You
th o
utpa
tient
se
rvic
e)
Le G
ran
d c
hem
inLe
pO
rtaG
e
(bea
cons
field
and
La
c Éc
ho)
pavi
LLO
n d
u n
Ou
veau
pO
int
de
vue
Fam
iLY
reLa
tiO
nSh
ipS
Supp
ort
Need
for s
uper
visi
on
Mild
-mod
erat
e
Fam
ily o
verw
helm
ed b
y ev
ents
or
in d
enia
l
Ince
ntiv
e en
viro
nmen
t, fa
mily
ov
erw
helm
ed b
y ev
ents
or i
n de
nial
iGt:
Ne
ed fo
r sup
ervi
sion
m
ild/m
oder
ate
Fam
ily o
verw
helm
ed b
y ev
ents
or
in d
enia
lG
ain
: GA
IN_I
ASA
M c
riter
ia B
6 :
Reco
very
Env
ironm
ent
GCTI
(Gen
eral
Con
flict
Tact
ics
Scal
e): M
ild to
mod
erat
eGV
I (Ge
nera
l Vic
timiza
tion
Inde
x): M
ild to
mod
erat
eGS
SI (G
ener
al S
ocia
l Sup
port
In
dex)
: Mod
erat
e to
hig
h (r
ever
se-s
core
d)
Ince
ntiv
e en
viro
nmen
t, fa
mily
ov
erw
helm
ed b
y ev
ents
, nee
d fo
r sup
ervi
sion
to s
ubst
itute
fo
r the
par
enta
l aut
horit
y
Ince
ntiv
e en
viro
nmen
t, fa
mily
ov
erw
helm
ed b
y ev
ents
, nee
d fo
r sup
ervi
sion
to s
ubst
itute
fo
r the
par
enta
l aut
horit
y
Ince
ntiv
e en
viro
nmen
t, fa
mily
ov
erw
helm
ed b
y ev
ents
, nee
d fo
r sup
ervi
sion
to s
ubst
itute
fo
r the
par
enta
l aut
horit
y
risk
of r
unni
ng a
way
Lo
w-m
oder
ate
Mod
erat
e-hi
ghiG
t:
Low
to m
oder
ate
Gai
n:
GAIN
_I A
SAM
crit
eria
B4
: Re
adin
ess
to C
hang
eET
PI (E
xter
nal T
reat
men
t Pre
s-su
re In
dex)
: low
to m
oder
ate
TRI (
Trea
tmen
t Res
ista
nce
Inde
x) =
low
to m
oder
ate
PF :
ASAM
crit
eria
B5
: Rel
apse
po
tent
ial
POS
(Pro
blem
Orie
ntat
ion
Scal
e) =
low
to m
oder
ate
(rev
erse
-sco
red)
GAIN
_I A
SAM
crit
eria
B6
: Re
cove
ry E
nviro
nmen
tGS
I (Ge
nera
l Sat
isfa
ctio
n In
dex)
: mod
erat
e to
hig
h
Mod
erat
eM
oder
ate-
high
*
*In
so fa
r as
the
refe
rent
, le
gal g
uard
ians
and
the
reso
urce
con
side
r thi
s ris
k m
anag
eabl
e
Mod
erat
e
APPENDIXES
53
cen
tre
d
OLL
ard
-cO
rmie
r (O
utpa
tient
Ser
vice
s)
cen
tre
d
OLL
ard
-cO
rmie
r
(clin
ical
pla
cem
ent Y
outh
17
yea
rs o
f age
and
ove
r)
pavi
LLO
n F
OSt
er
(You
th o
utpa
tient
se
rvic
e)
Le G
ran
d c
hem
inLe
pO
rtaG
e
(bea
cons
field
and
La
c Éc
ho)
pavi
LLO
n d
u n
Ou
veau
pO
int
de
vue
SOci
aL a
nd
LeG
aL S
YSte
mS
Lega
l sys
tem
AHSS
S /
YPA
/ YC
JAAH
SSS
/ YP
A /
YCJA
iGt:
LS
SSS
/ LPJ
/ LS
JPA
Gai
n:
GCS
(Gen
eral
Crim
e Sc
ale)
=
lége
r à m
odér
éGA
IN_I
ASA
M c
riter
ia B
6:Re
cove
ry E
nviro
nmen
t
AHSS
S /
YPA
/ YC
JAAH
SSS
/ YP
A /
YCJA
AHSS
S /
YPA
/ YC
JA
Seri
ousn
ess
of th
e of
fenc
esLo
w-m
oder
ate
High
iGt:
Lo
w-m
oder
ate
Gai
n:
With
in th
e pa
st 1
2 m
onth
sPC
I (Pr
oper
ty C
rime
Inde
x) =
lo
w to
mod
erat
eIC
S (I
nter
pers
onal
Crim
e Sc
ale)
= lo
wDC
I (Dr
ug C
rime
Scal
e)=
low
to
mod
erat
e
Mod
erat
e-hi
ghM
oder
ate-
high
Low,
mod
erat
e or
hig
h
del
inqu
ency
pro
file
Mild
-mod
erat
eHi
ghiG
t:
Low
-mod
erat
eM
oder
ate-
high
Activ
e de
linqu
ency
, par
ticip
a-tio
n in
a g
ang
Low,
mod
erat
e or
hig
h
Seri
ousn
ess
of th
e ad
o-le
scen
t’s s
ituat
ion
3-4
1 to
4
mO
tiva
tiO
n
to r
ecei
ve h
elp
in
rega
rd to
the
orie
ntat
ion
prop
osed
No e
xclu
sion
No e
xclu
sion
No re
stric
tions
Poss
ibili
ty o
f eng
agin
g th
e cl
ient
with
in 1
to 4
ses
sion
s
Cont
empl
atio
n:
Min
imal
reco
gniti
on o
f the
pr
oble
m
Cont
empl
atio
n: M
inim
al
reco
gniti
on o
f the
pro
blem
Cont
empl
atio
n: M
inim
al
reco
gniti
on o
f the
pro
blem
Spec
iFic
itie
S O
F th
e ce
ntr
eS O
r O
rGan
izat
iOn
S
appr
oach
Bio-
psyc
hoso
cial
with
a p
ers-
pect
ive
of re
duci
ng th
e ha
rmBi
o-ps
ycho
soci
al w
ith a
pe
rspe
ctiv
e of
redu
cing
th
e ha
rm
Bio-
psyc
hoso
cial
, mot
ivat
iona
l an
d co
gniti
ve-b
ehav
iour
al
inte
rvie
w
Bio-
psyc
hoso
cial
toge
ther
w
ith th
e 12
-ste
p Al
coho
lics
Anon
ymou
s m
odel
Stag
es in
the
mot
ivat
ion
for
chan
ge
Ther
apeu
tic c
omm
unity
, se
lf-he
lpBe
havi
oura
l; th
roug
h in
tens
ive
outd
oor a
ctiv
ities
rela
ted
to
the
12-s
tep
mod
el a
dapt
ed fo
r ad
oles
cent
clie
ntel
e, a
ll w
ithin
a
bio-
psyc
hoso
cial
per
spec
tive
clie
ntel
e24
yea
rs a
nd u
nder
as
wel
l as
thei
r fam
ily a
nd fr
iend
sFr
om 1
7 to
24
year
sFr
om 1
2 to
18
year
sFr
om 1
2 to
18
year
sFr
om 1
4 to
18
year
sFr
om 1
3 to
17
year
s
APPENDIXES
54
cen
tre
d
OLL
ard
-cO
rmie
r (O
utpa
tient
Ser
vice
s)
cen
tre
d
OLL
ard
-cO
rmie
r
(clin
ical
pla
cem
ent Y
outh
17
yea
rs o
f age
and
ove
r)
pavi
LLO
n F
OSt
er
(You
th o
utpa
tient
se
rvic
e)
Le G
ran
d c
hem
inLe
pO
rtaG
e
(bea
cons
field
and
La
c Éc
ho)
pavi
LLO
n d
u n
Ou
veau
pO
int
de
vue
Spec
iFic
itie
S O
F th
e ce
ntr
e O
r O
rGan
izat
iOn
S (c
On
t.)
dur
atio
n of
pro
gram
or
stay
Flex
ible
, dep
endi
ng o
n th
e yo
uth’
s ne
eds
Appr
oxim
atel
y on
e m
onth
with
th
e po
ssib
ility
of l
eavi
ng a
fter
7 da
ys
Flex
ible
, dep
endi
ng o
n th
e yo
uth’
s ne
eds
Betw
een
8 to
10
wee
ks6
to 8
mon
ths
42 d
ays
post
-cur
e re
inte
grat
ion
follo
w-u
pIn
divi
dual
or g
roup
mee
ting
by a
mul
tidis
cipl
inar
y te
am
(edu
cato
r, so
cial
wor
ker,
psyc
holo
gist
, crim
inol
ogis
t, ps
ycho
-edu
cato
r, et
c.)
Poss
ible
out
patie
nt fo
llow
-up
by a
mul
tidis
cipl
inar
y te
amNo
t app
licab
leOn
ce a
wee
k fo
r 4 m
onth
sAv
aila
ble
for a
s lo
ng a
s th
e cl
ient
wis
hes
One
mee
ting
a m
onth
for 1
2 m
onth
s
part
icul
ariti
esW
alk-
in re
cept
ion,
sch
ool
prog
ram
Trai
ning
for s
choo
ls,
com
mun
ity g
roup
s an
d fr
ont-
line
prac
titio
ners
The
clin
ical
you
th a
ccom
mod
a-tio
n of
fers
a p
lace
whi
ch g
ives
th
e yo
uth
som
e tim
e ou
t to
stop
the
dow
nwar
d sp
iral a
nd
initi
ate
a pr
oces
s of
refle
ctio
n
Inte
rven
tion
in th
e sc
hool
sSc
reen
ing
and
prog
ram
for
path
olog
ical
gam
blin
g
Scho
ol p
rogr
am
Com
puls
ory
scho
ol a
ttend
ance
ba
sed
on a
pro
gres
sive
ap
proa
ch. T
he u
sers
pla
y an
im
port
ant r
ole
in m
anag
ing
the
envi
ronm
ent a
nd a
n im
port
ant p
ositi
on is
ass
igne
d to
the
fam
ily a
s w
ell a
s to
the
refe
rent
s
Inte
nsiv
e ou
tdoo
r act
iviti
es
reas
ons
for
excl
usio
nVi
olen
t, un
cont
rolle
d an
d re
curr
ing
beha
viou
rs
Non-
resp
ect o
f a p
sych
iatr
ic
trea
tmen
t
Phys
ical
with
draw
al ri
sk,
seve
re m
enta
l hea
lth d
isor
der
No re
ason
s fo
r exc
lusi
onM
edic
al re
stric
tion
and
unco
n-tr
olle
d vi
olen
ceUn
cont
rolle
d vi
olen
ce, m
enta
l di
sord
ers
not s
tabi
lized
or
the
lack
of a
n at
tend
ing
prof
essi
onal
Med
ical
/phy
sica
l res
tric
tion
for c
arry
ing
out o
utdo
or
activ
ities
Serv
ices
for
the
fam
ily
and
frie
nds
Mee
tings
for p
aren
ts:
indi
vidu
al, a
s a
coup
le
or a
fam
ily a
nd p
aren
t gro
ups,
de
pend
ing
on w
heth
er o
r no
t the
you
th is
enr
olle
d in
a
prog
ram
The
yout
h pr
ogra
m o
ffers
se
rvic
es to
par
ents
and
frie
nds
of y
outh
s un
der t
he a
ge o
f 24
yea
rs
Mee
tings
for p
aren
ts:
indi
vidu
al, a
s a
coup
le o
r a
fam
ily a
nd p
aren
t gro
ups,
de
pend
ing
on w
heth
er o
r no
t the
you
th is
enr
olle
d in
a
prog
ram
Mee
tings
for p
aren
ts:
indi
vidu
al, a
s a
coup
le o
r a
fam
ily. P
aren
t gro
ups
and
wor
ksho
ps
The
fam
ily’s
par
ticip
atio
n is
co
nsid
ered
an
impo
rtan
t fac
tor
in th
e ad
oles
cent
’s s
ucce
ss.
It is
ther
efor
e re
ceiv
ed a
nd
supp
orte
d by
fam
ily s
ervi
ces,
in
vite
d to
get
invo
lved
and
co
nsul
ted
durin
g re
visi
ons
of
the
trea
tmen
t pla
ns
APPENDIXES
55
APPENDIX 2 – AUTHORIZATION, EXCHANGE OF INFORMATION
MATJM1
I AUTHORIZE to forward
My assessment
The recommendations concerning the follow-up to be provided
All information considered to be pertinent
Other (Specify):
to the specialized resources, members of the access mechanism.
Term of the authorization
Client's signature Parent's signature (if under 14 years)
Signature of the witness
Date:
Reserved for the personnel of the institution or organization
Consent cancelled on
Signature:
1 MATJM: mécanisme d'accès en toxicomanie pour les jeunes de la région de Montréal
(Substance abuse access mechanism for youth in the Montreal area)
Year Month Day
AUTHORIZATION
EXCHANGE OF INFORMATION
DayMonthYear
This authorization is valid for the duration of the follow-up episode in which I am presently engaged and I may cancel it at any time by advising a practitioner involved in my intervention plan.
User's initials
Fiche d'autorisation#1760C9.xls
APPENDIXES
56
APPENDIX 3 – CASE FOLLOW-UP SHEET
APPENDIXES
MATJM1 CASE FOLLOW-UP SHEET
Record no. (D.C.C. or Foster Pavilion)
Record no. of the resource Name of the resource
Family name (indicated on the health insurance card)
First name
Date of birth Sex: Male
Female
Recommendations
Referral to (organizations)
Date in-house services begun in-patient services begun Client did not attend the first follow-up interview
Client no longer attendsMonth Day Year Client decided to end the treatment
Date in-house services endedin-patient services ended Client moved
Ended by order (YCJA)Month Day Year Program completed or objectives attained
Program rules not respected (specify)
Violence
Consumption
Sexual relations between youth in the program
Other rules
High risk of suicide and referred to another service
If so, which? Referred to child psychiatry
Respondent him/herself Referred to another drug addiction treatment centre
Access mechanism Ran away
Family Other reasons, specify:
Centre jeunesse de Montréal-IU
Batshaw Youth and Family Centres
Centre Dollard-Cormier
Le Grand Chemin
Pavillon Foster Name of the practitioner:Portage
Pavillon Nouveau Point de Vue
Hospital or CSSS
Professional (private)
Community organizations
Others (specify): Name of the resource:
1 MATJM: mécanisme d'accès en toxicomanie pour les jeunes de la région de Montréal
(Substance abuse access mechanism for youth in the Montreal area)
(Please print)
Resource persons advised of the ending of specialized services
YearMonth Day
Please specify the reason(s) for ending the services
Yes No
fiche suivicorr1sept.xls
57 APPENDIXES
APPENDIX 4 – INDICATOR FACT SHEET, DEPENDENCY PROGRAM, SUBSTANCE ABUSE, MSSS, 2005 (TRANSLATION)
APPENDIX 4 – INDICATOR FACT SHEET, DEPENDENCY PROGRAM, SUBSTANCE ABUSE, MSSS, 2005(TRANSLATION)
Management agreementsIndicator fact sheet
DependenciesSubstance abuse
Sheet 1.7.1Number of youth assessed and referred by a joint, coordinated substance abuse access mechanism
DÉFINITION Number of users under the age of 18 years assessed and referred by a joint, coordinated accessmechanism to specialized substance abuse services grouping the various service providers duringthe financial period.
USE/INTERPRETATION
A user is a person whose record is active and who has access to substance abuse assessment andtreatment services. The users considered hereunder are those compiled in the financialmanagement manual, Volume 1, section 8430.
Warning An assessed user is a youth who, whether or not by means of an access mechanism, has used anassessment service which uses the recognized substance abuse seriousness index tool (Indice de
gravité de la toxicomanie – ado - IGTado).
A referred user is a youth who, following an assessment, whether or not within the scope of theaccess mechanism, has been referred to a resource offering specialized substance abuse services.
A joint, coordinated access mechanism allows youth clientele to be matched to the programsavailable by means of detection and assessment tools.
The number of youth assessed and referred must differentiate between the youth who used the
access mechanism and those who did not use the mechanism to obtain services during the targetperiod.
Within the scope of the Plan d’action en toxicomanie 1999-2001 (substance abuse action plan for
1999-2001) and the work in process to prepare a national plan of action to control substanceabuse, youth continue to be a privileged target for actions designed to detect, provide earlyintervention and referrals to treatment programs.
However, there are certain prerequisites necessary for assessing and referring the target clientele,
such as training the practitioners who detect and refer, implementing an access mechanism forspecialized services, promoting this mechanism among the referents and service users andagreements between the partners involved.
The access mechanism offers a value added which promotes the best match for the client, wherethe referents and service distributors work together and coordinate their activities to offer the mostappropriate services to the user.
According to the Enquête québécoise sur le tabagisme chez les élèves du secondaire (2002)(Quebec survey on tobacco use among secondary school students – 2002), produced by theInstitut de la Statistique du Québec, 5% of the youth in secondary school could be qualified as
problem consumers requiring the assistance of a specialized substance abuse practitioner. InQuebec, in 2005, we counted 572,813 youth aged between 12 and 17 years, excluding regions 10,17 and 18. Based on this data, for an area such as the national capital, we can predict that 2250
youth aged between 12 and 17 years will have a problem with use. To illustrate, in 2004-2005, theProgramme accès jeunesse en toxicomanie – PAJT (substance abuse access program) in thenational capital area should allow 295 youth to be assessed.
In addition, the study, La consummation de psychotropes chez les jeunes nouvellement inscrits à laprise en charge des centres jeunesse du Québec : Profils de gravité et caractéristiques associés(psychotropic drug use among youth newly registered as being taken charge of by the centres
jeuenesse du Québec: seriousness profiles and associated characteristics) indicate that 10.5% ofyouth between the ages of 12 and 17 years have use problems. We can estimate thatapproximately 4000 youth from 12 to 17 years are enrolled or admitted to the centre jeunesse for
behavioural disorders or delinquency, which leads to presume that, according to this study, 10.5%or 420 of these youth have use problems.
CALCULATION METHOD _ of users assessed within the scope of a joint, coordinated access mechanism.
_ of users referred to a substance abuse organization by a joint, coordinated access mechanism.
MEASUREMENT UNIT Number (users)
DISTRIBUTION(S) The number of users assessed and referred by region.
58
52 April 11, 2006
SOURCE OF INFORMATION Institutions and organizations which provide specialized services to youth.
The institution responsible for coordinating the access mechanism.
PERIODICITY OF DATA
COLLECTION
Data available since
Data is collected in periods 7-11-13.
Period from April 1, 2004 to March 31, 2005, 3214 youth must have been assessed and referred to
specialized services by a joint, coordinated access mechanism.
Recorded target provided
in the strategic plan for2010
Based on the data obtained through a survey carried out by the Institut de la statistique du Québec
in 2002, by 2010, assess, via an access mechanism, 4180 youth in Quebec who have a useproblem, being 15% of the youth estimated who have a psychotropic drug use problem.
Targets, guidelines orinternal standards (ex.:gradual attainment of the
target provided in theaction plan)
Threshold Reach 11% of the youth estimated to have a psychotropic drug use problem in Quebec, being 3150
youth.
AUTHORITIES
Supply
The development agencies complete the accountability chart.
Production and analysis Paul Roberge
Direction de la jeunesse et de la toxicomanieService des toxicomanies et des dépendances
Agent (design) MSSS
Dep_tox_jeune.docDocumentation date: February 2005
APPENDIXES
950, rue de Louvain EstMontréal (Québec) H2M 2E8
Tel.: 514.385.0046www.centredollardcormier.qc.ca
6, rue Foucreault, Saint-Philippe-de-Laprairie (Québec) J0L 2K0
Tel.: 450.659.8911