the Strategy Foundational
WINDSOR-ESSEX COMMUNITY OPIOID AND SUBSTANCE STRATEGY ANNUAL REPORT 2022
MESSAGE FROM THE CO-CHAIRS OF WECOSS
As the drug poisoning crisis continues to affect our region, it highlights the important role of WECOSS partners in providing services and support to our community. In 2022, interventions were guided by the WECOSS Modernization Recommendations and utilized a collective impact approach. The WECOSS is committed to ongoing community engagement to ensure its initiatives are meeting the needs of those working and residing in Windsor-Essex County.
Director of Public Health Programs,
Windsor-Essex County Health Unit
Every year, new challenges emerge that determine how we address substance use in Windsor-Essex County. Coordinated access emerged as a priority in 2022 to better support our community in finding the appropriate health and social services for their needs. The community partners and peers of the WECOSS continue to strive towards innovative approaches that mitigate the harms associated with substance use and “meet people where they’re at”.
Director of Mental Health and Addictions,
Hôtel-Dieu Grace Healthcare
The Windsor-Essex Community Opioid and Substance Strategy (WECOSS) was established in 2018 to bring together leadership representatives from across Windsor-Essex County to address the drug poisoning crisis. The WECOSS utilizes a four-pillar approach to address the harms of substance use at the community level through Prevention and Education, Harm Reduction, Treatment and Recovery, and Enforcement and Justice interventions. This multi-year strategy is led by a diverse network of community agencies and organizations, with input from people with lived/living experience (PWLE) using substances.
Since the Strategy began, an Annual Report has been released as part of the WECOSS’ commitment to ongoing community engagement. The purpose of each Annual Report is to highlight the work being done to address substance use in the community through the collaborative efforts of our WECOSS partners. The 2022 Annual Report provides an overview of the activities undertaken throughout the Strategy in its fifth year of implementation. The report describes the community impacts of substance use, the implementation of the WECOSS Modernization (2021), activities identified for implementation in year five, progress made on these activities, and future direction of the Strategy.
Modernization of the Strategy
In 2021, an evaluation of the WECOSS was conducted to assess the level of awareness and early impact of the WECOSS in the community and to evaluate the WECOSS’ strategy design. Key informant interviews were conducted with members of the WECOSS Leadership Committee, while an online survey was distributed to gather input from the public and WECOSS partner agencies. The findings from this evaluation were used to form recommendations as presented in the WECOSS Modernization (2021) to guide the pathway forward for the WECOSS, including highlighting priority areas for focus and action, and emphasizing a collective impact approach.
The WECOSS Modernization (2021) identified a set of five Structural and Capacity-Building Pathways and six Priority Action Areas to build upon the initial eight recommendations outlined within the WECOSS Action Plan (2018). In 2022, the Structural and Capacity-Building Pathways were addressed, and the associated outputs are highlighted in Table 1. below. The Priority Action Areas were used to develop the 2022 working group projects and will continue to guide the future directions of the WECOSS.
Structural and Capacity-Building Pathways and Outputs from 2022.
The vision and actions were outlined in the original Action Plan and WECOSS – Leadership Committee Terms of Reference; however, “modernization” of this shared vision for the entire collective needs to be addressed at the Leadership Committee level to ensure all members agree to the primary goals of WECOSS as a collective impact initiative.
- Implemented the revised WECOSS Terms of Reference detailing a “shared vision”.
The Strategy, along with its short and long-term goals, must be well-understood and agreed upon by the Leadership Committee.
- The Data and Program Evaluation Sub-Group developed a framework to allow for an evaluation of the entire WECOSS.
Ensuring a shared vision and set of measures are important, but there are core functions of leadership that will require attention to support a collective leadership approach.
- Implemented the revised WECOSS Terms of Reference which details the responsibilities and tenure of Leadership and Working Group members, the decision-making criteria for taking on WECOSS- initiated projects, and Co-Chair guidelines for Working Group meetings.
Advocacy work or specialized projects could be led by relevant members of the WECOSS Leadership Committee.
- Established the Decriminalization Sub-Group to discuss and support advocacy work.
- Established Student Recruitment Strategy through collaboration with the WE-SPARK Health Institute to support the implementation of projects across the WECOSS Working Groups.
Consistent and structured public communication across different channels can support trust, and commitment to a common agenda (Kania & Kramer, 2011).
- Developed a strategy for WECOSS Continuous Communication, which will be implemented as part of a 2023 intervention.
In Fall of 2022, the WECOSS initiated a Student Recruitment Strategy to address Pathway 4 of the Modernization, Capacity Building and Sustainability, while also supporting the professional development of local students. The Windsor-Essex County Health Unit (WECHU) recruited three students through the WE-SPARK Health Institute to support the implementation of projects across the WECOSS Working Groups. WE-SPARK is a partnership between Hôtel-Dieu Grace Healthcare, St. Clair College, the University of Windsor, and Windsor Regional Hospital that establishes research pipelines to address pressing health issues, promote excellence among health professionals, and advance discovery, innovation, technology, training, and community engagement.
WE-SPARK maintains a network of post-secondary students and recent graduates from the University of Windsor, St. Clair College, and the Schulich School of Medicine who work to support and advance local health research and related projects. The students recruited to WECOSS will continue support the working groups into 2023 to close out projects. Additionally, a collaboration between the WECOSS and the Windsor Family Health Team in 2022 engaged several students in a similar capacity.
The Modernization also supported several structural changes to the WECOSS in 2022. An integrated partnership was established between the WECOSS Treatment and Recovery Working Group and the Providers of Addiction Treatment (PAT) Committee, a regional committee that has operated for many years as a platform for service providers to share information about their agencies to help link clients to the most beneficial services as illustrated in Figures 1 & 2. Given the shared interests and goals of both the Treatment and Recovery Working Group and the PAT Committee, a liaison with membership on each committee will facilitate ongoing communication and information sharing between both groups moving forward.
A WECOSS Decriminalization Sub-Group was also established in 2022 to develop a strategy for advocacy for alternatives to criminalization in Windsor-Essex County, as indicated in Figure 1. As decriminalization is one component of a harm reduction strategy, this work will be integrated into the WECOSS Harm Reduction Working Group in 2023 (Figure 2). The Youth Engagement for Substance Use Sub-Committee of the WECOSS will also be integrated into the Prevention and Education Working Group in 2023 (Figures 1 & 2) after completing a youth-focused project in 2022.
Figure 1 - WECOSS STRATEGY IMPLEMENTATION FOR 2022
Figure 2 - WECOSS STRATEGY IMPLEMENTATION FOR 2023
Opioid and Substance Use Notification System
Ongoing implementation of the communication and emergency response systems between public health, emergency and health services, and other community stakeholders remains critical to the WECOSS. In 2022, there were eleven (11) community alerts issued as a result the Opioid and Substance Use Notification System (OSUNS). These alerts are issued when there are elevated rates of opioid-related emergency department visits and overdoses in the region. Alerts are used to mobilize community organizations that serve people who use substances to heighten awareness about these increases across the community, while also seeking to improve and strengthen local overdose prevention and harm reduction activities.
The alerts are limited in that it captures only the opioid-related overdoses in the community that result in an emergency department visit and therefore, the numbers that are reported are likely only a fraction of the opioid-related overdoses that occur in our community. Future efforts of the WECOSS include an OSUNS evaluation to improve the utility of the alerts given the current limitations.
In 2022, the Strategy saw a shift in the number of projects per Working Group to support the Structural and Capacity Building Pathways of the WECOSS Modernization (2021). The updated planning process detailed in the WECOSS Terms of Reference emphasized the need to reallocate time and resources to one concentrated project per year, as opposed to multiple projects. Focusing on one core project increases our capacity to implement projects that are meaningful and helps to coordinate the efforts of all partners involved in the WECOSS as part of a collective impact approach. The following are summaries of projects or specific initiatives that were undertaken across each of the four Pillar Working Groups in 2022.
2022 Project: Healthcare Provider Education and Engagement
WECOSS Action Plan Recommendation Two: Support healthcare providers to play a key role through appropriate prescribing practices, patient education about opioids and overdose prevention, and other pain management options.
WECOSS Action Plan Recommendation Six: Address stigma associated with problematic substance use through the development of supportive polices and education of healthcare professionals, community organizations and the public.
WECOSS Modernization Priority Action Area Two: Formalizing healthcare provider engagement and education.
Goal: To assess Healthcare Provider (HCP) needs for information, education, and resource supports to increase their capacity to meet the needs of patients with complex substance use issues.
Summary of Activities: A needs assessment survey was developed collaboratively with stakeholders from the Community Primary Care Partnership (CPC) to determine education and resource needs for Healthcare Providers (HCPs) to support clients who use substances. The survey assessed HCPs confidence in discussing the potential health consequences of opioid use with their clients, as well as their confidence regarding opioid use harm reduction, treatment, and recovery approaches and services. CPC member organizations distributed the online survey to physicians and nurse practitioners who completed them between October 31st and November 18th, 2022. The findings from this survey were used to collect resources that aligned with the identified needs of HCPs.
- A total of 35 healthcare providers completed a needs assessment survey (63% nurse practitioners, 33% physicians, 4% other professions)
- Topics where there was an identified need to improve confidence included:
- Avoiding stigmatization
- Discussing potential health consequences of opioid and non-opioid substance use
- Discussing the risk factors for developing opioid use disorder
- Discussing opioid-related harm reduction strategies
- Discussing treatment, support, and recovery for substance use disorders
- Making referrals for withdrawal services
Next Steps: In 2023, the resources complied from the findings of this project will be reviewed and implemented in primary care practice to assist HCPs in supporting people who use substances.
2022 Project: Community Engagement for Urgent Public Health Need Site and Consumption and Treatment Services and Harm Reduction Education
WECOSS Action Plan Recommendation Five: Increase access to a variety of harm reduction options for people who use opioids and those affected by people who use opioids.
WECOSS Modernization Priority Action Area Four: Augment harm reduction services and supplies through coordinated agency involvement and policy supports.
Goal: To support the integration of the UPHNS/CTS into the community by developing various public education activities that aim to increase awareness and reduce stigma towards these services, as well as other harm reduction approaches.
Summary of Activities: The Windsor-Essex County Health Unit (WECHU), in partnership with the WECOSS Harm Reduction Working Group and the CTS Stakeholder Advisory Committee, used the findings from the 2021 site-specific community consultation to guide the site selection and secure a lease agreement to operate an UPHNS/CTS at 101 Wyandotte Street East. Subsequently, a municipal council resolution was obtained, endorsing the location of the proposed site, and the UPHNS and CTS applications were submitted to the appropriate governmental bodies for review. Renovations on the building began in May of 2022 and are expected to conclude in early 2023.
A phased community engagement plan was then developed by the WECOSS, which outlined strategies for engaging the community on an ongoing basis as it relates to the proposed UPHNS/CTS. Included in the plan was the development of a key messaging document and social media toolkit for partnering organizations to use to support public education efforts for the site. Web content for a harm reduction hub was updated or created and included information about UPHNS/CTS’, naloxone and overdose prevention, safe needle disposal, needle syringe programs, harm reduction in the workplace with corresponding workplace policy templates, and stigma.
- Educational content prepared for an updated webpage and centralized harm reduction hub on wecoss.ca
- 1 social media toolkit prepared for community partners to use to share accurate information about the proposed UPHNS/CTS
Next Steps: As part of ongoing community engagement, activities that were outlined in the plan for 2023 included uploading an online feedback form for community members to ask questions or voice concerns about the UPHNS/CTS, hosting virtual town hall events for updates about the site, and public open house tours once the site was set to open. The harm reduction hub content will also be integrated onto WECOSS.ca in 2023 as part of the site’s community engagement strategy.
Needle Syringe Program: Pozitive Pathways Community Services (PPCS) continued with the provision of the Needle Syringe Program to increase access to harm reduction supplies.
- 16,236 client transactions were recorded by local NSP sites and mobile delivery programs
- 602,278 needles were distributed
Needle Disposal Bins: Systematized Data Collection: The Windsor-Essex County Health Unit (WECHU) continued to track the number of needles collected through needle bins installed across the City of Windsor.
- 76,957 were collected through the needle disposal bins installed across the City of Windsor
Ontario Naloxone Program (ONP): The WECHU continued to provide training and naloxone kits to registered ONP partners and recruited eligible community agencies into the ONP.
- 24 community partners were actively involved with the ONP, 4 of which were on-boarded
- 1,034 naloxone kits were distributed by participating ONP partners
- 1,142 individuals were trained on naloxone administration by participating ONP partners
Naloxone Expanded Access & Outreach: The WECHU, with support from community partners including, Essex-Windsor EMS, Hôtel-Dieu Grace Healthcare, Family Services Windsor-Essex, Canadian Mental Health Association Windsor-Essex County, and Windsor Police Services, held naloxone distribution events at various faith-based organizations in June and July of 2022 through the ONP. These events were held to raise awareness among faith communities of opioid-related overdoses and the use of naloxone to reverse the effects of overdose, to form partnerships with local places of worship and faith leaders, to decrease stigma among faith communities associated with the use of opioids and carrying naloxone, to train individuals on how to administer naloxone, and to distribute naloxone kits.
- 16 naloxone distribution events were held at faith-based organizations
- 525 naloxone kits distributed to members of faith-based organizations
- 492 individuals were trained on naloxone administration
2022 Project: Enhancing PATHWAYS to Programs and Services
WECOSS Action Plan Recommendation Seven: Work with provincial partners to advocate for increased funding to expand the local substance use treatment system.
WECOSS Modernization Priority Action Area Three: “No Wrong Door” – Enhancing access to services and supports.
WECOSS Modernization Priority Action Area Five: Address the social determinants of health that impact substance use and community well-being.
Goal: To address the barriers that exist for individuals to locate, navigate, and access local substance use, mental health, and social services and programs in Windsor-Essex County.
Summary of Activities: An environmental scan of substance use, mental health, and addictions programs and services was conducted to increase awareness of available supports to residents of Windsor-Essex County. The scan identified both privately and publicly funded services available at the local, provincial, and national levels. Findings from the scan will be used to create an online inventory on wecoss.ca to assist health and social service providers in locating, navigating, and accessing services for their clients. The inventory will also support the coordinated access work being done locally and provincially at the Mental Health and Addictions Networking Table.
An integrated partnership was also established between the Providers of Addictions Treatment (PAT) Committee and the Treatment and Working Group. The PAT is a long-standing committee that strives to enhance awareness, communication, and knowledge of substance use, mental health, and social services across Southwestern Ontario, a shared goal of the Treatment and Recovery Working Group. Partnership between these two groups allows for ongoing information-sharing and reporting, coordination between related efforts, and collaboration towards the project activities associated with the Enhancing PATHWAYS project.
- Local environmental scan completed which collected data on 668 substance use treatment and recovery, mental health, and supportive programs and services available at the local, provincial, and national levels
- Inventory development in progress on WECOSS.ca
- 2 education/training sessions held with the PAT Committee on local programs and services
Next Steps: In 2023, the Enhancing PATHWAYS project will shift to the next phase to embed the inventory on WECOSS.ca and pilot it with service providers, as well as to identify gaps, weaknesses, and duplications within the local substance use and mental health systems to inform future initiatives.
Global Appraisal of Individual Needs Short Screener Trainings: Hôtel-Dieu Grace Healthcare, in collaboration with the Centre for Addictions and Mental Health and the WECOSS Treatment and Recovery pillar, continued to deliver virtual training sessions to local service providers on how to administer the Global Appraisal of Individual Needs Short Screener (GAIN-SS).
- 3 virtual GAIN-SS training sessions were held, with 57 individuals taking the training for the first time and 9 taking it as a refresher class.
2022 Project: Addressing Substance Use in Re-Integration Supports
WECOSS Action Plan Recommendation Eight: Redefine the role for enforcement agencies and other first responders to build “public safety-public health” partnerships for a safer and healthier community.
WECOSS Modernization Priority Action Area Six: Build a shared understanding of community safety and well-being by strengthening public safety and public health partnerships that support vulnerable and marginalized populations.
Goal: To provide resources detailing available supports and services for substance use and harm reduction approaches to those who are justice-involved and have a history of substance use issues.
Summary of Activities: A survey was developed for justice-involved individuals who may be experiencing a concurrent or unrelated mental health concern and/or a substance use disorder. The purpose was to identify the substance use, harm reduction, and related health topics for which justice-involved individuals who use substances would like more education and/or information and the preferred methods of obtaining it. Another survey was also developed for justice-involved staff to assess their self-rated knowledge and confidence in sharing education and/or information with clients, as well as the substance use, harm reduction, and related health topics for which they wanted more education/information on. The findings from these surveys were used to generate a set of recommendations for increasing education and access to relevant services.
- A total of 179 participants completed the survey:
- 41 justice-involved staff
- 138 justice-involved individuals
- Among Justice-Involved Staff:
- 81% were confident in avoiding stigmatization of people who use substances
- 78% were confident in developing positive relationships with clients
- Information and supports wanted among justice-involved individuals included:
- Housing support (80%)
- Job skills or help getting a job (71%)
- Community support groups (67%)
- Help with obtaining identification (67%)
- Referral to mental health and substance use services (66%)
- Referral to withdrawal management or treatment for substance use (55%)
- Preferred methods for obtaining information included one-on-one discussions with staff at intake, appointments, or during education sessions
Next Steps: In 2023, a wallet card containing information on relevant supports and services will be created and distributed to justice-involved individuals. Additionally, a list of resources and educational materials will be compiled and uploaded to the wecoss.ca website to support the needs of justice-system staff. Other WECOSS projects like Enhancing Pathways will also help to fill in the some of the gaps identified from this reintegration supports project.