Executive Summary
The WECOSS: An Action Plan for Our Community (2018) is a set of key recommendations that guides the work of the Strategy. It aims to address substance use through a community-driven action plan, led by the WECOSS Leadership Committee, a diverse network of community organizations and people with lived experience (PWLE).
In late 2020, through early 2021, a comprehensive evaluation of the WECOSS was planned and conducted. The methodology used for the evaluation included two data collection methods. Key informant interviews were conducted with eight WECOSS-Leadership Committee members, as well as an open link survey for the public and WECOSS partner agencies. The purpose of this evaluation was:
- To assess the level of awareness and early impact of the WECOSS in the community
- To evaluate the WECOSS’s strategy design
The WECOSS Leadership Committee also met in recent months to review the specific impacts of the COVID-19 pandemic and to discuss a response and recovery plan tailored to the immediate needs in the region. The results of these discussions were also woven into the recommendations outlined in this report.
The evaluation results show that WECOSS and its activities have indeed made a positive impact in the region, with clear and valuable contributions. These include:
- Increased partnership and collaboration between inter-disciplinary stakeholders and service providers.
- Improved community awareness about the prevalence of substance use in the region.
- Reduced stigmatization towards substance use and harm reduction approaches.
The findings of this evaluation have been used to form recommendations to help guide the path forward for the WECOSS. Collective impact, as a model, needs to be brought to the forefront of the modernization of WECOSS. While the Windsor Essex County Health Unit has served as the backbone organization and this role remains critical, additional practices need to be put in place to support the further collective leadership required to make significant inroads to addressing substance use in Windsor and Essex County. The evaluation results also highlighted priority areas for focus and action for the WECOSS. The modernization of the WECOSS will support implementation of bold actions to help save lives and create a healthy and safe community for everyone.
Recommendations and Priorities
Findings from this evaluation can help structure recommendations that will be used to inform the next steps for the WECOSS. Some recommendations relate to improvements to the structural elements of the strategy, including the functionality of the working groups, while others relate to identified priority areas for focus and action.
The framework offered by a collective impact approach aligns well with the results from the current evaluation, for ways to improve the Strategy and help the many partners involved in the WECOSS to work better together. A collective impact approach requires five conditions for collective success – a common agenda, a set of shared measurements, mutually reinforcing activities, continuous communication, and a strong backbone organization (Kania & Kramer,
2011).
Structural and Capacity Building Recommendations
Pathway #1: Shared Vision. 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.
Suggested outputs for modernization would include:
- Revised WECOSS Terms of Reference detailing a “shared vision”.
Pathway # 2: Shared Measurements. The Strategy, along with its short and long-term goals, must be well-understood and agreed upon by the Leadership Committee. There are several
ways to move forward with this recommendation:
- Create a WECOSS data subgroup and an evaluation subgroup to identify key indicators to monitor and evaluation priorities, as well as to oversee this work.
- Establish a community scorecard, a tool for tracking a shared set of measurements.
- Construct a web-based dashboard, that includes relevant data on substance use (e.g., ED visits, EMS calls, crime data) to support clarity around the local issues.
Pathway # 3: Collective Leadership. 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. Outputs to support this include:
- Structures & resources to improve collective leadership, by developing a set of supportive documents:
- WECOSS Terms of Reference identifying responsibilities and tenure of Leadership and Working Group members, as well as decision-making criteria for taking on WECOSS- initiated projects.
- Guide for Co-chairs/meeting template and goals.
Pathway #4: Capacity Building and Sustainability. Advocacy work or specialized projects could
be led by relevant members of the WECOSS Leadership Committee. This can be accomplished by
collaboratively engaging in the following:
- Create a system and establish a process for discussing and supporting advocacy work at the Leadership Committee level for capacity building and sustainability, regardless of the focus of advocacy – whether it be for funding or specialized projects.
- Detailing the backbone agency and WECOSS partners’ concrete roles and responsibilities should be another vehicle used to ensure accountability, with authentic power to call partners to action, when needed.
Pathway # 5: Continuous Communication. Consistent and structured public communication across different channels can support trust, and commitment to a common agenda (Kania & Kramer, 2011). The following outputs can support this recommendation:
- Social Marketing Communication Plan so that every resident is aware of the main messaging of the WECOSS, specifically its vision, principles and goals.
- Quarterly WECOSS Newsletter/Social Media Accounts & Strategy could include regular updates from each of the pillar working groups and core WECOSS messaging.
- WECOSS.ca, promoted as the centralized hub for information on substance use to be expanded to include sections specific for healthcare providers and a dashboard that includes the shared measurements and tracking related to WECOSS and its member organizations.
Recommendations for Priority Action and Focus
The structural pathways outlined above will better support recommendations in the existing WECOSS Action Plan and will build a firm foundation as we take on emerging priorities. As part of the evaluation process, the following priority areas were identified and may be considered for the modernization of the strategy to ensure it is addressing pressing community issues.
Priority # 1: Foster inclusion as a core value starting with a WECOSS peer advisory committee.
Create and support spaces to meaningfully engage People with Lived and Living Experience by establishing a local peer advisory committee, centering diversity, equity, and inclusiveness.
The goal of these committees is to provide people with lived/living experience with opportunities to use their experiences and voice to help inform local programs, policies, and initiatives. These committees also provide opportunities for agencies to gather formalized feedback about their ongoing services and activities and to adapt them to better meet the needs of people with lived experience with substance use.
Priority # 2: Formalize healthcare provider engagement and education as key drivers in addressing substance use.
Formal efforts should be made to engage healthcare providers, as their role in addressing the opioid crisis is critical. These recommendations may include:
- Building access to safer supply programming, which has received support from the federal health leaders (2020), as these pharmaceutical-grade alternatives to the unregulated drug supply have been recognized as a life-saving and critical part of addressing the drug-poisoning crisis.
- Specialized education for key healthcare provider groups on Opioid Agonist Treatments (OAT), as well as safer supply clinical practices.
- Emergency departments (ED) must also be part of a community effort to support those who use substances, so that a crisis in the ED can potentially become an opportunity for treatment and recovery, including access to a safer opioid supply (META:PHI, 2021).
Priority # 3 No Wrong Door: Enhancing Access to Services and Supports.
Clear entry points for services and supports (e.g., harm reduction, treatment, and mental health service options) for clients with substance use disorders must be established. Once established, concerted efforts are required to ensure all stakeholders are aware of these entry points.
Priority # 4: Augment harm reduction services and supplies through coordinated agency involvement and policy supports.
In addition to the current work towards establishing a local Consumption and Treatment Services (CTS) Site, community-based overdose prevention approaches should be explored to provide information to businesses about naloxone, how to access it, and how to use it as a potentially life saving action (Toronto Public Health, 2021).
Formalized, coordinated outreach services, and harm reduction/overdose prevention resources in shelters should be enhanced. Harm reduction approaches may be further supported by policy development and memorandums of understanding (MOU) with agencies that provide harm reduction supplies. A policy template may be developed and shared with organizations in the community or an MOU, as elements to help organizations adopt more of a harm reduction philosophical approach.
Priority # 5: Address the social determinants of health that impact substance use and community well-being.
Enhance counselling services to support people who use substances as well as for service providers, especially for grief and loss associated with increased deaths related to overdoses. Allocating additional resources and providing further support to shelter and housing partners must also be considered as a priority in modernization of the WECOSS.
Efforts to enhance health literacy as it relates to substance use across the life-span should be prioritized to increase the understanding individuals have about their health and how to access health services or health information related to substance use or harm reduction approaches.
Priority # 6: Build a shared understanding of community safety and well-being by strengthening public safety and public health partnerships that support vulnerable and marginalized populations.
Regional police services remain committed to disrupting the supply of harmful substances by targeting drug trafficking and illegal production and importation (CACP, 2020). However, future action should be tempered with a willingness to explore decriminalization. If decriminalization was adopted, the time previously used to process criminal charges could instead be used to support those with substance use disorders to access pathways of care for substance use treatment or harm reduction programming (CACP, 2020).
Those pathways would need to be established through partnerships with the health and social systems for law enforcement and other first responders to better link people to the appropriate services. Recent developments in the community, such as the Mental Health and Addictions Response Teams (MHART) model, can be seen as supporting these pathways to care.
An initial step at the local level for WECOSS partners would be to begin reviewing the local implementation of the Good Samaritan Drug Overdose Act and consider a policy that does not make it mandatory for police to attend overdose calls, unless there is a threat to public safety or if the overdose is fatal.
Key References
Canadian Association of Chiefs of Police. (2020). Decriminalization for Simple Possession of Illicit Drugs:
Exploring Impacts on Public Safety & Policing. Retrieved from
https://www.cacp.ca/index.html?asst_id=2189
META:PHI. (2021). Toolkit for the Management of Opioid Use Disorder in the ED Setting. Retrieved from
https://www.metaphi.ca/ed-resources.html
Toronto Public Health (June 3, 2021). Toronto Overdose Action Plan: Status Report 2021. Retrieved from
https://www.toronto.ca/legdocs/mmis/2021/hl/bgrd/backgroundfile-167327…