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Critical Stages in Development - Establishment of a Community Working GroupMethadone Maintenance Treatment: A Community Planning GuideOn this page:
The establishment of a community working group is essential because the successful development and implementation of a methadone service will require a great deal of work and support from key community partners. A working group can play a pivotal role in developing service capacity. Even if a community working group decides not to proceed with the development of a treatment model, it may still want to meet to maintain a proactive rather than reactive position. One potential function would be to monitor trends in opiate use since new information may appear which clearly shows there is a need for methadone treatment. Roles for working group members should be clearly defined in the formative stages. Most community members will look to such professionals as the CAMH consultant or the DHC planner to take on a leadership role with the group. These people may be asked to chair the group which may include such duties as setting meeting dates, planning agendas, preparing minutes and facilitating the group's process as it addresses problem issues. The CAMH staff person will be seen as a key information source as a result of the links with the CAMH Opiate Clinic, the CAMH Methadone Treatment Dissemination Team, the Ontario Substance Abuse Bureau and the College of Physicians and Surgeons.
Inviting Community PartnersWhen inviting agencies, services or individuals to be part of a working group, it is better to err on the side of caution and develop a list that includes all the potential stakeholders who may want to have some input on this topic. The working group should include representatives from CAMH, addictions treatment, needle exchange programs, law enforcement, mental health, public health units, AIDS Committees, corrections, social services departments and the District Health Council. A special emphasis should be placed on recruiting consumer representatives. These individuals can be an excellent source of information on the needs of opioid users and methadone patients. Recruitment of consumers may be a difficult task if there is law enforcement representation on the working group. If possible, it would also be beneficial to have potential service providers such as physicians, pharmacists and laboratory services involved at this stage of the process.
Inviting Resistant StakeholdersThe decision when to invite resistant stakeholders to the table may be difficult to make since some partner agencies which have collaborated on other community projects in the past, may have reservations about methadone maintenance treatment. Unless one truly knows the individuals and services, you may not know their position on this issue. It is recommended that all stakeholders be invited to the initial meeting. It may be helpful to anticipate that all are potentially resistant to the concept of methadone treatment and will have questions about the needs-based information that has been gathered. Therefore, one of the initial outcomes will be to review the efficacy of methadone treatment and to review the information that has been gathered from sources who should be present at the table. Overall, from a community planning perspective, it is probably better to have resistant stakeholders at the table rather than working against the initiative outside of the planning group.
Initial Meeting - Educating the Working GroupSince many professionals have very limited time for community meetings, the purpose of the working group should be clearly stated. The development of a draft goals and objectives outline may be helpful to give them an idea of the purpose of the group. Obviously, one of the first items to be discussed is the information that has been gathered on the need for methadone treatment. In some cases, there may be information which clearly shows that there is a need to develop methadone treatment services. For example, if methadone clients are travelling to other communities to access this service, this is clear evidence which shows there is a need for this treatment option in this district. At this stage, it will be important to educate the group about methadone treatment and its efficacy as a treatment model. It may be useful to show a video produced by CAMH, Treating Opioid Dependence: A Case for Methadone in Ontario, which can be used as a tool to recruit physicians. The local CAMH consultant will be able to obtain a copy of this video (see Recommended Resources). It should also be explained that methadone maintenance treatment is a province-wide initiative that is being supported by a number of provincial groups including the Ministry of Health and Long-Term Care - Ontario Substance Abuse Bureau, College of Physicians and Surgeons of Ontario, Ontario College of Pharmacists and Centre for Addiction and Mental Health. The working group may want to invite a member of these organizations to make an educational presentation at a future meeting. At this stage even if the information is unclear about the need for methadone maintenance treatment, some individuals may argue that the community should at least develop a treatment capacity to address potential service needs.
Dealing with ConflictThe initial meeting of the group will give an idea of where people stand on the issue of methadone treatment and their perception of the need for this type of program in the community. Some individuals and/or agencies may make it quite clear that they are not in favour of this treatment model for various reasons which may include philosophical or personal issues. In addition, some groups may be advocates but might have biases toward one methadone treatment model over another (e.g. abstinence vs. harm reduction approaches). Addressing these issues as soon as possible is very important, since they may cause major delays in the planning phase. Inviting representatives from the Centre for Addiction and Mental Health's Opiate Clinic or the College of Physicians and Surgeons to make a presentation may assist in diffusing some potential problem areas. Since these individuals are well-grounded in the research, and in some cases directly involved in service provision, they are very credible and effective resources. Another source of information that may be helpful is the experiences of clients who may add insight on the merits of MMT as a result of their involvement with the treatment. Since methadone treatment is controversial for some individuals and because there are different methadone treatment models, it must be understood that it is difficult to win people over from one side to another. However, a key point that needs to be established when dealing with conflict in these areas is that even though people may not agree with a particular treatment approach, they hopefully will concur that methadone treatment has helped a number of opioid users and has the potential to help many more individuals. Since there is no shortage of research studies on the effectiveness of the treatment model as a whole, along with a variety of approaches, it is very difficult for one to question the efficacy of the treatment modality. The group may debate the relative merits of harm reduction versus abstinence models of methadone treatment. It will be important to show the value of the two models and to state that in an ideal system both are part of the treatment continuum of care. The working group would be best advised to focus on the needs of the client rather than the personal viewpoints that individuals may possess favouring one model over another. Focusing on clients' needs can assist in diffusing conflict and building a consensus.
Establishing ConsensusFollowing discussion on an area of conflict, it will be helpful to bring the group back to its goal and objectives. One of the best ways to establish a consensus is to focus on the needs of the clients. If opioid users are not able to access methadone treatment in their community, this should be the focal point of the group's energy. Establishing viable services which meet the needs of the target group should be the centre of attention. As stated earlier, dealing with conflict is inevitable in every working group and it is probably beneficial to deal with this as early as possible. This will allow the group to focus its time on the planning, development and implementation of the model.
Next>> Methadone Maintenance Treatment Model Development
Methadone Maintenance Treatment: A Community Planning Guide
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Last updated: May 30, 2007 12:01 PM Published: Nov 19, 2008 7:59 PM ID#P28428 |