Provincal Standards For Registered Assisted Living Supportive Recovery .

PROVINCAL STANDARDS FORREGISTERED ASSISTED LIVINGSUPPORTIVE RECOVERY SERVICESM inis t r y of Hea lt h a ndM inis t r y of Ment a l H ea lt h a nd A d d ic t io nsFa ll 2 0 2 1

WELCOMESUPPORTIVERECOVERYOPERATORS ANDSTAFF2

TERRITORIALACKNOWLEDGEMENTPhoto Credit GoldstreamFALL 2021We acknowledge that the ProvincialStandards for Registered Assisted LivingSupportive Recovery Services were createdon the unceded traditional and ancestralland of the lək̓ʷəŋən People, knowntoday as the Esquimalt and SongheesNations3

THANK YOUThe Ministr y of Mental Health andAddictions and the Ministr y of Health wishto thank the people with lived experience,family representatives, ser vice providers,Community Advisor y Committee members,Indigenous organizations, and regionalhealth authority managers whopar ticipated in focus group sessions, andwho also provided written and oralfeedback on draf t versions of thedocument.

DURING OUR TIME TODAYDuring our Session Background and Context Introduction to the Standards Implementation requirements Case Study: Standard 6 PersonalService Planning Implementation tools andresources –overviewAdditional resources underdevelopmentB y t h e e n d of o u r s e s s i o n t o d a y w e h o p e y o uwill understand1. The role the standards play in supporting sectorconsistency, quality and accountability2. The general structure of the Standards (requiredelements, enhanced practice, and guidance onimplementation)3. Provincial direction and requirements for contractedservices4. How to use the implementation tools available tosupport adoption of the standards5

BACKGROUND ANDCONTEXT:THE ROLE OF REGISTEREDSUPPORTIVE RECOVERYSERVICES

SUPPORTIVE RECOVERY: SECTOR DEVELOPMENTSBackgroundKey Sector DevelopmentsSince 2017 the Ministry ofHealth and the Ministry ofMental Health andAddictions has beenworking to improve theoverall safety, quality andconsistency of supportiverecovery services in theprovinceCCALA/AssistedLiving Regulation(2016-2019)HistoricalIncreased oversightFocus on health andsafetyMinimal oversightTraining Grants andlimitedOperator HandbookaccountabilityLimited supportsfor operatorsSDPR PerDiemIncrease(2019)Firstincrease in10 yearsRegisteredsupportiverecovery 30.90 35.90Standards forRegisteredSupportiveRecovery (2021)Build fromRegulationBest-practices forevidence-basedcareProvides supportand practiceguidance (the“how”)7

REGISTERED ASSISTED LIVING SUPPORTIVERECOVERY SERVICES– SERVICE DEFINITIONService SettingLive-in supportive recoveryservices registered as assistedliving under the CommunityCare and Assisted Living Act(supportive recoveryresidences) have therequirement of providing a safe,communal environment whereindividuals have the opportunityand the support to focus ontheir recovery journeyGoals of the Service1.Support individuals toreduce, abstain from, and/orreduce harms associated withsubstance useWho May Benefit from aRegistered Supportive RecoveryService?Individuals who have a goal to reduce,abstain from, or reduce harmsassociated with substance use andneed a supportive environment.2.Help individuals to stabilizeand prepare for the next stepsof their recovery journey3.Help individuals to buildskills and confidence toachieve their recovery goals8

WHY CREATE SERVICE STANDARDS?Support greater consistency inservice quality beyond the healthand safety and focus of regulationsDistinguish registered servicesfrom the 2011 Standards which aregeared towards licensed servicesSupport understanding of how toimplement best/wise practices andprinciples of evidence-based carein registered servicesOpportunity to provide furthersupports and tailored approach forsubstance use focused servicesRecognize that the context inwhich registered services operateis also increasingly complex9

REGUL ATIONS V. SERVICE STANDARDSThe standards build from the regulation to establish criteria for the delivery of high-quality care as supported byresearch evidence. In meeting the standards, service providers will generally be exceeding the regulatoryrequirements for services in the Assisted Living Regulation.A s s is t ed Liv ing R eg ula t io n Health and Safety focus Intended to support a variety of servicepopulations (seniors, mental health,substance use) Operators must adhere to all regulationsas set out in the ALR.2 0 2 1 S t a nd a rds f o r S up p o r t iv eR eco v er y Focus on best-practices, service quality and evidencebased care Distinct from professional or clinical care standards Focused on substance use specific supportiverecovery services Provide guidance “how to get there” Outcomes focused “what you should bedoing” Enforceable under the CCALA andmonitored by Assisted Living Registry Enforceable through health authority contracts:operators not under contract with health authoritiesare encouraged to adopt standards into their services10

APPLICABILITY The 2021 Standards are applicable to all supportive recovery services currently registered under theCommunity Care and Assisted Living Act The 2021 Standards supersede the 2011 Provincial Standards for Adult Residential Substance Use Serviceswith respect to the provision of registered supportive recovery services All Registered Assisted Supportive Recovery services must to follow the Assisted Living Regulation. Compliance with the Standards is not a regulatory requirement. Contracted services must comply with the Standards as part of their contract requirements11

SHAPING THE STANDARDST H E S TA N D A R D S W O U L D N OT H AV E B E E NPOSSIBLE WITHOUT THE CONTRIBUTIONSOF THE WRITING TEAM FROM INSIDEOUTI N C L U D I N G T R A C Y BY R N E , J E N N Y W E S TO N ,A N D M I C H E L E M U N D Y.P L E A S E L I S T E N A S W E TA K E A M O M E N T TOH E A R T H E M S P E A K A B O U T T H E C R E AT I O NO F T H E S TA N D A R D S A N D T H E I R H O P E S F O RT H E S E C TO R .

DEVELOPING THE STANDARDSA p p ro a chP r o c es s ( 1 2 mo nt hs )Evidenceinformed andreflective ofdiverseperspectivesInitial Information Gathering: Evidence and Literature Review In-person consultations (4sessions)Thematic Review and Development: Define structure, audience, andtone Confirm approach and standardsfocus (client journey)Drafting and Review andRefinements: Consultation groups and expertpanel draft review Creation of evaluation tool andimplementation resourcesC o nt r ib ut o r s Community Advisory Committeeoperators of supportive recoveryresidences Indigenous Community Partners andTreatment and Recovery ServiceOperators People and Loved-Ones with Lived andLiving Experience Health Authority Substance Use LeadsProject Oversight and Advice Expert advisory panel Strategic Advisory Committee13

SETTING THE FOUNDATIONSuppor tive Recover y Ser vicesGuiding AssumptionsP r inc ip les t ha t U nd er p in t he S t a nd a rd sThe Standards recognize: The effects of colonization continue to impact thewellness of First Nations, Metis and Inuit Personal experience with trauma and stigma plays a rolein how people seek care and interact with healthcaresystems There is a diverse landscape of Supportive RecoveryServices in British Columbia, Those services may be delivered by operators withdiverse approaches and perspectives. People have different recovery goals related tosubstance use, and There are many different paths to achieving “recovery”14

INDIGENOUS CULTURALSAFETY AND HUMILITY There is a standard devoted specifically toIndigenous Cultural Safety (ICS) and Humility;however, ICS principles and practices are alsowoven into all the standards. The voices of Indigenous and non-Indigenousservice providers and people with livedexperience are included throughout.“Cultural safety needs to be arequirement of the supportive recoveryservice, and it needs to be embeddedin everyday practice.”Unnamed Indigenous Artist- used with permission ofthe family A companion document has been created thatoffers service providers tools and IndigenousCultural Safety resources to help withimplementing the standards.15

SUPPORTING A CLIENT ON THEIRJOURNEY:INTRODUCING THE PROVINICNALS TA N DA R D S F O R R E G I S T E R E D A S S I S T E DL I V I N G S U P P O R T I V E R E CO V E R Y S E R V I C E S

OBJECTIVES OF THE STANDARDSHistorically, manysupportive recoveryservices haveoperated outside thetraditional healthcaresystem. As evidencebased best practicesregarding substanceuse grows, the role ofsupportive recoveryservices and theirimportance as a partof the substance usesystem of carecontinues to evolveRecognizing the vital role supportive services play in the substance use system ofcare, the Standards have been developed with the following objectives: To facilitate the provision of evidence-informed, safe and respectful care acrossthe province; To improve linkages between registered supportive recovery services andother substance use services, primary care providers, and organizations thatprovide psychosocial supports; To strengthen staff competencies in the areas of trauma- and resilienceinformed practice and Indigenous Cultural Safety and Humility; and To improve the information available to people about what they can expectfrom registered supportive recovery services as well as what is expected ofthem while they are accessing a service.17

SUPPORTING A CLIENT’S JOURNEY WHILE AT ASERVICEO v er v iewFollowing the journey of a clientwho is considering and ultimatelyparticipating in a registeredsupportive recovery service, theStandards are intended to helpoperators consider how toincorporate quality person-centeredelements into their serviceS t r uc t ureTwelve individual standards with a standard devoted specifically toIndigenous Cultural Safety (ICS) and Humility;Standards are oriented around a client’s journey, andaddress: Supporting informed decisions and preparing for thejourney Program planning, embedding principles and practices ofIndigenous Cultural Safety and Humility, and keepingresidents safe Supporting a person during their stay Preparing to leave the service Evaluation and continuous quality improvementEach standard includes an overarching statement, anexpression of intent and required elements18

STANDARDS AT A GL ANCEStandard 1: Introducing YourService and SupportingInformed Decision MakingStandard 2: SupportingPeople Who Are Waiting toAccess Your ServiceStandard 3: StaffingStandard 4: IndigenousCultural Safety and HumilityStandard 5: Helping NewResidents Settle InStandard 6: Personal ServicePlanningStandard 7: Medical Needsand Prescribed MedicationsStandard 8: EvidenceInformed PracticeStandard 9: Programmingand SupportsStandard 10: KeepingResidents SafeStandard 11: TransitioningPlanning and OngoingConnectionsStandard 12: Evaluating YourService19

CASE STUDY: DEVELOPING A PERSONAL SERVICEPLANBackground:In this scenario wewill be applyingthe requiredelements of theStandards andusing theImplementationResource tosupport Peter tocreate a PersonalService Plan Peter joined a registered service twodays ago and has spent his firstcouple of days adjusting to aroutine, connecting with otherclients, and checking in with staff. During the daily touch base Peterhas indicated that he is ready to startthinking about making some plansto support his stay and his recovery“I want to be asked what do I wantand what do I need. I want to makesure that their plan is my plan.”Details About Peter: His wellness support system includes hisMom, and a medical doctor Peter was referred to your service throughhis regional health authoritySections 33 – 35 and Schedule D of theAssisted Living Regulation deal with thepersonal service plan and describe generalrequirements for meeting the resident’sneeds and achieving their personal goals.Standard 6 sets out further requirements forhow to go about creating the plan as well asthe range of personal goals that the planmight include20