What you need to know
Substance use disorder, including opioids, alcohol and cannabis use disorders, is currently an urgent public health issue in Ontario. For Francophone communities, access to French mental health and addiction services is either limited or non-existent. For this reason, a research team at the Centre for Addiction and Mental Health launched the ECHO pilot project for Francophones to examine the needs of service providers and establish a French training program curriculum for the treatment of substance use disorders. In this issue of Research As It Happens, we feature an interview with members of the pilot project: nominated principal investigator Dr. Bernard Le Foll, principal investigator Aliou Sene, and Ph.D. student Jacob Cohen.
Note: The interview was conducted in French. Responses were translated into English and edited for clarity.
What is the purpose and context of the ECHO pilot project for Francophones?
Jacob Cohen: The purpose of this project is to create a French training program for substance use management based on the Extension of Community Healthcare Outcomes (ECHO) model. After reviewing the needs of service providers working with Francophone populations in Ontario, we are now looking to develop a customized curriculum tailored to the needs of these providers in official language minority communities (OLMCs).
Logo of the Extension of Community Healthcare Outcomes (ECHO) project. The French training curriculum that the research team wishes to create as part of this pilot project is based on this model.
Who is conducting the research?
Jacob Cohen: The research team is composed of various experts, including French-speaking academics, clinicians, health service managers and service planners.
The team is led by Dr. Bernard Le Foll (nominated principal investigator), Dr. Matthew Sloan (principal investigator), Dr. Allison Crawford (principal investigator), and Dr. Tara Elton-Marshall (co-investigator), as well as Aliou Sene (principal investigator).
Who is the target population?
Jacob Cohen: This study is geared toward health professionals who are already—or are interested in—offering substance use disorder services in OLMCs.
Why did your team decide to move forward with this project? How did you determine that there was a need for a project like the ECHO project for Francophones?
Aliou Sene: Despite legislation like the Official Languages Act and the French Language Services Act that give minority-language populations the right to access services in the official language of their choice, the reality is quite another matter. We know that language barriers can have a negative effect on the quality of services and on patient satisfaction.
Studies have also shown that despite Franco-Ontarians being the largest Francophone population outside Quebec, 53% say that access to mental health and addiction services in French is limited or, for that matter, non-existent.
Bernard Le Foll: We are seeing an increased need when it comes to substance use-related problems. In 2017, the hospitalization rate related to alcohol consumption was comparable to that for heart attacks. Moreover, the media often talks about the opioid crisis, illustrating that these substance use disorders have become a real health problem. Indeed, 12% of Canadians say they use these substances or related products.
Can you describe the research methodology and say where you are now?
Bernard Le Foll: As a pilot project, we began by learning about the substance use disorder service needs of French-language providers. To that end, we did a survey to collect this information. The analysis findings will enable us to determine how to provide support to health professionals serving Francophone communities. Initially, the focus will be to see how the ECHO model can help health providers establish the degree to which services and dedicated resources are lacking, and overcome this gap. We will then look at implementing quality improvement initiatives in terms of training in preparation for the next phases of this project.
Aliou Sene: The ECHO telementoring model uses videoconferencing to apply a hub-and-spoke approach to knowledge-sharing in which experts—the hub—conduct virtual clinics intended for community-based health providers who are regionally dispersed—the spokes. Therefore, we intend to organize training sessions in French in the form of short lectures on a specific topic, followed by the presentation and discussion of anonymized real cases. This approach would improve access to specialized care for remote populations. Members of the Réseau francophone pour les fournisseurs de services en santé mentale et en lutte contre les dépendances, or Francophone Network for Mental Health and Addictions Service Providers, as well other organizations working in this field are also involved in the implementation of this project. With their cooperation, we hope to recruit about 50 health professionals for the pilot project.
What findings of the provincial survey emerge as the main needs of the service providers?
Jacob Cohen: According to the data collected, alcohol and cannabis are the substances used most frequently by patients seeking substance use management services in French. Next comes tobacco, followed by opioids and then cocaine.
As for treatment options, health professionals say that the bulk of their work involves counselling or one-on-one psychotherapy sessions, group psychotherapy sessions and case management services. Substance use management in an institutional or outpatient setting is somewhat limited.
As a result, service providers feel that it would be helpful for them to expand their knowledge in these areas. They also expressed a special interest in the substance use treatment of individuals suffering from chronic pain.
Can you address some of the project’s limitations?
Jacob Cohen: The perspective of health professionals practising in rural or remote communities is often difficult to obtain because of their lack of access to information and their small numbers. The survey findings reflected this, with a relatively low number of responses in these regions compared with urban areas. The other challenge is finding experts able to deliver the course information in French. We are trying to address and overcome these issues primarily by involving the project’s community partners as much as possible.
What are the next steps in the ECHO project for Francophones?
Jacob Cohen: Now that the service providers have told us what their training needs are, the next step in the project is to develop a course whose content is able to address these needs using the ECHO model telementoring approach. The participant cohort will be composed of about 50 health professionals that we will recruit with the help of our community partners.
Research project contact person
Bernard Le Foll
Clinician Scientist and Head, Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, CAMH
Lead, Clinical Research Innovation Service, Addiction Division, CAMH
Head, Alcohol Research and Treatment Clinic, CAMH
Chair, Addiction Psychiatry, Department of Psychiatry, University of Toronto
Professor, departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry, Institute of Medical Sciences and Dalla Lana School of Public Health, University of Toronto.