Success Stories in Action: A digital front door makes addiction medicine more accessible

This series from the Ontario Mental Health and Addictions Virtual Care Collaborative highlights projects or initiatives across Ontario that have helped to ensure nobody is left behind in the rapid shift to virtual mental health and addictions care in response to COVID-19. Learn more about "Success Stories in Action".

An interview with Dr. Kim Corace and Dr. Melanie Willows

Dr. Kim Corace, Vice-President, Innovation & Transformation at The Royal

Dr. Melanie Willows, Clinical Director, Substance Use and Concurrent Disorders Program, The Royal

What are rapid access addiction medicine (RAAM) clinics?

Rapid access addiction medicine (RAAM) clinics are low-barrier clinics that provide rapid access to care for clients with problematic substance use, including alcohol and opioid use problems, which are growing problems in Ontario. RAAM clinics operate on a walk-in basis. Clients do not need an appointment or referral.

The RAAM clinic at The Royal operates in collaboration with different partners in the greater Ottawa community including, but not limited to, emergency departments, withdrawal management services community partners, primary care providers, and the AccessMHA coordinated access service available in eastern Ontario.

RAAM clinics reduce opioid-related hospitalizations, emergency department visits, and death. During the pandemic, they are needed more than ever.

What was the problem or challenge that your initiative responded to?

Prior to the pandemic, we had a RAAM clinic with daily walk-in access where people experiencing substance use and co-occurring mental health issues could receive care immediately when they needed it. Many clients were connected directly from the emergency department to the RAAM walk-in on the same day.

Once the COVID-19 pandemic began, infection prevention and control procedures meant that clients could not just walk in to the RAAM clinic anymore. Although the RAAM clinic pivoted immediately to offering virtual care, this shift meant the clinic was no longer low-barrier. When accessing virtual care, people needed an appointment at a set time.

The RAAM model is special because it is interdisciplinary. In person, clients move seamlessly between different service providers such as physicians, nurse practitioners, nurses, social workers and addiction counsellors.  This continuity means fewer appointments to make and keep as well as a warm hand-off between providers. It also offers opportunities for providers to collaborate across their various areas of expertise to best serve clients. This became difficult in the virtual environment during the COVID-19 pandemic when the team was not working in the same space and each appointment became separate.

Combined with these barriers in the virtual environment, the COVID-19 pandemic escalated rates of opioid and alcohol use and serious related harms, including increases in overdoses. It was a perfect storm.

How did your project/initiative work to reduce the digital divide?  

Alongside clients, clinicians, administrators, technology experts, researchers, and vendors, we co-designed a new digital solution called the RAAM Digital Front Door. It is essentially a virtual walk-in where people can access services from their computer, tablet, or smartphone. Someone can go to a website, enter information about themselves and connect with a provider immediately.

The platform also allows people to meet with several different providers: a nurse, a social worker etc., - without being disconnected in-between, replicating what is done in person in the walk-in environment.

The 3.0 version of the Digital Front Door uses its own integrated videoconferencing platform, which eases these transitions and facilitates multidisciplinary care meetings. It allows support people – whether at a community agency, or a spouse or parent – to  be brought into the appointment at the same time. There is even the ability for people to be connected from an emergency room visit, where they are given a QR code to get direct access to the Digital Front Door.  In addition, individuals connecting with AccessMHA who identify concerns related to alcohol and/or opioid use are directly connected to the RAAM Digital Front Door.

We are also able to work with our community partners to provide connectivity and support for clients who may not have access to the internet.

The Digital Front Door has meant that access to the RAAM clinic has a greater reach than when it was a physical drop-in only. Some folks in the region are not close enough to access the clinic, and many may not have access to transportation, and others maybe too unwell or nervous to attend in person.

The platform automatically integrates standardized intake and assessment, evaluation, and the collection of metrics. So for example, it collects how many clients visited and how long their appointments lasted. This is information we can use to understand how service is being used and guide quality improvement.

If your initiative could be scaled to other communities in the province, what resources or processes would need to be in place? Can you discuss some barriers that organizations could expect to encounter, and key facilitators to overcome those barriers?

We are now scaling and spreading the Digital Front Door to 15 RAAM clinics across Ontario. Funding and human resources are the biggest need and challenge in scaling up. In particular, to support clinics across the province of varying sizes and types—hospital-based, community-based—we need centralized coordination. We need people who can support the implementation, adaptation, standardization, and fine-tuning of the platform. There are clinicians, business analysts, project managers, evaluators, and knowledge brokers involved in various parts of the project. It takes a lot of people to make scale-up successful!

We also want to ensure continuous quality improvement going forward. The Digital Front Door isn’t a solution that just rests, it’s a solution that must always be adapting to client needs and the clinical services being offered. We have to keep it as seamless for clients as possible amidst these changes.

For example, one of the changes we are looking at making is further improving client access to a RAAM clinic by working more as a collective group of clinics. Maybe the RAAM clinic in your town does not have a provider available, but another one does. How can we use the network to make sure that person would get service the quickest way possible by connecting across the province using the Digital Front Door?

We know Francophone communities are underserved across the province. How can we use the Digital Front door to connect Francophone Ontarians to RAAM services in French if they are not available in the area where they live?

Eventually we plan to collectively network together 50+ clinics across the province, but this will require ongoing funding. The greater number of access points that we have, the better RAAM clinic accessibility will be across the province.

About the interviewees

Michelle ValbergDr. Kim Corace is the Vice-President of Innovation & Transformation at The Royal Ottawa Mental Health Centre, an Associate Professor in the Department of Psychiatry at University of Ottawa, a Clinical Investigator with the Institute of Mental Health Research, a Clinical Health Psychologist, and Past President of the Canadian Psychological Association (CPA). Working at provincial, national, and international levels, her work focuses on improving treatment access and outcomes for people with substance use and mental health problems, with a focus on developing collaborative hospital-community models of care. 
 
Melanie Willlows PhotoDr. Melanie Willows is an addiction medicine physician and is the Clinical Director of the Substance Use and Concurrent Disorders Program at The Royal Ottawa Mental Health Centre. She is an Assistant Professor at University of Ottawa, a Clinical Investigator with the Institute of Mental Health Research, a diplomate with the American Board of Addiction Medicine and Past President of the Canadian Society of Addiction Medicine (CSAM).  Dr. Willows collaborates with clinicians and researchers to develop new services that improve access and address gaps in care for substance use and mental health problems​.

For more information, contact communications@theroyal.ca.

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