Stepped Care in Newfoundland and Labrador
As each individual’s journey of wellness and recovery is unique, there is no right or wrong path. Therefore, stepped care aims to match individuals with the right care, at the right time, and then step up, or step down, intensity of supports offered based on need, preferences, and readiness of the individual to engage in services. Person-centric in its approach, stepped care focuses on the strengths of both individuals and communities, and provides diverse options that recognize a single approach will not necessarily work for everyone. People engage most successfully with mental health and addictions resources and supports when they are ready, involved in continuous feedback on progress with providers and decisions about care, and when treatments are then adjusted as needed.
Newfoundland and Labrador’s Stepped Care Model
Partners in Care
The inner circle surrounding the individual represents the many partners in care. That is, both the informal and formal supports who assist individuals in meeting their wellness goals.
Partners can include, but are not limited to, family, friends, and peers; health care providers, including family physicians and nurses; Elders; community leaders; and the Provincial Mental Health and Addictions Systems Navigator.
Partners in care are a crucial component of an individual’s recovery journey, and are involved throughout all steps of care. When health care providers and other partners in care collaborate across the system, a person-centric approach to support people on their recovery journey is sustained. Working together, partners in care help individuals build and draw upon the important relationships that have already been established in the individual’s life.
Stepped Care Categories
Stepped Care Categories
The categories represented within Newfoundland and Labrador’s Stepped Care Model are meant to show a natural flow from the least intensive programs and supports, to the most intensive supports and specialized programming.
Wellness-Based Self Help
Individuals are empowered to self-manage their own health and wellness by exploring available resources and programs that focus on healthy eating, sports and recreation, healthy sleep hygiene, mindfulness, social connections and self-help options; as well as utilizing natural, informal supports.
Peer-Led and Community Supported
Individuals can connect with peer-led and community supported programs and services, such as the provincial Lifewise Warm Line and U-Turn Drop-In Centre. These supports can range in intensity and involvement, and be used throughout one’s wellness journey.
Coach or Counselor Assisted Services
In this step, individuals are supported with interventions, through a blended approach of self-directed work using psychoeducational material, paired with brief connections with a trained coach or counsellor, either in person, online, or by phone. Coaches and counsellors work with individuals on applying skills to improve mental health and wellness, provide support, increase motivation, and facilitate connections to other services, as needed.
Individual, Family, Couples and Group Therapy
Mental health and addictions professionals provide group, individual, family and couples counselling to individuals with mental health or substance use concerns, as well as their family and friends, on a variety of topics.
Counselling can be received in a variety of ways, such as in-person, by phone, or video conference. Additionally, counsellors work collaboratively with individuals to connect them with other steps within the Stepped Care Model, as appropriate.
Doorways walk-in counselling service is also available throughout the province, including some correctional centres and schools, and provides rapid access to mental health and addictions counselling services, one session at a time. Individuals can attend Doorways as many times as they like with the option to see the same counsellor.
Specialized Services
Specialized services include intensive interventions to support individuals with multiple and sometimes complex needs, such as concurrent disorders and long-term mental illness. While some specialized programs, such as opioid dependence treatment (ODT) hubs and flexible assertive community treatment (FACT) teams, accept self-referrals, others, like psychiatry services, require a physician or nurse practitioner’s referral.
When the need for specialized services is clinically indicated, mental health and addictions professionals will complete further assessment, in collaboration with the individual, to identify services to best meet their needs.
Inpatient Programming
Individuals who require residential treatment at one of the provincial treatment centres, including the Grace Centre, Recovery Centre, Humberwood Addictions Treatment Centre, Tuckamore Youth Treatment Centre, or Hope Valley Youth Treatment Centre, work with their primary health care provider and mental health and addictions professional to determine readiness for inpatient treatment. Accessing this level of service requires individuals to complete a specialized assessment with mental health and addiction staff, and is unique to each facility.
In-patient mental health care is also available throughout the province in acute care facilities, and requires a physician or nurse practitioner assessment for admittance.
Emergency and Crisis Response
Referrals and/or assessments are not required to access emergency and crisis response services throughout the province, and individuals can immediately connect with services by calling 911, 811, Kids Help Phone, Sexual Assault Crisis Line, and the Crisis Text Line.
In-person emergency services are also available by visiting any emergency department throughout the province. Mobile crisis response teams, comprised of mental health and addictions professionals and trained police officers who respond together to crises in the community, are also available seven days a week in each region of the province.
Access Points
Navigating the variety of health services available in Newfoundland and Labrador can be challenging without clear points of access. Provincial Stepped Care Model provides three key access points to improve access to timely, quality mental health and addictions care. These three options are meant to be easily recalled and accessed, while providing choice on how the individuals wishes to receive care. The population-based approach include: In-person, by visiting/calling Doorways counselling clinics; Online, by visiting Bridgethegapp.ca; and Phone, by calling 811. Together, these access points point individuals in the right direction to support their wellness journey.
In-Person
Doorways provides rapid access to mental health and addictions counselling services throughout the province, one session at a time. Most locations offer walk-in services, or can arrange same day, next day or a scheduled appointment by phone or videoconference. Individuals can return to Doorways as often as needed, and when additional services or supports are required, mental health and addictions professionals work with the individual to connect them to a service that best meets their needs.
Individuals who choose Doorways as an access point, are asked to complete a Doorways screening form. The service provider uses information gathered from the screening form, along with clinical judgement, and information shared by the individual to work collaboratively in determining which service(s) within the Stepped Care Model best fit their needs and readiness to engage in programming.
When lower intensity services, including wellness-based self help, peer-led community supported or coach/counsellor assisted services are indicated, Doorways staff offer information, assist with registration for online programs, and/or complete referrals, if necessary. Refer to Appendix A for Doorways Access Pathway.
When higher intensity services, including group, individual, couples or family therapy; specialized services; and inpatient programming are clinically indicated, Doorways staff assist individuals with navigation and referral to other more appropriate services. *A complete listing of Doorways locations is available by calling 811 or visiting Bridgethegapp.ca.
Online
Bridgethegapp.ca is Newfoundland and Labrador’s “go-to” site for mental health and addictions information and resources, and connects individuals to local supports and services. Individuals can sign up for online programming, learn about mental health topics, access e-mental tools, identify services in their region, and share personal stories of recovery.
Bridgethegapp.ca contains many wellness and mental health options that are confidential, free and available to people of all ages. These evidence-based programs can be used on their own, or while accessing other more intensive steps in the Stepped Care Model, and offer meaningful and effective strategies to cope with a variety of issues, such as anxiety, stress, depression, and substance use.
Bridgethegapp.ca is always adding new programs and services. Soon, an interactive virtual assistant, named ‘Bridget’, will assist individuals in site navigation by prompting them to complete an online screener, with the option to explore e-mental health tools, sign up for free programs, or connect with the appropriate regional health authority or local mental health and addiction services. Individuals will also have the option to provide their screener results to a clinician, who will work collaboratively with them in determining which supports in the step care model are most appropriate.
Phone
Staffed by experienced, local registered nurses, the provincial 811 HealthLine provides information about physical and mental health services, answers health-related questions, triages and refers individuals to more appropriate services when required.
When individuals access the provincial mental health and addictions system by calling 811, a registered nurse will discuss their needs and concerns, and directly connect them to a range of services, as appropriate, through the use of a triage screening tool.
When lower intensity services, including wellness-based self help, peer-led community supported or coach/counsellor assisted services are clinically indicated, the 811 nurse will offer information, and/or provide live transfer to Lifewise to assist with registration and referral, if required, for online programs and services. When higher intensity services, including group, individual, couples or family therapy; specialized services; and inpatient programming are clinically indicated, the 811 nurse will transfer the triage information to appropriate regional health authority staff, who will contact the individual to complete further assessment and determine appropriate services within the Stepped Care Model.
811 also connects individuals directly to emergency and crisis response services, when required, including 911, mental health crisis calls, and mobile crisis response teams as needed. Refer to Appendix B for 811’s Access Pathway.
For more information about Newfoundland and Labrador’s Stepped Care Model, please visit https://www.youtube.com/watch?v=CF7gM-NG_hs