Consider client and community needs

Focus first on the needs and treatment goals of the clients. The primary goal of any MMT program is to improve clients’ health and quality of life. If your program cannot meet these treatment goals and needs of the clients, the full benefits to the client and the community cannot be realized.

People who are dependent on opioids are a diverse population with many reasons for seeking treatment. While most will benefit from counselling, they do not all have the same type or level of need for additional supportive services. For example, some may need shelter, food, child care or financial support, while others may not. Many clients also need support stabilizing and rebuilding family relationships through services such as marriage/relationship counselling, parent and family counselling and assistance in dealing with child welfare agencies.

If a client’s needs are not met, then their ability to stay in treatment may be jeopardized. Therefore, the services of the program model should be suitably varied and flexible and be able to respond to the needs of clients, their severity of dependence, personal circumstances, motivation and response to treatment.

Furthermore, there are some clients who have special treatment issues that require specific health and social supports. These include:

people with polysubstance-use behaviours
women
women who are pregnant
youth
homeless persons
people living in rural or remote areas
First Nations, Métis and Inuit clients
people living with HCV
people living with HIV/AIDS
people living with mental health disorders
offenders in the corrections system.

QUICK FACT

Research shows that combining counselling with MMT improves treatment outcomes and should be considered an essential component of methadone treatment programs (Wilson et al., 2007; Gossop et al., 2003; Callaly et al., 2001).

Develop a comprehensive MMT program model that includes access to community health and social support services. This will require agreements with the partner agencies and clear referral protocols, procedures and policies. (See Policies and procedures.) Community health and social support services may include counselling, case management, mental health services, health promotion, disease prevention and education and other community-based services, such as legal, financial, medical, child care, dental and housing services. (See Components of an MMT program.)

“It is fundamental that methadone maintenance treatment be integrated into a wider scope of services.” — MMT case manager

Design your model to be a client-centred program that:

is easily accessible
recognizes and accepts that every client enters treatment with widely varying experiences, expectations and needs
respects clients’ dignity
fosters a collaborative, relationship-building approach between clients and program team members
tailors treatment to meet individual clients’ needs
outlines clearly articulated rules that are followed consistently.

Client Peer Support

Consider including a client peer support element to your program. Peers can help spread the word about the program and its benefits to potential clients. They can inform new clients about the program and its services. They can also encourage each other at various points throughout their care continuum. Peers are especially valuable to clients who are in crisis.

Using peer support promotes client involvement in the clinic and the community. They can meet regularly to address issues that may arise concerning the clinic, the services or other aspects of the program. Furthermore, peers can be instrumental in raising awareness in the community and supporting recruitment of service providers. They should be encouraged to tell their stories (Hart, 2007; Wilson et al., 2007).

Clients who offer support to their peers should be trained and receive ongoing support and guidance from the appropriate counselling professionals in the program.