1. Building Capacity in NNADAP
Chiefs of Ontario
HOS2014, Ottawa, ON
June 25, 2014

2. Outline of Presentation:
• Where is NNADAP at in Ontario?
• Brief Background
o Scope & Complexities of Care, Core Functions,
o HOS Continuum of Care & the National Anti-Drug
Strategy
• Trends and Recent Community Declarations
• NNADAP Funding and Priorities
• Chiefs of Ontario Resolution #13/07
• Strategy to Advocate for Investing in NNADAP
• Next Steps

3. Ontario NNADAP:
• NNADAP began in the 1970’s with a goal to assist First Nations and Inuit
communities set up and operate programs aimed at reducing high levels of
alcohol (70’s), and then expanded to include drugs (80’s), and then solvent
abuse in 1995
• 10 NNADAP Funded Treatment Centres in Ontario, 55 nationally
• Approximately 117 First Nation Communities receive NNADAP funding
–16 First Nations receive no NNADAP funding
• 141 Community-based and 81 treatment centre NNADAP workers
• Position titles vary - may be called Addictions Prevention Worker, Youth
Prevention Worker, Addictions Counsellor, Drug and Alcohol
Counsellor, Wellness Worker, Addictions Case Manager, Community
Addictions Worker, Program Supervisor, Addictions and Mental Health
Worker, Healthy Alternatives Worker, etc.

4. Scope and Complexities of Position:
• NNADAP began 30 years ago as a prevention program
• Expanded to encompass many other areas; such as, crisis intervention,
assessment and referrals to withdrawal management and residential
treatment, referrals to mental health and other health and social services,
treatment planning, supportive and therapeutic counselling and therapy,
both one-on-one counselling and group sessions, home visits, aftercare,
workshops, community events/activities coordination, grief work,
gambling addictions awareness, suicide prevention/intervention, smoking
cessation, FAS/FAE, HIV/AIDS awareness, cultural programming, lateral
violence, health promotion, sexual abuse, family violence, concurrent
disorders, and the abused substances of the day.
• In many communities, one NNADAP worker is expected to help
individuals address issues in all of these areas

5. Honouring Our Strengths: Continuum
of Care (November 2011)
• Increasingly complex needs have dramatically changed the
landscape upon which for NNADAP: new drugs; mental
health issues; a rapidly growing First Nations youth
population; and growing prescription drug abuse concerns in
some regions and communities
• Responding to this need, in 2007, the AFN, NNAPF and
FNIHB oversaw a comprehensive, community-driven review
of substance use-related services and supports for First
Nations people in Canada –Result was Honoring our
Strengths: A Renewed Framework to Address Substance
Use Issues Among First Nations in Canada (HOS)
• HOS describes a continuum of care & the necessary supports
for a quality, culture based response to address substance use
issues for individuals, families, and communities

6. • Announced in 2007, the National Anti-Drug Strategy (NADS) nowAnnounced in 2007, the National Anti-Drug Strategy (NADS) now
provides $9.1 million ongoing to improve access to qualityprovides $9.1 million ongoing to improve access to quality
addiction services for First Nations and Inuit.addiction services for First Nations and Inuit.
Priority investment areasPriority investment areas::
• Improving the quality of services by investingImproving the quality of services by investing in workforcein workforce
development through training and certification.development through training and certification.
• Increasing the effectiveness and relevancy of treatment services.Increasing the effectiveness and relevancy of treatment services.
• Improving access to services by piloting eight multi-disciplinary,Improving access to services by piloting eight multi-disciplinary,
mental wellness teams in First Nations and Inuit communitiesmental wellness teams in First Nations and Inuit communities
across Canada.across Canada.
• An evidence-based review and renewal of on-reserveAn evidence-based review and renewal of on-reserve
addiction services (NNADAP Renewal).addiction services (NNADAP Renewal).
National Anti-Drug Strategy (NADS)
6

7. National Anti-Drug Strategy (Cont.)
Key NADS AchievementsKey NADS Achievements
More workers certified with aMore workers certified with a
recognized certification bodyrecognized certification body
In 2011-12, the percentage treatment counsellorsIn 2011-12, the percentage treatment counsellors
increased to 77% (157 of 204), up from 68% (186 of 272)increased to 77% (157 of 204), up from 68% (186 of 272)
in 2010-11.in 2010-11.
More treatment centres re-More treatment centres re-
profiled or expandedprofiled or expanded
Since 2007, 36 treatment centres have see their servicesSince 2007, 36 treatment centres have see their services
expanded or refocused to more effectively meetexpanded or refocused to more effectively meet
community needs and recognized service gaps (e.g.,community needs and recognized service gaps (e.g.,
women, youth, families, and mental health).women, youth, families, and mental health).
More treatment centresMore treatment centres
accreditedaccredited
In 2011-12, 82% of treatment centres wereIn 2011-12, 82% of treatment centres were
accredited, up from 74% in 2010-11 and 68% in 2009-accredited, up from 74% in 2010-11 and 68% in 2009-
10.10.
Piloting eight mental wellnessPiloting eight mental wellness
teams across Canadateams across Canada
Successful piloting of eight multidisciplinary mentalSuccessful piloting of eight multidisciplinary mental
wellness teams in First Nations and Inuit communitieswellness teams in First Nations and Inuit communities
across Canada.across Canada.
Completion of a review of on-Completion of a review of on-
reserve addiction servicesreserve addiction services
Review completed in 2011 with the launch ofReview completed in 2011 with the launch of HonouringHonouring
Our StrengthsOur Strengths. Framework is being implemented by. Framework is being implemented by
partners at all levels of the system.partners at all levels of the system.

8. Investments are not being retained
High stress, funding
frustrations,
difficulties of the job
and low salaries
leads to a high
turnover rate of
NNADAP workers –
often they take their
certification and
experience
elsewhere for a
more competitive
wage

9. Average Salaries in 2009
• Salaries have not improved since
2009
• In 2013 at least 23% of the
NNADAP & YSAP treatment
centers experienced staff
vacancies and had more than one
vacancy at a time. Four
treatment centres experienced 4,
5, 7 and 11 staff vacancies at one
time. These figures indicate
significant stress on capacity of a
treatment centre to offer
continuous quality programming.
• Staff burnout due to shortage of
staff and lack of competitive
salaries are the main reasons for
staff turnover
NNAPF, 2009
NNAPF, 2013

10. 2012 Salaries and Education
Information collected by ORAPC from 74 NNADAP workers in 2012
revealed:
3% $20,000 and under
14% $20,001 - $25,000
24% $25,001 - $30,000
27% $30,001 - $35,000
16% $35,001 - $40,000
10% $40,001 - $45,000
While those same workers reported the following education levels:
47% College Certificate
32% Addictions-Specific Certificate
25% University Degree
(There may be overlap; i.e. worker may have college certificate as well as university degree)

11. Education Levels
Highest level of education or training that
respondents have or will have in the next 2
years
2009
Overall
%
2004
Overall %
1999
Overall %
High school diploma 32.1 4 14
Addictions certificate 43.6 8
Addictions diploma 21.1 50 14
Bachelor’s or Masters degree 10.4 32 29
Indigenous cultural teacher
7.1
Not
captured
Not
captured
Indigenous ceremony conductor
7.5
Not
captured
Not
captured
2004 survey, 83% of respondents reported having an addictions specific
certificate or higher (e.g. diploma, degree or PhD), compared with only
40.3% having reported college graduation or higher in 1999

12. Continuum of Care - HOS
Elements of Care
•Element 1 – Community Development, Universal Prevention, and Health
Promotion
•Element 2 – Early Identification, Brief Intervention and Aftercare
•Element 3 – Secondary Risk Reduction
•Element 4 – Active Treatment
•Element 5 – Specialized Treatment
•Element 6 – Care Facilitation
Supporting the Continuum of Care
•Workforce Development
•Governance and Coordination of Systems
•Addressing Mental Health Needs
•Performance Measurement and Research
•Pharmacological Approaches
•Accreditation

13. Core Functions of Certification:
12 Core Functions of an Addictions Counsellor (First Nations Wellness/Addictions
Counsellor Certification Board, 2012)
1.Screening
2.Intake
3.Orientation
4.Assessment
5.Treatment Planning
6.Counselling: Individual, Group and Family
7.Case Management
8.Crisis Intervention
9.Client Education
10.Referral
11.Reports and Record Keeping
12.Consultation with Other Professionals

14. • No resources have been made available to implement
the continuum of care, thus a lack of resources
continues for communities wishing to implement the
continuum of care and provide a more comprehensive
ranges of services to better address substance use and
mental health issues in First Nations communities.

15. “Renewing NNADAP”—Discussion paper
According to the “Renewing NNADAP” (April 2010)—Common Themes
from the Regional Needs Assessment Reports and the NNADAP Renewal
National Forum (January 2010) lists five common themes seen as the
foundation for NNADAP renewal:
•Including culture and traditional practices in healing
•Involving families in treatment
•Programs for youth
•Training, support, and wage parity for NNADAP workers
•Accreditation of programs and certification of the workforce

16. Trends and Community Declarations:
• NNADAP Workers report that communities continue to face difficulties in dealing
with prescription drug abuse; Fentanyl Patches and Methadone have become an
increasing problem. We continue to see opioid abuse among other prescription
drugs as well.
• Alcohol abuse also continues to be a major problem.
• NNADAP Workers continue to face challenges with providing community based
treatment for clients on methadone.
• While residential treatment continues to be a high need, many community
members seeking assistance need to prepare for treatment while considering
leaving the community, care for children and other family obligations
• Many workers find themselves juggling increasing caseloads and helping clients
through accessing other available resources in the community. In the smaller,
more remote communities, this is an even larger problem.

17. Trends Cont’d:
• All NNADAP funded residential Treatment centres are now accredited
but are facing challenges with operations and staff turnover.
• There is a need for significant investments to address increasing operating
costs, ie utilities, fuel, food, capital, while addressing standards of excellent
in quality of care in a treatment environment
• 4 centres have modernized their programming to respond to trends in
addictions
• Cultural programming continues to be in high demand.
• No new programming dollars are available for community-based
treatment, cultural programming or addictions programming – though
there is the need to expand NNADAP at the community level and to
ensure services along the continuum of care;
• High case loads, low pay and minimal programming dollars is unacceptable
in attempts to deliver quality services for our people

18. Changes Among NNADAP Workforce:
• Ontario NNADAP Workers have taken on increased
responsibilities and roles requiring increased qualifications while the
funding has not increased to meet these changes. For example,
more Ontario NNADAP workers have achieved their post-
secondary education since the 1990’s and many have achieved their
addictions counselor certification, unfortunately NNADAP funding
has stayed the same not allowing increases in salary or
programming.
• In many communities, the amount of NNADAP funding received is
not enough to employ even one worker at a reasonable level much
less provide monies for programming, operational costs,
professional development, etc.

19. Salary Levels
In 2009, ORAPC drafted the following proposed NNADAP wage ranges based on job
descriptions and comparing them to similar off-reserve job descriptions and wage
levels.
NNADAP Position Salary Level Brought Forward
(3%/yr) - 2014
Secretary/Receptionist $26,000 - $32,000 $30,141 - 37,097
Prevention Worker $32,018 – $41,284 $37,118 - $47,859
Intake Worker $32,018 – $41,284 $37,118 - $47,859
Addictions Counsellor $35,437 – $47,130 $41,081 - $54,637
Case Manager $40,637 - $52,130 $47,109 - $60,433
Supervisor/Director/Administrator $60,000 - $80,000 $69,556 - $92,742

20. Salary Levels
NNAPF has developed a standardized salary scale for certified
NNADAP Addictions Counsellors Levels I to III as well as a
comparative wage analysis to the latest Ontario Public Service
Wage rates.
Ontario Institutional
and Health Care
Position Title/Classification Base Salary Bargaining Unit (2012)
Addictions Counsellor Level I $35,437 $47,736 – $51,064
Addictions Counsellor Level II $41,283 $50,273 – $53,955
Addictions Counsellor Level III $47,130 $53,268 - $57,304

21. NNADAP Funding and Priorities
• The main issue is the chronic underfunding of NNADAP;
• In its earlier years funding was distributed based on a funding formula. The
practice of funding formulas was retired at some point in the 90's and the
current Contribution Agreements-give the amount of NNADAP funding
provided (based on an the old formula) plus an additional 3% which
Health Canada provides to health programs across the board;
• all NNADAP services need continuous and adequate levels of
funding to address addictions issues in First Nation communities

22. Chiefs of Ontario Resolution #13/07
AOCC June 25 – 27, 2013
Whereas:
1. There have been significant advancements in the accreditation of
the National Native Alcohol and Drug Addictions Program
(NNADAP) and the National Youth Solvent Abuse Program
(NYSAP), and the ongoing certification of NNADAP/NYSAP
treatment and community workers in addictions specialization;
2. Increases in cost-of-living, coupled with chronic salary shortfalls,
have resulted in high turnover in staffing;
3. Increasing demands are being placed on the workforce due to
emerging awareness of the impacts of intergenerational trauma and
the complex needs of our First Nations clients;
4. On November 11, 2011 Chiefs at the National Assembly endorsed
the Honouring Our Strengths framework on NNADAP renewal
using a strengths-based approach in First Nations.

23. Chiefs of Ontario Resolution #13/07
AOCC June 25 – 27, 2013
Therefore Be It Resolved That We, the Chiefs in Assembly:
1.Endorse the development and implementation of the annual work
plan and the pay equity strategy that is being championed by the
NNADAP Treatment Centre Directors of Ontario and the Ontario
Regional Addictions Partnership Committee.
2.Direct that the outcomes of this initiative be presented at the
AOCC 2014.
Mover: Chief Isadore Day, Serpent River First Nation
Seconder: Chief Allan Towegishig, Long Lake #58 First Nation
Decision: Carried

24. Chiefs of Ontario Resolution, #14/28
AOCC June 9 – 11, 2014
• Unite in our efforts to support more investments in NNADAP at the
community-based and treatment centre programs, as per
recommendations and information provided by the Ontario Regional
Addictions Partnership Committee.
• Define and advocate all government levels for an increase in annualized
funding to all NNADAP budgets.
• Recognize NNADAP workers’ qualification and skill levels by providing
pay equity to the NNADAP workforce when additional funds are
received.
• Mandate COO to investigate the feasibility of a complaint under the
federal Human Rights Act challenging the lack of pay equity for NNADAP
workers and other discriminatory aspects of the program.
• Mandate that a Regional Chiefs Committee be established to advocate for
support on this initiative, and to regularly report to the Political
Confederacy, and the Chiefs in Assembly at the next AOCC.
• Update the Addictions And Mental Health Continuum of Care for
immediate opportunities.

25. Strategy for Investing in NNADAP:
• Unite in our efforts to support investing in
NNADAP programming – community-based and
treatment centres
• Lobby all levels of Government
• Conduct a Cost-Analysis of the investment vs lack of
action

26. The reviews have taken place,
The continuum of care is identified,
The current workforce is skilled,
We need to act now to lessen the devastation
of this addictions epidemic,
We need adequate resources in NNADAP, in
treatment centres and in our communities to
expand services to deliver quality services along
the continuum of care.